The Concept of conflict

Conflict may be said to be the state of psychological disequilibrium caused when an individual is conceptually forced to make choices between seemingly incompatible desires.An individual for example may be torn between strong sexual desires and the guilt feelings which these desires engender. Often these opposing desires are caused by the interaction between the individual and the environment. Marriage for example may create a need for adaptation which is in conflict with the desire for independence.A delinquent may have no problems with behavioural desires until they conflict with community standards. A student may not worry about inadequate performance until school pressure creates psychological distress with implied punitive threats. Counselling can only be effective under these circumstances when the inner tensions caused by conflicting desires are more painful to the individual than the pain and stress of finding a solution to the conflict.

Defence mechanisms

Freud believed that individuals in a state of inner conflict responded by exhibiting symptoms of anxiety and that the ego relied on defence mechanisms to control and handle anxiety effectively. In the Freudian view individuals use a defence mechanism to distort reality in some way which then protects them from unacceptable unconscious thoughts and unwanted realities. Defense mechanisms only become a cause for counselling when the individual is extremely reliant on them in an inappropriate or unhealthy way. Most people use defence mechanisms to make stress and inner conflict manageable and could not get through life without them. Excessive use of defence mechanisms however, may create more anxiety and stress than they can alleviate. It is important we understand that defence mechanisms are really conflict solutions.

Studies of human behaviour have shown that defence mechanisms come in different forms.

Anna Freud has conceptualised ten different forms of emotional defences. In this list she includes sublimation as a form of emotional defence. There are, however, many more of them depending on the frame of reference. In this course only the most common defence mechanisms are considered. These include denial, rationalisation, reaction formation and projection. Depending on the frame of reference the use of drugs, food and alcohol could even be included in the list of defence mechanisms since all these can be used for the same purpose, that is to protect the emotional stability of the individual.

Apart from their function as defence against unmanageable feelings defence mechanisms also protect us against our libido that naturally turns into anxiety when it cannot be adequately expressed in a relationship and consequently accumulates in our psyche. This anxiety can be a contributing factor to the development of depression.

A Description of Defence mechanisms

1. Repression

(Forgetting feelings and conflicts)

Psychologists use the term repression to describe the process of keeping unacceptable feelings and needs away from ego-consciousness.These memories which are forced away from conscious awareness are not available for active recall. Under severe stress repression can become so extensive that many memories can be kept from active recall. These memories are usually of a personal nature such as childhood memories rather than operational memories such as vocabulary or how to drive a car. Freud distinguished between primary repression and secondary repression, primary expression denoting the repression of the initial impulse, while secondary repression became the term for the control of its disguised representations .

2. Sublimation

(Developing surrogate goals)

Sublimation is the process of displacing energies from activities and objects of primary interest onto those of lesser instinctual interest. Sublimation means that an individual will develop goals that lie outside of the conflict area to protect himself or herself against emotional pain. For example: A person might favour life as a single person, when earlier experiences of emotional bonding and commitment to another human being were extremely painful.

Many of the goals that are regarded as important and many of an individual’s achievements are the result of energies and feelings that have been channelled into areas of life that lying outside the areas of conflict. This is so true that Freud hesitated to call sublimation a defence mechanism. He regarded sublimation as the natural process of emotional maturation and basically saw as a healthy person someone who successfully sublimated his or her energies. For Freud it was a natural and necessary development rather than a form of defence to ‘desexualise’ and ‘deagressify’ the id-impulses we are born with. Many modern psychotherapists do not agree with Freud’s notion and see sublimation as probably the most common form of emotional defence.

3. Reaction formation

(Exaggerating a contrary)

When an individual shows and at the conscious level believes in the possession of feelings different from the feelings possessed at an unconscious level that individual exhibits reaction formation.

For example a person may be bellicose and boastful to hide feelings of inferiority. Or to avoid the pain of frustration a person can deny needs in a way that exaggerates the opposite quality as children deprived of emotional support the need for support may be denied and the philosophy developed that it is essential to be an independent and self-reliant human being.

