VIDEO ANALYSIS 1

CIA- 1
ABHILASHA WANCHOO
22223002
DEPARTMENT OF PSYCHOLOGY
MPS341HN
PSYCHOTHERAPY- I
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Psychodynamic approach {Theoretical principles (brief)}

Drives and Instincts: Drives are innate and biological in nature that act as a fundamental
motivational source. There are two types of drives as per Freud one is Eros (life instincts) and
Thanatos (death instincts). Eros included self-preservation that is the ability to maintain their
well-being, and protect themselves from harm. It encompasses behaviours related to survival,
such as seeking food, shelter, and safety. Eros also includes the production of mental energy
(libido) and the other is species preservation. The death instinct or Thanatos drives
individuals toward self-destructive and aggressive behaviours. It includes a desire for
cessation of pain and the return to an inorganic, non-living state.

Instincts are the bridge between mental and physical world. Example: Hinger, thirst and
sex. Instincts has a source (body) and there can be a disequilibrium that arises in the source
and the aim is restoration of the equilibrium through an object that can satisfy the aim, for
e.g., Hunger’s source is stomach and when we feel hungry there is an disequilibrium and we
resort to food (object).

Id, Ego and Superego are the three instinctual drives of mind, id works on the pleasure
principle, ego works on the reality principle and superego works on the morality principle.
The three interact among each other for an individual to function appropriately.

Levels of consciousness: The three levels of consciousness given by Freud are pre-
conscious, conscious and unconscious. The preconscious is contains thoughts, memories, and
information that are not in immediate awareness but can be easily brought to consciousness
with attention and effort. The conscious is what contains thoughts, perceptions, and feelings
that are currently in our awareness. The unconscious includes those thoughts, memories and
information which are not in our awareness. These are typically hidden from awareness
because they are too emotionally charged, distressing, or socially unacceptable. The things
present in our unconscious may be brought to conscious through Freudian slips as jokes or
slip of tongues.

Theory of anxiety: Anxiety according to the approach stems from the inability of the infant
to manage or master disequilibrium therefore he indulges in acts such as crying and calling
for mother. It includes 4 concepts that is of birth trauma: after birth there is a shift into the
real environment with light/sounds, separation from mother: since for a particular period of
time the survival of the infant is dependent on the caregiver, fear of castration and superego
fear. Anxiety is believed to be a sign of ego’s weakness over which ego feels powerless.
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There are three types of anxiety- reality anxiety: external real circumstances that cause
anxiety, moral anxiety is what is caused by our super ego (guilt, inferiority etc) and neurotic
anxiety which is created by the id impulses.

Defence mechanisms: To relieve oneself from the distress caused by any thought, feeling
or emotions one use defence mechanisms to cope up with the anxiety and uncomfort caused
by them. Examples include projection, suppression, denial, repression, regression etc.

Psychosexual stages: There are 5 psychosexual stages which each individual goes
through, wherein they are faced with conflict and if they are unable to resolve the conflict
then it results in fixation in that stage. The first stage is oral stage (0-18 months) wherein the
pleasure area is the mouth, the second stage is anal stage (18 months- 3 years) here the
pleasure area is anus and this stage’s major focus us on toilet training, in the phallic stage (3
years- 6 years), the focus shifts to the genital area, and children become more aware of their
bodies and the differences between boys and girls. The stage includes two concepts Oedipus
complex and Electra complex, the fourth stage is latency stage (6-12 years) which is a period
of relative calm in which sexual impulses are suppressed. Children focus on developing
social and intellectual skills and forming same-sex friendships. The last stage is the genital
stage (12 years onwards) which represents the culmination of psychosexual development,
with a renewed focus on the genitals and sexual pleasure.

Object Relations Theory (Fairbarn)

Humans are not inherently pleasure seeking but object seeking. An individual can be seen
in relations with others. Fairbairn's concept of "objects" refers to internalized images of
caregivers, playing a crucial role in psychological development and relationships. He
introduced the concept of an internal saboteur, which can undermine self-esteem and create
conflicts. The central conflict in human development is relationship-related tensions.

Case Summary

Demographics

Name: Phil

Age: Middle aged (not specified)

Sex: Male
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Chief complaints: Recent onset of stress and anxiety, particularly around work-related
issues and creative pursuits.

