psychoanalysis - History, Technique, Theory, Modern Adaptations, Criticisms, Influence

The theory and clinical practice of a form of psychology which emphasizes unconscious aspects of the mental life of an individual. The treatment, pioneered by Freud, is a form of therapy which attempts to eliminate conflict by altering the personality in a positive way. Freud introduced ideas concerning the use of the study of dreams as a way of understanding people's deeper emotions; he emphasized the introspective study of the self and, with colleagues such as Adler, Karl Abraham (1877–1925), and Jung, advanced ideas about normal and abnormal psychological processes. The first Psychoanalytic Society was in Austria, but both a combination of differences of views and wider political events led to psychoanalysis having a greater impact on North American as opposed to European psychiatry.

Psychoanalysis is a family of psychological theories and methods based on the pioneering work of Sigmund Freud. As a technique of psychotherapy, psychoanalysis seeks to discover connections among the unconscious components of patients' mental processes.

History

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. As a result of talking with these patients, Freud came to believe that their problems stemmed from culturally unacceptable, thus repressed and unconscious, desires and fantasies of a sexual nature. As his theory developed, Freud developed and cast aside a myriad of different frameworks to model and explain the phenomena he encountered in treating his patients.

Prominent current schools of psychoanalysis include:

Self psychology, which emphasizes the development of a stable sense of self through mutually empathic contacts with other humans; Lacanian psychoanalysis, which integrates psychoanalysis with semiotics and Hegelian philosophy; Margaret Mahler Interpersonal psychoanalysis, which accents the nuances of interpersonal interactions; and Relational psychoanalysis, which combines interpersonal psychoanalysis with object-relations theory. Modern psychoanalysis, a body of theoretical and clinal 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.

Today psychoanalytic ideas are embedded in the culture, especially in childcare, education, literary criticism, and in psychiatry, particularly medical and non-medical psychotherapy.

Technique

The basic method of psychoanalysis is the transference and resistance analysis of free association.

Many clinicians hold that psychoanalysis is not recommended in cases of serious psychological disruption, such as psychosis, suicidal depression, or severe untreated alcoholism.

Some more recent forms of psychoanalysis seek to help patients gain self-esteem through greater trust of the self, overcome the fear of death and its effects on current behavior, and maintain several relationships that appear to be incompatible.

Although single-client sessions remain the norm, psychoanalysis has been adapted as a form of group therapy by Harry Stack Sullivan and others.

Efficacy

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).

Analysis of previous randomised controlled trials have suggested that psychoanalytic treatment is more effective than the absence of treatment in specific psychiatric disorders. Empirical research on the efficacy of psychoanalysis and psychoanalytic psychotherapy has also become prominent among psychoanalytic researchers. Further data also suggest that psychoanalysis is not effective (and possibly even detrimental) in the treatment of sex offenders.

Cost and length

The cost of psychoanalytic treatment ranges widely, 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. 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.

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.

An ongoing debate in professional psychoanalysis concerns the 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.

The American Psychoanalytic Association, however, limited access to training to medical doctors until quite recently. 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.

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.

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The theories distinctive of psychoanalysis generally include the following hypotheses:

Human development is best understood in terms of changing objects of sexual desire. Neuroses can be treated through bringing the unconscious wishes and repressed memories to consciousness in psychoanalytic treatment.

The unconscious and psychic structures

The unconscious refers to that part of mental functioning of which subjects make themselves unaware. For psychoanalysis, the unconscious does not include all of what is not conscious.

For Freud, the unconscious was a depository for socially unacceptable ideas, wishes or desires, traumatic memories, and painful emotions put out of mind by the mechanism of psychological repression.

The ego, super-ego, and id are the divisions of the psyche according to Freud's later "structural theory".

Roots of neurosis

In his earliest writings on the subject, Freud theorized that all neuroses were rooted in childhood sexual abuse (the so-called seduction theory). Later, Freud came to abandon or de-emphasize this hypothesis, emphasizing instead the importance of unconscious fantasy as the cause of neurosis, particularly fantasy structured according to the Oedipus complex.

The Oedipus complex is a concept developed by Sigmund Freud to explain the origin of certain neuroses in childhood.

Freud revisited the Oedipal territory in the final essay of Totem and Taboo.

