Ego Psychology, Case Study Example

Ego psychology, created by Anna Freud after her father Sigmund Freud encouraged her to expand on his original ego-id-superego models is a concept of various facets of human development and behavior. Classical psychoanalysis is based on the unconscious motivation of a person’s actions. Ego psychology focuses on dealing with the conscious mind and defense mechanisms. “Unlike drive theory, ego psychology represents a more optimistic view of potential human growth and development” (Blanck, 1994, p 343). Through the decades other theorists, such as Erik Erickson, have provided alternative theories for ego psychology.

To better understand the concept of ego psychology, it is important to understand the ego, id and superego. Freudian theory reveals three components of a person’s personality; id, ego and superego. The id is the personality we are born with and is completely unconscious; it is primary, instinctive and archaic. Our id at birth is governed by the pleasure principle. The id is vital to the survival of a baby with no other means to convey their needs but to demand attention. Self gratification is not realistic as we grow older and learn the socially accepted way to obtain what we want and need.  The id is the basis for our personality and the foundation for the direction a person’s personality will grow.

The ego comes into the picture at this point. This portion of the personality deals with actuality and realism. The ego works to get what the id wants, but in a way which is positive, polite and socially acceptable. The ego governs the id to ensure appropriate impulse regulation and proper expression of the wants and needs expressed. Successfully being taught to temper our wants and needs in a manner acceptable to others will lead to a healthy ego. The inability to move into this element of the personality creates people who are demanding and immature; unable to live the reality of good behaviors and self discipline. Our id never leaves us; the ego creates avenues for mature and acceptable behavior for the id to be able to obtain gratification in the proper place and time.

The final component of Freud’s trio is the superego. The superego is our sense of what is right and wrong. The superego is the development of personality taking into account what we learn from our parents and society.  This element of our personality provides guidance for making decisions and judgments. Balancing these three elements provides each individual with the opportunities to ignore childlike actions and realize the benefits of living in a world of reality, practicing patience and tolerance for situations and other people. This is considered the moral and ethical portion of our personalities. Freud believed that in a healthy person the ego will be the strongest in order to satisfy the needs of the id and not upset the superego; while taking into consideration the reality of every situation (Heffner, 2001).

According to Freud, the ego takes shape as a problem develops between the external world and the person’s identity, and therefore the ego is a form of conflict that is going on in the mind (Pitts, 2009). As the ego attempts to balance the id and the superego, some circumstances will present which causes the ego difficulty dealing with the moral, ethical or impulse constraints resulting in anxiety. Defense mechanisms come into play in order to help balance the id, ego and superego.  Moving into a defensive mode of behavior can happen consciously or subconsciously for the individual.

A healthy person learns to recognize the relationship between feelings and reacting in healthy and unhealthy manners. Defense mechanisms are used to alleviate stress and tension for the individual. It is up to the individual sub-consciousness to determine which defense mechanism will work. Defense mechanisms are internal to keep a person safe from physical or emotional harm. Learning to use the defenses constructively is important and the ineffective use of them can lead to dysfunction.  Although they are used in an unhealthy and dysfunctional manner, knowledge of how to use the behaviors in a constructive manner, without denial is one way to work through problems.

Denial, displacement, intellectualization, projection, rationalization, reaction formation, regression, repression, sublimation, and suppression are the main components of our defense mechanisms. Denial is the most prominent defense mechanism for the majority of individuals. This is a complete refusal to accept an event or situation. The psyche’s use of denial is a means of escaping the trauma related to dealing with a negative event or situation. This takes a huge amount of energy on the part of the person emotionally and results in the involvement of the other defense mechanisms to assist in dealing with the event.

Displacement occurs when a person uses impulses to take any aggression out; such as slamming a door and not a person. This is done by taking out a person’s frustrations or negative feelings on another person, animal or object. Intellectualization reduces the anxiety by viewing the situation in a cold, unemotional manner. A person who learns their home has burned down may use intellectualization to focus on the cause of the fire rather than dealing with the loss of home, property and memories.