Phil has difficulty in saying no to others and likes to stay invisible however at the same
time he wishes that his work is acknowledged. His early life experiences include that of his
school days when he had to transition from primary school to high school he faced a difficult
time and was overwhelmed which made him to adopt strategies that kept him at a low profile
and avoided attention. The onset of the illness began about 6 weeks go when he started to
sense disturbance in his behaviours with increased levels of anxiety. This was the same time
when he realised that he had 25 years working in the same organisation however he felt that
his efforts went unnoticed and were not very well acknowledged by the officials. He has a
fear of not doing things right and letting down people in the process of saying no to them. As
far as his creative work is concerned with like drawings and paintings which he avoids doing
now because he indulges himself in self-criticism but on the other hand in his work life he
views mistakes as a new learning opportunity.

Case Conceptualisation

Phil a middle aged man who has a history of difficulty saying no to others and a strong
fear of letting people down and is currently reporting issues of increased stress and anxiety
since the past 6 weeks.

Unconscious conflicts

When his childhood was explored it was fund out that his high school experience had been
particularly overwhelming for him, which he most likely pushed it down to his unconscious
are now triggered due to his work-related events and resurfacing as anxiety. That experiences
caused the individual entrenched fear of rejection, judgement, resentment and failure. His
reaction to being described as having a "cloak of invisibility" suggests that he may
unconsciously identify with this invisibility as a protective measure. It can also be so that
even though he said that home was a safe space for him there could also be other
environments in his past such as peer group or extended family relations or religious groups
wherein he might have faced with problems which can be explored in further sessions.

Instinctual drives

The id may be pushing him to seek recognition and validation in his creative pursuits, as
well as in his interactions with others. He desires immediate gratification and positive
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feedback. The superego there is a possibility may be a reason for his self-criticism and need
for perfection particularly in his creative endeavours. The ego on the other hand that works
on the reality principle so in case of Phil there is a conflict between the id which says that
there is a need for recognition but at the other hand superego is aware of the possible
consequence of his creative expression. The ego is struggling between the two extremities.

Theory of anxiety

The three types of anxiety given in psychodynamic approach and the one that suits best for
Phil if neurotic anxiety since there is an inner conflict from where the problem is arising. He
not being able to complete his creative pursuits and him being self-critical of his work can be
a result of his own high standards and the fear of not meeting them.

Defence mechanism

To cope up with the undesirable feelings Phil did engage in several defence mechanisms
such as-

• Repression: he might have pushed his past experiences of the secondary

school out of conscious awareness. This can also be the reason why he had to put an
effort to recall the incident and acknowledge what he felt during that time as it must
have been a difficult thing to do.
• Regression: It can be said that regression took place because his coping
strategy to maintain a low profile in secondary school. Even after growing up he used
the previous method of coping used in childhood by staying unnoticed and avoiding
conflicts.
• Projection: There is a possibility that he may unconsciously project his fear of
failure onto others as he reports saying yes with the fear of letting people down can be
an indicator of him interpreting as their opinions and thoughts as constructive rather
than critical.
• Reaction formation (perfectionism): In this individual acts opposite to their
true feelings, in this case, he may be overcompensating for feelings of inadequacy by
striving for perfection and indulging in acts of self-criticism. His self-criticism serves
to protect him from facing potential disappointment or failure in his creative
endeavours.

Object Relations
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Fairbairn's Object Relations Theory suggests that early relationships with caregivers
significantly influence personality and psychological functioning. The theory highlights the
tension between intimacy and fear of rejection, with self-doubt and self-criticism obstructing
healthy relationships. It has been influenced by modern object relations theories and is used
in psychodynamic and psychoanalytic therapies. The emphasis of the theory was specifically
mothers-infant relationship, in case of Phil he mentions his home having a safe and loving
environment which would mean that he had a positive home environment and this could be a
contributor to his sense of security and attachment.

In psychodynamic theory given by Freud much of the importance is given on the impact
mother has on the child however there are theories of attachment given by John Bowlby who
looks at the parent child relationship and its impact on the child. There are three kinds of
attachment style given by him the one that suits best for Phil appears to be anxious-
preoccupied attachment style, characterized by self-doubt and disappointment, may be a sign
of a child's struggle with self-confidence, social isolation, and a need for affirmation and
comfort, often resulting from a negative self-perception.

