Psychoanalysis

11/24/2015
PsychoanalysisWikipedia,thefreeencyclopedia
Psychoanalysis
FromWikipedia,thefreeencyclopedia
Psychoanalysisisasetof
Intervention
psychologicalandpsychotherapeutic
theoriesandassociatedtechniques,
ICD 94.31(http://icd9cm.chrisendres.com/index.php?
createdbyAustrianphysician
9CM srchtype=procs&srchtext=94.31&Submit=Search&action=search)
SigmundFreudandstemmingpartly
MeSH D011572
fromtheclinicalworkofJosefBreuer
andothers.[1]Overtime,
psychoanalysishasbeenrevisedanddevelopedindifferentdirections.SomeofFreud'scolleaguesand
students,suchasAlfredAdlerandCarlJung,wentontodeveloptheirownideasindependently.Freud
insistedonretainingthetermpsychoanalysisforhisschoolofthought,andAdlerandJungacceptedthis.[2]
TheNeoFreudiansincludedErichFromm,KarenHorney,andHarryStackSullivan.
Thebasictenetsofpsychoanalysisinclude:
1. aperson'sdevelopmentisdeterminedbyoftenforgotteneventsinearlychildhoodratherthanby
inheritedtraitsalone.
2. humanattitude,mannerism,experience,andthoughtislargelyinfluencedbyirrationaldrivesthatare
rootedintheunconscious
3. itisnecessarytobypasspsychologicalresistanceintheformofdefensemechanismswhenbringing
drivesintoawareness
4. conflictsbetweentheconsciousandtheunconscious,orwithrepressedmaterialcanmaterializeinthe
formofmentaloremotionaldisturbances,forexample:neurosis,neurotictraits,anxiety,depression
etc.
5. liberatingtheelementsoftheunconsciousisachievedthroughbringingthismaterialintothe
consciousmind(viae.g.skilledguidance,i.e.therapeuticintervention).[3]
Underthebroadumbrellaofpsychoanalysisthereareatleast22theoreticalorientationsregardinghuman
mentaldevelopment.Thevariousapproachesintreatmentcalled"psychoanalysis"varyasmuchasthe
theoriesdo.Thetermalsoreferstoamethodofanalysingchilddevelopment.
Freudianpsychoanalysisreferstoaspecifictypeoftreatmentinwhichthe"analysand"(analyticpatient)
verballyexpresseshisorherthoughts,includingfreeassociations,fantasies,anddreams,fromwhichthe
analystinferstheunconsciousconflictscausingthepatient'ssymptomsandcharacterproblems,and
interpretsthemforthepatienttocreateinsightforresolutionoftheproblems.Theanalystconfrontsand
clarifiesthepatient'spathologicaldefenses,wishesandguilt.Throughtheanalysisofconflicts,including
thosecontributingtoresistanceandthoseinvolvingtransferenceontotheanalystofdistortedreactions,
psychoanalytictreatmentcanhypothesizehowpatientsunconsciouslyaretheirownworstenemies:how
unconscious,symbolicreactionsthathavebeenstimulatedbyexperiencearecausingsymptoms.Freudian
psychoanalysisreliesontheconceptthatitisonlyafterhavingacathartic(e.g.healing)experiencecana
personbe"cured"andaided.[4]
Psychoanalysishasreceivedcriticismfromawidevarietyofsources.Itisregardedbysomecriticsasa
pseudoscience.Nonetheless,itremainsastronginfluencewithintherealmofpsychiatry,andmoresoin
somequartersthanothers.[5]
https://en.wikipedia.org/wiki/Psychoanalysis
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Contents
1 History
1.1 1890s
1.2 19001940s
1.3 1940spresent
2 Theories
2.1 Topographictheory
2.2 Structuraltheory
2.3 Egopsychology
2.3.1 Modernconflicttheory
2.3.2 Objectrelationstheory
2.3.3 Selfpsychology
2.3.4 JacquesLacanandLacanianpsychoanalysis
2.3.5 Interpersonalpsychoanalysis
2.3.6 Culturalistpsychoanalysis
2.3.7 Feministpsychoanalysis
2.3.8 Adaptiveparadigmofpsychoanalysisandpsychotherapy
2.3.9 Relationalpsychoanalysis
2.3.10 Interpersonalrelationalpsychoanalysis
2.3.11 Intersubjectivepsychoanalysis
2.3.12 Modernpsychoanalysis
3 Psychopathology(mentaldisturbances)
3.1 Adultpatients
3.2 Childhoodorigins
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4 Treatment
4.1 Techniques
4.1.1 Variationsintechnique
4.2 Grouptherapyandplaytherapy
4.3 Culturalvariations
4.4 Costandlengthoftreatment
5 Trainingandresearch
5.1 PsychoanalysisinBritain
5.2 Research
6 Evaluationofeffectiveness
7 Criticism
7.1 Asafieldofscience
7.2 Freudiantheory
8 Seealso
9 References
10 Literature
11 Analyses,discussionsandcritiques
12 Responsestocritiques
13 Externallinks
History
1890s
TheideaofpsychoanalysisfirststartedtoreceiveseriousattentionunderSigmundFreud,whoformulated
hisowntheoryofpsychoanalysisinViennainthe1890s.Freudwasaneurologisttryingtofindaneffective
treatmentforpatientswithneuroticorhystericalsymptoms.Freudrealisedthattherewerementalprocesses
thatwerenotconscious,whilsthewasemployedasaneurologicalconsultantattheChildren'sHospital,
wherehenoticedthatmanyaphasicchildrenhadnoapparentorganiccausefortheirsymptoms.Hethen
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wroteamonographaboutthissubject.[6]In1885,FreudobtainedagranttostudywithJeanMartinCharcot,
afamedneurologist,attheSalptrireinParis,whereFreudfollowedtheclinicalpresentationsofCharcot,
particularlyintheareasofhysteria,paralysesandtheanaesthesias.Charcothadintroducedhypnotismasan
experimentalresearchtoolanddevelopedthephotographicrepresentationofclinicalsymptoms.
Freud'sfirsttheorytoexplainhystericalsymptomswaspresentedinStudiesonHysteria(1895),co
authoredwithhismentorthedistinguishedphysicianJosefBreuer,whichwasgenerallyseenasthebirthof
psychoanalysis.TheworkwasbasedonBreuer'streatmentofBerthaPappenheim,referredtoincase
studiesbythepseudonym"AnnaO.",treatmentwhichPappenheimherselfhaddubbedthe"talkingcure".
Breuerwrotethatmanyfactorsthatcouldresultinsuchsymptoms,includingvarioustypesofemotional
trauma,andhealsocreditedworkbyotherssuchasPierreJanetwhileFreudcontendedthatattherootof
hystericalsymptomswererepressedmemoriesofdistressingoccurrences,almostalwayshavingdirector
indirectsexualassociations.[7]
AroundthesametimeFreudattemptedtodevelopaneurophysiologicaltheoryofunconsciousmental
mechanisms,whichhesoongaveup.Itremainedunpublishedinhislifetime.[8]
In1896Freudpublishedhissocalledseductiontheorywhichproposedthatthepreconditionsforhysterical
symptomsaresexualexcitationsininfancy,andheclaimedtohaveuncoveredrepressedmemoriesof
incidentsofsexualabuseforallhiscurrentpatients.[9]However,by1898hehadprivatelyacknowledgedto
hisfriendandcolleagueWilhelmFliessthathenolongerbelievedinhistheory,thoughhedidnotstatethis
publiclyuntil1906.[10]Thoughin1896hehadreportedthathispatients"hadnofeelingofrememberingthe
[infantilesexual]scenes",andassuredhim"emphaticallyoftheirunbelief",[11]inlateraccountsheclaimed
thattheyhadtoldhimthattheyhadbeensexuallyabusedininfancy.Thisbecamethereceivedhistorical
accountuntilchallengedbyseveralFreudscholarsinthelatterpartofthe20thcenturywhoarguedthathe
hadimposedhispreconceivednotionsonhispatients.[12][13][14]However,buildingonhisclaimsthatthe
patientsreportedinfantilesexualabuseexperiences,Freudsubsequentlycontendedthathisclinicalfindings
inthemid1890sprovidedevidenceoftheoccurrenceofunconsciousfantasies,supposedlytocoverup
memoriesofinfantilemasturbation.[15]Onlymuchlaterdidheclaimthesamefindingsasevidencefor
Oedipaldesires.[16]
19001940s
By1900,Freudhadtheorisedthatdreamshadsymbolicsignificance,andgenerallywerespecifictothe
dreamer.Freudformulatedhissecondpsychologicaltheorywhichhypothesisesthattheunconscioushas
orisa"primaryprocess"consistingofsymbolicandcondensedthoughts,anda"secondaryprocess"of
logical,consciousthoughts.Thistheorywaspublishedinhis1900book,TheInterpretationofDreams.[17]
ChapterVIIwasareworkingoftheearlier"Project"andFreudoutlinedhis"TopographicTheory".Inthis
theory,whichwasmostlylatersupplantedbytheStructuralTheory,unacceptablesexualwisheswere
repressedintothe"SystemUnconscious",unconsciousduetosociety'scondemnationofpremaritalsexual
activity,andthisrepressioncreatedanxiety.
