Sigmund freud and classic psychoanalysis by MikeJenny


									Chapter13. Theories of Personality
      and Psychopathology
 Sigmund freud and classic psychoanalysis

 The theory of Erik Erikson
Sigmund freud and classic psychoanalysis

      1. Topographic model of the mind

      2. Instinct or drive theory

      3. Ego psychology

      4. Classical psychoanalytic theory of

      5. Treatment and technique
Introduction——Sigmund Freud 1
 Sigmund Freud was born on
  May 6, 1856, in Freiburg, a
  small town in Moravia, which is
  now a part of the Czech
  Republic. When Freud was 4
  years old, his father, a Jewish
  wool merchant, moved the
  family to Vienna, where Freud
  spent most of his life.
Introduction——Sigmund Freud 2

 Following medical school, he specialized in neurology
  and studied for a year in Paris with Jean-Martin Charcot.
  He was also influenced by Ambroise-August Liebault
  and Hippolyte-Marie Bernheim, both of whom taught
  him hypnosis while he was in France. After his
  education in France, he returned to Vienna and began
  clinical work with hysterical patients. Between 1887 and
  1897, his work with these patients led him to develop
1.Topographic model of the mind
 The Conscious
 The Preconscious
 The Unconscious
 Limitations of the Topographic Theory
              1.1The Conscious
 the part of the mind in which perceptions coming from
  the outside world or from within the body or mind are
  brought into awareness. Consciousness is a subjective
  phenomenon whose content can be communicated only
  by means of language or behavior. Freud assumed that
  consciousness employed a form of neutralized psychic
  energy that he referred to as attention cathexis.
 In other words, people were aware of a particular idea or
  feeling as a result of investing a discrete amount of
  psychic energy in the idea or feeling.
           1.2The Preconscious
 The preconscious system is composed of those mental
  events, processes, and contents capable of being
  brought into conscious awareness by the act of focusing
 Conceptually, the preconscious interfaces with both
  unconscious and conscious regions of the mind. To
  reach conscious awareness, contents of the
  unconscious must become linked with words and thus
  become preconscious. The preconscious also serves to
  maintain the repressive barrier and to censor
  unacceptable wishes and desires.
            1.3The Unconscious

 The unconscious system is characterized by primary
  process thinking, which has as its principal aim the
  facilitation of wish fulfillment and instinctual discharge.
  It is governed by the pleasure principle and therefore
  disregards logical connections, has no concept of time,
  represents wishes as fulfillments, permits
  contradictions to exist simultaneously, and denies the
  existence of negatives.
 The contents of the unconscious can become
  conscious only by passing through the preconscious;
  when censors are overpowered, the elements can
  enter consciousness.
1.4 Limitations of the Topographic Theory

