Abstract

The following paper explores the creation of Ego Psychology as formed from Freud’s structural

theory. An overview of Ego Psychology is briefly summarized to highlight central concepts,

including the functioning roles of the id, the ego, and the superego. A clinical example of a

current client is presented that begins with a brief description of the client and his situation, with

an application of theory to follow. The client’s ego functions and defense mechanisms, along

with supporting evidence, are explained. Goals, objectives, and interventions informed by Ego

Psychology are formulated to create a detailed plan for treatment direction. No conclusions could

be drawn yet due to being in the beginning phase of the therapeutic process.
EGO PSYCHOLOGY: A CASE FORMULAITON

Overview of Ego Psychology

Freud’s structural theory of mental functioning and personality was proposed in the 1923

publication of The Ego and the Id. Structural theory, also referred to as drive theory, is based

upon a tripartite structure of the psyche. Before the tripartite theory, Freud had only worked with

topographic theory and believed the mind was constructed of layers- conscious, preconscious,

and unconscious (Blanck & Blanck, 1994). It was through this theory that the biopsychosocial,

bio (id) psycho (ego) social (super ego), concept was born. Structural theory allowed greater

understanding of the “individual’s negotiations with the external world and led to an appreciation

of the impact of the environment and interpersonal relationships on behavior” (Goldstein &

Turner, 1996). Freud theorized that the mind was divided into three structures he referred to as

the id, the ego, and the super ego.

According to Freud, pathology occurs when the ego is in conflict with the id and the

super ego. Freud thought the ego to control functions, both consciously and unconsciously, such

as perception, memory, judgment, decision making, and cognition. To avoid conflict, the ego

employs defense mechanisms to shield the internal structures. Therefore, psychological treatment

should focus on strengthening and empowering the ego to maintain optimal functioning. This

theory became Ego Psychology.

Ego psychology held a more optimistic and humanistic view of human potential and

functioning than classical psychoanalytic theory (Goldstein, 1995). In psychoanalysis, the

therapist focuses on uncovering repressed unconscious content that are causing pathology. In ego

psychology the therapist’s shift “attention to the mechanisms by which such content became

unconscious and how it remained so” (Christian, p. 2). Although it was Freud who originally
EGO PSYCHOLOGY: A CASE FORMULAITON

initiated ego psychology, it was his daughter, Anna Freud, that further developed and

conceptualized ego functioning and defense mechanisms. Adding to the work of Anna Freud,

Heinz Hartmann, and Erik Erikson made large developments regarding the functioning of the

ego.

Clinical Example

The client is an eight-year-old Caucasian male in the second grade whom resides with his

biological mother, father, and older brother. The client has no physical impairment and no

history of developmental delays. The client is experiencing difficulties in school behaviorally,

and his grades are dropping. His mother also reported that he’s falling behind in reading. The

client does meet the criteria for Attention Deficit Disorder (ADD), but is not currently being

treated for this, however, he does have a scheduled appointment to see a psychiatrist next week.

Furthermore, the client’s mother reports that her son displays oppositional behavior daily. He

often fights with his brother, throws tantrums, lies to avoid getting in trouble, argues with adults,

and is highly impulsive.

The client does live in a stable home environment and has all of his biological needs met.

Both his parents work full-time jobs and get along well. The mother reports that there is never

any arguing or yelling in front of the kids. The family has no financial or transportation

problems. The client, and his family, have experienced the loss of his uncle, two aunts, a

newborn cousin, and great grandmother from illnesses. The family reports that the client did not

have a close relationship with any of the deceased, and that the client didn’t appear to be affected

be the deaths. The family and client report no other traumatic experiences. The client was

brought to counseling by his mother.

EGO PSYCHOLOGY: A CASE FORMULAITON

Application of Theory

Assessment

The ego functions that mostly pertain to this case are judgment, impulse control, and

thought process regulation. The client’s use of defense mechanisms, specifically acting out and

excessive emotionality, will also be a focal point of treatment. Case formulation for treatment

will be constructed using the Problem > Person > Goals > Resources model, as noted by

Cabaniss, Cherry, Douglas, and Schwartz (2011).

The problem presented by the client’s parents consists of the client’s lack of

impulse control, poor judgment, and self-awareness/psychological mindedness. Focusing on self-

awareness and psychological mindedness will be the first priority in treatment. Beginning

treatment with self-awareness and psychological mindedness will help him conceptualize and

cope with intense emotions, and thereby allow him the ability to exercise better impulse control

and judgment.

