**3. Psychodynamics**

#### **3.1 History**

Sigmund Freud introduced the term "psychodynamics" in 1915. When he systematized his knowledge about the human psyche into three points of view: the economic, the topical, and the dynamic, he called this theoretical conception psychoanalytic metapsychology because he considered it as broad and deep as metaphysics [6].

The dynamic point of view refers to the activity or movements of psychic processes, particularly the confrontation of two psychic forces. From these stems the concept of "psychic conflict" underlying most mental functioning.

Goldsmith and Mandell state that philosophers already used the term "dynamic" in a psychological sense long before psychology. They give, as an example, Epicurus, who, by valuing the health of the body and the peace of the spirit, distinguished, alongside his disciples, dynamic pleasure (achieved with effort and suffering) from static pleasure (coming from the state of equilibrium).

These authors also state that during Freud's medical training, there were significant advances in physiology, which borrowed the term "dynamic" from physics. Thus, Freud used the notion of opposing forces in his first models of the mind, which explained the dynamics of psychic conflict.

Still, according to these authors, it was thanks to the significant advance of Dynamic Psychiatry in the U.S.A. that the term "dynamic" gained notoriety, even within modern psychiatry [7].

#### **3.2 Concept**

In 2006, Ivey published a paper dealing with the nature of psychodynamics. Early on, he writes that a psychological formulation is a hypothetical explanation of the factors contributing to the precipitation, development, and maintenance of the patient's problems. This formulation should focus on the nature, origin, and meaning of the difficulties presented by the person.

He describes the psychodynamic formulation as one based on the theoretical assumptions of psychoanalysis about the functioning of personality. From this perspective, personality is a dynamic system characterized by inevitable psychological conflict between opposing mental forces and unconscious defenses used to avoid or lessen the mental discomfort resulting from competition.

For this author, psychodynamics has the following characteristics:


When the study of psychodynamics progressed, two essential concepts emerged: "ego defense mechanisms" (E.D.M.) and "object relations" (OR).

This chapter presents the study of these topics separately. Still, it is essential to say that although they are different concepts, they are interconnected (see below the issue of psychodynamics and quality of life).

#### **3.3 Ego defense mechanisms**

The expression ego defense mechanism (E.D.M.) refers to the set of defenses of one neurosis and a particular defense. The central idea in both cases is that of protection, which is a mental operation that consists in rejecting any threat to the individual's well-being. The ego seeks to maintain the psyche's constancy. Thus, it can simultaneously be the instance in play in these operations and its agent [6].

The concept of defense mechanisms has come to the present day somewhat reformulated.

Psychologists and psychiatrists face difficulties defining ego objectively, partly because our conception of mental health is based more on theoretical constructs than operationally defined behaviors. Consequently, problems arise in quantifying it [9].

On the other hand, the same author states that the concept of E.D.M. remains one of the most remarkable theoretical contributions of psychoanalysis to medicine as it describes a "mental process" used in resolving internal conflicts. This process usually occurs unconsciously and can be identified in the clinic of both standard and pathological psychic situations [10].

From realizing that there are defenses in the psyche, they began to study them in more detail. Here is the concept of ego defense mechanism. The human mind pushes unpleasant ideas away from consciousness to maintain psychic equilibrium. The nature of the various defense mechanisms guides their classification.

Today, one of the most accepted criteria for classifying defense mechanisms is the individual's psychological maturity. Thus, there are three classes of defense mechanisms: mature defenses, neurotic defenses, and immature defenses, according to Freud [6].

George Vaillant proposes a theoretical hierarchy for the various E.D.M. The organizing concept of this hierarchy is that of psychic evolution. That is, the human psyche develops parallel to physical growth. In other words, the mind of a newborn is naturally immature, uses immature defenses, and will gradually evolve to maturity when it uses mature mechanisms.

To carry out this hierarchy of defenses, Vaillant considers the mechanisms as they manifest themselves in the lifestyle, that is, in the individual's external behavior.

He left out the intrapsychic manifestations of these mechanisms. Because besides being fleeting, they are imperceptible externally, which makes it impossible to evaluate them in an objective investigation.