 two main deficiencies :
   First, many patients' defense mechanisms that
     guard against distressing wishes, feelings, or
     thoughts were themselves not initially accessible
     to consciousness. Repression, then, cannot be
     identical with the preconscious, because by
     definition this region of the mind is accessible to
   Second, Freud's patients frequently
     demonstrated an unconscious need for
2 Instinct or drive theory
 Instincts
 Pleasure and Reality Principles
 Infantile Sexuality
 Object Relationships in Instinct Theory
 Concept of Narcissism
2.1 Instincts
 Libido
Ego Instincts
Life and Death Instinct
 Instinct, for example, refers to a pattern of species-
  specific behavior that was genetically derived and
  therefore is more or less independent of learning.
 In Freud's view, an instinct has four principal
  characteristics: source, impetus, aim, and object. The
  source refers to the part of the body from which the
  instinct arises. The impetus is the amount of force or
  intensity associated with the instinct. The aim refers to
  any action directed toward tension discharge or
  satisfaction, and the object is the target (often a person)
  for this action.
Freud defined libido as "that force by which the
 sexual instinct is represented in the mind."
 Freud's intent was to encompass the general
 notion of pleasure as well as sexuality .
                Ego Instincts
 From 1905 on, Freud maintained a dual instinct theory,
  subsuming sexual instincts and ego instincts connected
  with self-preservation.
 Freud viewed narcissistic investment as an essentially
  libidinal instinct and called the remaining nonsexual
  components the ego instincts.
 When psychoanalysts today discuss the dual instinct theory,
  they are generally referring to libido and aggression.
 Freud, however, originally conceptualized aggression as a
  component of the sexual instincts in the form of sadism.
 Finally, in 1923, to account for the clinical data he was
  observing, he was compelled to conceive of aggression as a
  separate instinct in its own right.
 The source of this instinct, according to Freud, was largely in
 skeletal muscles, and the aim of the aggressive instincts was
Life and Death Instincts
 The life and death instincts were regarded as forces
  underlying the sexual and aggressive instincts.
 Freud thought that the dominant force in biological
  organisms had to be the death instinct.
 In contrast to the death instinct, Eros (the life instinct)
  refers to the tendency of particles to reunite or bind to
  one another, as in sexual reproduction.
 The prevalent view today is that the dual instincts of
  sexuality and aggression are sufficient to explain most
  clinical phenomena without recourse to a death
     Pleasure and Reality Principles

 In 1911, Freud described two basic tenets of mental
  functioning, the pleasure principle and the reality principle.
 The pleasure principle is defined as an inborn tendency of
  the organism to avoid pain and to seek pleasure through
  the discharge of tension.
 The reality principle is considered to be a learned function
  closely related to the maturation of the ego; this principle
  modifies the pleasure principle and requires the delay or
  postponement of immediate gratification.
         Infantile Sexuality (1)
 Freud set forth the three major tenets of psychoanalytic
  theory when he published Three Essays on the Theory of
 First, he broadened the definition of sexuality to include
  forms of pleasure that transcend genital sexuality.
 Second, he established a developmental theory of childhood
  sexuality that delineated the vicissitudes of erotic activity
  from birth through puberty.
 Third, he forged a conceptual linkage between neuroses and
             Infantile Sexuality(2)

 Freud noted that infants are capable of erotic activity
  from birth, but the earliest manifestations of infantile
  sexuality are basically nonsexual and are associated with
  such bodily functions as feeding and bowel-bladder
 As libidinal energy shifts from the oral zone to the anal
  zone to the phallic zone, each stage of development is
  thought to build on and to subsume the accomplishments
  of the preceding stage.
          Infantile Sexuality(3)
 Freud suggested that phallic erotic activity in boys is a
  preliminary stage leading to adult genital activity.
 Freud postulated that females have two principal erotogenic
  zones, the vagina and the clitoris.
 He thought that the clitoris was the chief erotogenic focus
  during the infantile genital period but that erotic primacy
  shifted to the vagina after puberty.
 Studies of human sexuality have subsequently questioned
  the validity of this distinction.
          Psychosexual Stages
 Oral Stage      birth - 18 months old

 Anal Stage      18 months - 3 years

 Phallic Stage   3 years - 6 years

 Latency Stage   6 years - 12 years

 Genital Stage   12 years - adult
     Object Relationships in Instinct
 Freud suggested that the choice of a love object in adult
  life, the love relationship itself, and the nature of all other
  object relationships depend primarily on the nature and
  quality of children's relationships during the early years of
 In describing the libidinal phases of psychosexual
  development, Freud repeatedly referred to the
  significance of a child's relationships with parents and
  other significant people in the environment.
 Fixation(固着):根据弗洛伊德的理论,如果在性心理发展的某个阶段得到