The life and death instincts

Freud believed that humans were driven by two conflicting central desires: the life drive (Eros) (incorporating the sex drive) and the death drive (Thanatos).

Modern Adaptations

Cultural Adaptations

Psychoanalysis can be adapted to different cultures, as long as the therapist or counseling understands the client’s culture. Psychoanalysis also applies because Freud used techniques that allowed him to get the subjective perceptions of his patients. Therefore, it is more likely that Freudian constructs will be used in structured therapy (Thompson, et al., 2004). Psychoanalytic constructs fit with constructs of other more structured therapies, and Firestone (2002) thinks psychotherapy should have more depth and involve both psychodynamic and cognitive-behavioral approaches.

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, storytelling, bibliotherapy, and psychodrama. In the 1920’s, Anna Freud (Sigmund Freud’s daughter) adapted psychoanalysis for children through play. Psychoanalytic play therapy allows the child and the counselor to access material in the unconscious, material that was avoided and forgotten.

Other play therapy techniques

Bibliocounseling involves selecting stories from books that children can identify with (similar issues). 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; 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.

Criticisms

Psychoanalysis has been criticized on a variety of grounds by Karl Popper, Adolf Grünbaum, Mario Bunge, Hans Eysenck, Ludwig Wittgenstein, Peter Medawar, Ernest Gellner, Frank Cioffi, Frederick Crews, Arthur Janov and others. Janov claims that psychoanalysis intellectualizes the feeling process which only strengthens defenses. The other schools of psychology have produced alternative methods of psychotherapy, including behavior therapy, cognitive therapy, Gestalt therapy, primal therapy and person centered psychotherapy. Exchanges between critics and defenders of psychoanalysis have often been so heated that they have come to be characterized as the Freud Wars.

An important consequence of the wide variety of psychoanalytic theories is that different schools of psychoanalysis criticise each other. One consequence is that some critics offer criticism of specific ideas present only in one or more theories, rather than in all of psychoanalysis while not rejecting other premise of psychoanalysis. Defender of psychoanalysis argue that many critics (such as feminist critics of Freud) 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. 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 On the other hand, those who criticise psychoanalysis on scientific basis tend to dismiss the entire subject as pseudo science.

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.

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 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 (Fisher & However, these stages should not be viewed as crucial to modern psychoanalysis. What is crucial to modern psychoanalytic theory and practice is the power of the unconscious and the transference phenomenon. The recent development in neuroscience resulted in one side arguing that it have provided a biological basis for unconscious emotional processing in line with psychoanalytic theory while the other side arguing that such finding make psychoanalytic theory obsolte and irrelevant. 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 est. In fact, an increasing number of scientists regard psychoanalysis as a pseudoscience (Cioffi, F.

Among philosophers, Karl Popper argued that Freud's theory of the unconscious was not falsifiable and therefore not scientific. In other words, if it were possible to connect every conceivable experimental outcome with Freud's theory of the unconscious mind, then no experiment could refute the theory.

Some proponents of psychoanalysis suggest that its concepts and theories are more akin to those found in the humanities than those proper to the physical and biological/medical sciences, though Freud himself tried to base his clinical formulations on a hypothetical neurophysiology of energy transformations. For example, the philosopher Paul Ricoeur argued that psychoanalysis can be considered a type of textual interpretation or hermeneutics. 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.

Controversy over efficacy

Psychoanalysts, for most of their history, have relied on the clinical case report as the chief method of evaluating the efficacy of treatment.

At least in the United States, psychoanalysis has usually been perceived as a form of insight-based therapy, with the goal of bringing unconscious thoughts or memories into consciousness.

Theoretical criticism

Psychoanalysts have often complained about the significant lack of theoretical agreement among analysts of different schools.