This"topographictheory"isstillpopularinmuchofEurope,althoughithasfallenoutoffavourinmuchof
NorthAmerica.[18]In1905,FreudpublishedThreeEssaysontheTheoryofSexuality[19]inwhichhelaid
outhisdiscoveryofsocalledpsychosexualphases:oral(ages02),anal(24),phallicoedipal(today
called1stgenital)(36),latency(6puberty),andmaturegenital(pubertyonward).Hisearlyformulation
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includedtheideathatbecauseofsocietalrestrictions,
sexualwisheswererepressedintoanunconsciousstate,
andthattheenergyoftheseunconsciouswishescouldbe
turnedintoanxietyorphysicalsymptoms.Therefore,the
earlytreatmenttechniques,includinghypnotismand
abreaction,weredesignedtomaketheunconscious
consciousinordertorelievethepressureandthe
apparentlyresultingsymptoms.
InOnNarcissism(1915)[20]Freudturnedhisattentionto
thesubjectofnarcissism.Stillusinganenergicsystem,
Freudcharacterizedthedifferencebetweenenergydirected
attheselfversusenergydirectedatothers,calledcathexis.
InternationalPsychoanalyticCongress.
By1917,in"MourningandMelancholia",hesuggested
Photograph,1911.FreudandJunginthecenter
thatcertaindepressionswerecausedbyturningguilt
riddenangerontheself.[21]In1919in"AChildisBeing
Beaten"hebegantoaddresstheproblemsofselfdestructivebehavior(moralmasochism)andfranksexual
masochism.[22]Basedonhisexperiencewithdepressedandselfdestructivepatients,andponderingthe
carnageofWorldWarI,Freudbecamedissatisfiedwithconsideringonlyoralandsexualmotivationsfor
behavior.By1920,Freudaddressedthepowerofidentification(withtheleaderandwithothermembers)in
groupsasamotivationforbehavior(GroupPsychologyandtheAnalysisoftheEgo).[23]Inthatsameyear
(1920)Freudsuggestedhis"dualdrive"theoryofsexualityandaggressioninBeyondthePleasure
Principle,totrytobegintoexplainhumandestructiveness.Also,itwasthefirstappearanceofhis
"structuraltheory"consistingthreenewconceptsid,ego,andsuperego.[24]
Threeyearslater,hesummarisedtheideasofid,ego,andsuperegoinabookentitled,TheEgoandthe
Id.[25]Inthebook,herevisedthewholetheoryofmentalfunctioning,nowconsideringthatrepressionwas
onlyoneofmanydefensemechanisms,andthatitoccurredtoreduceanxiety.Hence,Freudcharacterised
repressionasbothacauseandaresultofanxiety.In1926,inInhibitions,SymptomsandAnxiety,Freud
characterisedhowintrapsychicconflictamongdriveandsuperego(wishesandguilt)causedanxiety,and
howthatanxietycouldleadtoaninhibitionofmentalfunctions,suchasintellectandspeech.[26]
Inhibitions,SymptomsandAnxietywaswritteninresponsetoOttoRank,who,in1924,publishedDas
TraumaderGeburt(translatedintoEnglishin1929asTheTraumaofBirth),analysinghowart,myth,
religion,philosophyandtherapywereilluminatedbyseparationanxietyinthe"phasebeforethe
developmentoftheOedipuscomplex"(p.216)[27]Freud'stheories,however,characterizednosuchphase.
AccordingtoFreud,theOedipuscomplex,wasatthecentreofneurosis,andwasthefoundationalsourceof
allart,myth,religion,philosophy,therapyindeedofallhumancultureandcivilization.Itwasthefirst
timethatanyoneintheinnercirclehadcharacterisedsomethingotherthantheOedipuscomplexas
contributingtointrapsychicdevelopment,anotionthatwasrejectedbyFreudandhisfollowersatthetime.
By1936,the"PrincipleofMultipleFunction"wasclarifiedbyRobertWaelder.[28]Hewidenedthe
formulationthatpsychologicalsymptomswerecausedbyandrelievedconflictsimultaneously.Moreover,
symptoms(suchasphobiasandcompulsions)eachrepresentedelementsofsomedrivewish(sexualand/or
aggressive),superego,anxiety,reality,anddefenses.Alsoin1936,AnnaFreud,Sigmund'sfamous
daughter,publishedherseminalbook,TheEgoandtheMechanismsofDefense,outliningnumerousways
themindcouldshutupsettingthingsoutofconsciousness.[29]
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1940spresent
WhenHitler'spowergrew,theFreudfamilyandmanyoftheircolleaguesflewtoLondon.Withinayear
SigmundFreuddied.[30]IntheUnitedStates,alsofollowingthedeathofFreud,anewgroupof
psychoanalystsbegantoexplorethefunctionoftheego.LedbyHeinzHartmann,Kris,Rappaportand
Lowenstein,thegroupbuiltuponunderstandingsofthesyntheticfunctionoftheegoasamediatorin
psychicfunctioning.Hartmanninparticulardistinguishedbetweenautonomousegofunctions(suchas
memoryandintellectwhichcouldbesecondarilyaffectedbyconflict)andsyntheticfunctionswhichwerea
resultofcompromiseformation.These"EgoPsychologists"ofthe1950spavedawaytofocusanalytic
workbyattendingtothedefenses(mediatedbytheego)beforeexploringthedeeperrootstothe
unconsciousconflicts.Inadditiontherewasburgeoninginterestinchildpsychoanalysis.Although
criticizedsinceitsinception,psychoanalysishasbeenusedasaresearchtoolintochildhood
development,[31]andisstillusedtotreatcertainmentaldisturbances.[32]Inthe1960s,Freud'searly
thoughtsonthechildhooddevelopmentoffemalesexualitywerechallengedthischallengeledtothe
developmentofavarietyofunderstandingsoffemalesexualdevelopment,manyofwhichmodifiedthe
timingandnormalityofseveralofFreud'stheories(whichhadbeengleanedfromthetreatmentofwomen
withmentaldisturbances).Severalresearchers[33]followedKarenHorney'sstudiesofsocietalpressuresthat
influencethedevelopmentofwomen.
Inthefirstdecadeofthe21stcentury,therewereapproximately35traininginstitutesforpsychoanalysisin
theUnitedStatesaccreditedbytheAmericanPsychoanalyticAssociation(APsaA),whichisacomponent
organizationoftheInternationalPsychoanalyticalAssociation(IPA),andthereareover3000graduated
psychoanalystspracticingintheUnitedStates.TheIPAaccreditspsychoanalytictrainingcentersthrough
such"componentorganisations"throughouttherestoftheworld,includingcountriessuchasSerbia,
France,Germany,Austria,Italy,Switzerland,[34]andmanyothers,aswellasaboutsixinstitutesdirectlyin
theU.S.
Theories
Thepredominantpsychoanalytictheoriescanbeorganisedintoseveraltheoreticalschools.Althoughthese
theoreticalschoolsdiffer,mostofthememphasizetheinfluenceofunconsciouselementsontheconscious.
Therehasalsobeenconsiderableworkdoneonconsolidatingelementsofconflictingtheories(cf.thework
ofTheodoreDorpat,B.Killingmo,andS.Akhtar).[35]Asinallfieldsofmedicine,therearesomepersistent
conflictsregardingspecificcausesofcertainsyndromes,anddisputesregardingtheidealtreatment
techniques.Inthe21stcentury,psychoanalyticideasareembeddedinWesternculture,especiallyinfields
suchaschildcare,education,literarycriticism,culturalstudies,andmentalhealth,particularly
psychotherapy.Thoughthereisamainstreamofevolvedanalyticideas,therearegroupswhofollowthe
preceptsofoneormoreofthelatertheoreticians.Psychoanalyticideasalsoplayrolesinsometypesof
literaryanalysissuchasArchetypalliterarycriticism.
