Psychoanalysis

From New World Encyclopedia
Previous (Psychedelic rock)
Next (Psychokinesis)


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.

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, S (1891). On Aphasia. NY: International Universities Press, 1953. ). He also became aware of the experimental treatment, a combination of hypnotism and "catharsis" done by "abreaction", his older mentor and colleague, Dr. 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. Dr. 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 casued 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" unconscious due to "society's" condemnation of premarital sexual activity, and this repression created anxiety. Freud also discovered what most of us take for granted today: that dreams were symbolic and specific to the dreamer. Often, dreams give clues to unconscious conflicts, and for this reason, Freud referred to dreams as the "royal road to the Unconscious." 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 new theory, which addressed the cause of neurotic symptoms — phobias, compulsions, obsessions, depressions, and "hysterical" conversions — amongst others, suggested 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.

Although criticized since its inception (See the recent criticism), psychoanalysis has been thriving as a research tool into childhood development (cf. the journal The Psychoanalytic Study of the Child), and has developed into a flexible, effective treatment 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). Cf. Blum, Harold P. (Ed.) (1977). Female Psychology. New York: International Universities Press. Also see the various works of Eleanor Galenson. Feminist analysts, e.g., Nancy Chodorow, and others. 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 (see www.apsa.org) which is a component organization of the International Psychoanalytical Association, and there are over 3,000 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., and is a fast-growing organization.

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 thoughout 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 levelled 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 fromt 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 superego includes our moral code and ideals. The ego is made up of a group of mechanisms (reality-testing, judgment, impulse control, etc.) that help us deal with the real world. 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 conflict model

The conflict model of the mind is designed to help analysts understand specific mental conflicts. This model of the mind divides the mind into basic units called compromise-formations. A compromise formation consists of a wish, a feeling of discomfort about the wish, and a defense used to eliminate that feeling of discomfort. For example, a patient might have an aggressive wish to attack authority figures, fear that if he or she were to do so punishment might result, and defensively intellectualize about general problems with authority rather than physically assaulting his or her superiors. The product of the wish, discomfort, and defense takes shape as a compromise between the three. Some influential analysts have argued that the conflict model is the most important psychoanalytic model, distinguishing psychoanalysis from other psychological theories such as humanistic psychology that minimize mental conflict.

The object-relational model

The object-relational model of the mind describes the mind as structured by internalized relationships with others. This model has it that we all internalize our childhood experiences with other people, and our patterns of thinking, wishing, and feeling are organized by these experiences. Psychoanalysts often refer to the internalized other as an "internal object." An analyst might use the object-relational model to understand, for example, a patient who seeks out abusive relationships because of an abusive childhood that has taught her that to be loved, he or she must tolerate abuse. The object-relational model is perhaps the most widely used theory among analysts today.

The intersubjective model

The most recently developed model listed here, the intersubjective model is closely related to the object-relational model. Intersubjectivity theory tries to capture the complex ways in which the subjective points of view of different people interact. According to intersubjectivity theory, all of our experiences are heavily influenced by the interface between our own subjectivities and those of others. Among other things, the intersubjective model has led many analysts to revise their understanding of the origins of repression and other defense mechanisms. Intersubjectivity theory proposes that between people, intersubjective fields are established in which some experiences can be conscious and some must be kept out of awareness. Defense mechanisms, from an intersubjective perspective, take shape in formative intersubjective interactions in which particular experiences are treated as unspeakable.

Theories

Wikinews
Wikinews has news related to this article:
Dr. Joseph Merlino on sexuality, insanity, Freud, fetishes and apathy

