Theoretical Perspective: Psychoanalytic

Introduction

Psychoanalytic theories of behaviour embrace a diversity of views that can be grouped into four main lines of thought: drive theory, which focuses primarily on basic needs of the individual and how these needs are channelled and expressed; ego theory, which stresses the nature and adequacy of the coping resources that people bring to bear in dealing with life situations; object relations theory, which emphasizes the representations people form in their minds of the characteristics of other people; and self-psychology, which attends to how people differentiate themselves from others and develop a sense of agency, authenticity, and self-esteem (see Pine, 1990). Despite many differences among them, these threads of psychoanalytic thought share three common premises, each of which has been confirmed by empirical research findings (see Masling, 1983, 1984; Westen & Gabbard, 1999): (a) unconscious mental processes, including thoughts, feelings, and motivations that exist outside of conscious awareness and influence an individual's personality characteristics and action tendencies; (b) a dynamic interplay between conflicting attitudes that generate anxiety leads in all people to defensive manoeuvres intended to reduce this anxiety; and (c) developmental experiences play an important role in shaping abiding personality characteristics and patterns of interpersonal relatedness.

Accordingly, psychological assessment from a psychoanalytic perspective serves the purpose of [Page 1012]elucidating aspects of personality structure and personality dynamics in ways that clarify the role of drives, conflict and defence, and object representations in shaping how people are likely to think, feel, and act. Assessment information framed in this way assists dynamically oriented clinicians in formulating the problems, diagnostic status, and treatment needs of patients they see and guides them in planning and conducting whatever psychotherapy they provide (see Blatt & Ford, 1994; Shectman & Smith, 1984). Familiarity with this psychoanalytic perspective on assessment also gives psychologists direction in their selection of assessment procedures and the manner in which they interpret the data they obtain. This impact of psychoanalytic theory on the selection of assessment procedures and their utilization in differential diagnosis and treatment planning can be traced to the seminal work of Rapaport, Gill, and Schafer (1968) and has subsequently been reflected in numerous other publications (see Weiner, 1983).

Assessing Personality Structure

Personality structure comprises a broad range of fairly stable characteristics and orientations of individuals that lead them to conduct themselves in certain ways. Most important among these persistent tendencies and abiding dispositions from a psychoanalytic perspective is a person's coping style, particularly with respect to his or her preferred defence mechanisms. Strictly defined, defence mechanisms constitute mental operations or overt behaviours undertaken without conscious awareness to minimize or avoid the experience of anxiety, as in attributing one's own unacceptable attitudes to someone else (projection) or having to repeat a useless ritual in order to feel comfortable (undoing). As elaborated in the work of Schafer (1954) and Cramer (2000), defence preference information emerging from psychological assessment can facilitate differential diagnosis, as in recognizing excessive reliance on projection as a likely indicator of paranoid tendencies and pervasive undoing as a clue to obsessive-compulsive disorder.

Appropriately selected and interpreted psychological assessment methods also help to identify the adequacy as well as the nature of an individual's defensive style and preferred ways of coping with stress. Particularly important in this respect is the utility of psychodiagnostic testing in measuring the maturity of an individual's personality organization. Test-based distinctions among neurotic, borderline, and psychotic levels of organization provide valuable information for differential diagnosis and many key aspects of treatment planning (see Lerner, 1998; McWilliams, 1994; Silverstein, 1999).

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