4. Projection

(Experiencing it out there)

Projection is the term for a form of defence in which a person disowns his or her own feelings and projects them onto others. The person can, for example, be out of touch with her own anger while at the same time she feels herself surrounded by all these angry people. A further example may be the thief who incorrectly assumes that others cannot be trusted.

5. Denial

Denial is a form of emotional defence by which an individual refuses to admit the existence of a painful experience or a whole aspect of self-personality which has the potential to produce anxiety. The denied aspect of the self often appears, according to Klein, as projection. It also can manifest as chronic muscular tension or as a form of psychosomatic illness.

6. Regression

A medical dictionary defines regression : "In psychology, a mental state and a mode of adjustment to difficult and unpleasant situations, characterised by behaviour of a type that had been satisfying and appropriate at an earlier stage of development but which no longer befits the age and social status of the individual." A person reacts against unpleasant and unmanageable feelings (anxiety) by regressing to an emotionally and developmentally earlier stage both in perception of the world and in behaviour. Regression can also be used therapeutically to access repressed feelings and to facilitate consciousness and reorganisation of personality.

7. Compensation

"The process of counterbalancing a lack or a defect of a bodily or physiological function." A typical form of compensation in the psychological area is the emphasis that a person places on on mental ability when they have a very low embodied self-esteem.

8. Muscular tension

Most people repress painful or embarrassing feelings and events which have occurred in their development. A major manifestation of this repression is muscular tension. Wilhelm Reich has called this phenomenon the "body armour." The natural function of muscles, which is to move and allow the person to be creative, is perverted when an individual is in the state of armouring. In this state the muscles serve to hold back spontaneous impulses.

When the armouring is strong the body mind disables the perception of pain and creates numbness in the muscles and at times in the tissue surrounding them. Without this numbness we would permanently be in physical pain. Both the numbness and the armour can be disabled consciously in psychotherapy or unconsciously by suddenly doing unusual or straining movements. The result can be pain in the muscles, emotional irritation or even emotional disintegration (nervous breakdown). The physical pain can be regarded as the correlate of the repressed painful emotion that is surfacing as psychosomatic symptom.

Deep breathing, certain exercises, deep-tissue massages like "Rolfing" or deep draining may be used to undo the numbness and dissolve the armouring. These body mind techniques can increase our physio-emotional charge and bring the patient into contact with both the muscular and the emotional pain while at the same time the armouring is gradually dissolved. When these techniques are used in an ongoing psychotherapeutic setting they are usually a powerful healing experience. If the processes occur outside of a therapeutic context the pain and other effects are experienced as symptoms of illness and because of a lack of conscious integration no healing takes place.

9.Compliance

Compliance is the term for a behavioural pattern with which a person tries to please people around him or her in order to avoid confrontation and the anxiety that would be triggered through the confrontation. People who react with compliance fear that being independent and having own (different) feelings and own ideas would not be tolerated by others, an expectation that of course reflects the person’s develpomental experiences.

10.Conversion

A defence mechanism whereby unconscious emotional conflict is transformed into a physical disability, where the affected part always has symbolic meaning relevant to the nature of the conflict."

Some approaches to psychotherapy

Freud and the psychoanalytic approach to psychotherapy.

Freud laid the foundations for most of the concepts of psychological thinking that are used in counselling and psychotherapy. He not only coined most of the current terminology but also created the psychodynamic worldview.

Freud created this worldview with techniques which he believed for probing the unconscious thoughts and desires of his patients. The unconscious is both the term for the lack of awareness of mental and emotional functioning and for "forgotten" personal history. What is done and felt can be observed but it is not known why it was done or felt.. The why is fundamental and psychoanalysis, the therapeutic technique created by Freud aims at its determination.

Originally the psychodynamic worldview was deterministic, pessimistic and reductionistic. Erikson (ego-psychology) Kohut (self-psychology) and in particular the object relations theorists Klein, Guntrip and Kernberg have broadened this worldview particularly in respect to the developmental stages of childhood, with which Freud associated the traumatic experiences that in his opinion led to neurosis. Freud regarded the oedipal phase of child development exclusively as the one in which these forming traumas took place. Later research indicated that experiences at other stages of development were equally important in the formation of neuroses.

