Psychoanalysis

Part of a series of articles on Psychoanalysis

Constructs Psychosexual development Psychosocial development Conscious • Preconscious Unconscious Id, ego, and super-ego Libido • Drive Transference • Resistance Defense mechanism Important Figures Sigmund Freud • Carl Jung Alfred Adler • Otto Rank Anna Freud • Margaret Mahler Karen Horney • Jacques Lacan Ronald Fairbairn • Melanie Klein Harry Stack Sullivan Erik Erikson • Nancy Chodorow Schools of Thought Self psychology • Lacanian Analytical psychology Object relations Interpersonal • Relational Attachment • Ego psychology

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Psychoanalysis comprises several interlocking theories concerning the functioning of the mind. The term also refers to a specific type of treatment where the analyst, upon hearing the thoughts of the analyzed (analytic patient), formulates and then explains the unconscious basis for the patient's symptoms and character problems. Unconscious functioning was first described by Sigmund Freud, who modified his theories several times over a period of almost 50 years (1889-1939) of attempting to treat patients who suffered with mental problems. In the past 70 years infant and child research and new discoveries in adults have led to further modification of theory. During psychoanalytic treatment, the patient tells the analyst various thoughts and feelings. The analyst listens carefully, formulates, then intervenes to attempt to help the patient develop insight into unconscious factors causing the problems. The specifics of the analyst's interventions typically include confronting and clarifying the patient's pathological defenses, wishes and guilt. Through the analysis of resistance (unconscious barriers to treatment), and transference to the analyst of expectations, psychoanalysis aims to unearth wishes and emotions from prior unresolved conflicts, in order to help the patient perceive and resolve lingering problems.

History

Origins

Psychoanalysis was devised in Vienna in the 1890s by Sigmund Freud, a neurologist interested in finding an effective treatment for patients with neurotic or hysterical symptoms. Freud became sensitized to the existence of mental processes that were not conscious as a result of his neurological consulting job at the Kinderkrankenhaus (Children's Hospital), where he noticed that many aphasic children had no organic cause for their symptoms. He wrote a monograph about this (Freud, On Aphasia. (1891) 1953). He also became aware of the experimental treatment, a combination of hypnotism and "catharsis" done by "abreaction," his older mentor and colleague, Josef Breuer, was using to treat the now famous patient, Anna O. In the late 1880s, Freud obtained a grant to study with Jean-Martin Charcot, the famed neurologist and syphilologist, at the Salpetrière in Paris. Charcot had become interested in his hysterical patients who had symptoms that mimicked general paresis, the psychotic illness that occurs due to tertiary syphilis. Charcot had found that many hysterics experienced paralyses, pains, coughs, and a variety of other symptoms with no demonstrable physical etiology (cause). Prior to Charcot's work, hysteria had been defined as a women's disease caused by a "wandering uterus" (the name hysteria means this in Greek). But Charcot found that men could have psychosomatic symptoms as well, and clearly influenced Freud's early theories.

As a result of talking with patients, Freud learned that the majority complained of sexual problems, especially coitus interruptus as birth control, which surprised him greatly. He first suspected their problems stemmed from cultural restrictions on sexual expression, and devised what today is called "topographic theory," in 1895. In this theory, which he later more or less discarded in 1923, unacceptable sexual wishes were repressed into the "System Unconscious," which he posited was unconscious due to "society's" condemnation of premarital sexual activity. This repression created anxiety, which manifest as symptoms. Freud then made perhaps his most enduring "discovery," that dreams were symbolic and specific to the dreamer. In his Interpretations of Dreams (1900), Freud argued that dreams give clues to unconscious conflicts, and for this reason, he referred to dreams as the "royal road to the Unconscious." This work gave expression to his own self-reflection and the crystallization of his theory of the Oedipus conflict. From anxiety over "coitus interruptus" and other anxiety-producing events, Freud created a "structural" model (not "the" Structural model–see below), a universal problematic at the root of human society that touched everyone.

After several theoretical modifications, the discovery of narcissism in 1915, and the study of paranoia, masochism, and depression in 1917, Freud eventually reorganized his data into what became known as structural theory in a small book called The Ego and the Id in 1923. This later theory, developed as his theory was coming under attack from his former disciples who had broken with Freud over his neglect of the Ego in his theory of the Unconscious, revised his approach to the cause of neurotic symptoms—phobias, compulsions, obsessions, depressions, and "hysterical" conversions—among others, suggesting that such problems were created by conflicts among various wishes and guilt, which produced anxiety. To handle the anxiety, the mind forgot or repressed certain conflicting thoughts. In other words, now he felt that anxiety produced repression, not the other way around.