The predominant psychoanalytic theories include

  • Conflict Theory, which theorizes that emotional symptoms and character traits are complex solutions to intrapsychic conflict. See Brenner (2006), Psychoanalysis: Mind and Meaning, New York: Psychoanalytic Quarterly Press. 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 (dependant, 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, which 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, parallelling some of cognitive theory, includes the notions of autonomous ego functions: mental functions not dependant, 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, which 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 (e.g., 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.
  • Structural Theory, which breaks the mind up into the id, the ego, and the superego. Actually, in German, the word for id is "es," which means "it." The word ego was coined by Freud's translators; Freud used the term, "ich" meaning "I" in English. Freud called the superego the "Über-ich." The id was designated as the repository of sexual and aggressive wishes, which Freud called "drives." The ego was composed of those forces that opposed the drives — defensive operations. The superego was Freud's term for the conscience — values and ideals, shame and guilt. One problem Brenner (2006) later found with this theory (see above) was that Freud also suggested that forgotten thoughts ("the repressed") were also "located" in the id. However, Freud here realized that drives could be conscious or unconscious, and that consciousness vs. unconsciousness was a quality of any mental operation or any mental conflict. Forgetting things could be done on purpose, or not. People could be aware of guilt, or not aware.
  • 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.
  • 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 developed primarily by Stephen Mitchell. His suggestions for technique applied to patients who seemed unable to develop trusting, close relationships. 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 (cf. the work of Theodore Dorpat, B. Killingmo, and S. Akhtar). As in all fields of medicine (for example, [1]}, 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, literary criticism, and in psychiatry, particularly medical and non-medical psychotherapy. Though there is a mainstream of evolved analytic ideas, there are groups who more specifically follow the precepts of one or more of the later theoreticians. It also plays a role in literary analysis. See Archetypal literary criticism.

Psychopathology (mental disturbances)

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 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, 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.

Panic, phobias, conversions, obsessions, compulsions and depressions (analysts call these "neurotic symptoms") are not usually caused by deficits in functions. Instead, 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. Finally, the various elements are managed by 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, etc.

Furthermore, we know that many adult problems can 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). Later, Freud came to realize that, although child abuse occurs, that not all neurotic symptoms were associated with this. He realized that neurotic people often had unconscious conflicts that involved incestuous fantasies deriving from different stages of development. He found the stage from about three to six years of age (preschool years, today called the "first genital stage") to be filled with fantasies about marriage with both parents. Although arguments were generated in turn-of-the-(20th)century Vienna about whether adult seduction of children was the basis of neurotic illness, there is virtually no argument about this problem in the 21st century.

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.

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.

Techniques

The basic method of psychoanalysis is the transference and resistance analysis of free association. The patient, in a relaxed posture, is directed to say whatever comes to mind. Dreams, hopes, wishes, and fantasies are of interest, as are recollections of early family life. Generally the analyst simply listens, making comments only when, in his or her professional judgment, an opportunity for insight on the part of the patient arises. In listening, the analyst attempts to maintain an attitude of empathic neutrality, a nonjudgmental stance designed to create a safe environment. The analyst asks that the analysand speak with utter honesty about whatever comes to awareness while interpreting the patterns and inhibitions that appear in the patient's speech and other behavior.

File:Freud Sofa-sm.jpg
Freud's patients would lie on this couch during psychoanalysis

A general rule of thumb in psychoanalytic treatment is that more insight-oriented techniques are to be used with healthier patients, whereas more supportive techniques are to be used with more disturbed patients. The most common example of an insight-oriented technique is an interpretation, in which the analyst delivers a comment to the patient that describes one or more cluster of unconscious wishes, anxieties, and defenses. An example of a supportive technique might be reassurance, in which the analyst tries to lower the patient's level of anxiety by assuring he/she that what he or she fears will not come to pass, or will be manageable. Analysts usually prefer to make more insight-oriented interventions when possible, as they feel that such interventions are usually less judgmental than other techniques.

Currently, most psychoanalysts claim that analysis is most useful as a method in cases of neurosis and with character or personality problems. Psychoanalysis is believed to be most useful in dealing with ingrained problems of intimacy and relationship and for those problems in which established patterns of life are problematic. As a therapeutic treatment, psychoanalysis generally takes three to five meetings a week and requires the amount of time for natural or normal maturational change (three to seven years).

Randomized controlled studies have suggested that psychodynamic treatment is helpful in cases of depressive disorders (4 randomized controlled trials (RCTs)), anxiety disorders (1 RCT), post-traumatic stress disorder (1 RCT), somatoform disorder (4 RCTs), bulimia nervosa (3 RCTs), anorexia nervosa (2 RCTs), borderline personality disorder (2 RCTs), Cluster C personality disorder (1 RCT), and substance-related disorders (4 RCTs). [2]

Much recent psychoanalytic work has been devoted to exploring the use of psychoanalytic principles and techniques in shorter face-to-face psychodynamic psychotherapy, and integrating psychoanalysis with other psychotherapeutic techniques such as those of cognitive behavior therapy. Empirical research on the efficacy of psychoanalysis and psychoanalytic psychotherapy has also become prominent among psychoanalytic researchers. An open-door review of outcome studies of psychoanalysis can be found here

Cost and length

Although psychoanalytic treatment used to be expensive, cost today ranges from as low as ten dollars a session (with an analytic candidate in training at an institute) to over 250 dollars a session with a senior training analyst.