 性心理发展的早期经验对人格形成和成人行为模式有着很深层次的影响。
       Oral Stage —— Definition
 The earliest stage of development
  in which the infant's needs,
  perceptions, and modes of
  expression are primarily centered
  in the mouth, lips, tongue, and
  other organs related to the oral
    Oral Stage —— Description
 Oral drives consist of two separate components: libidinal and
 The oral triad consists of the wish to eat, to sleep, and to
  reach that relaxation that occurs at the end of sucking just
  before the onset of sleep.
 Oral aggression may express itself in biting, chewing, spitting,
  or crying.
 Oral aggression is connected with primitive wishes and
  fantasies of biting, devouring, and destroying.
       Oral Stage —— Objectives
 To establish a trusting dependence on nursing and sustaining objects, to
   establish comfortable expression and gratification of oral libidinal needs

   without excessive conflict or ambivalence from oral sadistic wishes.
  Oral Stage —— Pathological traits

 Such traits can include excessive optimism, narcissism,
  pessimism, and demandingness(贪得无厌).
 Oral characters are often excessively dependent and require
  others to give to them and to look after them.
 Oral characters are often extremely dependent on objects for
  the maintenance of their self-esteem.
 Envy and jealousy are often associated with oral traits.
Oral Stage —— Character traits
 Successful resolution of the oral phase provides a
  basis in character structure for capacities to give to
  and receive from others without excessive
  dependence or envy and a capacity to rely on others
  with a sense of trust, as well as with a sense of self-
  reliance and self-trust.
      Anal Stage —— Definition
 The stage of psychosexual development that is prompted by
  maturation of neuromuscular control over sphincters, particularly the
  anal sphincters, thus permitting more voluntary control over
  retention or expulsion of feces.
   Anal Stage —— Description

 This period is marked by a recognizable
  intensification of aggressive drives mixed with
  libidinal components and in sadistic impulses.

 Acquisition of voluntary sphincter control is
  associated with an increasing shift from passivity to
      Anal Stage —— Objectives
 The anal period is essentially a period of striving for
  independence and separation from the dependence on
  and control by the parent.
 The objectives of sphincter control without overcontrol
  (fecal retention) or loss of control (messing) are matched
  by the child's attempts to achieve autonomy and
  independence without excessive shame or self-doubt
  from loss of control.
  Anal Stage —— Pathological traits

 Orderliness, obstinancy, stubbornness, willfulness,
  frugality, and parsimony are features of the anal
  character derived from a fixation on anal functions.
 Anal characteristics and defenses are most typically
  seen in obsessive-compulsive neuroses.
Anal Stage —— Character traits
 personal autonomy
 independence
 personal initiative
 a capacity for self-determining behavior without a
  sense of shame or self-doubt,
   Phallic Stage —— Definition
 The phallic stage of sexual development begins sometime
  during the third year of life and continues until approximately

  the end of the fifth year.
  Phallic Stage —— Description
 The phallic phase is characterized by a primary focus of
  sexual interests, stimulation, and excitement in the
  genital area.
 The penis becomes the organ of principal interest to
  children of both sexes.
 The phallic phase is associated with an increase in
  genital masturbation accompanied by predominantly
  unconscious fantasies of sexual involvement with the
  opposite-sex parent.
 Phallic Stage —— Objectives

 The objective of this phase is to focus erotic interest in the

   genital area and genital functions.
  Phallic Stage —— Pathological
 幼儿开始将性能量里比多指向外界对象,男孩的性欲指向
 男孩的欲望指向母亲时,总要无意识地与父亲争夺爱,敌
  Phallic Stage —— Character traits