Later developments

Although criticized since its inception, psychoanalysis has been thriving as a research tool into child development (cf. the journal The Psychoanalytic Study of the Child), and remains one among many treatment approaches for certain mental disturbances (see Wallerstein's (2000) Forty-Two Lives in Treatment: A Study of Psychoanalysis and Psychotherapy). In the 1960s, Freud's early (1905) thoughts on the childhood development of female sexuality were challenged; this challenge led to the development of a variety of understandings of female sexual development, many of which modified the timing and normality of several of Freud's theories (which had been gleaned from the treatment of women with mental disturbances) (Blum, 1977). Several researchers, coming together in Blum's 1977 book, Female Psychology, followed Karen Horney's studies of societal pressures that influence the development of women. Most contemporary North American psychoanalysts employ theories that, while based on those of Sigmund Freud, include many modifications of theory and practice developed since his death in 1939.

Today, there are approximately 35 training institutes for psychoanalysis in the United States accredited by the American Psychoanalytic Association which is a component organization of the International Psychoanalytical Association, and there are over three thousand graduated psychoanalysts practicing in the United States. The International Psychoanalytical Association accredits psychoanalytic training centers throughout the rest of the world, including countries such as Serbia, France, Germany, Austria, Italy, Switzerland, and many others, as well as about six institutes directly in the U.S.

Theories

Psychoanalysis is theoretically diverse. Most analysts use some selection of the following psychoanalytic models of the mind.

Freudian theories

Freudian psychoanalysis is complicated in part because Freud revised his theories over time in response to his own experiences but also the criticism of other analysts, a number of whom began as Freudian but eventually developed their own theories. Freud never expressly repudiated any of his earlier theories, but there are three distinct versions that appeared over time.

The economic model

Freud's original model of the mind is commonly referred to as the "economic model." The economic model of the mind is rarely used today, but is of historical importance. In this view, psychological problems stem from anxiety. Anxiety is caused by the inability of the libidinal energy to cathect its object. In the economic model, the mind is pictured as an energy system. Mental energy or "libido" may be distributed in a variety of ways throughout the system, "cathecting" various activities or processes with energy. Human beings are motivated by the need to achieve pleasure by "discharging" pent-up libido. If the pent-up libido fails to achieve its goal, the discharge of energy on an object, it causes a state of "dis-ease," which Freud called anxiety. This system originated during Freud's earlier, pre-psychoanalytic period. Freud would later try to update this system in his Inhibitions, Symptoms and Anxiety (1926) to bring it into alignment with the needs of his ego theory which did not exist in the 1890s when the theory was first developed, but he could only do so at the cost of jettisoning the whole libidinal structure and reversing his earlier views on the etiology of anxiety. (Freud's own ego theory was only developed in response to the critiques leveled by some of his former proteges who left the psychoanalytic movement to focus more on ego psychology, including Carl Jung and Alfred Adler.) In the latter essay, Freud reversed his model from the earlier essay, with anxiety serving as cause and not effect. Currently, the vast majority of analysts have abandoned the economic model because it is rather complicated and relies heavily on nineteenth century ideas about hydraulics. Still, a small number of philosophically-minded analysts retain the economic model because they believe that its vagueness is helpful in alluding to features of mental life that may lie beyond scientific understanding.

The topographical model

The topographical model of the mind developed from Freud's theory of the unconscious and his notion of repressed wishes, fantasies, and thoughts. It is rooted in the theory of the Oedipus complex. In the topographical model, the mind is divided into conscious, preconscious, and unconscious systems. The conscious system includes all that we are subjectively aware of in our minds. The preconscious includes material that we are capable of becoming aware of, but do not happen to be aware of currently. The unconscious system includes material defensively removed from our awareness by means of repression and other defense mechanisms. It corresponds to "classical" psychoanalysis, before the demands of critiques by Carl Jung, Alfred Adler and others forced Freud to abandon his primary focus on the unconscious and develop a theory of the ego as well. In this "classic" psychoanalytic practice, during clinical work analysts try to move unconscious material to the preconscious and then to the conscious mind, to increase the patient's self-awareness.

Although the topographic model remains in use in various clinical formulations and discussions, Freud was forced to acknowledge its inherent limitations and paradoxes. In particular he came to recognize that the topographical model made the locus of conflict one between a pragmatic consciousness, or ego, and the unconscious, repressed wishes. But that did not account for the fact that the ego itself was not merely a gatekeeper. The locus of the struggle would be moved and fixed between separate mental process within the unconscious. A new theory, Freud felt, was needed to account for the fact that the defenses and the defended against material could both be in the repressed unconscious. It was this insight that led him to the reconsiderations of the creation of the structural model in 1923.