Figure 1

Attachment styles given by Bowlby.

Ethical considerations and skills used by the therapist

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Right for autonomy: The therapist offered her insights and understanding from what Phil
was saying and allowed him to freely associate his thoughts which lead him to think deeper
and analyse the situation.

Analytical skills and summarisation: She rephrased the sentences used by the client which
were more coherent and relevant for the client as well as made the session more insightful.
This also made effective communication possible.

Self-reflection: Every time the client recalled something or shared something she allowed
him to self-reflect.

Non-verbal gesture & Active listening: The constant nods that were accompanied while
the client was speaking and “hmm” “okay” made the client feel heard and acknowledged too.
Through active listening she was able to paraphrase what was been said and also she
confronted him when he said that in work he does not function the same way he does when
indulging in hi creative works so she helped identify discrepancy in the way he was thinking
when he was put in different contexts like at work and at his home when wanting to engage in
creativity.

Non-judgemental attitude: Whatever the client spoke about there was a neutral expression
and appropriate reactions were given to what was being said there was no sign of the therapist
judging the client.

Patience: The therapist showed great amount of patience as the client was at times circling
around one fact and also sometimes took time in recalling or delivering what he wanted to.

Self-reflection: She does mention that she keeps going back to the word used by him
“invisibility cloak” which made the client also understand that she had been attentive when
he spoke and whatever insights the therapist was giving she reflected upon it.

Empathy: The therapist displayed empathy towards the distress being experienced by the
client.

Non-directive stance: She did not direct the conversations and let client lead the session at
their own pace which led to self-discovery and self-awareness. He was able to trace it down
to his childhood as well as he could understand how differently he thinks while at work and
while making through his creative pursuits.

Therapist- Client relationship

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In the video there seems to be a healthy therapist- client relationship. There were no signs
of transference or countertransference observed. Transference in psychodynamic therapy
involves clients unconsciously transferring emotions from past figures, while
countertransference refers to the therapist's emotional reactions to the client. The therapist did
explore the life of the client deeply she did ask for his early experiences and his environment
at home along with his workplace culture, she was constantly also asking what the term
meant while he was speaking like she referred him using “cloak of invisibility” and
understand what he meant by it in deeper sense and she also asked him about when he used
the word “procrastination” what did it mean. After the client completed what he was speaking
she made valuable inputs and how she was interpreting what was spoken which aimed at
uncovering unconscious processes and providing insight into the client's behaviour and
motivations. The therapeutic relationship appeared to be a safe and supportive space for this
transformative work to occur.

Erickson’s Psychosocial Stage

As per Erickson’s stages, looking at his approximate age appears to be in the “Generativity
vs stagnation” stage. Generativity refers to as the desire to contribute to the society or be a
part of the change and stagnation on the other hand refers to the sense of not being able to
make an impact or leaving a lasting impact. He completed 25 years in the same organisation
yet he might have felt that he did not make a lasting impact on the organisation which can be
inferred through the lack of adequate acknowledgement he received which further triggered
his anxiety. He also referred that his colleague mentioned him to be wearing a “cloak of
invisibility” which might have made him feel that he did not belong to the place he had been
working so long despite the thought that he enjoyed staying that ways but the realisation set
him off. Those who fail to attain the generativity skill feel unproductive in and uninvolved
with the world.

However, this was the just the first sessions displayed in the video as far as it can be made
out these look like the symptoms of Generalised Anxiety Disorder (GAD) though as the
sessions progress then further a better diagnosis can be made be made.

Conclusion

Phil had multiple causes associated to his illness as he had been experiencing a major life
time change that is 25 years in an organisation which would also mean that he is moving
towards retirement and that his long service was not adequately acknowledged may have
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been a specific work-related stressor, also his self-expectations having a set bar which he was
in doubt of is he would be able to accomplish to add on his past experience in his high school
was also contributing to the problems he was facing and with the major life event occurring 6
weeks back triggered the illness. To recognise his anxiety and seek help was a bold step.