Psychological Theories in Psychiatry

There are a large number of competing theories influencing contemporary psychotherapeutic thinking. Psychotherapies derived from psychoanalytic, cognitive, and behavior theory are the most widely used. Cognitive and behavioral interventions have the strongest empirical verification; little empirical evidence supports the efficacy of analytiddynamic therapies.

Psychoanalytic/Psychodynamic theory

The principal theorist responsible for launching psychoanalysis as a technique and psychodynamic theory in general is Sigmund Freud. Freud's theories proposed that unconscious motivations and early developmental influences were essential to understanding behavior. Freud's original theories have proven quite controversial and have led to the creation of various alternative or derivative theories.

Twentieth-Century Schools of Psychodynamic Psychology

There are three major twentieth-century psychodynamic schools: drive psychology, ego psychology, and object relations theory.

Drive Psychology

Drive psychology posits that infants have sexual (and other) drives. This theory proposes that sexual and aggressive instincts are present in each individual and that each individual passes sequentially through psychosexual developmental stages (oral, anal, phallic, latency, and genital). Included in drive psychology is conflict theory, which proposes to explain how character and personality development are influenced by the interaction of drives with the conscience and reality.

Ego Psychology

Freud eventually developed a tripartite theory of the mind in which the psychic structure was composed of the id, ego, and superego. Under this theory, the id is the compartment of the mind containing the drives and instincts. The superego contains the sense of right and wrong, largely derived from parental and societal morality. The ego is responsible for adaptation to the environment and for the resolution of conflict. A major function of the ego is the reduction of anxiety. Ego defenses (Table 17-1) are proposed as psychic mechanisms that protect the ego from anxiety. Some ego defenses (e.g., sublimation) are more functional to the individual than others (e.g.,
denial).

Object Relations Theory

Object relations theory (objects refers to important people in one's life) departs from drive theory in that the relationship to an object is motivated by the primacy of the relationship rather than the object being a means of satisfying a drive. Child observation furthered object relations theory, emphasizing concepts of attachment and separation.