The philosopher Jacques Derrida incorporated certain aspects of psychoanalytic theory into his practice of deconstruction in order to question what he called the 'metaphysics of presence' or 'self-presence', the defining trait (for Derrida) of traditional metaphysics, namely its assumption that the meaning of utterances can be pinned down and made fully evident to consciousness, perhaps most evident in Descartes' conception of 'clear and distinct ideas'. Derrida is here influenced by Freud (among others such as Marx and Nietzsche.) For instance, Freud's insistence, in the first chapter of 'The Ego and the Id', that philosophers will recoil from his theory of the unconscious is clearly a forbearer to Derrida's understanding of metaphysical 'self-presence'. However, Derrida goes on to turn certain of these practices against Freud himself, in order (in Derrida's typical manner) to reveal tensions and contradictions in Freud's work which are nonetheless the very conditions upon which it can operate - its simultaneous conditions of possibility and impossibility. in 'The Ego and The Id' and 'Totem and Taboo') Derrida will insist (for instance in 'The Postcard') that the prominence of the father in Freud's own analysis is at the same time indebted to and an example of the prominence given to the father in Western metaphysics and theology since Plato. Thus, (in a similar manner to that in which Levi-Strauss reads Freud's understanding of the Oedipal complex as but another version of the Oedipus myth,) Derrida understands Freud as remaining partly within that theologico-metaphysical tradition ('phallologocentrism' Derrida helpfully calls it) which Freud nonetheless criticizes. However, the purpose of Derrida's analysis is not to refute Freud per se, (which would only be to reaffirm traditional metaphysics) but rather to reveal an aporia (an undecidability) at the very heart of Freud's project. Such a 'deconstruction' (or indeed psychoanalysis) of Freud does tend to cast doubt upon the possibilty of delimiting psychoanalysis as a rigorous science. However in doing so it celebrates and pledges a critical alliegance to that side of Freud which emphasises the open-ended and improvisatory nature of psychoanalysis, and its (methodical and ethical) demand (for instance in the opening chapters of the 'Interpretaion of Dreams,') that the testimony of the analysand should be given prominence in the practice of analysis.

Psychoanalysis, or at least the dominant version of it, has been denounced as patriarchal or phallocentric by proponents of feminist theory.Other feminist scholars appreciate how Freud opened up society to female sexuality.

Influence

A few of the most influential psychoanalysts and theorists, philosophers and literary critics who were or are influenced by psychoanlaysis include Alfred Adler, Karl Abraham, Franz Alexander, Lou Andreas-Salomé, Jacob Arlow, Michael Balint, Therese Benedek, John Benjamin, Bruno Bettelheim, Edward Bibring Wilfred Bion, John Bowlby, Charles Brenner, Abraham A. Eissler, Erik Erikson, Ronald Fairbairn, Pierre Fédida, Otto Fenichel, Sandor Ferenczi, Anna Freud, Sigmund Freud, Erich Fromm, Frieda Fromm-Reichmann, Merton Gill, Andre Green, Ralph R.

Critiques of psychoanalysis

Borch-Jacobsen, M (1996). ISBN 0-8101-1370-8 Grünbaum, Adolf (1979), Is Freudian Psychoanalytic Theory Pseudo-Scientific by Karl Popper's Criterion of Demarcation?, "American Philosophical Quarterly", 16, Ap 79, s.131-141. Grünbaum, Adolf (1985) The Foundations of Psychoanalysis: A Philosophical Critique ISBN 0-520-05017-7 Janov, Arthur, "Grand Delusions." Chapter 8: Freud's theory as therapy: The talking cure that doesn't heal. ISBN 0-465-09128-8 Skeptic's dictionary entry on psychoanalysis Skeptic's dictionary entry on repressed memory

Online papers about psychoanalytic theory

Benjamin, J. Psychoanalysis and psychotherapy: A revision Kernberg, O. Psychoanalysis, psychoanalytic psychotherapy and supportive psychotherapy: contemporary controversies Mitchell, Stephen A. On the clinical psychoanalytic theory and its role in the inference and confirmation of particular clinical hypotheses "Ordinary Language Essentials of Clinical Psychoanalytic Theory"

Online papers and links about psychoanalytic research

Blatt, S. Psychoanalysis: With whom, for what, and how? (2001), Transformation Cycles as Organizers of Psychoanalytic Process: The Method of Sequential Specification Freud, Sigmund (1920). Dream Psychology: Psychoanalysis for Beginners Masling, J.(1999). An Evaluation of Empirical Research Linked to Psychoanalytic Theory Shaver, P. (1999) The scientific status of unconscious processes: Is Freud really dead? Change after long term psychoanalytic psychotherapy Bulletin of the Psychoanalytic Research Society Psychoanalytic Research Consortium Psychology

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