A number of psychoanalysts who were contemporaries and even students of Freud developed their own theories when their observations of their own patients led them to different conclusions. Carl Jung for example postulated that individuals possessed two unconscious minds a personal mind similar to that described by Freud and a species specific mind. This species specific mind he termed the collective unconscious and he theorised that it was inherited from the ancestors of the human species. Alfred Adler (1870-1937) one of Freud’s early colleagues postulated that people were more concerned with their hopes for the future than by their past experiences. He regarded mankind in a much more benevolent light than did Freud and saw less influence for internal drives and forces in predestining humans to a life of conflict and turmoil. Adler believed in a more important principle in which individuals would strive for superiority because they possessed a prime drive to fulfill individual potential. By arguing that individuals were basically altruistic, humane and cooperative and that each possessed a drive towards a just society in which human dignity was paramount Adler developed a humanistic view of personality quite distinct from that of Freud.

The Behavioural and Social Learning Approach

The behaviourists consider that conditioning (learning) is responsible for personality development rather than internal drives or factors. In their worldview an individual’s personality is a consequence of complex social interactions and learning unique to that person. Behaviourists also theorise that personality traits are not internal but the consequence of environmental forces and learning. The reason that traits appear stable, in their theory, is that the individual environment remains stable over long time frames. Behaviourists contend that if an individual’s environment is sufficiently manipulated it can be used to create personality change. A person’s personality can be changed by stimulus - response manipulation. Behaviourist theory is very popular in the United States of America where it appeals to the constitutional notion of equality at birth. It fails however to address the observation that there are significant individual personality differences just after birth and that these traits and temperaments are long lasting.

Social Learning Theories

Social learning theorists whilst agreeing that the environment has an effect on personality development argue that this development is equally determined by an individual’s effect on the environment. Social learning theory states that thinking is an important determinant of development. The implication in this theory is that personality is situationally dependent or dependent on the views of other people. For example the likelihood of aggression when returning goods to a retail outlet is linked to the individual’s expectations of the success of aggression in the circumstances.

Humanist Theories

The concept of self is at the focus of all humanistic theories of personality. The person’s self refers to the personal internal experiences and their subjective evaluation of these. Whilst there are many variations within the humanist approach these share a number of common themes.They all reject the notion of the importance of underlying personality traits, motivations and conflicts in the development of personality. They concentrate instead on the importance of free will and choice. They reject the idea that environmental forces determine personality arguing instead that individuals develop according to their own individual experiences and perception of those experiences according to their unique world view. The humanists also stress that individuals need to grow to their fullest potential and achieve self actualisation. Self actualisation is the humanistic perception that most people move in the direction of achieving full emotional potential. In the humanist tradition there is no simple way to have a more creative and fulfilled life. Following the example of people who appear to have achieved is of little value and no guarantee of personal self actualisation. The humanists by interviewing and observing many people have gained some insight into helping people by fostering self actualisation.

Within the humanist tradition two people deserve special attention for their concepts on the nature of the self and the importance of empathy both initially in child rearing and later in psychotherapy. Rogers had already regarded empathy as one of the most basic ingredients of good psychotherapy. Kohut and Gill, by creating a clearer understanding of the concept of self, focused on empathy as a central concept. Empathy describes our ability to put ourselves into another person’s shoes or, in other words, to enter their worldview. By confronting children unempathically with their logical adult world many parents stifled the natural development of their children’s self. This is described in self psychology terminology as a failure of the core nuclear self to get a chance to develop into a mature coherent self. By providing unconditional empathic attunement a counsellor can provide clients with the "reparenting" that they need to develop this coherent self and self actualisation.

In psychotherapy empathy can be expressed on many different levels both verbally and nonverbally. Even the fact that we ask when we have not fully grasped the meaning of what the client is communicating is a sign of our empathy. The patient can observe genuine interest in their communication, which for many people is a moving experience in itself.

Rogers, Perls, Frankl and the existential-humanistic tradition

When people are observed in terms of their past experiences and the ways they shape them, from the existential humanistic viewpoint they are regarded as being empowered and able to make decisions which influence their self development.

