Ego Psychology (1) NARRATED 9-17-14

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by Jessica Rosin, Olivia Cole, Carla Days and Suzan Wilson SOUTHERN ADVENTIST UNIVERSITY

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Ego Psychology:

Ego Psychology Jessica Rosin, Olivia Cole, Carla Days, and Suzan Wilson

Ego Psychology: A Psychodynamic Theory:

Ego Psychology: A Psychodynamic Theory Along with psychoanalysis, relational and object relations theory, and self psychology, ego psychology emphasizes the importance of stages of psychosocial development and unconscious mental processes of human behavior. The psychodynamic theories were dominant in the social work profession between the 1920’s and the 1970’s . They have increasingly come under attack in the past 50 years by proponents of newer theories. Ego psychology and many of the relational theories are classified as psychodynamic. Ego psychology is concerned with individuals in the context of their psychosocial environments, while the relational theories have a stronger focus on interpersonal relationships and their effects on individual functioning.

Psychodynamic Theories:

Psychodynamic Theories Psychodynamic theories initially described the mind as consisting of three components: id, ego, and superego. Id: represents innate drives Ego: adapts the drives to socially acceptable outlets Superego: represents the conscious, or internalized value system

Ego:

Ego Ego psychology developed as a theory of human behavior that focuses on the role of the ego more than mind’s other two components. The ego is largely your conception of “who you are. It is “you” who thinks, feels, and acts in a reasonable consistent manner. It is everything you do to reflect, plan, and act in ways that allow you to “fit in” more or less adequately with the environments in which you live. The ego is the part of one’s personality that is responsible for negotiating between internal needs and demands of social living. It is where cognition occurs,, but unconscious mental processes also influence conscious thinking. Defense mechanisms, which are unconscious distortions of reality, frequently come into play as we attempt to manage our interpersonal and other conflicts. A client’s potential for personal growth or problem resolution does not always require attention to unconscious processes, but giving them that attention often maximizes his or her potential for change.

Ego Psychology:

Ego Psychology Ego psychology emerged from psychoanalysis, beginning in the 1930’s . Is development was related to the desire of some theories to build a psychology of normal development, the influence of new humanistic ideas in the social sciences that emphasized adaptive capacities rather than pathology, and the American social value of pragmatism.

Development of Ego Psychology:

Development of Ego Psychology Ego psychology was initially developed outside the profession, but reflected changes within the social work profession. “Pure” psychoanalysis was represented in the diagnostic school of social work, in which assessment and treatment planning, independent of the client’s preferences and environmental constraints, was considered most appropriate. The newer functional school recognized that intervention should be client driven (collaborative) and that social workers needed to mold their techniques to the realities (and limitations) of the service environment, including time limitations. With ego psychology, the social work profession shifted its thinking away from the role of the unconscious in psychological activity toward a greater emphasis on client strengths and adaptability. This was in part a reaction against Freud’s heavy emphasis on drives, and highlighted the ego’s role in promoting healthy social functioning.

Ego Psychology Utilization:

Ego Psychology Utilization Ego psychology and other psychodynamic theories continue to be utilized in the social profession, although they have faced increasing theoretical “competition” during the past forty years in light of new ideas about human nature, challenges in providing quality services to diverse populations, and changing attitudes about the mission of the profession. One of the most prominent recent scholars of ego psychology argues that the theory will continue to be useful for social workers so long as it assumes a broad view of the impact of social realities on clients’ lives, reduces the traditionally hierarchical relationship between the social worker and client, fully embraces the strengths perspective, helps oppressed persons develop a stronger sense of identity, and adapts to the needs of diverse populations.

Major Concepts:

Major Concepts Ego functioning includes both conscious and unconscious processes. People are born with several innate drives. People are born with an innate capacity to adapt to their environments, and this capacity further develops through learning and psychosocial maturation. This the drive to mastery and competence. Social influences on psychological functioning are significant, and many of these are transmitted through the family unit. Problems in social functioning can occur at any stage of development due to person-environment as well as internal conflicts.

Drives: Pleasure and Aggression & Mastery and Competence:

Drives: Pleasure and Aggression & Mastery and Competence Pleasure and Aggression: inevitably bring people into conflict with social norms. They must be channeled into appropriate outlets for their fulfillment and thus may be frustrating at times. Mastery and Competence: Are considered conflict free, representing an innate inclination to exist harmoniously in one’s environment. It evolves through life from one’s talents, mastery of developmental skills, motivations that derive from personal goals, and innate relationship seeking orientation. Acknowledging this drive is consistent with the strengths perspective of social work, because it assumes that all people have talents that can be utilized as they seek functional competence.