A person may use projection as a means to deny unacceptable traits and project them onto someone else. Projection could be used in a situation where someone does not want to do something, such as watch a particular movie. Instead of saying no and creating social anxiety for themselves, they may try to make others believe the movie is not worth watching; thereby the decision not to watch the movie is placed on someone else. Rationalization takes logic into the situation and ignores the reality. This defense mechanism removes the anxiety and protects the persons’ self-esteem. A student getting a poor score on a class project may rationalize that the professor does not like them; placing the blame for the poor score on anyone or anything other than themselves.

Regression is taking a step backwards in development. Much like an adult throwing a temper tantrum in order to get what they want. This defense mechanism is reversion back into past behaviors from a much younger age. A person may be fixed at a certain stage; classical Freud depictions are oral and anal stages. Overeating is considered regression fixated on the oral stage. Overly excessive neatness can be seen in someone fixated in the anal stage.

Repression is the inability to remember unpleasant memories from the past, such as abuse or trauma. This works as an attempt to keep situations from a person’s conscious understanding.  Sublimation is displaying inappropriate desires in ways acceptable by other.. Suppression is retreating back into unconsciousness by trying to forget the situation. Reaction formation takes the opposite emotion to reduce the anxiety, a form of hiding true feelings.

Erik Erickson, another psychiatrist and theorist furthered the concept developed by Freud and created a concept which reaches beyond just the childhood experience and ego development into a lifelong process; known as lifespan development. He felt that the ego was the most important concept and is independent of the id and superego.  He included society and culture as part of the development phase. His theory also supported the inclusion of personality traits, and the development of a personality lasted a lifetime with continual learning and evolving based on the successful completion of each development stage.

The use of ego psychology in assessing a client is a psychodynamic method to move the person closer to a level of clear self-awareness. Helping the client to be able to look at the past events which have shaped their lives and created the problems will enable to person to understand their actions and emotions. The past events a person endures directly affects the way they make choices and decisions. The influence is strong and clients in denial of any past historical issues have to find a way to psychologically and emotionally grow towards a healthier understanding of their behaviors. Learning and understanding a client’s past will assist in developing the focus for therapy.

Long-term behavioral intervention and therapy should be focused on the central problem the client is addressing. Free form therapy has lost popularity due to the inconsistent nature of allowing a person to let their thoughts wander.  Directing the client in the realms of honestly looking at the past in relation to the present and focusing on the real matter creates a relationship and bond of trust between client and therapist. Ego psychology presents a solid platform for psychodynamic therapy through guided and pointed interaction and discussion by the therapist and client.

Case Study Assessment

The case study selected is based on Nikko (name changed for confidentiality), a 45-year-old Afghan male who has been homeless for approximately nine months.  Nikko’s assessment reveals a tall, stocky built male, slightly disheveled and unkempt. He has an untrimmed, graying beard and moustache. Nikko is communicative in verbal exchange with an accent difficult to understand.  He presents stable and with normal mood.  He is extremely pleasant and highly motivated to refrain from substance abuse; admitting he is not able to do this on his own. Nikko has no identification and is not covered under any financial or medical plans. He displays sincerity in his desire for help.

Nikko smells of alcohol and has a history of alcohol and drug abuse. He uses marijuana occasionally. He admits to alcohol being his drug of choice. Nikko reports hearing voices occasionally.  He states this is usually while under the influence of alcohol. He has tried to stop drinking previously; unsuccessfully due to experiencing shakes in the morning hours. He has had several arrests due to alcohol induced violent behaviors. He has undergone detoxification previously only to return to the streets and alcohol upon discharge.

During the interview with Nikko he clearly demonstrated his inability to understand how his use of alcohol is a defensive behavior to self-medicate as a means to block out his past.

Denise: What goes through your mind when you are sober and decide to take a drink?

Nikko: I feel sad and want to feel better.

Denise: Why do you feel sad?

Nikko:  No reason, I just feel sad sometimes and I just want to feel better.  Drinking makes me feel better.  It makes me relax and feel at peace.