Length of treatment varies. Some psychodynamic approaches, such as Brief Relational Therapy (BRT), Brief Psychodynamic Therapy (BPT), and Time-Limited Dynamic Therapy (TLDP) limit treatment to 20-30 sessions. Full-fledged psychoanalysis, however, generally lasts longer- with an average of 5.7 years, according to a recent survey. Which treatment length is optimal depends on the individual's needs.

Training

Throughout the history of psychoanalysis, most psychoanalytic organizations have existed outside of the university setting, with a few notable exceptions.

Psychoanalytic training usually occurs at a psychoanalytic institute and may last approximately 4-10 years. Training includes coursework, supervised psychoanalytic treatment of patients, and personal psychoanalysis lasting 4 or more years.

Most psychoanalytic institutes require that applicants already possess a graduate degree. Applicants usually have degrees in clinical social work (MSW or DSW), clinical psychology (PhD or Psy.D), or medicine (MD). A handful of institutes also accept applicants who have graduate degrees in nonclinical disciplines.

An ongoing debate in professional psychoanalysis concerns the prior qualifications candidates must have to enter analytic training. Freud believed that applicants from the humanities and many nonmedical disciplines are as well prepared as physicians for psychoanalytic training. Early in the history of psychoanalysis, prominent analytic organizations tried to limit psychoanalytic training to physicians. Later, after extensive debates and legal battles, psychoanalytic training in most institutes was opened to nonmedical mental health professionals, such as psychologists and clinical social workers. Currently, access to training by applicants from nonclinical disciplines, such as literary studies and philosophy, is limited. A small number of institutes, citing Freud's belief that training in the humanities provides good preparation for analytic training, admit nonclinical applicants. However, there is an ongoing effort by analysts with prior training in mental health to restrict access to analytic institutes by such applicants, repeating the early monopoly on psychoanalytic training by physicians.

Other definitions

Psychoanalysis is:

  • A therapeutic technique for the treatment of neurosis.
  • A technique used to train psychoanalysts. A basic requirement of psychoanalytic training is to undergo a successful analysis.
  • A technique of critical observation. The successors and contemporaries of Freud—Carl Jung, Alfred Adler, Wilhelm Reich, Melanie Klein, Wilfred Bion, Jacques Lacan, and many others—have developed Freud's theories and advanced new theories using the basic method of quiet critical observation and study of individual patients and other events.
  • A body of knowledge so acquired.
  • A clinical theory. See, for example, "Ordinary Language Essentials of Clinical Psychoanalytic Theory" by Wynn Schwartz.
  • A movement, particularly as led by Freud, to secure and defend acceptance of the theories and techniques.

Psychoanalysis involves extended exploration of the self, a realization of the Delphian motto, "Know thyself". In this it resembles the extended meditative practices of Buddhist monastic schools such as Zen. If successful, it gives a person the capacity to be present in the moment, responding authentically to circumstances, being free of infantile responses inappropriate to the situation.

Today psychoanalytic ideas are imbedded in the culture, especially in childcare, education, literary criticism, and in psychiatry, particularly medical and non-medical psychotherapy. Though there is a mainstream of evolved analytic ideas, there are groups who more specifically follow the precepts of one or more of the later theoreticians.

Psychoanalyses in groups

Though the most commonly held image of a psychoanalytic session is one in which a single analyst works with a single client, 'group' sessions with two or more clients are not unknown. Carrying out psychoanalysis in groups can be motivated by economic factors (individual analysis is time-consuming and expensive) or by the belief that clients may benefit from witnessing the various client-client and analyst-client interactions. In most forms of group-based analysis, the group is initially an artefact created by the analyst selecting the various members; the assumption is that the common relationship to the analyst will lead to the formation of a genuine group situation. Group psychotherapy of 'natural' groups (e.g. of whole families) seems to be a relative rarity.

