Psychoanalysis is a family of psychological theories and methods which attempt to elucidate unconscious relations in a systematic way through an associative process. The fundamental subject matter of psychoanalysis is the unconscious patterns of life revealed through free associations expressed by the analysand (patient). The analyst's goal is to help liberate the analysand from unexamined or unconscious barriers of transference and resistance, that is, past patterns of relatedness that are no longer serviceable or that inhibit freedom.
Psychoanalysis was developed in Vienna in the 1890s by Sigmund Freud, a doctor 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, and as his theory developed, he included desires and fantasies of an aggressive nature, as well. Freud considered these aspects of life instinctive drives, libidinal energy/Eros and (later) the death instinct/Thanatos. Freud's description of Eros/Libido included all creative, life-producing instincts. The Death Instinct represented an instinctive drive to return to a state of calm, or non-existence. Since Freud's day psychoanalysis has developed in many ways especially as a study of the personal, inter-personal and intra-subjective sense of self.
Psychonalysis has been criticized on a variety of grounds by Karl Popper, Adolf Grünbaum , Ernest Gellner, Frederick Crews , and others. Popper argues that it is not traditionally scientific because it is not falsifiable. Grünbaum argues that it is falsifiable, and in fact turns out to be false.
Some defenders of psychoanalysis suggest that it's logics and formulations are more akin to the those found in the humanites 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. 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.
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.
Although psychoanalytic techniques have been used in a few cases to successfully treat psychosis (with great effort and major sacrifice on the part of the analyst), psychoanalysis is generally thought by analysts to be useful as a method in cases of neurosis and 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 necessary for maturational change (three to seven years).
- 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.
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, storytelling, bibliotherapy , and 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.
- 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.
- Corey, G. (2001). Theory and practice of counseling and psychotherapy. (6th ed.). Belmont, CA: Brooks/Cole Thompson Learning
- 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.
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