Topographictheory
TopographictheorywasnamedandfirstdescribedbySigmundFreudinTheInterpretationofDreams
(1900).[36][37]ThetheoryhypothesizesthatthementalapparatuscanbedividedintothesystemsConscious,
Preconscious,andUnconscious.Thesesystemsarenotanatomicalstructuresofthebrainbut,rather,mental
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processes.AlthoughFreudretainedthistheorythroughouthislifehelargelyreplaceditwiththeStructural
theory.[38]TheTopographictheoryremainsasoneofthemetapsychologicalpointsofviewfordescribing
howthemindfunctionsinclassicalpsychoanalytictheory.
Structuraltheory
Structuraltheorydividesthepsycheintotheid,theego,andthesuperego.Theidispresentatbirthasthe
repositoryofbasicinstincts,whichFreudcalled"Triebe"("drives"):unorganizedandunconscious,it
operatesmerelyonthe'pleasureprinciple',withoutrealismorforesight.Theegodevelopsslowlyand
gradually,beingconcernedwithmediatingbetweentheurgingoftheidandtherealitiesoftheexternal
worlditthusoperatesonthe'realityprinciple'.Thesuperegoisheldtobethepartoftheegoinwhichself
observation,selfcriticismandotherreflectiveandjudgmentalfacultiesdevelop.Theegoandthesuperego
arebothpartlyconsciousandpartlyunconscious.[38]
Egopsychology
EgopsychologywasinitiallysuggestedbyFreudinInhibitions,SymptomsandAnxiety(1926).Thetheory
wasrefinedbyHartmann,Loewenstein,andKrisinaseriesofpapersandbooksfrom1939throughthelate
1960s.LeoBellakwasalatercontributor.Thisseriesofconstructs,parallelingsomeofthelater
developmentsofcognitivetheory,includesthenotionsofautonomousegofunctions:mentalfunctionsnot
dependent,atleastinorigin,onintrapsychicconflict.Suchfunctionsinclude:sensoryperception,motor
control,symbolicthought,logicalthought,speech,abstraction,integration(synthesis),orientation,
concentration,judgmentaboutdanger,realitytesting,adaptiveability,executivedecisionmaking,hygiene,
andselfpreservation.Freudnotedthatinhibitionisonemethodthatthemindmayutilizetointerferewith
anyofthesefunctionsinordertoavoidpainfulemotions.Hartmann(1950s)pointedoutthattheremaybe
delaysordeficitsinsuchfunctions.
Frosch(1964)describeddifferencesinthosepeoplewhodemonstrateddamagetotheirrelationshipto
reality,butwhoseemedabletotestit.Deficitsinthecapacitytoorganizethoughtaresometimesreferredto
asblockingorlooseassociations(Bleuler),andarecharacteristicofschizophrenia.Deficitsinabstraction
abilityandselfpreservationalsosuggestpsychosisinadults.Deficitsinorientationandsensoriumareoften
indicativeofamedicalillnessaffectingthebrain(andtherefore,autonomousegofunctions).Deficitsin
certainegofunctionsareroutinelyfoundinseverelysexuallyorphysicallyabusedchildren,wherepowerful
effectsgeneratedthroughoutchildhoodseemtohaveerodedsomefunctionaldevelopment.
Accordingtoegopsychology,egostrengths,laterdescribedbyKernberg(1975),includethecapacitiesto
controloral,sexual,anddestructiveimpulsestotoleratepainfuleffectswithoutfallingapartandtoprevent
theeruptionintoconsciousnessofbizarresymbolicfantasy.Syntheticfunctions,incontrasttoautonomous
functions,arisefromthedevelopmentoftheegoandservethepurposeofmanagingconflictprocesses.
Defensesaresyntheticfunctionsthatprotecttheconsciousmindfromawarenessofforbiddenimpulsesand
thoughts.Onepurposeofegopsychologyhasbeentoemphasizethatsomementalfunctionscanbe
consideredtobebasic,ratherthanderivativesofwishes,affects,ordefenses.However,autonomousego
functionscanbesecondarilyaffectedbecauseofunconsciousconflict.Forexample,apatientmayhavean
hystericalamnesia(memorybeinganautonomousfunction)becauseofintrapsychicconflict(wishingnotto
rememberbecauseitistoopainful).
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Takentogether,theabovetheoriespresentagroupofmetapsychologicalassumptions.Therefore,the
inclusivegroupofthedifferentclassicaltheoriesprovidesacrosssectionalviewofhumanmentation.
Therearesix"pointsofview",fivedescribedbyFreudandasixthaddedbyHartmann.Unconscious
processescanthereforebeevaluatedfromeachofthesesixpointsofview.The"pointsofview"are:1.
Topographic2.Dynamic(thetheoryofconflict)3.Economic(thetheoryofenergyflow)4.Structural5.
Genetic(propositionsconcerningoriginanddevelopmentofpsychologicalfunctions)and6.Adaptational
(psychologicalphenomenaasitrelatestotheexternalworld).[39]
Modernconflicttheory
Modernconflicttheory,avariationofegopsychology,isarevisedversionofstructuraltheory,most
notablydifferentbyalteringconceptsrelatedtowhererepressedthoughtswerestored(Freud,1923,1926).
Modernconflicttheorycentersaroundhowemotionalsymptomsandcharactertraitsarecomplexsolutions
tomentalconflict.[40]Itdispenseswiththeconceptsofafixedid,egoandsuperego,andinsteadposits
consciousandunconsciousconflictamongwishes(dependent,controlling,sexual,andaggressive),guilt
andshame,emotions(especiallyanxietyanddepressiveaffect),anddefensiveoperationsthatshutofffrom
consciousnesssomeaspectoftheothers.Moreover,healthyfunctioning(adaptive)isalsodetermined,toa
greatextent,byresolutionsofconflict.
Amajorobjectiveofmodernconflicttheorypsychoanalysisistochangethebalanceofconflictinapatient
bymakingaspectsofthelessadaptivesolutions(alsocalled"compromiseformations")conscioussothat
theycanberethought,andmoreadaptivesolutionsfound.CurrenttheoreticiansfollowingBrenner'smany
suggestions(seeespeciallyBrenner's1982book,TheMindinConflict)includeSandorAbend,MD(Abend,
Porder,&Willick,(1983),BorderlinePatients:ClinicalPerspectives),JacobArlow(ArlowandBrenner
(1964),PsychoanalyticConceptsandtheStructuralTheory),andJeromeBlackman(2003),101Defenses:
HowtheMindShieldsItself.
Objectrelationstheory
Objectrelationstheoryattemptstoexplaintheupsanddownsofhumanrelationshipsthroughastudyof
howinternalrepresentationsoftheselfandothersareorganized.Theclinicalsymptomsthatsuggestobject
relationsproblems(typicallydevelopmentaldelaysthroughoutlife)includedisturbancesinanindividual's
capacitytofeelwarmth,empathy,trust,senseofsecurity,identitystability,consistentemotionalcloseness,
andstabilityinrelationshipswithsignificantothers.(Itisnotsuggestedthatoneshouldtrusteveryone,for
example.)Conceptsregardinginternalrepresentations(alsosometimestermed,"introspects","selfand
objectrepresentations",or"internalizationofselfandother")althoughoftenattributedtoMelanieKlein,
wereactuallyfirstmentionedbySigmundFreudinhisearlyconceptsofdrivetheory(ThreeEssaysonthe
TheoryofSexuality,1905).Freud's1917paper"MourningandMelancholia",forexample,hypothesized
thatunresolvedgriefwascausedbythesurvivor'sinternalizedimageofthedeceasedbecomingfusedwith
thatofthesurvivor,andthenthesurvivorshiftingunacceptableangertowardthedeceasedontothenow
complexselfimage.[41]
VamikVolkan,in"LinkingObjectsandLinkingPhenomena",expandedonFreud'sthoughtsonthis,
describingthesyndromesof"Establishedpathologicalmourning"vs."reactivedepression"basedonsimilar
dynamics.MelanieKlein'shypothesesregardinginternalizationduringthefirstyearoflife,leadingto
paranoidanddepressivepositions,werelaterchallengedbyRenSpitz(e.g.,TheFirstYearofLife,1965),
whodividedthefirstyearoflifeintoacoenestheticphaseofthefirstsixmonths,andthenadiacriticphase
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forthesecondsixmonths.MargaretMahler(Mahler,Fine,andBergman,ThePsychologicalBirthofthe
HumanInfant,1975)andhergroup,firstinNewYork,theninPhiladelphia,describeddistinctphasesand
subphasesofchilddevelopmentleadingto"separationindividuation"duringthefirstthreeyearsoflife,
stressingtheimportanceofconstancyofparentalfigures,inthefaceofthechild'sdestructiveaggression,to
thechild'sinternalizations,stabilityofaffectmanagement,andabilitytodevelophealthyautonomy.