This author carried out a prospective study for 25 years with a group of men selected from a sample of 268 university students. The original selection criterion was to be healthy, physically and psychologically.

General practitioners, psychiatrists, psychologists, and anthropologists assessed the level of health and then came up with a group of 30 subjects.

The author himself conducted a two-hour individual interview with each of the 30 participants in the group. Since graduation from the university, this group has been evaluated, on average, every two years, using extensive questionnaires with many open autobiographical questions and periodic interviews to characterize the defense profile of each member.

From the material accumulated about each participant over the 25 years, the author mapped each one's defense style and classified them as "mature," "neurotic," and "immature."

In parallel, an independent evaluator assessed the degree of adaptation of the participants in the following areas of life: work, marriage, and health.

He performed this task based on the same material produced over 25 years and rated the individuals' adaptation as "great," "good," and "fair."

At the end of the research, each participant ranked regarding defenses and adaptation to life.

By cross-referencing these data, the author concluded that individuals with mature defenses had optimal adaptation to life, while individuals with immature defenses had regular adaptation to life.

The hierarchy proposed by Vaillant is, in fact, the same as that of other authors. The big difference lies in this "clinical assessment," that is, in searching for objective evidence of the results, carried out by crossing data from the hierarchy of defenses and adaptation to life [10].

Recently, he proposed to classify ego defense mechanisms into four groups after studying primitive states of mind in psychotic patients.

### 1.Narcissistic-psychotic defenses

These defenses usually occur as part of a psychotic process but can also happen in young children's and adults' dreams or fantasies. They share the common goal of avoiding, denying, or distorting reality.

#### 2.Immature defenses

These mechanisms are pretty standard in preadolescence and adult character disorders. Although socially inappropriate or undesirable, they usually subside as interpersonal relationships improve or as personal maturity increases. Anxieties related to intimacy or its loss subsidize such mechanisms.

#### 3.Neurotic defenses

These defenses are common in apparently normal and healthy individuals, as well as in neurotic disorders. They generally alleviate the disturbing effect and are in

neurotic forms of behavior. Depending on the circumstances, they also appear as an adaptive or socially acceptable aspect.

#### 4.Mature defenses

These mechanisms are healthy and adaptive throughout the life cycle.

They are socially adaptive and valuable in integrating personal needs and motives, social demands, and interpersonal relationships. They may underlie behavior patterns that appear to be admirable and virtuous [11].

In her classic book "The Ego and the Mechanisms of Defense," Anna Freud argues that such mechanisms are how the ego avoids displeasure and anxiety, in addition to controlling impulsive behaviors and affective urgencies.

Thus, for this author, defense mechanisms represent an essential dimension of personality, as they participate in the elaboration of the behavior patterns of each human being [12].

American Psychiatric Association presents the concept of a defense mechanism as an automatic psychological process that protects the individual from anxiety and awareness of internal or external stressors or dangers. Defense mechanisms mediate the individual's reaction to emotional conflicts and external stressors [13].

To conclude this topic, remember that Vaillant states that ego defense mechanisms can change the individual's perception of both internal and external reality [10].

#### *3.3.1 Assessment of the ego defense mechanisms*

The concept of ego defense mechanisms has long attracted clinicians and disappointed researchers. With their tendency toward subjective assessments, clinicians find this concept a valuable way to decipher the secrets of mental life. On the other hand, researchers consider the evaluations of defenses unreliable and unacceptably subjective [14].

The task of empirically validating defenses paralyzed experimental psychology for almost a century. After reviewing 250 articles, Moss concluded that evaluating defense mechanisms is inadequate and that, generally, experimental reliability comes from clinical assessments [15].

The methodological difficulties in objectively assessing ego defense mechanisms are in four groups.

#### *3.3.1.1 Defenses are not visible in the behavior*

Just as Pluto was not visible in nineteenth-century astronomy, psychological defenses are invisible in the twenty-first century. The behavior of the human being only contains characteristics of E.D.M. and does not present them entirely. Thus, it is necessary to find them from these fragments.

To read defenses evaluator needs to know, as deeply as possible, both the internal and external reality of the patient and himself in the same depth.