The client’s general level of functioning is below average for his developmental stage,

academically and behaviorally, as evidenced by reports from his teacher and principal. Although

the client’s ego functioning can be considered impaired in terms of cognitive functioning, the

client’s developmental stage may likely play a large role in this area as he is still too young for

such abstract thinking and in-depth thought processes.

As stated above, the client’s ego functioning is impaired in the areas of impulse control,

poor judgment, and self-awareness/psychological mindedness. The client’s characteristic defense

mechanisms include, (1) acting out, as evidenced by his daily tantrums and avoidance of painful

or uncomfortable feelings, (2) identification, as evidenced by feelings of jealousy and

EGO PSYCHOLOGY: A CASE FORMULAITON

competitiveness among his peers and brother, and (3) excessive emotionality, as evidenced by

not being able to balance thought content and affect in times of distress (Cabaniss, Cherry,

Douglas, and Schwartz, 2011). These defense mechanisms are maladaptive as they are causing

the client, and those around him, further distress. The client’s strengths to be utilized during

treatment consist of supportive relationships with family and teachers, as well as his caring and

joyful personality. The client’s weakness that may be a hindrance to the therapeutic process

involves his lack of complex cognitive abilities due to his age and developmental stage.

The client’s goal is “to not get in trouble so much,” while his mother’s goal is for “him to

display better behavior.” The therapist agrees with these short-term goals and adds the long-term

goal of developing better judgment and emotion regulation. The client is not lacking any

resources in areas regarding financial situations, health insurance, family support, and time

constraints.

Intervention

There are two basic types of intervention strategies in ego psychology, ego-sustaining

techniques and ego-modification techniques (Walsh, 2010). According to Walsh (2010), ego-

sustaining techniques assist the client in understanding motivations and behaviors to resolve

present difficulties. These techniques include including sustainment,

exploration/description/ventilation, person-situation reflection, and direct influence. However, it

is important to note that these interventions and strategies are to be carried out with clients that

have relatively intact ego functions (Walsh, 2010). On the other hand, ego-modification

strategies, called developmental reflections, are used when clients have more maladaptive

patterns of functioning and facilitates the exploring of unconscious processes and past

experiences (Walsh, 2010).

EGO PSYCHOLOGY: A CASE FORMULAITON

Due to the developmental stage of the client, ego-sustaining techniques will be used for

intervention. The therapeutic process will begin with establishing rapport and developing a

therapeutic relationship with the client. After some rapport is established, the client’s thoughts

and feelings about his behavior will be explored with objectives focusing on gaining control of

difficult emotions, seeing problems as more manageable, as well as, recognizing and

understanding his emotional reactions. It is theorized that these interventions will enable the

client to become more self-aware, and thereby equips the client with tools to utilize in the

following stages of treatment that will focus on exercising impulse control and good judgement.

Discussion and Conclusion

I’ve only begun to establish rapport with the client, as I’ve only been seeing him for a

few weeks. We have started working on identifying emotions verbally, psychologically, and

physiologically. Because I’ve only just begun working with this client, I cannot yet draw

conclusions on the effectiveness of these interventions, or the outcome of the therapeutic

process. I will, however, employ this knowledge and better understanding of ego functions and

defense mechanisms, along with suggested interventions, in the sessions to come. I look forward

to utilizing information regarding ego functions and defense mechanisms in the future to gain a

clearer view of the client’s difficulties and the manner in which they cope to improve my

practice.
EGO PSYCHOLOGY: A CASE FORMULAITON

References

Blanck, G., & Blanck, R. (1994). Ego psychology: Theory and practice (2nd ed.). New York,

NY: Columbia University Press.

Cabaniss, D. L., Cherry, S., Douglas, C. J., & Schwartz, A. R. (2011). Psychodynamic

psychotherapy: A clinical manual (1st ed.). Chichester, West Sussex: John Wiley & Sons.

Christian, C. (2011). From ego psychology to modern conflict theory. In M. Diamond (Ed.), The

second century of psychoanalysis: Evolving perspectives on psychoanalytic action. (1st

ed.). London: Routledge.

Goldstein, E. (1996). Ego Psychology Theory. In F. Turner (Ed.), Social Work Treatment (4th

ed., pp. 191-199). New York, NY: The Free Press.

Goldstein, E. G. (1995). Ego psychology and social work practice (2nd ed.). New York: The

Free Press.

Walsh, J. (2010). Theories for direct social work practice (2nd ed.). Belmont, CA: Wadsworth

Cengage Learning.