JohnFrosch,OttoKernberg,SalmanAkhtarandSheldonBachhavedevelopedthetheoryofselfandobject
constancyasitaffectsadultpsychiatricproblemssuchaspsychosisandborderlinestates.PeterBlos
described(inabookcalledOnAdolescence,1960)howsimilarseparationindividuationstrugglesoccur
duringadolescence,ofcoursewithadifferentoutcomefromthefirstthreeyearsoflife:theteenusually,
eventually,leavestheparents'house(thisvarieswiththeculture).Duringadolescence,ErikErikson(1950
1960s)describedthe"identitycrisis",thatinvolvesidentitydiffusionanxiety.Inorderforanadulttobe
abletoexperience"WarmETHICS"(warmth,empathy,trust,holdingenvironment(Winnicott),identity,
closeness,andstability)inrelationships(seeBlackman,101Defenses:HowtheMindShieldsItself,2001),
theteenagermustresolvetheproblemswithidentityandredevelopselfandobjectconstancy.
Selfpsychology
Selfpsychologyemphasizesthedevelopmentofastableandintegratedsenseofselfthroughempathic
contactswithotherhumans,primarysignificantothersconceivedofas"selfobjects".Selfobjectsmeetthe
developingself'sneedsformirroring,idealization,andtwinship,andtherebystrengthenthedevelopingself.
Theprocessoftreatmentproceedsthrough"transmutinginternalizations"inwhichthepatientgradually
internalizestheselfobjectfunctionsprovidedbythetherapist.Selfpsychologywasproposedoriginallyby
HeinzKohut,andhasbeenfurtherdevelopedbyArnoldGoldberg,FrankLachmann,PaulandAnna
Ornstein,MarianTolpin,andothers.
JacquesLacanandLacanianpsychoanalysis
Lacanianpsychoanalysis,whichintegratespsychoanalysiswithstructurallinguisticsandHegelian
philosophy,isespeciallypopularinFranceandpartsofLatinAmerica.Lacanianpsychoanalysisisa
departurefromthetraditionalBritishandAmericanpsychoanalysis,whichispredominantlyEgo
psychology.JacquesLacanfrequentlyusedthephrase"retournerFreud"("returntoFreud")inhis
seminarsandwritings,asheclaimedthathistheorieswereanextensionofFreud'sown,contrarytothoseof
AnnaFreud,theEgoPsychology,objectrelationsand"self"theoriesandalsoclaimsthenecessityof
readingFreud'scompleteworks,notonlyapartofthem.Lacan'sconceptsconcernthe"mirrorstage",the
"Real",the"Imaginary",andthe"Symbolic",andtheclaimthat"theunconsciousisstructuredasa
language".[42]
ThoughamajorinfluenceonpsychoanalysisinFranceandpartsofLatinAmerica,Lacanandhisideas
havetakenlongertobetranslatedintoEnglishandhehasthushadalesserimpactonpsychoanalysisand
psychotherapyintheEnglishspeakingworld.IntheUKandtheUS,hisideasaremostwidelyusedto
analyzetextsinliterarytheory.[43]DuetohisincreasinglycriticalstancetowardsthedeviationfromFreud's
thought,oftensinglingoutparticulartextsandreadingsfromhiscolleagues,Lacanwasexcludedfrom
actingasatraininganalystintheIPA,thusleadinghimtocreatehisownschoolinordertomaintainan
institutionalstructureforthemanycandidateswhodesiredtocontinuetheiranalysiswithhim.[44]
Interpersonalpsychoanalysis
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Interpersonalpsychoanalysisaccentsthenuancesofinterpersonalinteractions,particularlyhowindividuals
protectthemselvesfromanxietybyestablishingcollusiveinteractionswithothers,andtherelevanceof
actualexperienceswithotherpersonsdevelopmentally(e.g.familyandpeers)aswellasinthepresent.This
iscontrastedwiththeprimacyofintrapsychicforces,asinclassicalpsychoanalysis.Interpersonaltheory
wasfirstintroducedbyHarryStackSullivan,MD,anddevelopedfurtherbyFriedaFrommReichmann,
ClaraThompson,ErichFromm,andotherswhocontributedtothefoundingoftheWilliamAlansonWhite
InstituteandInterpersonalPsychoanalysisingeneral.
Culturalistpsychoanalysis
Somepsychoanalystshavebeenlabeledculturalist,becauseoftheprominencetheyattributedcultureinthe
genesisofbehavior.[45]Amongothers,ErichFromm,KarenHorney,HarryStackSullivan,havebeen
calledculturalistpsychoanalysts.[45]Theywerefamouslyinconflictwithorthodoxpsychoanalysts.[46]
Feministpsychoanalysis
Feministtheoriesofpsychoanalysisemergedtowardsthesecondhalfofthe20thcentury,inaneffortto
articulatethefeminine,thematernalandsexualdifferenceanddevelopmentfromthepointofviewof
femalesubjects.ForFreud,maleissubjectandfemaleisobject.ForFreud,Winnicottandtheobject
relationstheories,themotherisstructuredastheobjectoftheinfant'srejection(Freud)anddestruction
(Winnicott).ForLacan,thewomancaneitheracceptthephallicsymbolicasanobjectorincarnatealack
inthesymbolicdimensionthatinformsthestructureofthehumansubject.Feministpsychoanalysisis
mainlypostFreudianandpostLacanianwiththeoristslikeTorilMoi,JoanCopjec,JulietMitchell,[47]
TeresaBrennan[48]andGriseldaPollockthatrethinksArtandMythology[49]followingFrenchfeminist
psychoanalysis,[50]thegazeandsexualdifferencein,ofandfromthefeminine.[51]Frenchtheoristslike
LuceIrigaraychallengesthephallogocentrism.[52][53]BrachaEttingeroffersa"matrixial"subject's
dimensionthatbringsintoaccounttheprenatalstage(matrixialconnectivity)[54]andsuggestsafeminine
maternalEros,matrixialgazeandPrimalmotherphantasies.[55]JessicaBenjaminaddressesthequestionof
thefeminineandlove.[56]Feministpsychoanalysisinformsandincludesgender,queerandpostfeminist
theories.
Adaptiveparadigmofpsychoanalysisandpsychotherapy
TheadaptiveparadigmofpsychotherapydevelopsoutoftheworkofRobertLangs.Theadaptive
paradigminterpretspsychicconflictprimarilyintermsofconsciousandunconsciousadaptationtoreality.
LangsrecentworkinsomemeasurereturnstotheearlierFreud,inthatLangsprefersamodifiedversionof
thetopographicmodelofthemind(conscious,preconscious,andunconscious)overthestructuralmodel
(id,ego,andsuperego),includingtheformersemphasisontrauma(thoughLangslookstodeathrelated
traumasratherthansexualtraumas).[38]Atthesametime,LangsmodeloftheminddiffersfromFreudsin
thatitunderstandsthemindintermsofevolutionarybiologicalprinciples.[57]
Relationalpsychoanalysis
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Relationalpsychoanalysiscombinesinterpersonalpsychoanalysiswithobjectrelationstheoryandwith
intersubjectivetheoryascriticalformentalhealth,wasintroducedbyStephenMitchell.[58]Relational
psychoanalysisstresseshowtheindividual'spersonalityisshapedbybothrealandimaginedrelationships
withothers,andhowtheserelationshippatternsarereenactedintheinteractionsbetweenanalystand
patient.InNewYork,keyproponentsofrelationalpsychoanalysisincludeLewAron,JessicaBenjamin,
andAdrienneHarris.FonagyandTarget,inLondon,havepropoundedtheirviewofthenecessityof
helpingcertaindetached,isolatedpatients,developthecapacityfor"mentalization"associatedwith
thinkingaboutrelationshipsandthemselves.AriettaSlade,SusanCoates,andDanielSchechterinNew
Yorkhaveadditionallycontributedtotheapplicationofrelationalpsychoanalysistotreatmentoftheadult
patientasparent,theclinicalstudyofmentalizationinparentinfantrelationships,andtheintergenerational
transmissionofattachmentandtrauma.