Cultural Adaptations

Psychoanalysis can be adapted to different cultures, as long as the therapist or counseling understands the client’s culture. For example, Tori and Blimes found that defense mechanisms were valid in a normative sample of 2,624 Thais. The use of certain defense mechanisms was related to cultural values. For example Thais value calmness and collectiveness (because of Buddhist beliefs), so they were low on regressive emotionality. Psychoanalysis also applies because Freud used techniques that allowed him to get the subjective perceptions of his patients. He takes an objective approach by not facing his clients during his talk therapy sessions. He met with his patients’ where ever they were, such as when he used free association—where clients would say whatever came to mind without self-censorship. His treatments had little to no structure for most cultures, especially Asian cultures. Therefore, it is more likely that Freudian constructs will be used in structured therapy (Thompson, et al., 2004). In addition, Corey postulates that it will be necessary for therapist to help clients develop a cultural identity as well as an ego identity. Since Freud has been criticized for not accounting for external/societal forces, it seems logical that therapist or counselors using his premises will work with the family more. Psychoanalytic constructs fit with constructs of other more structured therapies, and Firestone (2002) thinks psychotherapy should have more depth and involve both psychodynamic and cogitative-behavioral approaches. For example, Corey states, that Ellis, the founder of Rational Emotive Behavioral Therapy (REBT) would allow his clients to experience depression over a loss, such an emotion would be rational—often people will be irrational deny their feelings. Since Freudian constructs can fit with other psychotherapeutic and counseling approaches, it can also be adapted to a variety of cultures, but it can not be employed in its widest use as Freud and Firestone would advocate (Firestone, 2002; Tori and Blimes 2002,).

Adaptations for age and managed care

Play Therapy for different ages

Psychoanalytic constructs can be adapted and modified to both age and managed care through the use of play therapy such as art therapy, creative writing, Sand Tray Therapy, storytelling, bibliotherapy, and analytical psychodrama. In the 1920's, Anna Freud (Sigmund Freud's daughter) adapted psychoanalysis for children through play. Using toys and games, she was able to enhance relationship with the child - Freud has been criticized for his, objective and disengaged, approach. When children play, they often engage in a make believe world where they can express their fears and fantasies, and they do so without censorship, so it resembles very much the technique of free association. Psychoanalytic play therapy allows the child and the counselor to access material in the unconscious, material that was avoided and forgotten. This material is re-integrated into the conscience, and the counselor is able to work with the child and the family to address the trauma or issue that was forgotten. With adults, the term art therapy is used, instead of play, however they are synonymous. The counselor simply adapts art therapy to the age of the client. With children, a counselor may have a child draw a portrait of his self, and then tell a story about the portrait. The counselor watches for re-occurring themes - regardless of whether it is with art or toys. With adults, the counselor may work one on one or in a group and have clients do various art activities like painting or clay to express themselves - toys here would not probably not be age appropriate, and children stop pretend play as they transition into adolescence. Since play is considered appropriate in Occidental (Western) culture, it allows people to deal with personal/social issues that they would normally avoid - it allows them to drop their defenses without anxiety and fear.

Other play therapy techniques

Bibliocounseling involves selecting stories from books that children can identify with (similar issues). Through this story, a child will be more likely to not feel defensive and will work to find alternative solutions to problems. Storytelling is similar, the counselor may tell a story but not use a name, and instead he may address the child with each new sentence using his name. For example, He may say, "next, Eric, the little boy had dream about a mouse that was not like the other mice..."

Play therapy for managed care

Unlike traditional psychoanalysis, play therapy takes much shorter time span; which allow insurance companies to cover it for their clients. Even more, it provides more structure to the process allowing for specific measurable goals. Psychoanalytic theory will be applied in more preventative ways, such as educating parents on how to best meet the needs of the child and enhance the child's development and growth. Lastly, more advocates may use homework assignments such as journal writing to save time (Thompson et al., 2004).

Expressive writing for managed care

According to a book, review by Berman (2003) the writing cure provides an analysis of research that supports expressive writing as a way to integrate cognitions and work through trauma. People who write about traumatic events experience more self control. The Writing Cure offers new, cost-effective ways to treat clients; clients can even use expressive writing to work through their own personal/social issues.