Existentialism, as described by Kierkegaard, Heidegger, Jaspers and Sartre, created an antithesis to a worldview that regarded life as predetermined by fate or outer forces. For them being alive was about having choices and they recognised that the freedom of choice in most individuals creates anxiety. In some sense it could be said that within the framework of existentialistic thinking Freud’s interest in the past is a defence mechanism against this anxiety.

For this reason existential-humanistic therapists do not encourage patients to dwell in the past but challenge them to come to a new worldview on the grounds of what is working for them at present and what is not.

Within the framework of the existential-humanistic tradition Rogers, Perls and Frankl went about their work in different ways. Rogers, with his client-centred psychotherapy, focused primarily on entering the clients’ worldview and in doing so helped them in finding new directions, new and more useful beliefs.

Perls, on the other hand, was in his practical work with clients extreme directive. When Roger’s focus was on listening, Perls could be called an influencing therapist. Frankl can be placed somewhere in the middle between Rogers and Perls.

ANXIETY STRESS AND ILLNESS.

Among the most common early symptoms of chronic stress are headaches from muscle tension, gastrointestinal disturbances, skin rashes and hives, dizziness, and fatigue. Chronic stress also can lead to high blood pressure, which is referred to as hypertension.

During stressful situations the kidneys react by retaining sodium and fluid. This increased retention is believed to be the direct cause of stress induced hypertension Hypertension in turn can bring on a heart attack, stroke, or kidney failure. Chronic stress also can aggravate arthritis, colitis (an inflammation of the colon, or large intestine), asthma, hypoglycaemia (low blood sugar), ulcers, and diabetes. Although chronic stress has not been found to be clearly associated with the onset of cancer, it does appear to accelerate the disease in those who have it. Chronic stress also is related to an increased chance of succumbing to contagious diseases.

STRESS AND THE IMMUNE SYSTEM.

Stress is related to so many different kinds of illness because it can have a direct effect on the body's immune system. Early researchers suspected that there was some kind of direct link between the nervous and immune systems that was independent of the actions of hormones such as those involved in the hypothalamic-pituitary-adrenal axis. The link was unknown. Recent research has begun to uncover the mystery.

The immune system's proper functioning can be determined by examining the effectiveness of the body's lymphocytes (white blood cells). Lymphocytes are the body's means of attacking and destroying foreign or invading organisms. One of the most important recent discoveries linking the nervous and immune systems was the discovery that lymphocytes are covered with receptors for neuropeptides. Neuropeptides are messengers created by nerve cells. This finding suggests that there is a definite link between the two systems.

Researchers have suspected such a link for years, not only because stress was known to have an effect on health, but also because of some direct evidence of this effect on the body's ability to fight disease. For instance, in one study conducted at the Mount Sinai School of Medicine in New York, researcher Steven J. Schleifer and his colleagues examined the lymphocyte counts of men who were married to women dying of cancer. The average age of the men was 55 years. Within 10 months, the wives of all the men died. The white blood count of these men became lower and lower as the stress continued. Schleifer discovered that their lymphocyte counts were significantly depressed after bereavement. Lower lymphocyte levels are believed to make people more susceptible to disease. In fact, after the death of a spouse, it's not uncommon for the remaining partner to become seriously ill or to die within 2 years. This higher rate of illness and death is observed more among surviving partners than among similar individuals of the same age who have not suffered the loss of a spouse.

Natural killer cells are a special kind of lymphocyte and are an important component of our immune systems. They help to destroy invading diseases. How severely these important cells are impaired has been found to vary directly with the amount of stress reported by people who are not able to cope effectively with their situations. The more the stress the people were experiencing, the more severely their killer cells were impaired.

Because of this discovery of the connections between the two systems, it can now be understood how shocks to the nervous system, can lead to illness. The ability of the body's immune system to resist attack effectively does not seem to be directly related to how much stress each subject faces but instead to how well that person was coping with the stress. In other words, a person who can cope with stress may have a better chance of staying healthy than a person who cannot cope. The key to the maintenance of good health may be not how much stress is faced, but rather in how well it is handled. This may well be the reason for the observation that two individuals in the same stressful job can show totally different reactions to the stress they face.

