Psychoanalytic therapy is a type of talk therapy that helps individuals overcome emotional and mental struggles by understanding and addressing unconscious conflicts. This therapy approach is based on the theories and principles of Sigmund Freud, the father of psychoanalysis. In this blog post, we will explore the psychoanalytic theory that is most helpful in understanding the clinical case of a 35-year-old male struggling with social anxiety and low self-esteem. We will also suggest psychoanalytic interventions that could benefit the patient.
Several psychoanalytic theories could help understand this clinical case. However, we will focus on the Object Relations Theory. This theory suggests that early childhood experiences shape an individual’s object relations, which refers to how an individual perceives and relates to others. Object relations theory posits that the internalised representation of one’s primary caregiver, usually the mother, is critical to an individual’s later relationships. The theory suggests that the quality of this attachment forms the foundation for later emotional development, and relational patterns are established during the first few years of life.
Object Relations Theory asserts that individuals develop internalised representations of their primary caregivers that are carried forward into adulthood. These internalised representations or objects can be internalised positively or negatively. For instance, if the caregiver is responsive, nurturing, and supportive, the child will internalise a positive object representation. On the other hand, if the caregiver is neglectful, unresponsive, or abusive, the child will internalise a negative object representation. These internalised representations form the basis of later relationships, and individuals with hostile object relations tend to struggle with intimacy and establishing healthy relationships.
In the clinical case of the 35-year-old male, his hostile object relations can be traced back to his experience in school when he was ten years old. He was expelled from school and publicly shamed in a local newspaper. The incident had a lasting impact on his self-esteem, causing him to feel anxious and overwhelmed in social situations. The Object Relations Theory suggests that his early experiences with authority figures, such as the school administration and his parents, contributed to his negative object relations. As a result, he developed a negative self-image that affected his ability to establish healthy relationships in adulthood.
The primary goal of psychoanalytic therapy is to help individuals become more aware of their unconscious conflicts and emotions. In this clinical case, psychoanalytic treatment could help the patient uncover the unconscious conflicts contributing to his social anxiety and low self-esteem. Psychoanalytic interventions that could benefit the patient include free association, dream analysis, and transference.
Free association is a psychoanalytic technique in which patients are asked to say whatever comes to mind without censoring their thoughts. This technique can help patients uncover unconscious thoughts, emotions, and memories contributing to their struggles. Free association could help the patient explore their experience during the school incident and discover any repressed emotions related to the event. The patient can gain insight into their negative object relations and develop a more positive self-image by exploring these emotions.
Dream analysis is another psychoanalytic technique that can help patients explore their unconscious thoughts and emotions. Dreams are considered a window into the unconscious mind. Analysing them can help the patient gain insight into their underlying conflicts. Dream analysis could help the patient explore recurring dreams related to his negative self-image and social anxiety. By exploring these dreams, the patient can gain insight into their negative object relations and develop a more positive self-image.
Transference is a psychoanalytic phenomenon in which the patient transfers their feelings and emotions towards significant figures from their past onto the therapist. In this clinical case, the patient may transfer his negative feelings towards authority figures, such as the school administration, onto the therapist. The therapist could use transference to explore and explore the patient’s unconscious conflicts. By exploring the patient’s feelings towards the therapist, the therapist can help them uncover any repressed emotions related to the school incident and other experiences that contribute to their negative object relations. The therapist could also use transference to help the patient develop a more positive object representation of authority figures, such as the therapist, which could lead to improved relationships in the future.
Psychoanalytic therapy can effectively treat individuals struggling with social anxiety, low self-esteem, and relationship difficulties. In this clinical case, the Object Relations Theory provides a framework for understanding the patient’s negative object relations and how they contribute to his current struggles. Psychoanalytic interventions such as free association, dream analysis, and transference can help patients explore their unconscious conflicts and emotions, gain insight into their negative object relations, and develop a more positive self-image. With time, patience, and support from the therapist, the patient can overcome his social anxiety and build healthier relationships.
By Ari Sotiriou M.A. psychodynamic psychotherapist co-founder Online Therapy Clinic