Study Discussions
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sis the therapist actively interprets for clients the significance of their statements, behaviors, and dreams. But Freud cautioned that therapists should not reveal true meanings too early. Beginning therapists are often tempted to interpret the unconscious meaning behind an act or a statement as soon as they perceive it. However, this early insight could be threatening for an unprepared ego, causing the client to construct new and stronger unconscious defenses.
When the timing is right, psychoanalysts interpret statements and dream symbols for their clients. Freud provided an example of this interpretation in one of his famous cases. Dora was an 18-year-old patient from an affluent family. She complained of headaches and other physical problems. One area of trauma for Dora concerned a married couple, who Freud referred to as Mr. and Mrs. K. Mrs. K. was having an affair with Dora’s father. To make matters worse, Mr. K. had made sexual advances toward Dora. One day during therapy, Dora related the following dream:
A house was on fire. My father was standing beside my bed and woke me up. I dressed quickly. Mother wanted to stop and save her jewel-case; but Father said: “I refuse to let myself and my two children be burnt for the sake of your jewel-case.” We hurried downstairs, and as soon as I was outside, I woke up. (Freud, 1901/1953, p. 64)
To the untrained ear, the dream seems innocent and meaningless enough, similar to dreams we all have and give little thought to. But for Freud, the dream was filled with clues about the causes of Dora’s problems. With a little questioning, Freud learned that shortly before the dream, Mr. K. had given Dora an expensive jewel case as a present. With this information, Freud had all the pieces to the puzzle he needed. As he explained to Dora,
Perhaps you do not know that “jewel-case” is a favourite expression for the female genitals.… You said to yourself: “This man is persecuting me; he wants to force his way into my room. My ‘jewel-case’ is in danger, and if anything happens it will be Father’s fault.” For that reason in the dream you chose a situation which expresses the opposite—a danger from which your father is saving you. Mr. K. is to be put in the place of your father just as he was in the matter of standing beside your bed. He gave you a jewel-case; so you are to give him your jewel-case.… So you are ready to give Mr. K. what his wife withholds from him. That is the thought which has had to be repressed with so much energy, and which has made it necessary for every one of its elements to be turned into its opposite. The dream confirms once more what I had already told you before you dreamt it—that you are summoning up your old love for your father in order to protect yourself against your love for Mr. K. (p. 69)
Freud interpreted several important psychoanalytic concepts for Dora. He identified her use of symbols and the repression of her true desires. He explained how she used reaction formation —dreaming the opposite of what she really wanted—and how her repressed desires for her father affected her behavior. Not surprisingly, Dora had difficulty accepting this interpretation at first. As this example illustrates, clients must obtain a reasonable understanding of psychoanalytic theory before they can appreciate the therapist’s interpretation of their dreams, thoughts, and behaviors.
Ironically, one of the first signs that therapy is progressing is the development of resistance. For example, clients might declare the sessions aren’t helping and they want to discontinue therapy. Or they might lapse into long silences, return to material already discussed, miss appointments, or insist certain topics aren’t worth exploring. These attempts at resistance could indicate the therapist and client are getting close to the crucial material. The threatened ego is desperately attempting to defend against the approaching demise of its defenses as crucial unconscious thoughts are poised to burst into consciousness.
Another necessary step in traditional psychoanalysis is the development of transference. Here emotions associated with people from the past are displaced onto the therapist. For example, a client might talk to and act toward the therapist as if the therapist were a deceased parent. Unconscious emotions and previously undelivered speeches buried long ago are unleashed, feelings that often lie at the heart of the client’s disorder. Freud warned that handling transference was a delicate and crucial part of the therapy process. He also cautioned
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therapists against countertransference, in which therapists displace their own feelings toward other individuals onto the client.