Therefore, the clinical evaluation of defenses necessarily involves the subjectivity of the evaluator, which makes such an evaluation unreliable.

Even using a hierarchy of defenses (mature, neurotic, and immature), difficulties arising from the subjectivity of the evaluator remain [10].

#### *3.3.1.2 The defenses are not clinical entities*

Psychiatrists and psychologists generally work with reasonably well-defined clinical situations from the study of human behavior, and defenses are not clinical entities cataloged in a diagnostic manual. They are much more a "psychic process" than a clinical entity, which requires a detailed understanding of all the possible unfolding of these processes in the patient's expressed behavior. The small number of qualified evaluators to identify E.D.M. can also be considered a methodological difficulty, in addition to the psychic process, in general, being difficult to measure due to its conceptual complexity [9].

#### *3.3.1.3 Defenses are fleeting phenomena*

The appearance of a specific ego defense results from a complex "play of forces" mediated by the ego between the psychic instances (superego and id) and external reality. Since this is a dynamic game, the defenses change instantly, which makes it more challenging to evaluate. In this way, the profile of defenses becomes more important than one in isolation. And therein lies the difficulty because direct observation in a diagnostic interview, for example, only flashes of the defenses are identified, thus making long-term tracking necessary [9].

#### *3.3.1.4 The evaluation is uncomfortable*

As the elaborative process of the defenses is predominantly unconscious, it is already possible to assume the level of psychic depth at which it occurs. And nothing is unconscious by chance, but rather, because the individual cannot tolerate becoming aware of specific contents that are active in his mind. Thus, addressing these issues will be uncomfortable for the subject, making assessment more difficult, especially in research. The patient expects some therapeutic benefit in a clinical situation and may bear a little more discomfort in the investigation than in the study [9].

Bond et al. developed the "defense style questionnaire" (DSQ ), considering the above methodological difficulties. It is a self-reporting questionnaire with 67 items to assess the conscious derivatives of defense mechanisms. This instrument aims to identify the characteristic style of defenses from the way people consciously or unconsciously deal with psychic conflict. Precise comments that the person can make about their behavior can indicate the defense's profile [16].

Andrews et al. reorganized the instrument into 40 items related to the 20 defenses described in the DSM-III-R. Two statements will evaluate each defense. Thus, the DSQ-40 emerged, which assesses and classifies defenses into three groups: mature, neurotic, and immature [17].

#### **3.4 Object relations**

By object relations, one should understand how a person relates to his world, that is, how he seeks to satisfy his interests by connecting to other people. One can think that a human being seeks in the other what they lack; in this sense, the other is the object of the former's satisfaction.

One should also consider that the object can be real or imaginary, depending on the individual's ability to have contact with reality or how much he dives into his fantasies [6].

#### *The Role of Psychodynamics on Quality-of-Life Interventions DOI: http://dx.doi.org/10.5772/intechopen.108653*

Thus, the object relation that a baby establishes with its mother when demanding the immediate satisfaction of its hunger differs from the object relation that another baby sets with its mother when supporting a few moments for its need to be satisfied. In the first case, one can perceive the urgency for satisfaction, and in the second, tolerance in the face of dissatisfaction.

However, it is worth pointing out that throughout the history of the theory of object relations, this concept has received marked specifications from several authors. In 1915, Freud introduced the concept of drive that moves the human being.

The drive has the following characteristics: source, force, purpose, and object. The strength varies from one situation to another, depending on the individual's needs. As a rule, the source is organic and located in the erogenous zones.

The purpose of the drive is always to seek satisfaction, no matter the means. The object is everything that can provide this satisfaction. It can be a complete person or part of it or a remarkable characteristic.

It is important to emphasize that, within this model, the object relation consists of a constant search for the satisfaction of the subject's needs. And the most expected quality of the object is that it is "satisfactory." Otherwise, it must be replaced by another [6].

In 1917, in a further theoretical study of the theme, Freud described the process of internalizing the lost object when studying the dynamics of mourning. He states that the resolution of grief occurs when the person internalizes the qualities he admired in the person who died.