The Significance of Emotional Life:

The Significance of Emotional Life In ego psychology, some conscious thinking is a product of the drives, from which emptions also spring. We are pleasure seekers and “feelers” by nature, and thoughts are our means of deciding how to gratify the drives. Defense mechanisms result from the need to manage drives when we become frustrated, as we frequently do in the social world, where impulses must always be converted into acceptable behaviors. Personal growth is not always feasible when attending only to our conscious processes. We need to explore our thoughts and feelings to better understand our essential drives. Our capacity for change may be facilitated by uncovering ideas and feelings we typically keep out of consciousness. In that way we can better understand our impulses and direct them toward appropriate sources for gratification.

The Ego and It’s Functions:

The Ego and It’s Functions The ego is not a physical structure, but a concept describing the part of personality that negotiates between our needs and the outside world. It is present from birth and is our source of attention, concentration, learning, memory, will, and perception. The functioning of the ego is partly unconscious. In ego psychology, both past and present experiences are relevant in influencing our social functioning. The influence of drives on emotions and thoughts is not dismissed, but conscious thought processes receive greater emphasis. The ego mediates internal conflicts, which might result from drive frustration, but it also mediates the interactions of a person with stressful environmental conditions. Ego psychology is a developmental theory, so its principles support attention to ego development throughout the life cycle.

The Ego and Its Functions Continued:

The Ego and Its Functions Continued Awareness of the external environment Judgment Sense of Identity Impulse control Through process regulation Interpersonal (object) relations Defense mechanisms Stimulus regulation Autonomous functions

The Defense Mechanisms:

The Defense Mechanisms Ego psychology practitioners are sensitive to a client’s use of defense mechanisms, because the manner in which these are employed has a great influence on one’s ability to manage challenges. Defenses are unconscious, automatic responses that enable us to minimize perceived threats or keep them out of our awareness entirely. They are coping mechanisms used by all people to protect themselves against becoming overwhelmed by anxiety. Defenses distort reality to varying degrees, because they provide us with a conscious perspective on a particular situation that is biased toward out preserving a sense of security. People can use defenses in healthy and unhealthy ways. Defenses are used appropriately when promote our adaptive functioning and goal achievement and minimize interpersonal conflicts.

Common Defense Mechanisms:

Common Defense Mechanisms Denial Displacement Intellectualization Introjection Isolation of Affect Projection Rationalization Reaction Formation Regression Repression Somatization Sublimation Undoing

Client’s Use of Defense Mechanisms Evaluation:

Client’s Use of Defense Mechanisms Evaluation Flexibility versus Rigidity: The behavior may or may not appropriate to the social context. Future versus Past Orientation: Defenses should promote adaptive behavior in the present and future. When their use is based on past events that no longer affect the client, they may be maladaptive. General Reality Adherence versus Significant Distortion: All defenses distort reality, but people can distort reality to such a degree that they lose basic awareness to their environment.

Nature of Problems and Change:

Nature of Problems and Change In ego psychology, problems or challenges may result fro conflicts within the person or between the person and the external world. During the ego-based intervention, the social worker helps the client either build new ego strengths or use existing ego strengths more effectively. Change is manifested in the client’s ability to utilize his or her ego functions to enhance self-understanding and achieve greater mastery of challenges, crises, or life transitions. These are all empowering activities.

Goals of Intervention:

Goals of Intervention Enhance client’s inner capacities through ego development Modify or change environmental conditions Improve the fit between a person’s ego capacities and environmental conditions by working on both areas Acquire new problem-solving and coping skills Achieve insight through reflection about their strengths, limitations, and potential resources Maladaptive defenses may be confronted and appropriate e defenses strengthened Empowerment with knowledge or movement toward more productive stances with respect to their challenges Insight can be empowering to the extent that it strengthens client’s cohesion and focus They should emerge from the intervention process with an approved capacity for self-direction.

Assessment:

Assessment One of the first steps in doing an assessment is to evaluate the strengths and limitation of the client’s ego functions, through the questioning process. It is equally important to view other data information such as medical records and medical evaluation for any physiological impairments that may have an impact on the client's ego function. The social worker should gather as much relevant information as possible to determine if the client will benefit from the new skills.

Intervention:

Intervention It is important for the social worker build a working alliance with the patient that exemplifies a positive emotional bond. The social worker and the client should agree and be comfortable with the type of intervention and goal they want to obtain. The social worker should be able to show forth empathy and have the ability to perceive the client’s feelings and communicate that to the client.

Transference and Counter Transference:

Transference and Counter Transference Transference was initially defined as a client's unconscious projection of feelings, thoughts, and wishes onto the practitioner. The practitioner does not actually possess those characteristics but the client acts as if the practitioner does. It is important that the social worker is aware of their emotional reactions for this is what facilitates the intervention process.