From the outset, psychoanalysis has been controversial, and the debate about its effectiveness has never ended (Gabbard et al., 2002). Nonetheless, a large number of practicing psychotherapists identify their approach as “psychoanalytic” (Cook et al., 2010; Thoma & Cecero, 2009). Recent reviews of carefully designed studies find evidence that psychoanalytic therapies are often effective when treating a wide variety of psychological disorders (Leichsenring, 2007; Leichsenring & Rabung, 2008; Shedler, 2010). However, these claims of effectiveness have been met with skepticism (Beck & Bhar, 2009; McKay, 2011; Roepke & Renneberg, 2009). Critics also argue that psychoanalysis, if it works, can often take years and therefore is not as cost-effective as many short-term therapies. It is probably safe to say, like most things associated with Freud, the controversies surrounding psychoanalysis are likely to continue.
ASSESSMENT: PROJECTIVE TESTS
LO 3.4 Explain how psychologists use projective tests to assess personality.
Psychoanalysts are faced with a unique problem when it comes to measuring the concepts of interest to them. By definition, the most important thoughts are those the test taker is unable to report directly. So how do psychoanalytic therapists and researchers measure unconscious material? The solution is to bypass direct reports altogether.
Projective tests present individuals with ambiguous stimuli, such as inkblots or vague pictures. Test takers respond by describing what they see, telling stories about the pictures, or somehow reacting to the material. The tests provide no clues about correct or incorrect answers, which makes each person’s responses highly idiosyncratic. One person may see a circus and an elephant, whereas another identifies a cemetery and a woman in mourning. As the name projective test implies, psychoanalysts consider these responses projections from the unconscious. The ambiguous material gives test takers an opportunity to express pent-up impulses. However, as with other expressions of unconscious impulses, the significance of the response is not apparent to the test taker.
Some Popular Projective Tests
In 1921, Hermann Rorschach published a paper in which he described a procedure involving inkblots that he used in his work with patients diagnosed with schizophrenia. Although Rorschach died the next year at age 38, his work stimulated other psychologists who continued to develop the test that still bears its creator’s name. The Rorschach inkblot test consists of 10 cards, each containing nothing more than a blot of ink, sometimes in more than one color. Test takers are instructed to describe what they see in the images. They are free to use any part of the inkblot and are usually allowed to give several responses to each card. Although some of the cards may be quite suggestive, they are in fact nothing more than inkblots.
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This psychologist is administering one of the most widely used personality tests: the Rorschach inkblot test. The participant tells the psychologist what they see on the card; whether these responses provide a valid assessment of their personality remains a controversy.
©iStockphoto.com/Oleh Veres
Inkblot test responses can be analyzed with any of several scoring systems developed over the years. However, most psychologists probably rely on their personal insights and intuition when interpreting responses. Unusual answers and recurring themes are of particular interest, especially if they are consistent with information revealed during therapy sessions. For example, most therapists would take note if a client sees dead bodies, graves, and tombstones in the ambiguous images. Similarly, clients who see acts of self-inflicted pain or other violent images probably provide therapists with topics to explore in future sessions.
The Thematic Apperception Test (TAT) is another widely used projective test. The TAT was designed by Henry Murray (Chapter 7) and consists of a series of ambiguous pictures. Test takers are asked to tell a story about each picture—who the people are, what is going on, what has led up to the scene, and what the outcome is going to be. Although most of the pictures contain images of people, facial expressions and the nature of the relationship between the people are intentionally vague. Thus, test takers may see love, guilt, anger, or grief in the faces. The characters may be fighting, plotting, loving, or unaware of each other. They may be in for a happy, sad, horrifying, or disappointing end to their situation. Although therapists often rely on their intuition when interpreting test responses, many relatively objective scoring procedures are available. Examples of how psychologists use these procedures in research are presented in Chapters 4 and 8.
Yet another projective test used by many therapists is the Human Figure Drawing test. Although initially developed in the 1920s as a measure of intelligence, psychologists soon recognized the test also could be used to measure important personality constructs (Handler, 1996). The ambiguous stimulus in this test consists of a blank piece of paper and instructions to draw a picture for the psychologist. In many cases, test takers are simply asked to draw a person, but sometimes psychologists instruct them to draw a family or a tree. Although it has been used in many ways, most often the Human Figure Drawing test is seen as an indicator of psychological problems, particularly in children (Bardos & Powell, 2001; Matto, 2002).