Denise:  What do you mean by feeling at peace?

Nikko: Sometimes my mind wanders back to my life as a child and drinking takes that away.  It clears my head and makes me feel like I don’t have to worry or be afraid.

Denise: Can you tell me about your childhood?

Nikko: I would rather not, it makes me sad and I will just want to drink again.

This demonstrates the strong defense mechanisms which Nikko has implemented. He recognizes that alcohol will make mask his emotions and feelings and therefore, when in duress he continually relapses into substance abuse.

Nikko has never married and is childless. His parents and older sister died in Afghanistan. He has three brothers currently living in Virginia and a younger sister living in California. He reports his drug and alcohol use began as a small child after witnessing the murder of his parents and sister at the age of nine while in Afghanistan. He admits to using substances to hide his depression, and to self-medicate his feelings and emotions of losing his family.

Nikko’s limitations include his years of adaption through dysfunctional methods. He has unconsciously dealt with his problems by suppression and repression. His limitations include lack of support and proper psychological treatment knowledge. Nikko has a low impulse control historically.

Nikko is clinically diagnosed with hypertension, glaucoma, arthritis and asthma, insomnia, depression and anxiety. He suffers from post traumatic stress syndrome. He reports neural problems in his legs below his knees as a result from constant running from the Soviet military as a young boy. He reports having nightmares and flashbacks to events and killings he witnessed while in Afghanistan. He does not appear to be psychotic. He has blackouts, seizures, hallucinations, delirium tremors, and a history of suicide attempts. He is medicated with Prozac and Paxil.

Intervention

Nikko has voluntarily enrolled into The Bower Resident’s Committee, Inc.  He is attempting to address his alcohol and substance abuse coupled with his mental illness. Initial assessment reveals his desire to get help and treatment. He will be clinically examined by the house staff for his medical problems to ensure appropriate medication use and dosage. He will undergo psychological counseling with recommendations for treatment and length of stay at the Center. Recommendations for detoxification period will also be given.

It will be important to direct Nikko to self-awareness and the influence of his past on his lifelong behavior of substance abuse and mental illness. Working to resolve negative emotions due to traumatic memories and the key contributors to his behavior will be the short-term intervention to begin the process. The various methods available to deal with his habits effectively should be introduced to Nikko. Ego psychology through intervention therapy and the need to learn methods for thought recognition and control will be taught to him.  Helping Nikko work through his childhood memories will be important in helping him better understand his destructive habits of self medicating.

Behavioral intervention techniques will be instrumental in the recovery process for Nikko.  Providing Nikko with the understanding of how ego psychology works within his core personality will enable him to develop new strengths for positive behavior. His ego functions are the key to the understanding for Nikko to change his defense mechanisms, build his current strengths and turn his weaknesses into new strengths. He will have case workers to work one-on-one with to assist him in developing his ego functions appropriately. The case worker will guide Nikko to learn to control his feelings and thoughts, develop motivation and create hope for his future.

Through providing the knowledge of how behavior is guided by positive and negative consequences and the aspects to learn behavior notification, Nikko can begin to understand his stressors and triggers. Nikko’s maladaptive patterns stems from the pleasure versus aggression drives.  Pharmaceutical intervention does not appear to be needed at this time. Introducing pharmaceuticals for Nikko may foster his dependence on substances to self-medicate.

Treating Nikko’s psychological problems involves a major effort to develop his social skills. Educational and vocational evaluation should also be done to determine his current level and potential for growth. This will be an important part of his intervention, secondary only to developing behavioral techniques with behavior therapy and modification skills. Attempts to contact his family for inclusion in his intervention would be helpful in providing a support system. His family’s involvement would also be useful in the development of his social, interpersonal, and vocational maturity. Developing healthy relationships and learning to discover his feelings in a healthy manner will enhance his potential for recovery.