 The phallic stage provides the foundations for an
  emerging sense of sexual identity, a sense of
  curiosity without embarrassment, initiative without
              The Oedipus Story
Once upon a time…
  King Laius and Queen
  Jocasta of Thebes have a
  new baby boy. They are
  warned by a prophet, “Your
  child will grow up to murder
  his father and marry his
    Why is this story meaningful?
Because Oedipus acts out a
wish that everyone has had in
early childhood (Freud)! This
is the incest fantasy, falling
in love with the mother,
jealousy of the father – the
Oedipus Complex.
              Latency Stage
          ages 6 years to 12 years
 sexual drives and impulses
  become inactive
 maturation of the ego
 consolidation of the superego
 energy channeled into
  friendships and mastering the
             Genital Stage
        ages 13 years through life
 adolescents struggle for
  balance between
  dependency and
 healthy adults have
  capacity to work and play
  creatively and efficiently
  toward meaningful goals
阶段   性敏感区 潜在冲突来源   固着导致的性格特点
口欲期 口、嘴唇、   断奶   嘴部行为,如抽烟、过度饮
      舌           食;被动性和易上当
肛欲期   肛门  上厕所的训练 杂乱无章、吝啬、固执,或
生殖器  生殖器 俄狄浦斯情结   虚荣,莽撞,或者相反
潜伏期 无特定区 防御机制的发 无(一般此阶段不会发生固
      域     展         着)
生殖期  生殖器 成熟的性亲密 成功完成早期阶段的成年人
            行为   会对他人产生真诚的兴趣并
Structural Model of
A. Id
B. Ego
C. Superego
 Only mental system present at birth
 encompasses all inherited personality
 wants pleasure/immediate gratification
 all of our energy comes through the id
 too much = psychopathology
  interacts directly with real,
   external world
  mediates between id and
   external environment
  is the policeman of our mind
  balances us and keeps id and
   superego in check
    contains moral standards and
     value systems “shoulds”
    develops out of ego by parental
    acts as a conscience (or “ego
    too much = neurosis, anxiety,
    Structural Theory of the Mind
 Id
 ego
 superego
 Freud used this term to refer to a reservoir of
  unorganized instinctual drives. Operating under the
  domination of the primary process, the id lacks the
  capacity to delay or modify the instinctual drives with
  which an infant is born. The id should not, however, be
  viewed as synonymous with the unconscious because
  both the ego and the superego have unconscious
 The ego spans all three topographic dimensions of
 conscious, preconscious, and unconscious. Logical and
 abstract thinking and verbal expression are associated
 with conscious and preconscious functions of the ego.
 Defense mechanisms reside in the unconscious domain
 of the ego. The ego is the executive organ of the psyche
 and controls motility, perception, contact with reality, and,
 through the mechanisms of defense available to it, the
 delay and modulation of drive expression.
 Freud believed that the modification of the id occurs as a
  result of the impact of the external world on the drives.
  The pressures of external reality enable the ego to
  appropriate the energies of the id to do its work. As the
  ego brings influences from the external world to bear on
  the id, it simultaneously substitutes the reality principle
  for the pleasure principle. Freud emphasized the role of
  conflict within the structural model and observed that
  conflict occurs initially between the id and the outside
  world, only to be transformed later to conflict between
  the id and the ego.
 The superego establishes and maintains an individual's
  moral conscience based on a complex system of ideals
  and values internalized from parents. Freud viewed the
  superego as the heir to the Oedipus complex: Children
  internalize parental values and standards around the age
  of 5 or 6 years. The superego then serves as an agency
  that provides ongoing scrutiny of a person's behavior,
  thoughts, and feelings; makes comparisons with
  expected standards of behavior; and offers approval or
  disapproval. These activities occur largely unconsciously.
 The ego ideal is often regarded as a component of the
  superego: It is an agency that prescribes what a person
  should do according to internalized standards and values.
  The superego, by contrast, is an agency of moral
  conscience that proscribes-that is, dictates what a
  person should not do. Throughout the latency period and
  thereafter, people continue to build on early
  identifications through their contact with admired figures
  who contribute to the formation of moral standards,
  aspirations, and ideals.
             Ego psychology
 Structural Theory of the Mind
 Functions of the Ego
 Defense Mechanisms
 Theory of Anxiety
 Ego psychology: Structural Theory
           of the Mind
 Id:
   Freud used this term to refer to a reservoir of
      unorganized instinctual drives. Operating under
      the domination of the primary process, the id
      lacks the capacity to delay or modify the
      instinctual drives with which an infant is born.