The research results also show quite clearly, that ability to cope with stress is directly related to the individual’s physical health.

Hassles

Sometimes patients know the exact cause of their stress and have an idea about how to handle the problem. Much of the time, however, they can't put identify the problem when feeling under stress. Stress doesn't have to be only the result of an extreme trauma such as a plane or car crash. Over time a number of what people call "hassles" can add up, resulting in stress. Hassles include getting stuck m a traffic jam, receiving a personal insult from someone, not being appreciated enough on the job, receiving a parking ticket, having to rush to gel to work, burning the dinner, watching a favourite television show get preempted, being $2 short at the supermarket, spilling ink on your clothes and sleeping through the alarm. These irritations can accumulate and create an overall feeling of stress that cant be blamed on any one. Enough of these little irritations can lead to a general adaptation syndrome and the reaction can last a long time. This type of feeling is known as anxiety. Anxiety is different from fear. If you are fearful you know what you're afraid of. If you are anxious you may not know what the cause is. Anxiety is not object-related The American Psychiatric Association has defined anxiety as "apprehension, tension or uneasiness that stems from the anticipation of danger, the source of which is largely unknown or unrecognised."

Anxiety levels are generally found to be higher among those people who handle stress poorly. Such people go through the day with a feeling of dread that's just below the surface, a constant tenseness. They're steeled for the next insult. Why do some people become anxious when facing hassles while others remain calm and relaxed? Recent evidence indicates that there may be a biological or genetic difference in people most susceptible to life's hassles.

It has been reported that identical twins are much more likely to react similarly to stress than are fraternal (non-identical) twins. Other evidence indicates that there may be biochemical differences among people that influence how they handle stress. Specific brain cells that seek out benzodiazepines have been discovered. Benzodiazepines are tranquillisers such as Valium. The existence of such natural receptors implies that the brain must be manufacturing 'its own natural tranquilisers. This finding indicates that the brain relies on neurochemistry to mediate how much anxiety people feel in the face of stress.

Managing anxiety

Anxiety is a normal survival mechanism which often arises from inappropriate or excessive use of defence mechanisms. Patients requiring counselling suffer from debilitating anxieties that interfere with their happiness and fulfillment. Many anxious patients are threatened by meeting new people, including practitioners. Patients can become even more anxious when talking about their anxieties. Assisting your patients to develop anxiety management skills usually involves focusing on their thought processes.

Sometimes patients actually possess good management skills, but let their anxieties hinder their use. As an example of this, some college students perform well in practice examinations, but poorly on assessment. Some able students are hindered by their genuinely poor examination skills. In this case it is important to focus on action skills as well as on their thinking skills. Table 11.1 shows some common thinking skills for managing anxiety. The action skills required are not as easy to list as they vary with the presenting problems. For example, patients require different action skills for attending job interviews from those required for developing intimate relationships..

Table 11.1 Illustrative thinking and action skills for managing anxiety

THINKING SKILLS

Using coping self-talk. Anxious patients engage in much anxious self-talk. Their anxiety symptoms are signals for telling themselves that they cannot cope or do anything right. In social situations, their self-talk may be about making fools of themselves. Often patients with panic disorders convince themselves that one of their vital system (for instance, cardiovascular or pulmonary) may collapse. They may even present with breathing difficulties.

Choosing realistic personal rules. Anxious patients often to have internalised personal rules that lead to both fear of failure and self-devaluation. Making perfectionist demands on self and others is a central characteristic of such rules. Anxious patients can be far too self-conscious because they subconsciously believe that they have a need for the approval of others.

Perceiving accurately. Anxious patients usually overemphasize the degree of threat in situations. They focus on pessimistic outcomes to the exclusion of realistic outcomes. Their ability to assess evidence for the reality of their perceptions is impaired. These patients also underestimate both their ability to cope and the supports available to them. Defensiveness, in which patients deny or exaggerate aspects of their personality which they find threatening, is another way that their anxiety interferes with perception.