The structural model

Perhaps the most famous psychoanalytic model of the mind, the structural model divides the mind into three mental agencies or "structures:" the id, the ego, and the superego. The id is the source of our motivation, and includes sexual and aggressive drives. The id was designated as the repository of sexual and aggressive wishes, which Freud called "drives." The superego includes our moral code and ideals. The superego was Freud's term for the conscience–values and ideals, shame, and guilt. The ego is made up of a group of mechanisms (reality-testing, judgment, impulse control, and so on) that essentially mediate between the id and the superego. The ego was composed of those forces that opposed the drives—defensive operations. Analysts who use the structural model commonly focus on helping patients handle conflicts that occur between these three mental agencies. Many also use the structural model for clinical diagnosis. A structural-model diagnosis entails an assessment of the level of functioning of the patient's id, ego, and superego, and the specific areas of weakness and strength in each. For example, psychoanalysts usually diagnose a patient as psychotic if his or her ego suffers a severe impairment in reality-testing.

Post-Freudian Theories

The predominant psychoanalytic theories include

* Conflict Theory theorizes that emotional symptoms and character traits are complex solutions to intrapsychic conflict (Brenner 2006). This revision of Freud's structural theory (Freud, 1923, 1926) dispenses with the concepts of a fixed id, ego, and superego, and instead posits unconscious and conscious conflict among wishes (dependent, controlling, sexual, and aggressive), guilt and shame, emotions (especially anxiety and depressive affect), and defensive operations that shut off from consciousness some aspect of the others. Moreover, healthy functioning (adaptive) is also determined, to a great extent, by resolutions of conflict. A major goal of modern conflict theorist analysts is to attempt to change the balance of conflict through making aspects of the less adaptive solutions (also called compromise formations) conscious so that they can be rethought, and more adaptive solutions found. Current theoreticians following Brenner's many suggestions (see especially Brenner's 1982 book, The Mind in Conflict) include Sandor Abend, MD (Abend, Porder, & Willick, (1983), Borderline Patients: Clinical Perspectives), Jacob Arlow (Arlow and Brenner (1964), Psychoanalytic Concepts and the Structural Theory), and Jerome Blackman (2003), 101 Defenses: How the Mind Shields Itself). Conflict theory is the prevalent analytic theory taught in psychoanalytic institutes, throughout the United States, accredited by the American Psychoanalytic Association.

* Ego Psychology has a long history. Begun by Freud in Inhibitions, Symptoms and Anxiety (1926), the theory was refined by Hartmann, Loewenstein, and Kris in a series of papers and books from 1939 through the late 1960s. Leo Bellak picked up the work from there. This series of constructs, paralleling some of cognitive theory, includes the notions of autonomous ego functions: mental functions not dependent, at least in origin, on intrapsychic conflict. Such functions include: sensory perception, motor control, symbolic thought, logical thought, speech, abstraction, integration (synthesis), orientation, concentration, judgment about danger, reality testing, adaptive ability, executive decision-making, hygiene, and self-preservation. Freud noted inhibition as a way the mind may interfere with any of these functions to avoid painful emotions. Hartmann (1950s) pointed out that there may be delays or deficits in such functions. Frosch (1964) described differences in those people who demonstrated damage to their relationship to reality, but who seemed able to test it. Deficits in the capacity to organize thought are sometimes referred to as blocking or loose associations (Bleuler), and are characteristic of the schizophrenias. Deficits in abstraction ability and self-preservation also suggest psychosis in adults. Deficits in orientation and sensorium are often indicative of a medical illness affecting the brain (and therefore, autonomous ego functions). Deficits in certain ego functions are routinely found in severely sexually or physically abused children, where powerful affects generated throughout childhood seem to have eroded some functional development. Ego strengths, later described by Kernberg (1975), include the capacities to control oral, sexual and destructive impulses; to tolerate painful affects without falling apart; and to prevent the eruption into consciousness of bizarre symbolic fantasy. Defensive activity, which shuts certain conflictual thoughts, fantasies, and sensations out of consciousness, is also sometimes included here, although defensive operations are different from autonomous functions. Nevertheless, the term "ego defense" has become common.