Interpersonalrelationalpsychoanalysis
Theterminterpersonalrelationalpsychoanalysisisoftenusedasaprofessionalidentification.
Psychoanalystsunderthisbroaderumbrelladebateaboutwhatpreciselyarethedifferencesbetweenthetwo
schools,withoutanycurrentclearconsensus.
Intersubjectivepsychoanalysis
Theterm"intersubjectivity"wasintroducedinpsychoanalysisbyGeorgeE.AtwoodandRobertStolorow
(1984).Intersubjectiveapproachesemphasizehowbothpersonalitydevelopmentandthetherapeutic
processareinfluencedbytheinterrelationshipbetweenthepatient'ssubjectiveperspectiveandthatof
others.Theauthorsoftheinterpersonalrelationalandintersubjectiveapproaches:OttoRank,HeinzKohut,
StephenA.Mitchell,JessicaBenjamin,BernardBrandchaft,J.Fosshage,DonnaM.Orange,Arnold"Arnie"
Mindell,ThomasOgden,OwenRenik,IrwinZ.Hoffman,HaroldSearles,ColwynTrewarthen,EdgarA.
Levenson,JayR.Greenberg,EdwardR.Ritvo,BeatriceBeebe,FrankM.Lachmann,HerbertRosenfeld
andDanielStern.
Modernpsychoanalysis
"Modernpsychoanalysis"isatermcoinedbyHymanSpotnitzandhiscolleaguestodescribeabodyof
theoreticalandclinicalapproachesthataimtoextendFreud'stheoriessoastomakethemapplicabletothe
fullspectrumofemotionaldisordersandbroadenthepotentialfortreatmenttopathologiesthoughttobe
untreatablebyclassicalmethods.Interventionsbasedonthisapproachareprimarilyintendedtoprovidean
emotionalmaturationalcommunicationtothepatient,ratherthantopromoteintellectualinsight.These
interventions,beyondinsightdirectedaims,areusedtoresolveresistancesthatarepresentedintheclinical
setting.ThisschoolofpsychoanalysishasfosteredtrainingopportunitiesforstudentsintheUnitedStates
andfromcountriesworldwide.ItsjournalModernPsychoanalysishasbeenpublishedsince1976.[59]
Psychopathology(mentaldisturbances)
Adultpatients
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Thevariouspsychosesinvolvedeficitsintheautonomousegofunctions(seeabove)ofintegration
(organization)ofthought,inabstractionability,inrelationshiptorealityandinrealitytesting.In
depressionswithpsychoticfeatures,theselfpreservationfunctionmayalsobedamaged(sometimesby
overwhelmingdepressiveaffect).Becauseoftheintegrativedeficits(oftencausingwhatgeneral
psychiatristscall"looseassociations","blocking","flightofideas","verbigeration",and"thought
withdrawal"),thedevelopmentofselfandobjectrepresentationsisalsoimpaired.Clinically,therefore,
psychoticindividualsmanifestlimitationsinwarmth,empathy,trust,identity,closenessand/orstabilityin
relationships(duetoproblemswithselfobjectfusionanxiety)aswell.
Inpatientswhoseautonomousegofunctionsaremoreintact,butwhostillshowproblemswithobject
relations,thediagnosisoftenfallsintothecategoryknownas"borderline".Borderlinepatientsalsoshow
deficits,oftenincontrollingimpulses,affects,orfantasiesbuttheirabilitytotestrealityremainsmoreor
lessintact.Adultswhodonotexperienceguiltandshame,andwhoindulgeincriminalbehavior,are
usuallydiagnosedaspsychopaths,or,usingDSMIVTR,antisocialpersonalitydisorder.
Panic,phobias,conversions,obsessions,compulsionsanddepressions(analystscallthese"neurotic
symptoms")arenotusuallycausedbydeficitsinfunctions.Instead,theyarecausedbyintrapsychic
conflicts.Theconflictsaregenerallyamongsexualandhostileaggressivewishes,guiltandshame,and
realityfactors.Theconflictsmaybeconsciousorunconscious,butcreateanxiety,depressiveaffect,and
anger.Finally,thevariouselementsaremanagedbydefensiveoperationsessentiallyshutoffbrain
mechanismsthatmakepeopleunawareofthatelementofconflict."Repression"isthetermgiventothe
mechanismthatshutsthoughtsoutofconsciousness."Isolationofaffect"isthetermusedforthe
mechanismthatshutssensationsoutofconsciousness.Neuroticsymptomsmayoccurwithorwithout
deficitsinegofunctions,objectrelations,andegostrengths.Therefore,itisnotuncommontoencounter
obsessivecompulsiveschizophrenics,panicpatientswhoalsosufferwithborderlinepersonalitydisorder,
etc.
Thissectionaboveispartialtoegopsychoanalytictheory"autonomousegofunctions".Asthe"autonomous
egofunctions"theoryisonlyatheory,itmayyetbeprovenincorrect.
Childhoodorigins
Freudiantheoriesbelievethatadultproblemscanbetracedtounresolvedconflictsfromcertainphasesof
childhoodandadolescence,causedbyfantasy,stemmingfromtheirowndrives.Freud,basedonthedata
gatheredfromhispatientsearlyinhiscareer,suspectedthatneuroticdisturbancesoccurredwhenchildren
weresexuallyabusedinchildhood(thesocalledseductiontheory).Later,Freudcametobelievethat,
althoughchildabuseoccurs,neuroticsymptomswerenotassociatedwiththis.Hebelievedthatneurotic
peopleoftenhadunconsciousconflictsthatinvolvedincestuousfantasiesderivingfromdifferentstagesof
development.Hefoundthestagefromaboutthreetosixyearsofage(preschoolyears,todaycalledthe
"firstgenitalstage")tobefilledwithfantasiesofhavingromanticrelationshipswithbothparents.
Argumentswerequicklygeneratedinearly20thcenturyViennaaboutwhetheradultseductionofchildren,
i.e.childsexualabuse,wasthebasisofneuroticillness.Therestillisnocompleteagreement,although
nowadaysprofessionalsrecognizethenegativeeffectsofchildsexualabuseonmentalhealth.[60]
Manypsychoanalystswhoworkwithchildrenhavestudiedtheactualeffectsofchildabuse,whichinclude
egoandobjectrelationsdeficitsandsevereneuroticconflicts.Muchresearchhasbeendoneonthesetypes
oftraumainchildhood,andtheadultsequelaeofthose.Instudyingthechildhoodfactorsthatstartneurotic
symptomdevelopment,Freudfoundaconstellationoffactorsthat,forliteraryreasons,hetermedthe
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Oedipuscomplex(basedontheplaybySophocles,OedipusRex,wheretheprotagonistunwittinglykillshis
fatherLaiusandmarrieshismotherJocasta).ThevalidityoftheOedipuscomplexisnowwidelydisputed
andrejected.[61][62]Theshorthandterm,"oedipal"laterexplicatedbyJosephJ.Sandlerin"Onthe
ConceptSuperego"(1960)andmodifiedbyCharlesBrennerin"TheMindinConflict"(1982)refersto
thepowerfulattachmentsthatchildrenmaketotheirparentsinthepreschoolyears.Theseattachments
involvefantasiesofsexualrelationshipswitheither(orboth)parent,and,therefore,competitivefantasies
towardeither(orboth)parents.HumbertoNagera(1975)hasbeenparticularlyhelpfulinclarifyingmanyof
thecomplexitiesofthechildthroughtheseyears.
"Positive"and"negative"oedipalconflictshavebeenattachedtotheheterosexualandhomosexualaspects,
respectively.Bothseemtooccurindevelopmentofmostchildren.Eventually,thedevelopingchild's
concessionstoreality(thattheywillneithermarryoneparentnoreliminatetheother)leadtoidentifications
withparentalvalues.Theseidentificationsgenerallycreateanewsetofmentaloperationsregardingvalues
andguilt,subsumedundertheterm"superego".Besidessuperegodevelopment,children"resolve"their
preschooloedipalconflictsthroughchannelingwishesintosomethingtheirparentsapproveof
("sublimation")andthedevelopment,duringtheschoolageyears("latency")ofageappropriateobsessive
compulsivedefensivemaneuvers(rules,repetitivegames).
