Class Notes: Psychodynamic Theory

Jerome S. Blackman M.D., F.A.P.A.
Author of 101 Defenses: How the Mind Shields Itself

A good dynamic formulation incorporates the nature of the person (temperamentally and in terms of other fixed attributes), the nature of the current stressors, and the nature of the developmental issue that those stressors activate for that person. You should be asking yourself, what are the causes of the patient's psychodynamic breakdown? What are the influences in the patient's life that contributed to the present disorder? Address environmental, genetic, and psychological factors relevant to determining the patient's symptoms. The latter can be addressed by focusing on the person's characterologic makeup by assessing their:

• autonomous ego functions
• ego strength
• object relations capacity
• superego

Definitions

Primary process

bizarre, dreamlike thoughts; immediate gratification drive; think infants and psychotics; pleasure principle; (I want all my gratifications, including mutually contradictory ones, right now!)

Secondary process

sequential, logical, reality-oriented types of cognition; mediates between the demands of the id and the constraints of reality and ethics

Observing ego

the part of the self that is conscious and rational and can comment on emotional experience; self reflection

Personality Disorders (in crisis)

Psychosis may result when acutely inflamed emotions melt down several ego functions simultaneously; as a rule, the more that autonomous ego functions are disturbed, the more the person shades into the psychotic range

Self and object constancy

stable and reliable images of the self and others; patient's with a lack of object constancy are unable to integrate the good and bad aspects of self and others.

Ego Strength

1. the analytic term for the elusive capacity to cope despite adversity; ascribing someone with a strong ego means that he or she does not deny or distort harsh realities but finds ways of prevailing that take them into account.
2. The ego's capacity to manage affects, wishes, impulses without melting down or becoming excessively defensive.

Ego Regression

Interference with an autonomous ego function (e.g. intelligence) or an ego strength (e.g. impulse control) stops working to protect you from an unpleasant affect

More to come!