Intervention Strategies:

Intervention Strategies Exploration/Description/Ventilation is interventions that the social worker uses to elicit thoughts and feelings about a particular area or concerns in order to help the client to express or explore more such as : Gain control of incapacitating emotions Feel less alone and overwhelmed Become motivated to take action Develop greater hope, confidence, motivation, and self- acceptance Reduce defensiveness See problems as more manageable

Sustainment:

Sustainment Sustainment is an intervention strategy used by the social worker that: Promotes the relationship with the client Conveys a caring attitude Expresses interest and confidence in the client Reassures the client about his potential and ability to meet goals Creates a supportive atmosphere

Person-Situation Reflection:

Person-Situation Reflection This intervention promotes the client’s capacity to reflect. Helps clients in reflection feelings, self-concept, and attitudes Helps clients become aware of current circumstances and interactions with others Assists clients in discussion of pros and cons of certain actions

Advice and Guidance (Direct Influence):

Advice and Guidance (Direct Influence) This intervention guides the client in decision making without directly influencing. Social worker avoids giving advice but provides direction Guides client in decision making by way of their own thinking Helps client to explore their reasons for their decisions Reviews with the client the pros and cons of their decisions

Developmental Reflection:

Developmental Reflection This strategy helps the client to experience emotions that may have been suppressed. Explores with client their past and present experiences by using questions, comments, explanations Helps client reflect on past and present experiences and current sense of self Assists client in recognizing patterns in their relationships Confronts irrational thinking and behavior as appropriate

Endings in Ego Psychology:

Endings in Ego Psychology Finding an end point in ego psychology interventions is not always easy. Focus on the client’s new skills and knowledge Assist client to continue growth opportunities Help the client to continue to review his past, present, and future after the counseling relationship ends -Develop strategies for client’s continues self-reflection

Spirituality:

Spirituality Finding fulfillment on the quest for meaning life: Help the client to become aware of impulses unconsciously avoided Help client to process experiences to enhance personal and social well being Assist the client with processing spiritual concerns if client is comfortable with this

Attention to Social Justice Issues:

Attention to Social Justice Issues According to the National Association of Social Workers (NASW) Code of Ethics (2008) social workers should challenge social injustice on behalf of vulnerable and oppressed individuals and groups of people. Social workers must be aware of the socio-cultural and environmental issues in a client’s life. Therapists who practice Ego psychology can help clients engage in larger system change activities and empower clients, but the theory itself does not encourage these interventions. Being aware of one’s strengths, limitations, and resources helps the oppressed feel liberating and powerful, and ego psychology can be used to empower their clients to meet these goals (Walsh, 2014).

Evidence of Effectiveness:

Evidence of Effectiveness Case studies have been mainly used as the means of evaluating the effectiveness of psychodynamic theories.

Evidence of Effectiveness Continued:

Evidence of Effectiveness Continued Practitioners discuss the following in the evaluation of case studies: The characteristics of the clients Their own thoughts and actions Improvement if any How the process was conducted and was it appropriate

Evidence of Effectiveness Continued:

Evidence of Effectiveness Continued Ego psychology was found to be effective with various populations in case study research including: Couples Clients with schizophrenia Children of alcoholic mothers African American adults Adults experiencing grief reactions Persons with substance abuse disorders Couples Clients with schizophrenia Children of alcoholic mothers African American adults Adults experiencing grief reactions Persons with substance abuse disorders Persons with borderline personalities Persons with borderline personalities

Effectiveness of Psychodynamic Interventions Using Experimental Designs:

Effectiveness of Psychodynamic Interventions Using Experimental Designs Studies provided evidence of effectiveness in some psychiatric disorders using short term psychodynamic psychotherapy ( STPP ). Researchers compared the effectiveness of STPP to minimal treatment and non-treatment controls for adults and found greater improvement in treatment groups which included persons with somatic, anxiety, depression and adjustment disorders maintaining medium and long term follow-up.

One Case, Two Formulations: Psychodynamic and CBT Efficacy and Effectiveness:

One Case, Two Formulations: Psychodynamic and CBT Efficacy and Effectiveness

Criticisms:

Criticisms Psychodynamic theories have been the most widely used in practice over the past 35 years. Increasingly practitioners are criticizing Ego Psychology and all of the psychodynamic theories. First, outcomes are difficult to evaluate due to subjectivity. Second, Ego Psychology and psychodynamic theories in general rely on the medical model (pathological) (Goldstein, 1995). Third, the client’s social environment is neglected and its impact on human behavior. Lastly, the diversity of clients is not fully appreciated along with characteristics and strengths.

Summary:

Summary Ego psychology has been in existence longer than any other theory and even though there are many criticisms social workers use the concepts and intervention strategies with many different types of clients to uncover unconscious thought processes (Walsh, 2014).

References:

References Goldstein, E. (1995). The emergence and assimilation of ego psychology into social work practice. Ego Psychology and Social Work Practice (2nd Ed.) Retrieved from http://books.google.com/books?id=hMmd3Rq13ZAC&lpg=PR7&ots=oNwAeXObCX&dq=ego%20psychology%20effectiveness&lr&pg=PA33#v=onepage&q=ego%20psychology%20effectiveness&f=false Walsh, J. (2014). Ego psychology. Theories for Direct Social Work Practice (3rd Ed.). Belmont, CA: Cengage Learning

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