Treatment
Usingthevariousanalyticandpsychologicaltechniquestoassessmentalproblems,somebelievethatthere
areparticularconstellationsofproblemsthatareespeciallysuitedforanalytictreatment(seebelow)
whereasotherproblemsmightrespondbettertomedicinesandotherinterpersonalinterventions.Tobe
treatedwithpsychoanalysis,whateverthepresentingproblem,thepersonrequestinghelpmustdemonstrate
adesiretostartananalysis.Thepersonwishingtostartananalysismusthavesomecapacityforspeechand
communication.Aswell,theyneedtobeabletohaveordeveloptrustandinsightwithinthepsychoanalytic
session.Potentialpatientsmustundergoapreliminarystageoftreatmenttoassesstheiramenabilityto
psychoanalysisatthattime,andalsotoenabletheanalysttoformaworkingpsychologicalmodel,which
theanalystwillusetodirectthetreatment.Psychoanalystsmainlyworkwithneurosisandhysteriain
particularhowever,adaptedformsofpsychoanalysisareusedinworkingwithschizophreniaandother
formsofpsychosisormentaldisorder.Finally,ifaprospectivepatientisseverelysuicidalalonger
preliminarystagemaybeemployed,sometimeswithsessionswhichhaveatwentyminutebreakinthe
middle.Therearenumerousmodificationsintechniqueundertheheadingofpsychoanalysisduetothe
individualisticnatureofpersonalityinbothanalystandpatient.
Themostcommonproblemstreatablewithpsychoanalysisinclude:phobias,conversions,compulsions,
obsessions,anxietyattacks,depressions,sexualdysfunctions,awidevarietyofrelationshipproblems(such
asdatingandmaritalstrife),andawidevarietyofcharacterproblems(forexample,painfulshyness,
meanness,obnoxiousness,workaholism,hyperseductiveness,hyperemotionality,hyperfastidiousness).The
factthatmanyofsuchpatientsalsodemonstratedeficitsabovemakesdiagnosisandtreatmentselection
difficult.
AnalyticalorganizationssuchastheIPA,APsaAandtheEuropeanFederationforPsychoanalytic
Psychotherapyhaveestablishedproceduresandmodelsfortheindicationandpracticeofpsychoanalytical
therapyfortraineesinanalysis.Thematchbetweentheanalystandthepatientcanbeviewedasanother
contributingfactorfortheindicationandcontraindicationforpsychoanalytictreatment.Theanalystdecides
whetherthepatientissuitableforpsychoanalysis.Thisdecisionmadebytheanalyst,besidesmadeonthe
usualindicationsandpathology,isalsobasedtoacertaindegreebythe"fit"betweenanalystandpatient.A
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person'ssuitabilityforanalysisatanyparticulartimeisbasedontheirdesiretoknowsomethingabout
wheretheirillnesshascomefrom.Someonewhoisnotsuitableforanalysisexpressesnodesiretoknow
moreabouttherootcausesoftheirillness.
Anevaluationmayincludeoneormoreotheranalysts'independentopinionsandwillincludediscussionof
thepatient'sfinancialsituationandinsurances.
Techniques
Thebasicmethodofpsychoanalysisisinterpretationofthepatient'sunconsciousconflictsthatare
interferingwithcurrentdayfunctioningconflictsthatarecausingpainfulsymptomssuchasphobias,
anxiety,depression,andcompulsions.Strachey(1936)stressedthatfiguringoutwaysthepatientdistorted
perceptionsabouttheanalystledtounderstandingwhatmayhavebeenforgotten(alsoseeFreud'spaper
"Repeating,Remembering,andWorkingThrough").Inparticular,unconscioushostilefeelingstowardthe
analystcouldbefoundinsymbolic,negativereactionstowhatRobertLangslatercalledthe"frame"ofthe
therapy[63]thesetupthatincludedtimesofthesessions,paymentoffees,andnecessityoftalking.In
patientswhomademistakes,forgot,orshowedotherpeculiaritiesregardingtime,fees,andtalking,the
analystcanusuallyfindvariousunconscious"resistances"totheflowofthoughts(sometimescalledfree
association).
Whenthepatientreclinesonacouchwiththeanalystoutofview,thepatienttendstoremembermore,
experiencesmoreresistanceandtransference,andisabletoreorganizethoughtsafterthedevelopmentof
insightthroughtheinterpretiveworkoftheanalyst.Althoughfantasylifecanbeunderstoodthroughthe
examinationofdreams,masturbationfantasies(cf.Marcus,I.andFrancis,J.(1975),Masturbationfrom
InfancytoSenescence)arealsoimportant.Theanalystisinterestedinhowthepatientreactstoandavoids
suchfantasies(cf.PaulGray(1994),TheEgoandtheAnalysisofDefense).[64]Variousmemoriesofearly
lifearegenerallydistortedFreudcalledthem"screenmemories"andinanycase,veryearlyexperiences
(beforeagetwo)cannotberemembered(SeethechildstudiesofEleanorGalensonon"evocative
memory").
Variationsintechnique
Thereiswhatisknownamongpsychoanalystsas"classicaltechnique",althoughFreudthroughouthis
writingsdeviatedfromthisconsiderably,dependingontheproblemsofanygivenpatient.Classical
techniquewassummarizedbyAllanCompton,MD,ascomprisinginstructions(tellingthepatienttotryto
saywhat'sontheirmind,includinginterferences)exploration(askingquestions)andclarification
(rephrasingandsummarizingwhatthepatienthasbeendescribing).Aswell,theanalystcanalsouse
confrontationtobringinganaspectoffunctioning,usuallyadefense,tothepatient'sattention.Theanalyst
thenusesavarietyofinterpretationmethods,suchasdynamicinterpretation(explaininghowbeingtoonice
guardsagainstguilt,e.g.defensevs.affect)geneticinterpretation(explaininghowapasteventis
influencingthepresent)resistanceinterpretation(showingthepatienthowtheyareavoidingtheir
problems)transferenceinterpretation(showingthepatientwaysoldconflictsariseincurrentrelationships,
includingthatwiththeanalyst)ordreaminterpretation(obtainingthepatient'sthoughtsabouttheirdreams
andconnectingthiswiththeircurrentproblems).Analystscanalsousereconstructiontoestimatewhatmay
havehappenedinthepastthatcreatedsomecurrentissue.
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Thesetechniquesareprimarilybasedonconflicttheory(seeabove).Asobjectrelationstheoryevolved,
supplementedbytheworkofBowlby,Ainsworth,andBeebe,techniqueswithpatientswhohadmore
severeproblemswithbasictrust(Erikson,1950)andahistoryofmaternaldeprivation(seetheworksof
AugustaAlpert)ledtonewtechniqueswithadults.Thesehavesometimesbeencalledinterpersonal,
intersubjective(cf.Stolorow),relational,orcorrectiveobjectrelationstechniques.Thesetechniquesinclude
expressinganempathicattunementtothepatientorwarmthexposingabitoftheanalyst'spersonallifeor
attitudestothepatientallowingthepatientautonomyintheformofdisagreementwiththeanalyst(cf.I.H.
Paul,LetterstoSimon.)andexplainingthemotivationsofotherswhichthepatientmisperceives.Ego
psychologicalconceptsofdeficitinfunctioningledtorefinementsinsupportivetherapy.Thesetechniques
areparticularlyapplicabletopsychoticandnearpsychotic(cf.,EricMarcus,"PsychosisandNear
psychosis")patients.Thesesupportivetherapytechniquesincludediscussionsofrealityencouragementto
stayalive(includinghospitalization)psychotropicmedicinestorelieveoverwhelmingdepressiveaffector
overwhelmingfantasies(hallucinationsanddelusions)andadviceaboutthemeaningsofthings(tocounter
abstractionfailures).
Thenotionofthe"silentanalyst"hasbeencriticized.Actually,theanalystlistensusingArlow'sapproachas
setoutin"TheGenesisofInterpretation"),usingactiveinterventiontointerpretresistances,defenses
creatingpathology,andfantasies.Silenceisnotatechniqueofpsychoanalysis(alsoseethestudiesand
opinionpapersofOwenRenik,MD)."Analyticneutrality"isaconceptthatdoesnotmeantheanalystis
silent.Itreferstotheanalyst'spositionofnottakingsidesintheinternalstrugglesofthepatient.For
example,ifapatientfeelsguilty,theanalystmightexplorewhatthepatienthasbeendoingorthinkingthat
causestheguilt,butnotreassurethepatientnottofeelguilty.Theanalystmightalsoexplorethe
identificationswithparentsandothersthatledtotheguilt.