Criticisms

Psychonalysis has been criticized on a variety of grounds by Karl Popper, Adolf Grünbaum, Peter Medawar, Ernest Gellner, Frank Cioffi, Frederick Crews, and others. Popper argues that it is not scientific because it is not falsifiable. Grünbaum argues that it is falsifiable, and in fact turns out to be false. Behaviourism, evolutionary psychology, and cognitive psychology reject psychoanalysis as a pseudoscience. [3] Humanistic psychology maintains that psychoanalysis is a demeaning and incorrect view of human beings. [citation needed] The other schools of psychology have produced alternative methods of psychotherapy, including behavior therapy, cognitive therapy, and person centred psychotherapy. Exchanges between critics and defenders of psychoanalysis have often been so heated that they have come to be characterized as the Freud Wars.

Some defenders of psychoanalysis suggest that its logics and formulations are more akin to those found in the humanities than those proper to the physical and biological sciences, though Freud himself tried to base his clinical formulations on a hypothetical neurophysiology of energy transformations, an approach that was systematized by David Rapaport. Rapaport argued that psychoanalytic theory can be organized systematically if it is seen in relation to the dynamics of libidinal energy that emerge from the drives and conflict with controls and defenses. By the 1970's, psychoanalytic writers like Roy Schafer and George Klein treated psychoanalysis as two separate theories, one, a theory of energy transformations that lacked empirical validation and the other, an "experience-near" theory of human intentionality that was philosophically independent of the reductionism and determinism of 19th century science as seen in the works of Helmholz and Hobbes. Reductionism and determinism were recognized as contrary to the clinical methods and goals of psychological liberation. Psychoanalysis as a collection of clinical theories was recast as a theory of interpretation and development with a focus on understanding how the varieties of nonconscious dispositions and actions influence a person's life in the form of transference and resistance.

In a closely related argument, the philosopher Paul Ricoeur argued that psychoanalysis can be considered a type of textual interpretation or hermeneutics. Like cultural critics and literary scholars, Ricoeur contended, psychoanalysts spend their time interpreting the nuances of language- the language of their patients. Ricoeur claimed that psychoanalysis emphasizes the polyvocal or many-voiced qualities of language, focusing on utterances that mean more than one thing. Ricoeur classified psychoanalysis as a hermeneutics of suspicion. By this he meant that psychoanalysis searches for deception in language, and thereby destabilizes our usual reliance on clear, obvious meanings. The philosopher Jacques Derrida took a similar position. Derrida used psychoanalytic theory to question what he called the metaphysics of presence, a body of philosophical theory which assumes that the meaning of utterances can be pinned down and made fully evident.

Psychoanalysts have often complained about the significant lack of theoretical agreement among analysts of different schools. Many authors have attempted to integrate the various theories, with limited success. An important consequence of the wide variety of psychoanalytic theories is that psychoanalysis is difficult to criticize as a whole. Many critics have attempted to offer criticisms of psychoanalysis that were in fact only criticisms of specific ideas present only in one or more theories, rather than in all of psychoanalysis. For example, it is common for critics of psychoanalysis to focus on Freud's ideas, even though only a fraction of contemporary analysts still hold to Freud's major theses. As the psychoanalytic researcher Drew Westen puts it, "Critics have typically focused on a version of psychoanalytic theory—circa 1920 at best—that few contemporary analysts find compelling...In so doing, however, they have set the terms of the public debate and have led many analysts, I believe mistakenly, down an indefensible path of trying to defend a 75 to 100-year-old version of a theory and therapy that has changed substantially since Freud laid its foundations at the turn of the century." link to Westen article

An early 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. An increasing amount of psychoanalytic research from academic psychologists and psychiatrists who have worked to quantify and measure psychoanalytic concepts has begun to address this criticism. However, a survey of scientific research by Seymour Fisher and R. P. Greenberg 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 it be confirmed that such traits in adults result from childhood experiences. Likewise there is failure to demonstrate that insight, expressed in Freudian terms as making the unconscious conscious, improves a person's behavior or increases their level of functioning, there being strong indications that other factors are involved. E. Fuller Torrey, considered by some a leading American psychiatrist, writing in Witchhdoctors 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 est.

Research on psychodynamic treatment of some populations shows mixed results. Research by analysts such as Bertram Karon and colleagues at Michigan State University had suggested that when trained properly, psychodynamic therapists can be effective with schizophrenic patients. More recent research casts doubt on these claims. The Schizophrenia Patient Outcomes Research Team (PORT)report argues in its Recommendaton 22 against the use of psychodynamic therapy in cases of schizophrenia, noting that more trials are necessary to verity its effectiveness. However, it has been noted that the PORT recommendation is based on the opinions of clinicians rather than on empirical data, and empirical data exist that contradict this recommendation.link to abstract A review of current medical literature in The Cochrane Library, (the updated abstract of which is available online) reached the conclusion that no data exist supporting the view that psychodynamic psychotherapy is effective in treating schizophrenia. Further, data also suggest that psychoanalysis is not effective (and possibly even detrimental) in the treatment of sex offenders.