* Object relations theory attempts to explain vicissitudes of human relationships through a study of how internal representations of self and of others are structured. The clinical problems that suggest object relations problems (usually developmental delays throughout life) include disturbances in an individual's capacity to feel warmth, empathy, trust, sense of security, identity stability, consistent emotional closeness, and stability in relationships with chosen other human beings. (It is not suggested that one should trust everyone, for example). Concepts regarding internal representations (also sometimes termed, "introjects," "self and object representations," or "internalizations of self and other") although often attributed to Melanie Klein, were actually first mentioned by Sigmund Freud in his early concepts of drive theory (1905, Three Essays on the Theory of Sexuality). Freud's 1917 paper "Mourning and Melancholia," for example, hypothesized that unresolved grief was caused by the survivor's internalized image of the deceased becoming fused with that of the survivor, and then the survivor shifting unacceptable anger toward the deceased onto the now complex self image. Vamik Volkan, in "Linking Objects and Linking Phenomena," expanded on Freud's thoughts on this, describing the syndromes of "Established pathological mourning" vs. "reactive depression" based on similar dynamics. Melanie Klein's hypotheses regarding internalizations during the first year of life, leading to paranoid and depressive positions, were later challenged by Rene Spitz (as in The First Year of Life, 1965), who divided the first year of life into a coenesthetic phase of the first six months, and then a diacritic phase for the second six months. Margaret Mahler (Mahler, Fine, and Bergman (1975), "The Psychological Birth of the Human Infant") and her group, first in New York, then in Philadelphia, described distinct phases and subphases of child development leading to "separation-individuation" during the first three years of life, stressing the importance of constancy of parental figures, in the face of the child's destructive aggression, to the child's internalizations, stability of affect management, and ability to develop healthy autonomy. Later developers of the theory of self and object constancy as it affects adult psychiatric problems such as psychosis and borderline states have been John Frosch, Otto Kernberg, and Salman Akhtar. Peter Blos described (1960, in a book called "On Adolescence) how similar separation-individuation struggles occur during adolescence, of course with a different outcome from the first three years of life: the teen usually, eventually, leaves the parents' house (this varies with the culture). During adolescence, Erik Erikson (1950, 1960s) described the "identity crisis," that involves identity-diffusion anxiety. In order for an adult to be able to experience "Warm-ETHICS" (warmth, empathy, trust, holding environment (Winnicott), identity, closeness, and stability) in relationships (see Blackman (2003), 101 Defenses: How the Mind Shields Itself), the teenager must resolve the problems with identity and redevelop self and object constancy.

Other schools include:

• Self psychology, which emphasizes the development of a stable sense of self through mutually empathic contacts with other humans, was developed originally by Heinz Kohut, and has been elucidated by the Ornsteins and Arnold Goldberg. Marian Tolpin explicated the need for "transmuting internalizations" (1971) during treatment, to correct what Kohut referred to as a disturbance in the "self-object" internalizations from parents.

• Lacanian psychoanalysis, which integrates psychoanalysis with semiotics and Hegelian philosophy, based on the anthropological reading of Hegel by Alexandre Kojeve, developed in French academic circles.

• Analytical psychology, which has a more spiritual approach, was founded by Carl Jung.

• Interpersonal psychoanalysis, which accents the nuances of interpersonal interactions, was first introduced by Harry Stack Sullivan, MD, and developed further by Frieda Fromm-Reichmann. It is the primary theory, still taught, at the William Alanson White Center.

• Relational psychoanalysis, which combines interpersonal psychoanalysis with object-relations theory as critical for mental health, was introduced by Stephen Mitchell. Relational psychoanalysis emphasizes how the individual's personality is shaped by both real and imagined relationships with others, and how these relationship patterns are re-enacted in the interactions between analyst and patient. Fonagy and Target, in London, have propounded their view of the necessity of helping certain detached, isolated patients, develop the capacity for "mentalization" associated with thinking about relationships and themselves.

• Modern psychoanalysis, a body of theoretical and clinical knowledge developed by Hyman Spotnitz and his colleagues, extended Freud's theories so as to make them applicable to the full spectrum of emotional disorders. Modern psychoanalytic interventions are primarily intended to provide an emotional-maturational communication to the patient, rather than to promote intellectual insight.

Although these theoretical "schools" differ, most of them continue to stress the strong influence of unconscious elements affecting people's mental lives. There has also been considerable work done on consolidating elements of conflicting theory (for example, the work of Theodore Dorpat, B. Killingmo, and S. Akhtar). As in all fields of medicine, there are some persistent conflicts regarding specific causes of some syndromes, and disputes regarding the best treatment techniques.

Today psychoanalytic ideas are embedded in the culture, especially in childcare, education, and in psychiatry, particularly medical and non-medical psychotherapy. However, while psychoanalysis has influenced the general culture, its theoretical models have largely been discarded by scientific approaches to psychology. Psychoanalysis as a theory is primarily the purview of literary criticism and cultural theories.