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The notion that children’s drawings provide a peephole into their inner thoughts and feelings has strong intuitive appeal. Schoolteachers often take note of children who never draw smiles on the faces of the characters they sketch. Similarly, children who frequently draw monsters or ghoulish creatures could be expressing some disturbing inward feelings. A glance at the drawings by emotionally disturbed children presented in Figure 3.2 makes a persuasive case that children sometimes express through drawing what they otherwise might not put into words.
Description
Figure 3.2 Human Figure Drawings by Emotionally Disturbed Children
Elizabeth Munsterberg Koppitz. Psychological Evaluation of Children’s Human Figure Drawings. New York: Grune & Stratton. 1968.
Evaluation of Projective Tests
Hundreds of studies have been conducted with projective tests, most often with the Rorschach inkblot test. Responses to the inkblots have been used to predict everything from intelligence to sexual orientation. Unfortunately, psychologists disagree on how to interpret most of this research (Garb et al., 2005). Critics point to unacceptably low indices of reliability and frequent
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failures to find evidence for the validity of the test (Wood et al., 2010). One team of reviewers concluded “there is currently no scientific basis for justifying the use of Rorschach scales in psychological assessment” (Hunsley & Bailey, 1999, p. 266). Other psychologists challenge whether the inkblot procedure should be described as a test at all. They argue that the Rorschach is more accurately characterized as a highly structured interview.
But there are two sides to every controversy, and advocates for the Rorschach test raise several important points in its defense. First, one needs to separate good studies designed to test appropriate predictions from poor studies that attempt to tie test responses to any and all behaviors (Weiner, 1995, 1996). When reviewers look at results from sound studies making reasonable predictions, they find evidence for the test’s usefulness (Choca, 2013; Gronnerod, 2004; Mihura et al., 2013; Viglione, 1999). Moreover, newer, more rigorous systems for coding Rorschach responses have proved far more reliable than earlier methods (Erdberg, 2019; Viglione & Hilsenroth, 2001; Weiner, 2001). Second, establishing good validity data for projective tests is more difficult than it is for other kinds of personality measures. If a therapist concludes from an inkblot test that a client has a certain unconscious conflict, what objective evidence can the therapist provide to establish the validity of this claim? A therapist could make any claim about unconscious material, and we would have no way to know whether the therapist is correct. Indeed, if objective indicators of unconscious thoughts existed, therapists wouldn’t need to use projective tests in the first place.
Despite the controversy, the Rorschach and many other projective tests continue to be widely used (Wright et al., 2017). And this use extends far beyond psychotherapy. For example, projective tests are often used by school psychologists to evaluate social and emotional adjustment in children (Hojnoski et al., 2009) and by psychologists working with law enforcement and court officials (Gacono & Evans, 2008).
One reason for the popularity of projective tests is they may uncover information not easily obtained through other procedures. For example, therapists working with children sometimes allow a child to play with a family of dolls. Imagine a child who acts out a drama in which the mother and father dolls are cruel to the child doll. The child might be revealing something about the situation at home that the child cannot easily express through other means.
Then again, many psychologists warn against overinterpreting responses to projective tests. The child in the previous example could merely be acting out a scene from a recent television program. Because the validity of projective tests remains open to challenge, psychologists usually are advised not to rely heavily on the tests when making diagnoses (Wood et al., 2002). Instead, projective test results should be viewed as but one source of information about a client. They should be taken into consideration along with information collected through interviews, observations, case histories, and other psychological tests.
STRENGTHS AND CRITICISMS OF FREUD’S THEORY
LO 3.5 Describe the strengths and criticisms of Freud’s theory.
None of the approaches to personality covered in this book can spark an argument as quickly as Freudian theory. Every clinical psychologist and personality researcher has an opinion about the value and accuracy of Freud’s ideas. Although few accept all of Freud’s observations and postulates unquestioningly, adherents of the Freudian view strongly defend the basic assumptions Freud made about the nature of human functioning. Critics tend to be equally passionate in their evaluations.