Although the popularity of psychoanalysis was in decline during the 1980's and early 1990's, prominent psychoanalytic institutes have experienced an increase in the number of applicants in recent years. link to article

References
ISBN links support NWE through referral fees

  • Berman, J. (2003). [Review of the book The writing cure: How expressive writing promotes health and well-being. [Electronic version]. Psychoanalytic psychology, 20(3), 575-578.
  • Brenner, C. (1954). An elementary textbook of psychoanalysis.
  • Corey, G. (2001). Theory and practice of counseling and psychotherapy. (6th ed.). Belmont, CA: Brooks/Cole Thompson Learning
  • Seymour Fisher,, The Scientific Credibility of Freud's Theories and Therapy, Columbia University Press (October, 1985), trade paperback, ISBN 023106215X
  • Firestone, R.W. (2002). "The death of psychoanalysis and depth therapy." [Electronic version]. Psychotherapy: Theory, Research, Practice, and Training, 39(3), 223-232.
  • Kramer, Peter D., Listening to Prozac: A Psychiatrist Explores Antidepressant Drugs and the Remaking of the Self ISBN 0670841838.
  • Luhrmann, T.M., Of Two Minds: The Growing Disorder in American Psychiatry ISBN 0679421912.
  • Thomson, C.L, Rudolph L.B., & Henderson, D. (2004). Counseling children. (6th ed.). Belmont, CA: Brooks/Cole Thompson.
  • Tori, C.D. & Blimes, M. (Fall 2002). "Cross-cultural and Psychoanalytic Psychology: The Validation of defense measure in an Asian population." [Electronic version]. Psychoanalytic psychology, 19(4), 701-421.
  • E. Fuller Torrey, Witchdoctors and Psychiatrists: The Common Roots of Psychotherapy and Its Future, Perennial Library, Harper & Row (1986), trade paperback, 320 pages, ISBN 0060970243
  • Psychoanalytic Theory: An Introduction, by Anthony Elliott, an introduction that explains psychoanalytic theory with interpretations of major theorists [4]
  • The Psychoanalytic Movement: The Cunning of Unreason, by Ernest Gellner. A critical view of Freudian theory. ISBN 0810113708
  • Mitchell, S. & Black, M. (1995). Freud and Beyond: A History of Modern Psychoanalytic Thought
  • Wachtel, P. (1989). Psychoanalysis and Cognitive Behavior Therapy: Toward an Integration. New York: Basic Books.

Online papers about psychoanalytic theory


Online papers and links about psychoanalytic research

Critiques of psychoanalysis

  • Erwin, Edward, A Final Accounting: Philosophical and Empirical Issues in Freudian Psychology ISBN 0262050501
  • Gellner, Ernest, The Psychoanalytic Movement: The Cunning of Unreason. A critical view of Freudian theory. ISBN 0810113708
  • Grünbaum, Adolf, The Foundations of Psychoanalysis: A Philosophical Critique ISBN 0520050177
  • Macmillan, Malcolm, and Frederick Crews, Freud Evaluated: The Completed Arc ISBN 0262631717

External links


Credits

New World Encyclopedia writers and editors rewrote and completed the Wikipedia article in accordance with New World Encyclopedia standards. This article abides by terms of the Creative Commons CC-by-sa 3.0 License (CC-by-sa), which may be used and disseminated with proper attribution. Credit is due under the terms of this license that can reference both the New World Encyclopedia contributors and the selfless volunteer contributors of the Wikimedia Foundation. To cite this article click here for a list of acceptable citing formats.The history of earlier contributions by wikipedians is accessible to researchers here:

The history of this article since it was imported to New World Encyclopedia:

Note: Some restrictions may apply to use of individual images which are separately licensed.

Retrieved from https://www.newworldencyclopedia.org/p/index.php?title=Psychoanalysis&oldid=537224

Content is available under Creative Commons Attribution/Share-Alike License; additional terms may apply. See Terms of Use for details.
Copyright Logo
Powered by MediaWiki