      The id should not, however, be viewed as
      synonymous with the unconscious because both
      the ego and the superego have unconscious
 Ego
   The ego spans all three topographic dimensions of
    conscious, preconscious, and unconscious. Logical
    and abstract thinking and verbal expression are
    associated with conscious and preconscious
    functions of the ego. Defense mechanisms reside in
    the unconscious domain of the ego. The ego is the
    executive organ of the psyche and controls motility,
    perception, contact with reality, and, through the
    mechanisms of defense available to it, the delay and
    modulation of drive expression.
 Superego
    The superego establishes and maintains an
    individual's moral conscience based on a complex
    system of ideals and values internalized from parents.
    Freud viewed the superego as the heir to the Oedipus
    complex: Children internalize parental values and
    standards around the age of 5 or 6 years. The
    superego then serves as an agency that provides
    ongoing scrutiny of a person's behavior, thoughts,
    and feelings; makes comparisons with expected
    standards of behavior; and offers approval or
    disapproval. These activities occur largely
 ego psychology as it is known today really began with
  the publication in 1923 of The Ego and the Id. This
  landmark publication also represented a transition in
  Freud's thinking from the topographic model of the mind
  to the tripartite structural model of ego, id, and superego.
  He had observed repeatedly that not all unconscious
  processes can be relegated to a person's instinctual life.
  Elements of the conscience, as well as functions of the
  ego, are clearly unconscious as well.
The theory of Erik Erikson
Introduction 简介
Epigenetic principle渐次生成原则
             一 Introduction 1:
 Erik Homburger Erikson was born in 1902 in Frankfurt,
  Germany. His father, a Danish Protestant新教徒, and his
  mother, a Danish Jew犹太教徒, separated before he was
  born, and he grew up in the home of his mother and
  German-Jewish stepfather, a pediatrician儿科医生.
  Erikson trained as a lay psychoanalyst in Europe and
  was schooled in the Montessori Method of education.
 Erikson immigrated to the United States in 1933.
                Introduction 2:
 He became interested in the influence of culture on child
  development, and as a result of his studies in the 1930s
  and the 1940s, including anthropological work with the
  Sioux in South Dakota and the Yurok in northern
  California, his book Childhood and Society was
  published in 1950. In this publication, he presented a
  psychosocial theory of development that describes
  crucial steps in people's relationships with the social
  world, based on the interplay between biology and
 艾里克森(Erik Homburger Erikson, 1902-1994)生于德国的法兰克
 1933年他参加了维也纳精神分析学会,并追随安娜学习儿童精神分析。
 1936-1939年在耶鲁大学医学研究院精神病学系工作;
 1939-1944年参加加利福尼亚大学伯克利分校儿童福利研究所的纵向
 1951-1960年在匹兹堡大学医学院任精神病学教授;
 1960年起任哈佛大学人类发展学教授,直到1970年退休;
 艾里克森是继哈特曼之后自我心理学的杰出代表,他进一步发展了哈
                Introduction 3:
 Erikson drew on much of freudian psychology, but he
  added to Sigmund Freud's theory of infantile sexuality幼
  稚性欲 by concentrating on children's development
  beyond puberty青春期. Erikson concluded that human
  personality is determined not only by childhood
  experiences, but also by those of adulthood.
     2 Epigenetic principle(1)
 Erikson's formulations were based on the concept of
  epigenesis, a term borrowed from embryology. His
  epigenetic principle holds that development occurs in
  sequential, clearly defined stages, and that each stage
  must be satisfactorily resolved for development to
  proceed smoothly. According to the epigenetic model, if
  successful resolution of a particular stage does not occur,
  all subsequent stages reflect the failure in the form of
  physical, cognitive, social, or emotional maladjustment.
   2.1Relation to Freudian Theory
 Erikson accepted Freud's concepts of instinctual
  development and infantile sexuality. For each of Freud's
  psychosexual stages (for example, oral, anal, phallic),
  Erikson described a corresponding zone with a specific
  pattern or mode of behavior. Thus, the oral zone is
  associated with sucking or taking-in behavior; the anal
  zone is associated with holding on and letting go.
  Erikson emphasized that the development of the ego is
  more than the result of intrapsychic wants or inner
  psychic energies. It is also a matter of mutual regulation
  between growing children and a society's culture and
      2.2 Stages of the Life Cycle
 Erikson described eight stages of the life cycle (Table
  6.3). Each stage is marked by one or more internal
  crises, defined as turning points-periods when people
  are in a state of increased vulnerability. Ideally, when a
  crisis is mastered successfully, people gain strength and
  move on to the next stage.
   Stage1. Basic Trust versus Basic Mistrust