Psychopathology

Psychoanalysis generally holds that many adult problems trace their origins to unresolved conflicts from certain phases of childhood and adolescence. Freud, based on the data gathered from his patients early in his career, suspected that neurotic disturbances occurred when children were sexually abused in childhood (the so-called seduction theory). This theory was developed during the early period of Freud's work, and memories were elicited using hypnotism. Later, Freud came to realize that the elicited memories under hypnosis were unreliable, and that not all neurotic symptoms were associated with actual seduction scenes. He then speculated that neurotic people often had unconscious conflicts that involved incestuous fantasies deriving from different stages of development, the so-called Oedipus complex. He hypothesized that the stage from about three to six years of age (preschool years, today called the "first genital stage") was filled with fantasies about marriage with both parents.

Although arguments were generated in turn-of-the-(twentieth) century Vienna about whether adult seduction of children was the basis of neurotic illness, there is virtually no argument about this problem in the twenty-first century. However, Freud was searching for a general theory, which could not be based on actual seduction scenes. Since Freud, many psychoanalysts who work with children have studied the actual effects of child abuse, which include ego and object relations deficits and severe neurotic conflicts. Much research has been done on these types of trauma in childhood, and the adult sequelae of those. On the other hand, many adults with symptom neuroses and character pathology have no history of childhood sexual or physical abuse.

Oedipus complex

In studying the childhood factors that start neurotic symptom development, Freud found a constellation of factors that, for literary reasons, he termed the Oedipus complex (based on the play by Sophocles, Oedipus Rex, where the protagonist unwittingly kills his father Laius and marries his mother Jocasta). The shorthand term, "oedipal," (later explicated by Joseph Sandler, 1960, in "On the Concept Superego" and modified by Charles Brenner (1982) in "The Mind in Conflict") refers to the powerful attachments that children make to their parents in the preschool years. These attachments involve fantasies of marriage to either (or both) parent, and, therefore, competitive fantasies toward either (or both) parents. Humberto Nagera (1975) has been particularly helpful in clarifying many of the complexities of the child through these years.

The terms 'positive' and 'negative' oedipal conflicts have been attached to the heterosexual and homosexual aspects, respectively. Both seem to occur in development of most children. Eventually, the developing child's concessions to reality (that they will neither marry one parent nor eliminate the other) lead to identifications with parental values. These identifications generally create a new set of mental operations regarding values and guilt, subsumed under the term "superego." Besides superego development, children "resolve" their preschool oedipal conflicts through channeling wishes into something their parents approve of ("sublimations") and the development, during the school-age years ("latency") of age-appropriate obsessive-compulsive defensive maneuvers (rules, repetitive games).

When there is disturbance in the family during the first genital phase (such as death of a parent or divorce), unusual magnification of anxieties in the child may occur. This sets the stage for problems during latency and adolescence. Later in life, under certain circumstances, a recrudescence of symptoms may occur during periods that are either stressful or symbolic–such as marriage, having children, or graduating from school.

Controversies regarding infantile sexuality and the oedipus complex are prevalent within and without psychoanalytic circles.

Neuroses

According to psychoanalytic theory, panic, phobias, conversions, obsessions, compulsions and depressions (generally referred to as "neurotic symptoms") are not usually caused by deficits in functions as in the psychoses (see below); rather, they are caused by intrapsychic conflicts. The conflicts are generally among sexual and hostile-aggressive wishes, guilt and shame, and reality factors. The conflicts may be conscious or unconscious, but create anxiety, depressive affect, and anger. This results in defensive operations–essentially shut-off brain mechanisms that make people unaware of that element of conflict. "Repression" is the term given to the mechanism that shuts thoughts out of consciousness. "Isolation of affect" is the term used for the mechanism that shuts sensations out of consciousness. Neurotic symptoms may occur with or without deficits in ego functions, object relations, and ego strengths. Therefore, it is not uncommon to encounter obsessive-compulsive schizophrenics, panic patients who also suffer with borderline personality disorder, and so forth.

Psychoses

The various psychoses involve deficits in the autonomous ego functions (see above) of integration (organization) of thought, in abstraction ability, in relationship to reality and in reality testing.

• In depressions with psychotic features, the self-preservation function may also be damaged (sometimes by overwhelming depressive affect). Because of the integrative deficits (often causing what general psychiatrists call "loose associations," "blocking," "flight of ideas," "verbigeration," and "thought withdrawal"), the development of self and object (others) representations is also impaired. Clinically, therefore, psychotic individuals manifest limitations in warmth, empathy, trust, identity, closeness and/or stability in relationships (due to problems with self-object fusion anxiety) as well.