Strengths
Even if all of Freud’s ideas were to be rejected by modern personality theorists, he would still deserve an important place in the history of psychology. Freud’s was the first comprehensive theory of human behavior and personality. Most subsequent personality theorists have found it necessary to point out where their theories differ from or correct weaknesses in Freud’s works. Many of these psychologists built their theories on the foundation laid by Freud, borrowing key concepts and assumptions. As discussed in Chapter 5, many of those who studied with Freud or were trained in the Freudian tradition went on to develop and promote their own versions of psychoanalytic theory. In short, Freud’s observations set the direction for subsequent personality theory and research. Even recent approaches to personality, although far removed from psychoanalytic theory, are probably influenced in many ways by Freud’s ideas.
Freud also can be credited with developing the first system of psychotherapy. Today, treating psychological disorders through discussions with a therapist is widely accepted. Although psychotherapy might have evolved without Freud, it certainly would not have evolved the way it
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did. Techniques such as free association, hypnosis, and dream interpretation have become standard tools for many therapists. Indeed, some clients are disappointed to find their therapist has no couch and does not plan to hypnotize them or interpret their dreams. Nonetheless, surveys reveal a large number of young as well as experienced psychotherapists identify their perspective as “psychoanalytic.”
In addition, Freud can be credited with popularizing and promoting many important psychological concepts. As discussed in Chapters 4, 6, and 16, many of the topics researched by psychologists today have their roots in one or more of Freud’s concepts, even if they no longer carry much of the Freudian flavor. By placing these concepts on the menu of psychological topics many years ago, Freud influenced the subject matter of much personality research today.
Criticisms
Although Freud’s ideas were so revolutionary that they were rejected by many in the medical and academic communities at the time, some writers argue Freud’s ideas may not have been so original or groundbreaking after all. For example, one investigator discovered that between 1870 and 1880 at least seven books were published in Europe that included the word unconscious in the title (Whyte, 1978). Because the educated elite in Europe was relatively small, another writer concluded “at the time Freud started his clinical practice every educated person must have [been] familiar with the idea of the unconscious” (Jahoda, 1977, p. 132).
A couple of points can be offered in Freud’s defense. First, Freud often cited earlier works on topics similar to the ones he was introducing. Second, Freud was the first person to organize many loosely related ideas into one theory of human behavior. Although many of Freud’s contributions may have had precedents in earlier writings, there is a large difference between introducing an idea and organizing, integrating, and developing many ideas into a comprehensive model of human behavior.
A second criticism often made of Freudian theory is that many aspects of the theory and psychoanalysis are not testable. For example, if a Freudian psychologist decides a client has a strong unconscious hatred for her sister, what sort of evidence would demonstrate the conclusion is incorrect? What if the client says she is not aware of any negative feelings toward the sister? The psychologist might say she is repressing them. What if the client describes how much she loves her sister? Obviously, a reaction formation. The problem is if there is no way an aspect of the theory can fail to be supported, it cannot be truly tested, and this makes the theory considerably less useful to scientists.
It would be unfair to say Freud was unconcerned about finding evidence to support his ideas. However, Freud’s heavy reliance on case studies to support his theory falls short of the standards required by many scientists. Among other concerns, all the information we have about these cases was filtered through Freud. It is possible that Freud recognized and recorded only the statements and behaviors that supported his theory and ignored or failed to notice those that did not. It also is possible Freud caused his patients to say the things he wanted to hear. Psychotherapy clients can be highly vulnerable to accepting whatever a person in a position of authority tells them and may be highly motivated to please that person. It is interesting to note that when interpreting Dora’s dream, Freud wrote the dream confirmed what he already knew.
SUMMARY
LO 3.1 Discuss some of the early experiences and discoveries that laid the foundation for Freud’s theory.
The first comprehensive theory of personality was developed by Sigmund Freud. Aft