 (Birth to about 1 year)
 Corresponds to the oral psychosexual stage
 Trust shown by ease of feeding, depth of sleep, bowel
 Depends on consistency and sameness of experiences
  provided by caretaker or outer provider
 Second 6 months: teething and biting move infant from
  getting to taking
 Weaning leads to nostalgia for lost paradise
 If basic trust is strong, child maintains hopeful attitude,
  develops self-confidence
 Oral zone associated with mode of being satisfied
 Stage2. Autonomy versus Shame and Doubt

 (About 1 to 3 years)
 Corresponds to the muscular-anal stage
 Biologically includes learning to walk, feed self, talk
 Need for outer control, firmness of caretaker before
  development of autonomy
 Shame occurs when child is overly self-conscious
  through negative exposure and punishment
 Self-doubt can evolve if parents overly shame child, eg,
  about elimination
 Anal zone associated with mode of holding on and letting
            Stage3. Initiative versus Guilt

 (3 to 5 years)
 Corresponds to the phallic psychosexual stage
 Initiative arises in relation to tasks for the sake of activity,
  both motor and intellectual
 Guilt may arise over goals contemplated (especially
  aggressive goals)
 Desire to mimic adult world; involvement in oedipal
  struggle leads to resolution through social role
 Sibling rivalry frequent
 Phallic zone associated with mode of competition and
        Stage4. Industry versus Inferiority

 (6 to 11 years)
 Corresponds to the latency psychosexual stage
 Child is busy building, creating, accomplishing
 Receives systematic instruction and fundamentals of
 Danger of sense of inadequacy and inferiority if child
  despairs of tools, skills, and status among peers
 Socially decisive age
 No dominant zone or mode
     Stage5. Identity versus Role Diffusion

 (11 years through end of adolescence)
 Struggle to develop ego identity (sense of inner
  sameness and continuity)
 Preoccupation with appearance, hero worship, ideology
 Group identity (with peers) develops
 Danger of role confusion, doubts about sexual and
  vocational identity
 Psychosexual moratorium, stage between morality
  learned by the child and the ethics developed by the
 No dominant zone or mode
        Stage6. Intimacy versus Isolation

 (21 to 40 years)
 Tasks are to love and to work
 Intimacy is characterized by self-abandonment, mutuality
  of sexual orgasm, intense friendship, attachments that
  are life-long
 Isolation is marked by separation from others and view
  that others are dangerous
 General sense of productivity in this stage
 No dominant zone or mode
     Stage7. Generativity versus Stagnation

 (40 to 65 years)
 Generativity includes raising children, guiding new
  generation, creativity, altruism
 Stagnation not prevented by having a child; parent must
  provide nurturance and love
 Self-concern, isolation, and absence of intimacy are
  characteristic of stagnation
 No dominant zone or mode
         Stage 8. Integrity versus Despair