• In patients whose autonomous ego functions are more intact, but who still show problems with object relations (that is, relations with others), the diagnosis often falls into the category known as "borderline." Borderline patients also show deficits, often in controlling impulses, affects, or fantasies–but their ability to test reality remains more or less intact.

• Those adults who do not experience guilt and shame, and who indulge in criminal behavior, are usually diagnosed as psychopaths, or, using DSM-IV-TR, antisocial personality disorder.

Psychoanalysis has not generally proven effective in treating the psychoses.

Indications and contraindications for analytic treatment

Using the various analytic theories to assess mental problems, several particular constellations of problems are more suited for analytic techniques (see below) whereas other problems respond better to medicines and different interpersonal interventions.

To be treated with psychoanalysis, whatever the presenting problem, the person requesting help must demonstrate

1. good capacity to organize thought (integrative function)
2. good abstraction ability
3. reasonable ability to observe self and others
4. some capacity for trust and empathy
5. some ability to control emotion and urges, and
6. good contact with reality (excludes most psychotic patients)
7. some guilt and shame (excludes most criminals)
8. reasonable self-preservation ability (excludes severely suicidal patients)

If any of the above are faulty, then modifications of techniques, or completely different treatment approaches, must be instituted. The more there are deficits of serious magnitude in any of the above mental operations (1-8), the more psychoanalysis as treatment is contraindicated, and the more medication and supportive approaches are indicated. In non-psychotic first-degree criminals, any treatment is often contraindicated.

The problems treatable with analysis include: phobias, conversions, compulsions, obsessions, anxiety attacks, depressions, sexual dysfunctions, a wide variety of relationship problems (dating and marital strife, for example), and a wide variety of character problems (such as painful shyness, meanness, obnoxiousness, workaholism, hyperseductiveness, hyperemotionality, hyperfastidiousness). The fact that many of such patients also demonstrate deficits in numbers 1-8 above makes diagnosis and treatment selection difficult.

Technique

The basic method of psychoanalysis is interpretation of the analysand's unconscious conflicts. According to the theory, these conflicts interfere with current-day functioning causing painful symptoms such as phobias, anxiety, depression, and compulsions. James Strachey (1936) stressed that figuring out ways the patient distorted perceptions about the analyst led to understanding what may have been forgotten (also see Freud's paper "Repeating, Remembering, and Working Through"). In particular, unconscious hostile feelings toward the analyst could be found in symbolic, negative reactions to what Robert Langs later called the "frame" of the therapy–the setup that included times of the sessions, payment of fees, and necessity of talking. In patients who made mistakes, forgot, or showed other peculiarities regarding time, fees, and talking, the analyst can usually find various unconscious "resistances" to the flow of thoughts (sometimes called free association).

Freud's patients would lie on this couch during psychoanalysis

The popular image of analysis is the patient lying on the couch with the analyst seated. When the patient reclines on a couch with the analyst out of view, the patient tends to remember more, experience more resistance and transference, and be able to reorganize thoughts after the development of insight–through the interpretive work of the analyst. (Transference is the transfer of affect from the patient onto the analyst. This can sometimes lead the patient to have an extreme emotional relationship with the analyst. The resolution of this relationship is considered to be the resolution of the problem.)

Although fantasy life can be understood through the examination of dreams, masturbation fantasies (Marcus, I. and Francis, J. (1975), Masturbation from Infancy to Senescence) are also considered important. The analyst is interested in how the patient reacts to and avoids such fantasies (Paul Gray (1995), The Ego and the Analysis of Defense). Various memories of early life are generally distorted—Freud called them "screen memories"—and in any case, very early experiences (before age two)—can not be remembered.

Variations in technique

There is what is known among psychoanalysts as "classical technique," although Freud throughout his writings deviated from this considerably, depending on the problems of any given patient. This technique is primarily based on conflict theory.

As object relations theory evolved, supplemented by the work of Bowlby, Ainsorth, and Beebe, techniques with patients who had more severe problems with basic trust and a history of maternal deprivation led to new techniques with adults. These have sometimes been called interpersonal, intersubjective, relational, or corrective object relations techniques. Such techniques involve expressing empathy and warmth toward the patient.

Finally, ego psychological concepts of deficit in functioning led to refinements in supportive therapy. These techniques are particularly applicable to psychotic and near-psychotic patients. These supportive therapy techniques focus more on discussions of reality and generally involve the use of medications to relieve depression and delusions.