Predicting realistically. The predictions of anxious patients focus on dangers and risks. They often possess catastrophic thoughts and images about the future and their ability to cope with it. They are pessimists rather than optimists, either in general (pervasive anxiety) or in regard to the specific situations in which they become anxious (situational anxiety).

Setting realistic goals. Some anxious patients set goals that are too low in order to protect themselves from failure. Many anxious patients set goals that are too high and become fearful about achieving them.

Using visualizing skills. Most anxious patients have poor skills for using visualisation as a tool both for relaxation and also for the rehearsal of action skills.

ACTION SKILLS

Action skills are the specific personal skills required in particular situations. Anxiety may either be the cause of poor action skills or their consequence. Those patients who do have good action skills may find that anxiety causes difficulty in implementing them. Other patients may need to develop specific skills: for instance, at public speaking, driving a car, managing a company, controlling an unruly class. Developing competence in these skills lowers anxiety levels.

Relaxation skills. Anxious patients usually possess poor relaxation skills and take part in few pleasurable and relaxing activities. They often have poor muscular and mental relaxation skills.

Relaxation skills

Practitioners can train their patients in muscular and mental relaxation skills. These can be taught as self-help skills. Patients may use these relaxation techniques not only for managing anxiety, but for dealing with other problems such as tension headaches, hypertension and insomnia.

Progressive muscular relaxation skills

Progressive muscular relaxation describes the progressive development of the relaxation response.

Patients are advised to:

* to find a quiet comfortable space where they will be uninterrupted

* they should wear loose-fitting, comfortable clothing

* remove items such as glasses and shoes

* have their arms either by their sides or on the arms of chairs

* have their legs uncrossed and their eyes closed

They are then taught how to tense and relax various muscle groups. A five-step tension-relax cycle for each muscle groups recommended. These steps are: (1) focus, focus attention on a particular muscle group; (2) tense, tense the muscle group; (3) hold, maintain the tension for five to seven seconds; (4) release, release the tension in the muscle group; and (5) relax, spend 20 to 30 seconds focusing on letting go of tension and further relaxing the muscle groups.

Muscle groups

Right hand and forearm Right biceps

Left hand and forearm Left biceps

Forehead

Eyes, nose and upper cheeks

Jaw and lower cheeks

Neck and throat

Chest and shoulders

Stomach

Right thigh

Right calf

Right foot

Left thigh

Left calf

Left foot

When giving relaxation instructions use a calm and soothing voice. Repetition can be used to enhance relaxation, for instance, 'Your forehead feels increasingly calm and relaxed... calm and relaxed... calm and relaxed.' In the procedure observe the patient’s body posture and breathing to check on their degree of relaxation. Ask how relaxed they feel and whether they feel that there are any muscle groupings requiring further attention. If necessary spend extra time relaxing these muscles. You can end relaxation sessions by counting backwards from five to one and., when you get to one, asking the patient to wake up feeling pleasantly relaxed.

Patients should be told that progressive muscular relaxation requires practice to gain its full benefits. At first, they should practise daily for at least 15 minutes. Emphasise the necessity for self monitoring their sessions and anticipation of likely obstacles to their sessions.

Brief muscular relaxation skills

Brief muscular relaxation skills aim to induce deep relaxation with less time and effort. When patients are skilled at the achievement of full progressive muscular relaxation, they can be introduced to these skills. Brief relaxation skills are useful both in counselling sessions and in daily life. At first the patient relaxes muscle groupings sequentially and then as a whole.

Mental relaxation skills

Patients can be taught to visualize restful scenes at the end of progressive muscular relaxation. Such a scene might be 'lying under the trees in a paddock on a warm, sunny day, feeling a gentle breeze, watching the clouds'. These scenes can be visualised independently of the muscular relaxation procedures.

Systematic desensitization

Systematic desensitization is useful when patients have specific anxieties or phobias, rather than generalised tension. It involves three elements:

1. training in deep muscular relaxation

2. the construction of a hierarchy of themes on the anxiety-evoking situation

3. asking the patient, when relaxed, to imagine items from the hierarchy

This technique will be taught in the workshop sessions.

REVIEW QUESTION