 (over 65 years)
 Integrity is a sense of satisfaction that life has been
  productive and worthwhile
 Despair is a loss of hope that produces misanthropy and
 Persons in the state of despair are fearful of death
 An acceptance of one's place in the life cycle is
  characteristic of integrity
                  3 Comment:
 Erikson's stages are not fixed in time. Development is
  continuous; a particular stage may dominate at a certain
  time, but a person may have residual problems carried
  from one stage to the next or may be under severe
  stress and regress wholly or in part to an earlier stage.
  The time boundaries of each stage represent
  approximations agreed on by most workers in the field.
            4 Psychopathology
 Each stage of the life cycle has its own
  psychopathological outcome if it is not mastered
   Basic Trust
                4.1 Basic Trust 1
 An impairment of basic trust leads to basic mistrust. In
  infants, social trust is characterized by ease of feeding,
  depth of sleep, smiling, and general physiological
  homeostasis. Prolonged separation during infancy can
  lead to hospitalism or anaclitic depression. In later life,
  this lack of trust may be manifested by dysthymic
  disorder, a depressive disorder, or a sense of
                  Basic Trust 2
 People who experienced a sense of social mistrust in
 the first years are likely to develop paranoid or
 delusional disorders, schizoid personality disorder and,
 in most severe cases, schizophrenia, Substance-related
 disorders , substance-dependent personalities .
 If not nurtured properly, infants may feel empty, starved
 not just for food but also for sensual and visual
 stimulation. They may become, as adults, seekers after
 stimulating thrills that do not involve intimacy and that
 help ward off feelings of depression.
                 4.2 Autonomy 1
 The stage in which children attempt to develop into
  autonomous beings is often called the terrible 2s,
  referring to toddlers' willfulness at this period of
  development. If shame and doubt dominate over
  autonomy, compulsive doubting may occur.
 The inflexibility of the obsessive personality also results
  from an overabundance of doubt. Too rigorous toilet
  training, commonplace in today's society, which requires
  a clean, punctual, and deodorized body, can produce an
  overly compulsive personality that is stingy, meticulous,
  and selfish. Known as anal personalities, such people
  are parsimonious, punctual, and perfectionistic (the three
                 4.2 Autonomy 2
 Too much shaming causes children to feel evil or dirty
  and may pave the way for delinquent behavior. In effect,
  children say, "If that's what they think of me, that's the
  way I'll behave." Paranoid personalities feel that others
  are trying to control them, a feeling that may have its
  origin during the stage of autonomy versus shame and
  doubt. When coupled with mistrust, the seeds are
  planted for persecutory delusions. Impulsive disorder
  may be explained as a person's refusing to be inhibited
  or controlled.
                   4.3 Initiative 1
 Erikson stated: "In pathology, the conflict over initiative is
  expressed either in hysterical denial, which causes the
  repression of the wish or the abrogation of its executive
  organ by paralysis or impotence; or in overcompensatory
  showing off, in which the scared individual, so eager to
  `duck,' instead `sticks his neck out.' " In the past, hysteria
  was the usual form of pathological regression in this area,
  but a plunge into psychosomatic disease is now common.
                     Initiative 2
 Excessive guilt may lead to a variety of conditions, such
  as generalized anxiety disorder and phobias. Patients
  feel guilty because of normal impulses, and they repress
  these impulses, with resulting symptom formation.
  Punishments or severe prohibitions occurring during the
  stage of initiative versus guilt can produce sexual
                     Initiative 3
 Conversion disorder or specific phobia may result when
  the oedipal恋母情结的 conflict is not resolved. As sexual
  fantasies are accepted as unrealizable, children may
  punish themselves for these fantasies by fearing harm to
  their genitals. Under the brutal assault of the developing
  superego, they may repress their wishes and begin to
  deny them. If this pattern is carried forward, paralysis,
  inhibition, or impotence can result. Sometimes, in fear of
  not being able to live up to what others expect, children
  may turn to psychosomatic disease
                     4.4 Industry
 Erikson described industry as a "sense of being able to
  make things and make them well and even perfectly."
  When children's efforts are thwarted, they are made to
