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It is common to combine psychotherapy with medications. Split treatment describes the arrangement where a physician prescribes medication and someone else provides therapy. In these cases, the physician and therapist should regularly communicate regarding the patient's treatment.
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PSYCHOANALYSIS AND RELATED THERAPIES
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Psychoanalysis and its related therapies are derived from Sigmund Freud's psychoanalytic theories of the mind. Freud proposed that behaviors, or symptoms, result from unconscious mental processes, including defense mechanisms and conflicts between one's ego, id, superego, and external reality. Since the time of Freud, many other psychoanalytic theories have been developed. Influential theorists have included Melanie Klein, Heinz Kohut, Michael Balint, Margaret Mahler, and others.
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Examples of psychoanalytic therapies include the following:
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KEY FACT
Normal development: Id is present at birth, ego develops after birth, and superego development is traditionally considered to be completed by age 6.
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KEY FACT
According to Freud, the superego is the aspect of one's psyche that represents “morality, society, and parental teaching.”
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FREUD'S THEORIES OF THE MIND
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Unconscious: Includes repressed thoughts that are out of one's awareness; involves primary process thinking (primitive, pleasure-seeking urges with no regard to logic or time, prominent in children and psychosis). Thoughts and ideas may be repressed into the unconscious because they are embarrassing, shameful, or otherwise too painful.
Preconscious: Contains memories that are easy to bring into awareness, but not unless consciously retrieved.
Conscious: Involves current thoughts and secondary process thinking (logical, organized, mature, and can delay gratification).
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KEY FACT
The Freudian superego represents internalization of cultural rules.
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Id: Unconscious; involves instinctual sexual/aggressive urges and primary process thinking.
Superego: Moral conscience and ego ideal (inner image of oneself that one wants to become).
Ego: Serves as a mediator between the id, superego, and external environment, and seeks to develop satisfying interpersonal relationships; uses defense mechanisms (see below) to control instinctual urges and distinguishes fantasy from reality using reality testing. Problems with reality testing occur in psychotic individuals.
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Defense mechanisms are used by the ego to protect oneself and relieve anxiety by keeping conflicts out of awareness. They are (mostly) unconscious processes that are normal and healthy if they are mature and used in moderation (i.e., adaptive). They may be unhealthy if immature (i.e., maladaptive). Immature defense mechanisms can be used excessively as seen in some psychiatric disorders.
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Defense mechanisms are often classified hierarchically. Mature defense mechanisms are healthy and adaptive, and they are seen in high-functioning and healthy adults. Neurotic defenses are encountered in obsessive-compulsive patients, patients with other anxiety disorders, and adults under stress. Immature defenses are seen ...