Method:
- Complex interview called Life Events & Difficulties Scale (LEDS) developed.
- Interviewers trained in use of LEDS
- 539 women in Camberwell, London interviewed using the LEDS.
- Interviewers obtained details of stressful events in the previous year, with background circumstances in which they occurred.
- LEDS aimed to uncover stressful childhood events
- Interviewers prepared written account of each event of source of stress, which could be rated by panel of researchers for how stressful it would be for a typical person
- To avoid bias, raters had no knowledge of if person there were looking at had suffered depression
- It was later ascertained which interviewees suffered from depression
- Researchers then looked for links between who suffered depression and who had recently had a stressful life and who had stressful events in childhood.
Results:
- Both recent high levels of stress & having suffered stressful childhood events left people particularly vulnerable to depression
- 80% of women who suffered depression had major stressful life-event in previous year
- 3 of the 4 factors that had the strongest links with depression involved recent levels of stress.
- These due to lack of intimate relationship, paid employment & presence of 3 or more children in the home
- However, childhood events were also important, especially death of woman’s mom before she reached age 11
Evaluation:
Brown and Harris study is important as unlike the case-studies that make up the bulk of psychodynamic research, it was performed on a large group of participants and there was a degree of scientific rigour. For example, the researchers assessing the degree of stress the participants had endured had not met the women and did not know whether they were suffering depression. This meant that the likelihood of bias in their assessment was reduced considerably. However, like all structured interview studies, Brown & Harris’ work still has the limitation that it relies on participants’ ability to report accurately and truthfully their experiences, including those many years in the past.
After the study of Brown and Harris is Bifulco et al (1991). Where he reported that depression was more common in women who had lost their mothers by death or by family re-ordering (i.e. changes to the family such as separation, divorce and remarriage). Interestingly, death of the mother was more likely than loss by family re-ordering to precede depression.
Kessler and Magee (1993) found that several childhood factors, including parental heavy drinking, domestic violence, the death of a parent and the lack of a close relationship with an adult all increased the probability of suffering depression in adulthood.
These studies clearly show that childhood stress, traumatic experiences and lack of good relationships increase the probability of later mental disorder.
BUT there are causes for mental disorder. There is an increasing body of research showing that genes can be important in predisposing people to mental disorder. There are also some conditions that appear to be the result of faulty learning of behaviour. Psychodynamic factors are thus not the only factor that we need to be aware of in working with people with mental health difficulties. There is a risk of wasting time looking for links with early experience where there are none.
Aims of Psychoanalysis:
- To allow repressed feelings & desires in the person’s unconscious to come to light.
- In acknowledging such repression, the individual should release the feelings into their conscious thoughts.
- Then there should be no further problems, since the unconscious urges are now conscious.
Freud looked at neuroses and saw mental illnesses as stemming from underlying problems. These neuroses, which could be phobias, anxiety or feelings of depression, are seen as ways of adapting to unconscious urges. However, they are not good ways of adapting, because the person is ‘malfunctioning’. The ego is trying to maintain a balance between the demands of the id and the demands of the super ego. These demands often conflict. The ego may resolve the problems by repressing them in the unconscious. However, these feelings show themselves somehow, and this can be in the form of neuroses. The unconscious urges can reveal themselves as stressful dreams too, as well as in unreasonable hatred of certain people or some other similar symptoms.
Defence mechanisms are there to protect the individual against these urges; however, they can themselves lead to stress and anxiety and are not effective ways of dealing with the problems. For example, if through projection you see people as murderous, then the defence mechanism of projection is not helping you.
Disorders treated by psychoanalysis include eating disorders, anxiety, multiple personality disorder, personality disorder, schizophrenia, sexual dysfunction, depression and youth disorders. Others are alcoholism, post-traumatic stress disorder, substance abuse and obsessive-compulsive disorders.
In psychoanalysis the therapist wants the patient to reveal unconscious wishes and desires. There is also the understanding that problems stem from early childhood. So psychoanalysis involves taking people back in their minds to their early childhood and examining possible problems. In traditional psychoanalysis, the analysist is out of sight, behind the couch. No emotions are supposed to be expressed by the analyst, who is ‘faceless’. It is the patient who must uncover the problems and reveal the contents of the unconscious to consciousness. However, in practice, because of transference, counter transference and resistance, the analyst cannot really remain anonymous. The treatment means the client attends for about one hour a week for several years, and this is expensive.
Transference:
- This is an important part of the process.
- This happens when the patient projects repressed feelings onto the doctor.
- Feelings of love, or hatred
- Usually client transfers good feelings onto the analyst at first.
- Feelings become negative later, just as child becomes hostile to its parents.
Countertransference:
- This refers to feelings the analyst then has towards the client.
- These can be feelings of irritation, dislike or sexual attraction
- Freud saw these feelings of countertransference as a failing, but these days they are considered to be inevitable
Resistance:
- Resistance is a defence mechanism that helps the client to resist these interpretations.
- They will be resisted, because they are going to be painful
- Defence mechanisms are there to keep those feelings and urges unconscious
- So the client may make jokes, excuses, fall asleep or turn up late
- The analysist must have enough of a relationship with the client to help them to work through the resistance
Free Association:
- The client says whatever comes into their mind, no matter how absurd or unrelated it seems
- The analyst and the client then examine such associations, and again look for meanings
Dream Interpretation:
- The client can outline dreams, and together the client and the analyst can interpret them
- It is as if 2 adults are getting together to study a child
- Dreams involve symbols and these symbols are analysed
- The idea is that the unconscious desires might be revealed in dreams, but they would still be disguised, and it is the analyst job to help to uncover meanings behind dreams.