By developing a systematic approach to his analysis and intervention, the hope is that it will provide him with the skills for behavior modification for cessation of alcohol and drug abuse. Nikko is homeless and in order for him to improve his life situation he will need to be alcohol and drug free to be able to pursue vocational opportunities. The goal of his intervention will be successful behavior modification to learn to live without alcohol and drugs and be free to develop his skills for obtaining a job and support himself.

Ego Psychology and Case Study

Nikko appears to be in denial and suppression. He admits to a lifelong history of attempts to sedate himself with intoxicants. His years in Afghanistan bring painful thoughts and memories associated with excruciating events including the murder of his family and killings and torture of other people. As a young child he found himself in an undesirable position and element. His psyche refused to deal with the events, conversely, on a conscious level. However, it is not known at this time if Nikko is suffering from repression with lost memories or only from suppression. He has used his defense mechanisms to attempt to adapt and deal with his past; however, he has a long history of unresolved conflict and agonizing recollections. Nikko demonstrates poor impulse control with failed sobriety attempts, violent outbursts and suicide attempts.

Anderson and Levy (2009), report that suppressing retrieval shuts out the intrusive memories, restoring control over the direction of thought and our emotional well-being. Nikko began this process as a young child which has implemented the process of suppression to be ingrained into his way of life. Nikko has fallen into the cycle of substance abuse in attempts to medicate himself and does not know or understand how to break out of the succession.

Nikko’s history of violence and attempted suicides further supports his defense mechanism throughout his life. He uses aggression and repression to deal with his anguish; both inwardly and outwardly. His suicide attempts demonstrate repression through his aggression inwardly while his repeated arrests due to violence are simply his turning his aggression outwardly towards others (Apter, et.al, 1989).  Both are attempts to deal with his past using defense mechanisms.

Apter, et. al. (1989), demonstrated this through a study of 60 psychiatric patients revealing regression to be significantly higher in suicidal patient; consistent with clinical observations of severe infantile acting out behavior in suicidal patients. Stress is felt to be an indicator for the degree and level of suicidal ideations the patient may be under. Defense mechanisms play a large role in violence and suicidal ideations; acting out in various manners depending on the specific individual and circumstances.

Nikko is living in an off balance stance in regards to his id, ego and superego. The three concepts work together to be able to provide solidarity and maturity in thoughts, actions and behavior.  Nikko has allowed his id to dominate his choices. He appears to have an intact ego which does not function at all levels all of the time. Learning to create and develop a solid understanding and practice the dynamics of a balanced id, ego and superego will be a challenge for Nikko. Understanding how it feels to work with these three concepts will broaden the client’s perceptive of growing into a healthy psychologically balanced life.

Strengths and Limitations

In the individual person’s functioning, therapists have used the terms ‘strong or weak egos’ to describe how a person handles traumatic situations (Polanksy, p. 50).  People are often categorized into being a ‘strong’ or ‘weak’ person. Each person has their own threshold of tolerance and pain. A limitation of ego psychology is the inability to measure a person’s functioning and perseverance to pay attention to their feelings and emotions. Clients have to actively engage in their recovery and their tolerance is a factor in the success or failure as well as the length of time in recovery and therapy.

The ego of the client is the key to ego psychology and successful intervention. How long the client has sublimated into adaption and the unhealthy live styles is a large consideration in the strength or limits of ego psychology. A person’s instinctual drives and environmental stimuli can also limit the effectiveness of ego psychology. Willfulness can be positive or negative to the intervention. The struggles each individual experiences are distinctive to the ego and can be strengthening or limiting depending on the individual. Defense mechanisms and the client’s way of thinking can waste or create energy.

Specific strengths of ego psychology include the validity of reality testing of the client, the thought processes and interpersonal relationships. How adaptable the person is to reality is also a strength. Limits include the client’s poor impulse control and resulting frustration for failure. The client’s strong tendency to use primary ego defenses such as childlike behavior limits the recovery time. This is a cycle which is difficult for clients to break free from.  Knowing the strengths and limits of the ego functioning of the client is important and distinctive for each person.