In other words, he recognizes that during coexistence, one person "feeds" on the qualities of the other. In this way, the grieving person can separate from the one who passed away and, simultaneously, stays with them inside them as an internal object. In this case, the subject-object relation is an entirely intrapsychic relationship [6].

Melanie Klein observed environmental features within the infant's mind from her clinical work with children.

She noticed, for example, that children relate to their toys by imitating how their parents (or adults in general) relate to them. From there, she theoretically developed the notion of the introjection of objects, which made it possible to classify them as internal and external. Internal ones make up the raw material of fantasy. The internalization process clarifies the mechanism by which the environment influences the individual.

The fact that Melanie Klein valued the intrinsic qualities of the object in the constitution of the infantile mind is considered, by several authors, as a theoretical advance concerning Freud, for whom the emphasis was on the drive. The subjectobject relation in the Freudian view was on the subject, specifically on the satisfaction of his needs, and the object would enter only as a compliment.

In the Kleinian view, the subject-object relation is on the relationship itself. The subject's needs are as important as the object's. In other words, for Melanie Klein, object relation is a proper interaction between the subject's characteristics and the object's [18].

Since "object relations" designate the subject's mode of relating to their world, one might ask: how does the pattern of object relations interfere with that person's quality of life?

#### *3.4.1 Assessment of object relations*

Attempts to empirically study object relations date back many years, but interest in formal assessment has not yet approached clinical application.

However, in recent years, several researchers developed scales that intend to assess OR, having as one of the objectives to assist in evaluating the results of psychotherapies [19].

Kernberg, when dealing with the difficulties of elaborating these scales, states that the current controversies regarding the definition of the construct on object relations can be summarized in the following terms: The concept of OR is not sufficient to conform to psychoanalytic principles, such as the notion of conflict, defense, or transference. The idea lacks specificity, indicating the need for an object relations theory [20].

On the other hand, British school theorists, notably Melanie Klein, define OR as unconscious fantasy [21]. Although the work of this group is influential in terms of clinical guidelines, it does not stand up to scientific criticism because one canot validate its assumptions [22].

This author states that this dilemma becomes even more evident when one intends to research in OR.

This difficulty is because the analysis of the OR variables shows a vast disparity between them. For example, hostility is a relatively quantifiable and consistent variable within most theories. At the same time, mutuality is so abstract that it cannot be measured or imagined within a theoretical framework.

Although the methodology for evaluating object relations is still in its early stages, several strategies for measuring these relations exist.

The same author describes twelve OR assessment scales in detail, each with its theoretical construct and quantifiable variables. Although all the constructs are psychoanalytic, it is curious to observe how each author chooses a particular approach. For example, Blatt et al. [22] use the concept of ego and developmental psychology to structure the "concept of the object scale," and Diamond et al. use the separation and individuation theory to build the "object relations inventory" [23].

Among the twelve scales mentioned above, one stands out for the multidimensionality of objective relations. This one is the bell object relations and reality test inventory (BORRTI - Form O), a scale that considers the conceptual depth of psychoanalytic ego psychology and advances in test theory and method [19].

This scale originated from the operating model of OR developed by Bellak et al. [24]. These psychologists described the multidimensionality of OR along a continuum. From pathologically absent relationships to good relationships that are relatively distortion-free and rewarding from the point of view of ego needs. BORRTI - Form O is a scale covering the entire spectrum of object relations functioning. So, it can evaluate OR as defined by these authors.

#### **3.5 Psychological maturity**

Psychological maturity can be defined as the ability to love and work; self-control and self-acceptance contribute to this. It can also be defined as the ability to interact with a wide range of people and be socially appropriate without being supervised; increasing levels of role performance make this possible.

On the other hand, psychological maturity should be defined from both the observers' and the actor's perspectives. From the observer's perspective, maturity concerns having a good reputation, which involves being liked and respected [25]. From the actor's perspective, maturity involves (a) self-acceptance, which we interpret as not being guilty, anxious, and moody, and (b) being attentive and responsive to others' needs, expectations, and feelings.

More specifically, psychological maturity can also be defined as the individual's ability to use mature ego defenses and have normal object relations, in contrast to psychological immaturity (immature ego defenses and pathological object relations).