InterpersonalRelationalpsychoanalystsemphasizethenotionthatitisimpossibletobeneutral.Sullivan
introducedtheterm"participantobserver"toindicatetheanalystinevitablyinteractswiththeanalysand,
andsuggestedthedetailedinquiryasanalternativetointerpretation.Thedetailedinquiryinvolvesnoting
wheretheanalysandisleavingoutimportantelementsofanaccountandnotingwhenthestoryis
obfuscated,andaskingcarefulquestionstoopenupthedialogue.
Grouptherapyandplaytherapy
Althoughsingleclientsessionsremainthenorm,psychoanalytictheoryhasbeenusedtodevelopother
typesofpsychologicaltreatment.PsychoanalyticgrouptherapywaspioneeredbyTrigantBurrow,Joseph
Pratt,PaulF.Schilder,SamuelR.Slavson,HarryStackSullivan,andWolfe.Childcenteredcounselingfor
parentswasinstitutedearlyinanalytichistorybyFreud,andwaslaterfurtherdevelopedbyIrwinMarcus,
EdithSchulhofer,andGilbertKliman.Psychoanalyticallybasedcouplestherapyhasbeenpromulgatedand
explicatedbyFredSander,MD.Techniquesandtoolsdevelopedinthefirstdecadeofthe21stcenturyhave
madepsychoanalysisavailabletopatientswhowerenottreatablebyearliertechniques.Thismeantthatthe
analyticsituationwasmodifiedsothatitwouldbemoresuitableandmorelikelytobehelpfulforthese
patients.M.N.Eagle(2007)believesthatpsychoanalysiscannotbeaselfcontaineddisciplinebutinstead
mustbeopentoinfluencefromandintegrationwithfindingsandtheoryfromotherdisciplines.[65]
Psychoanalyticconstructshavebeenadaptedforusewithchildrenwithtreatmentssuchasplaytherapy,art
therapy,andstorytelling.Throughouthercareer,fromthe1920sthroughthe1970s,AnnaFreudadapted
psychoanalysisforchildrenthroughplay.Thisisstillusedtodayforchildren,especiallythosewhoare
preadolescent(seeLeonHoffman,NewYorkPsychoanalyticInstituteCenterforChildren).Usingtoysand
games,childrenareabletodemonstrate,symbolically,theirfears,fantasies,anddefensesalthoughnot
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identical,thistechnique,inchildren,isanalogoustotheaimoffreeassociationinadults.Psychoanalytic
playtherapyallowsthechildandanalysttounderstandchildren'sconflicts,particularlydefensessuchas
disobedienceandwithdrawal,thathavebeenguardingagainstvariousunpleasantfeelingsandhostile
wishes.Inarttherapy,thecounselormayhaveachilddrawaportraitandthentellastoryabouttheportrait.
Thecounselorwatchesforrecurringthemesregardlessofwhetheritiswithartortoys.
Culturalvariations
Psychoanalysiscanbeadaptedtodifferentcultures,aslongasthetherapistorcounselorunderstandsthe
client'sculture.Forexample,ToriandBlimesfoundthatdefensemechanismswerevalidinanormative
sampleof2,624Thais.Theuseofcertaindefensemechanismswasrelatedtoculturalvalues.Forexample,
Thaisvaluecalmnessandcollectiveness(becauseofBuddhistbeliefs),sotheywerelowonregressive
emotionality.PsychoanalysisalsoappliesbecauseFreudusedtechniquesthatallowedhimtogetthe
subjectiveperceptionsofhispatients.Hetakesanobjectiveapproachbynotfacinghisclientsduringhis
talktherapysessions.Hemetwithhispatientswherevertheywere,suchaswhenheusedfreeassociation
whereclientswouldsaywhatevercametomindwithoutselfcensorship.Histreatmentshadlittletono
structureformostcultures,especiallyAsiancultures.Therefore,itismorelikelythatFreudianconstructs
willbeusedinstructuredtherapy(Thompson,etal.,2004).Inaddition,Coreypostulatesthatitwillbe
necessaryforatherapisttohelpclientsdevelopaculturalidentityaswellasanegoidentity.
Costandlengthoftreatment
Thecosttothepatientofpsychoanalytictreatmentrangeswidelyfromplacetoplaceandbetween
practitioners.Lowfeeanalysisisoftenavailableinapsychoanalytictrainingclinicandgraduateschools.
Otherwise,thefeesetbyeachanalystvarieswiththeanalyst'strainingandexperience.Since,inmost
locationsintheUnitedStates,unlikeinOntarioandGermany,classicalanalysis(whichusuallyrequires
sessionsthreetofivetimesperweek)isnotcoveredbyhealthinsurance,manyanalystsmaynegotiatetheir
feeswithpatientswhomtheyfeeltheycanhelp,butwhohavefinancialdifficulties.Themodificationsof
analysis,whichincludedynamictherapy,brieftherapies,andcertaintypesofgrouptherapy(cf.Slavson,S.
R.,ATextbookinAnalyticGroupTherapy),arecarriedoutonalessfrequentbasisusuallyonce,twice,or
threetimesaweekandusuallythepatientsitsfacingthetherapist.Asaresultofthedefensemechanisms
andthelackofaccesstotheunfathomableelementsoftheunconscious,psychoanalysiscanbean
expansiveprocessthatinvolves2to5sessionsperweekforseveralyears.Thistypeoftherapyreliesonthe
beliefthatreducingthesymptomswillnotactuallyhelpwiththerootcausesorirrationaldrives.The
analysttypicallyisa'blankscreen',disclosingverylittleaboutthemselvesinorderthattheclientcanuse
thespaceintherelationshiptoworkontheirunconsciouswithoutinterferencefromoutside.
Thepsychoanalystusesvarioustechniquesasencouragementfortheclienttodevelopinsightsintotheir
behaviorandthemeaningsofsymptoms,includinginkblots,parapraxes,freeassociation,interpretation
(includingdreamanalysis),resistanceanalysisandtransferenceanalysis.
Manystudieshavealsobeendoneonbriefer"dynamic"treatmentsthesearemoreexpedienttomeasure,
andshedlightonthetherapeuticprocesstosomeextent.BriefRelationalTherapy(BRT),Brief
PsychodynamicTherapy(BPT),andTimeLimitedDynamicTherapy(TLDP)limittreatmentto2030
sessions.Onaverage,classicalanalysismaylast5.7years,butforphobiasanddepressionsuncomplicated
byegodeficitsorobjectrelationsdeficits,analysismayrunforashorterperiodoftime.Longeranalyses
areindicatedforthosewithmoreseriousdisturbancesinobjectrelations,moresymptoms,andmore
ingrainedcharacterpathology.
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Trainingandresearch
PsychoanalytictrainingintheUnitedStates,inmostlocations,involvespersonalanalytictreatmentforthe
trainee,conductedconfidentially,withnoreporttotheEducationCommitteeoftheAnalyticTraining
Instituteapproximately600hoursofclassinstruction,withastandardcurriculum,overafouryearperiod.
Classesareoftenafewhoursperweek,orforafulldayortwoeveryotherweekendduringtheacademic
yearthisvarieswiththeinstituteandsupervisiononceperweek,withasenioranalyst,oneachanalytic
treatmentcasethetraineehas.Theminimumnumberofcasesvariesbetweeninstitutes,oftentwotofour
cases.Maleandfemalecasesarerequired.Supervisionmustgoonforatleastafewyearsononeormore
cases.Supervisionisdoneinthesupervisor'soffice,wherethetraineepresentsmaterialfromtheanalytic
workthatweek,examinestheunconsciousconflictswiththesupervisor,andlearns,discusses,andis
advisedabouttechnique.
ManypsychoanalytictrainingcentersintheUnitedStateshavebeenaccreditedbyspecialcommitteesof
theAPsaAortheIPA.Becauseoftheoreticaldifferences,otherindependentinstitutesarose,usually
foundedbypsychologists,whountil1987werenotpermittedaccesstopsychoanalytictraininginstitutesof
theAPsaA.Currentlytherearebetween75and100independentinstitutesintheUnitedStates.Aswell,
otherinstitutesareaffiliatedtootherorganizationssuchastheAmericanAcademyofPsychoanalysisand
DynamicPsychiatry,andtheNationalAssociationfortheAdvancementofPsychoanalysis.Atmost
psychoanalyticinstitutesintheUnitedStates,qualificationsforentryincludeaterminaldegreeinamental
healthfield,suchasPh.D.,Psy.D.,M.S.W.,orM.D.Afewinstitutesrestrictapplicantstothosealready
holdinganM.D.orPh.D.,andmostinstitutesinSouthernCaliforniaconferaPh.D.orPsy.D.in
psychoanalysisupongraduation,whichinvolvescompletionofthenecessaryrequirementsforthestate
boardsthatconferthatdoctoraldegree.ThefirsttraininginstituteinAmericatoeducatenonmedical
psychoanalystswasTheNationalPsychologicalAssociationforPsychoanalysis.,(1978)inNewYorkCity.