Struggles and Hardships

Nikko will face many struggles during his treatment. Half of his immediate family is dead, the other lives in other states. He has a language barrier with his thick accent. His homelessness and lack of identification present a large obstacle for him. His ethnicity, age and overall abilities hinder him and present potential struggles as he learns to deal with his problems. The mere fact that he does not have an identity or a place to live will make it difficult to begin to understand how a person’s ego is important to living productively. Learning the healthy part of his ego will be difficult since he has lived his life struggling with the past and unable to move into the current or future for himself.

Ego psychology is unique to each individual person. Nikko’s struggles will be specific to his situation and circumstances. Given his desire to help himself, and his admission of substance abuse is a positive for Nikko; however, his ingrained past behavior will be an adversity to his treatment process.  Encouraging the development of new relationships for Nikko in group therapy can help him overcome some of his struggles.

Nikko will need to learn to recognize his depression as a secondary symptom. The primary emotions he feels due to witnessing his family’s murder include several emotions to include anger, fear, grief and apathy. He may also feel guilt associated with their death and his survival. The helplessness he left at the time of their death along with his apparent inability to deal with his emotions will be difficult for him to work through. The inability of his ego to deal with emotions constructively indicates the struggles Nikko may endure as he progresses through treatment.

Summary

Ego psychology and the study of defense mechanisms have a long history of observation and critique from its foundation by Sigmund Freud to today’s therapist and theorists. Freud’s defense mechanisms are still recognized and employed by psychologists.  Other mechanisms are also used such as humor, passive-aggression, affiliation and altruism. Encouraging the patient to understand the behaviors and reactions to negative situations and finding constructive behaviors is the key to treatment. Some of the mechanisms can be used constructively such as affiliation and turning to friends for support. Altruism is also a mechanism which can be used constructively by helping others, while working through denial at the same time.

The case study of Nikko is representative of a person using defense mechanisms associated in ego psychology to relieve anxiety and stress. His genuine desire to help himself by entering the Bowery Resident’s Committee, Inc. for treatment of his mental health and deal with his substance abuse is authentic.  Working with Nikko in the Center to develop his id, ego and superego to resolve his conflicts will reduce his anxiety and hopefully he will be able to accept treatment and therapy to the fullest advantage.

References

Anderson, M.C., Levy, B.J. “Suppressing Unwanted Memories.” Psychological Science. 2009. Retrieved December 1, 2009 from www.psychologicalscience.org/journals/cd/18_4…/andersonfinal.pdf

Apter, A., Pultchik, R., Sevy, S., Korn, M., Brown, S., and van Praag, H., 1989. “Defense Mechanisms in Risk of Suicide and Risk of Violence,” Am J Psychiatry 1989; 146:1027-103. Retrieved December 1, 2009 from http://ajp.psychiatryonline.org/cgi/content/abstract/146/8/1027

Book Review. “Ego Psychology Theory and Practice, 2^nd edition.” Child and Adolescent Social Work Journal. August 1994: 11(4) 322+.  Columbia University Press.  Gertrude and Rubin Blanck. New York

Heffner, C.L.  “Personality Development.”  Psychology 101 Chapter 3, Section 5. AllPsych History. 2001. Retrieved December 1, 2009 from http://allpsych.com/about.html

Pitts, J. “What is Ego Psychology.”  HealthGuidance.com  2009. Retrieved December 1, 2009 from http://www.healthguidance.org/entry/11247/1/What-Is-Ego-Psychology.html

Polansky, N.A. “Ego Psychology and Communication: Theory for the Interview.” Transaction Publishers: New Brunswick. 1971. Retrieved December 18, 2009 from http://books.google.com/books?id=HWNW9kT11cEC&pg=PA48&lpg=PA48&dq=ego+psychology+strengths+and+weaknesses&source=bl&ots=mA8shi8eB_&sig=bpZitpoFt6JG-bsyWvMEFhXYgP4&hl=en&ei=PRMtS9XuOILZlAeSjKGqBw&sa=X&oi=book_result&ct=result&resnum=9&ved=0CDAQ6AEwCA#v=onepage&q=&f=false