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정신분석적사례이해
작성자  simonshin 작성일  2017.02.25 20:22 조회수 817 추천 0
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 갈등과 발달상 고착의 구별  
첨부파일 : f1_20170225202317.pdf
 

과목: 정신분석적 사례이해

주제: 갈등과 발달상 고착의 구별

강사: 신현근 박사

내용: 강의안

교재: McWilliams, N. (1999). Assessing developmental Issues. In Psychoanalytic Case Formulation (pp. 65-84). New York: International Guilford Press.

 A Conflict or a Developmental Arrest

 

1.    At the heart of Freud’s model of the development of neurotic symptoms was the notion of unconscious conflict.

 

2.    First hypothetical cases

2.1. This is elementary stuff, and even Freud’s most straightforward cases were rarely this simple.

2.2. I bring up these vignettes to illustrate the difference between etiologies of unconscious conflict and those expressing a developmental arrest.

2.3. For both Herman and Amy, things had been going along well until a particular circumstance threw them psychologically off balance.

2.3.1.   For Amy, it was the press of adolescent hormones that upset her prior homeostasis.

2.3.2.   For Herman, it was the impingement of his sick father on his comfortable routines.

2.4. Neither one could tolerate knowing some aspects of what they unconsciously felt about their respective situations.

2.4.1.   Both became symptomatic rather than face the shame or guilt of acknowledging sexual and aggressive drives that were culturally taboo.

2.4.2.   Their respective neuroses arose from the need to keep from consciousness the feelings of longing and resentment that their circumstances naturally provoked.

 

3.    The second hypothetical cases

3.1. These second hypothetical situations would inspire the inference by an interviewer that in each instance something had gone seriously wrong developmentally.

3.2. The second version of Amy could not, for whatever reason, experience her mother as admirable enough to want to become like her in any respect.

3.2.1.   An interviewer might conclude that she had a profound fear of growing up, not just a culturally conditioned aversion to sexual enjoyment.

3.3. The second Herman had never been able psychologically to separate and individuate from a father he still wanted so fervently to please.

3.4. Both of them are maturationally stuck.

3.4.1.   They have failed to move reasonably adaptively through life because they are still trying to solve problems of its earliest years.

3.5. Whereas in the first versions of their psychological circumstances they had matured satisfactorily and then regressed under stress, in the second version they never got beyond an infantile preoccupation that was badly addressed from infancy on.

3.5.1.   Their specific symptoms are the same in each scenario, but the meanings and implications of them are quite different.

 

4.    Psychoanalytic literature in the second half of this century became very concerned with discriminating between these two types of presentation.

 

5.    Anna Freud, for example, wrote in 1970:

5.1. In our times, the analyst’s therapeutic ambition goes beyond the realm of conflict and the improvement of inadequate conflict solutions. It now embraces the basic faults, failures, defects, and deprivations, e.g., the whole range of adverse external and internal factors, and it aims at the correction of their consequences. Personally, I cannot help feeling that there are significant differences between the two therapeutic tasks and that every discussion of technique will need to take account of these. (p. 203)

5.2. The “basic faults” she mentions refer to the work of Michael Balint (e.g., 1968), one of the first analysts to explore issues such as core self-esteem as opposed to those of conflict between drive and inhibition.

 

6.    The work of Stolorow and Lachmann (1980) on distinguishing between defensive processes and a more pervasive maturational arrest they called “developmental prestages of defense” is another seminal paper on this kind of distinction.

7.    In the self psychology tradition, there is emphasis on two coexisting lines of development, one involving the drives and their objects, and the other involving the self and its felt wholeness, goodness, and consistency, a much more diffuse, developmentally implicated area.

7.1. Kohut (1971, 1977) and his followers have consistently argued that analysts need to understand the latter processes better than Freud and most of his early successors did.

8.    I am elaborating on this issue because it is critical to establishing a good case formulation.

8.1. Every interviewer needs to try to understand with every patient how much of his or her suffering results from some immediate stimulus to unconscious, conflicted material, and how much of it reflects a kind of arrested psychological development.

8.2. We also must keep in mind that maturation can be markedly uneven; that a person can have extraordinarily well-developed capabilities yet suffer from a crippling deficit in the area of, say, sexuality or the ability to be alone or the capacity to mourn, or comfort with competitiveness. “Fixation” is not a simple, unidimensional thing.

 

 
 
 
 
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