Although single-client sessions remain the norm, psychoanalytic theory has been used to develop other types of psychological treatment. Psychoanalytic group therapy was pioneered by Harry Stack Sullivan and others. Child-centered counseling for parents was instituted early in analytic history by Freud, and was later further developed by Irwin Marcus, Edith Schulhofer, and Gilbert Kliman. Psychoanalytically based couples therapy has been promulgated and explicated by Fred Sander.

Criticisms

Exchanges between critics and defenders of psychoanalysis have often been so heated that they have come to be characterized as the Freud Wars.

Challenges to scientific validity

An early and important criticism of psychoanalysis was that its theories were based on little quantitative and experimental research, and instead relied almost exclusively on the clinical case study method. In comparison, brief psychotherapy approaches such as behavior therapy and cognitive therapy have shown much more concern for empirical validation (Morley et al. 1999). Some even accused Freud of fabrication, most famously in the case, and miraculous cure of Anna O. (Borch-Jacobsen 1996).

Popper argued that psychoanalysis is a pseudo-science because its claims are not testable and cannot be refuted, that is, they are not falsifiable, the hallmark of any science. Popper did not object to the idea that some mental processes could be unconscious, but rather that the theory could always assign an explanation that, when proven false, could simply be explained as the work of another mechanism. For example, if a client's reaction was not consistent with the psychosexual theory then an alternate explanation would be given (such as defense mechanisms, reaction formation).

Grünbaum argued that psychoanalytic based theories are falsifiable, and in fact are false. Other schools of psychology have produced alternative methods for psychotherapy, including behavior therapy, cognitive therapy, Gestalt therapy and person-centered psychotherapy. Anthropologist Roy Wagner in his classic work The Invention of Culture ridicules psychoanalysis and tried to account for personality and emotional disorder in terms of invention and convention (Ingham 2007).

Other critics

E. Fuller Torrey, considered by some to be a leading American psychiatrist, writing in Witchdoctors and Psychiatrists (1986) stated that psychoanalytic theories have no more scientific basis than the theories of traditional native healers, "witchdoctors" or modern "cult" alternatives such as Erhard Seminars Training est (76). In fact, an increasing number of scientists regard psychoanalysis as a pseudoscience (Cioffi, 1998).

Hans Eysenck determined that improvement was no greater than spontaneous remission. Between two-thirds and three-fourths of “neurotics” would recover naturally; this was no different from therapy clients.

Michel Foucault, and similarly Gilles Deleuze, noted that the institution of psychoanalysis has become a center of power, with its confessional techniques sharing similarities with the Christian tradition (Weeks, 1990).

A survey of scientific research showed that while personality traits corresponding to Freud's oral, anal, Oedipal, and genital phases can be observed, they cannot be observed as stages in the development of children, nor can it be confirmed that such traits in adults result from childhood experiences (Fisher & Greenberg, 1977, 399).