  feel that personal goals cannot be accomplished or are
  not worthwhile, and a sense of inferiority develops. In
  adults, this sense of inferiority can result in severe work
  inhibitions and a character structure marked by feelings
  of inadequacy. For some people, the feelings may result
  in a compensatory drive for money, power, and prestige.
  Work can become the main focus of life, at the expense
  of intimacy.
                   4.5 Identity 1
 Many disorders of adolescence can be traced to identity
  confusion. The danger is role diffusion. Erikson stated:
 Where this is based on a strong previous doubt as to
  one's sexual identity, delinquent and outright psychotic
  incidents are not uncommon. If diagnosed and treated
  correctly, those incidents do not have the same fatal
  significance that they have at other ages. It is primarily
  the inability to settle on an occupational identity that
  disturbs young people. Keeping themselves together,
  they temporarily overidentify, to the point of apparent
  complete loss of identity, with the heroes of cliques and
                      Identity 2
 Other disorders during the stage of identity versus role
  diffusion include conduct disorder, disruptive behavior
  disorder, gender identity disorder, schizophreniform
  disorder, and other psychotic disorders. The ability to
  leave home and live independently is an important task
  during this period. An inability to separate from the
  parent and prolonged dependence may occur.
                    4.6 Intimacy
 The successful formation of a stable marriage and family
  depends on the capacity to become intimate. The years
  of early adulthood are crucial for deciding whether to get
  married and to whom. Gender identity determines object
  choice, either heterosexual or homosexual, but making
  an intimate connection with another person is a major
  task. People with schizoid personality disorder remain
  isolated from others because of fear, suspicion, the
  inability to take risks, or the lack of a capacity to love.
                4.7 Generativity
 From about 40 to 65 years, the period of middle
  adulthood, specific disorders are less clearly defined
  than in the other stages described by Erikson. People
  who are middle aged show a higher incidence of
  depression than do younger adults, a finding that may be
  related to middle-aged people's disappointments and
  failed expectations as they review the past, consider
  their lives, and contemplate the future. The increased
  use of alcohol and other psychoactive substances also
  occurs during this time.
                    4.8 Integrity
 Anxiety disorders often develop in older people. In
  Erikson's formulation, this development may be related
  to people's looking back on their lives with a sense of
  panic. Time has run out, and chances are used up. The
  decline in physical functions can contribute to
  psychosomatic illness, hypochondriasis, and depression.
  The suicide rate is highest over the age of 65. People
  facing dying and death may find it intolerable not to have
  been generative or able to make significant attachments
  in life. Integrity, for Erikson, is characterized by an
  acceptance of life. Without acceptance, people feel
  despair and hopelessness that can result in severe
  depressive disorders.
                   5 Treatment
 For Erikson, establishing a state of trust between doctor
  and patient is the basic requirement for successful
  therapy. When psychopathology stems from basic
  mistrust (for example, depression), a patient must re-
  establish trust with the therapist, whose task, like that of
  the good mother, is to be sensitive to the patient's needs.
  The therapist must have a sense of personal
  trustworthiness that can be transmitted to the patient.
 Effective therapy requires that therapists actively convey
  to patients the belief that they are understood. This is
  done not only through empathetic listening but also by
  verbal assurances, which enable a positive transference,
  built on mutual trust to develop.
 Mutuality, which is important in Erikson's system of
  health, is also vital to a cure. Erikson urged that the
  relationship of the healer to the sick person be one of
  equals "in which the observer who has learned to
  observe himself teaches the observed to become self-
                     5.2 Goals
 Erikson discussed four dimensions of the
  psychoanalyst‘s job.
   The patient's desire to be cured and the analyst's
     desire to cure is the first dimension.
   The second dimension Erikson called objectivity-
   The third dimension runs along the axis of
   The fourth dimension is tolerance-indignation.

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