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• Hall, Calvin S. A Primer of Freudian Psychology. Plume, 1999. ISBN 978-0452011830
• Ingham, John M. Simplicity and complexity in anthropology. On the Horizon 15 (1) (2007): 7-14.
• Jacobson, Edith. Depression; Comparative Studies of Normal, Neurotic, and Psychotic Conditions. International Universities Press, 1976. ISBN 0823611957
• Kafka, John. Multiple Realities in Clinical Practice. Yale University Press, 1989. ISBN 0300043503
• Kernberg, Otto. Severe Personality Disorders: Psychotherapeutic. Yale University Press; 1993. ISBN 0300053495
• Kohut, Heinz. Analysis of the Self: Systematic Approach to Treatment of Narcissistic Personality Disorders. International Universities Press, 2000. ISBN 0823680029
• Kramer, Peter D. Listening to Prozac: A Psychiatrist Explores Antidepressant Drugs and the Remaking of the Self. Viking Adult, 1993. ISBN 0670841838.
• Laplanche, Jean and J.B. Pontalis. The Language of Psycho-Analysis. W. W. Norton & Company, 1974. ISBN 0393011054
• Luhrmann, T. M. Of Two Minds: The Growing Disorder in American Psychiatry. Knopf, 2000. ISBN 0679421912.
• Marcus, I. and J. Francis, eds. Masturbation from Infancy to Senescence. International Universities Press, 1975. ISBN 0823631508.
• Mitchell, S. & M. Black. Freud and Beyond: A History of Modern Psychoanalytic Thought. HarperCollins Publishers, 1996. ISBN 0465014054
• Meltzer, Donald. The Kleinian Development. (New edition), Karnac Books; Reprint ed. 1998. ISBN 1855751941
• Meltzer, Donald. Dream-Life: A Re-Examination of the Psycho-Analytical Theory and Technique. Karnac Books, 1983. ISBN 0902965174
• Popper, Karl R. Science: Conjectures and Refutations, 104-110. reprinted in Grim P. Philosophy of Science and the Occult. Albany, NY: 1990.
• Racker, Heinrich. Transference and Counter-Transference. International Universities Press, 2001. ISBN 0823683230
• Rosenfeld, Herbert A. Impasse and Interpretation: Therapeutic and Anti-Therapeutic Factors in the Psycho-Analytic Treatment of Psychotic, Borderline, and Neurotic Patients. Tavistock Publications, 1987. ISBN 0422610100
• Searles, Harold F. Collected Papers on Schizophrenia and Related Subjects. International Universities Press, 1966. ISBN 0823609804
• Segal, Hanna. The Work of Hanna Segal: A Kleinian Approach to Clinical Practice (Classical Psychoanalysis and Its Applications). Jason Aronson, (1993) 2003. ISBN 0876684223
• Spielrein, Sabina. Destruction as Cause of Becoming. 1993.
• Steiner, John. Psychic Retreats. Routledge, 1993. ISBN 0415099242
• Stoller, Robert. Presentations of Gender. Yale University Press, 1992. ISBN 0300054742
• Spitz, Rene. The First Year of Life: Psychoanalytic Study of Normal and Deviant Development of Object Relations. International Universities Press, 2006. ISBN 0823680568
• Thomson, C. L., L. B. Rudolph, & D. Henderson. Counseling children. Wadsworth Publishing, 2006. ISBN 978-0495007753
• Tori, C.D., & M. Blimes. Cross-cultural and Psychoanalytic Psychology: The Validation of defense measure in an Asian population. [Electronic version]. Psychoanalytic psychology 19(4) (Fall 2002): 701-421.
• Weeks, Jeffrey. Sexuality and its Discontents: Meanings, Myths, and Modern Sexualities. New York, NY: Routledge, 1990. ISBN 0415045037.
• Winnicott, Donald. Playing and Reality. Routledge, 2005. ISBN 0415345464
• Zaretsky, Eli. Secrets of the Soul: A Social and Cultural History of Psychoanalysis. Vintage Books, 2005. ISBN 1400079233

Critiques of psychoanalysis

• Aziz, Robert. The Syndetic Paradigm: The Untrodden Path Beyond Freud and Jung. 2007. Albany, NY: State University of New York Press. ISBN 978-0791469828.
• Borch-Jacobsen, M. Remembering Anna O: A century of mystification. London: Routledge, 1996. ISBN 0415917778
• Cioffi, F. Freud and the Question of Pseudoscience. Open Court Publishing Company, 1998. ISBN 081269385X
• Erwin, Edward. A Final Accounting: Philosophical and Empirical Issues in Freudian Psychology. The MIT Press, 1995. ISBN 0262050501
• Fisher S. and R. P. Greenberg. The Scientific Credibility of Freud’s Theories and Therapy. New York, NY: Basic Books, 1977; New Edition, Columbia University Press, 1985. ISBN 978-0231062152
• Fisher S. and R. P. Greenberg. Freud Scientifically Reappraised: Testing the Theories and Therapy. New York, NY: John Wiley, 1995. ISBN 978-0471578550
• Gellner, Ernest. The Psychoanalytic Movement: The Cunning of Unreason. A critical view of Freudian theory. Northwestern University Press, 1996. ISBN 0810113708
• Grünbaum, Adolf. Is Freudian Psychoanalytic Theory Pseudo-Scientific by Karl Popper's Criterion of Demarcation? American Philosophical Quarterly 16 (1979): 131-141.
• Grünbaum, Adolf. The Foundations of Psychoanalysis: A Philosophical Critique. University of California Press, 1985. ISBN 0520050177
• Loftus, Elizabeth F. & K. Ketcham. The Myth of Repressed Memory. New York: St. Martin's Press, 1994. ISBN 978-0312141233
• Macmillan, Malcolm. Freud Evaluated: The Completed Arc. The MIT Press, 1996. ISBN 0262631717
• Morley S., C. Eccleston, and A. Williams. Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain 80 (1-2) (1999): 1-13.
• Webster R. Why Freud was wrong. New York, NY: Basic Books, Harper Collins, 1995. ISBN 0465091288

External links

All links retrieved December 2, 2022.

• The American Psychoanalytic Association
• Sigmund Freud - Life and Work

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