ItwasfoundedbytheanalystTheodorReik.TheContemporaryFreudian(originallytheNewYork
FreudianSociety)anoffshootoftheNationalPsychologicalAssociationhasabranchinWashington,DC.
Itisacomponentsociety/instituteortheIPA.
Somepsychoanalytictraininghasbeensetupasapostdoctoralfellowshipinuniversitysettings,suchasat
DukeUniversity,YaleUniversity,NewYorkUniversity,AdelphiUniversity,andColumbiaUniversity.
Otherpsychoanalyticinstitutesmaynotbedirectlyassociatedwithuniversities,butthefacultyatthose
institutesusuallyholdcontemporaneousfacultypositionswithpsychologyPh.D.programsand/orwith
medicalschoolpsychiatryresidencyprograms.
TheIPAistheworld'sprimaryaccreditingandregulatorybodyforpsychoanalysis.Theirmissionisto
assurethecontinuedvigoranddevelopmentofpsychoanalysisforthebenefitofpsychoanalyticpatients.It
worksinpartnershipwithits70constituentorganizationsin33countriestosupport11,500members.Inthe
US,thereare77psychoanalyticalorganizations,institutesassociationsintheUnitedStates,whichare
spreadacrossthestatesofAmerica.APSaAhas38affiliatedsocietieswhichhave10ormoreactive
memberswhopracticeinagivengeographicalarea.TheaimsofAPSaAandotherpsychoanalytical
organizationsare:provideongoingeducationalopportunitiesforitsmembers,stimulatethedevelopment
andresearchofpsychoanalysis,providetrainingandorganizeconferences.Thereareeightaffiliatedstudy
groupsintheUSA(twoofthemareinLatinAmerica).Astudygroupisthefirstlevelofintegrationofa
psychoanalyticalbodywithintheIPA,followedbyaprovisionalsocietyandfinallyamembersociety.
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TheDivisionofPsychoanalysis(39)oftheAmericanPsychologicalAssociation(APA)wasestablishedin
theearly1980sbyseveralpsychologists.UntiltheestablishmentoftheDivisionofPsychoanalysis,
psychologistswhohadtrainedinindependentinstituteshadnonationalorganization.TheDivisionof
Psychoanalysisnowhasapproximately4,000membersandapproximately30localchaptersintheUnited
States.TheDivisionofPsychoanalysisholdstwoannualmeetingsorconferencesandofferscontinuing
educationintheory,researchandclinicaltechnique,asdotheiraffiliatedlocalchapters.TheEuropean
PsychoanalyticalFederation(EPF)istheorganizationwhichconsolidatesallEuropeanpsychoanalytic
societies.ThisorganizationisaffiliatedwiththeIPA.In2002therewereapproximately3,900individual
membersin22countries,speaking18differentlanguages.Therearealso25psychoanalyticsocieties.
TheAmericanAssociationofPsychoanalysisinClinicalSocialWork(AAPCSW)wasestablishedby
CraytonRowein1980asadivisionoftheFederationofClinicalSocietiesofSocialWorkandbecamean
independententityin1990.Until2007itwasknownastheNationalMembershipCommitteeon
Psychoanalysis.Theorganizationwasoriginallyfoundedbecausealthoughsocialworkersrepresentedthe
largernumberofpeoplewhoweretrainingtobepsychoanalysts,theywereunderrepresentedassupervisors
andteachersattheinstitutestheyattended.AAPCSWnowhasover1000membersandhasover20
chapters.Itholdsabiannualnationalconferenceandnumerousannuallocalconferences.
Experiencesofpsychoanalystsandpsychoanalyticpsychotherapistsandresearchintoinfantandchild
developmenthaveledtonewinsights.Theorieshavebeenfurtherdevelopedandtheresultsofempirical
researcharenowmoreintegratedinthepsychoanalytictheory.[66]
PsychoanalysisinBritain
TheLondonPsychoanalyticalSocietywasfoundedbyErnestJoneson30October1913.Withthe
expansionofpsychoanalysisintheUnitedKingdomtheSocietywasrenamedtheBritishPsychoanalytical
Societyin1919.Soonafter,theInstituteofPsychoanalysiswasestablishedtoadministertheSocietys
activities.Theseinclude:thetrainingofpsychoanalysts,thedevelopmentofthetheoryandpracticeof
psychoanalysis,theprovisionoftreatmentthroughTheLondonClinicofPsychoanalysis,thepublicationof
booksinTheNewLibraryofPsychoanalysisandPsychoanalyticIdeas.TheInstituteofPsychoanalysisalso
publishesTheInternationalJournalofPsychoanalysis,maintainsalibrary,furthersresearch,andholds
publiclectures.ThesocietyhasaCodeofEthicsandanEthicalCommittee.Thesociety,theinstituteand
theclinicarealllocatedatByronHouse.
ThesocietyisacomponentoftheIPA,abodywithmembersonallfivecontinentsthatsafeguards
professionalandethicalpractice.ThesocietyisamemberoftheBritishPsychoanalyticCouncil(BPC)the
BPCpublishesaregisterofBritishpsychoanalystsandpsychoanalyticalpsychotherapists.Allmembersof
theBritishPsychoanalyticalSocietyarerequiredtoundertakecontinuingprofessionaldevelopment.
MembersoftheSocietyhaveincludedMichaelBalint,WilfredBion,JohnBowlby,AnnaFreud,Melanie
Klein,JosephJ.Sandler,andDonaldWinnicott.
TheInstituteofPsychoanalysisistheforemostpublisherofpsychoanalyticliterature.The24volume
StandardEditionoftheCompletePsychologicalWorksofSigmundFreudwasconceived,translated,and
producedunderthedirectionoftheBritishPsychoanalyticalSociety.TheSociety,inconjunctionwith
RandomHouse,willsoonpublishanew,revisedandexpandedStandardEdition.WiththeNewLibraryof
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PsychoanalysistheInstitutecontinuestopublishthebooksofleadingtheoristsandpractitioners.The
InternationalJournalofPsychoanalysisispublishedbytheInstituteofPsychoanalysis.Nowinits84th
year,ithasoneofthelargestcirculationsofanypsychoanalyticjournal.
Research
OverahundredyearsofcasereportsandstudiesinthejournalModernPsychoanalysis,thePsychoanalytic
Quarterly,theInternationalJournalofPsychoanalysisandtheJournaloftheAmericanPsychoanalytic
Associationhaveanalyzedtheefficacyofanalysisincasesofneurosisandcharacterorpersonality
problems.Psychoanalysismodifiedbyobjectrelationstechniqueshasbeenshowntobeeffectiveinmany
casesofingrainedproblemsofintimacyandrelationship(cf.themanybooksofOttoKernberg).Asa
therapeutictreatment,psychoanalytictechniquesmaybeusefulinaonesessionconsultation.[67]
Psychoanalytictreatment,inothersituations,mayrunfromaboutayeartomanyyears,dependingonthe
severityandcomplexityofthepathology.
Psychoanalytictheoryhas,fromitsinception,beenthesubjectofcriticismandcontroversy.Freud
remarkedonthisearlyinhiscareer,whenotherphysiciansinViennaostracizedhimforhisfindingsthat
hystericalconversionsymptomswerenotlimitedtowomen.ChallengestoanalytictheorybeganwithOtto
RankandAlfredAdler(turnofthe20thcentury),continuedwithbehaviorists(e.g.Wolpe)intothe1940s
and'50s,andhavepersisted(e.g.Miller).Criticismscomefromthosewhoobjecttothenotionthatthereare
mechanisms,thoughtsorfeelingsinthemindthatcouldbeunconscious.Criticismsalsohavebeenleveled
againstthediscoveryof"infantilesexuality"(therecognitionthatchildrenbetweenagestwoandsix
imaginethingsaboutprocreation).Criticismsoftheoryhaveledtovariationsinanalytictheories,suchas
theworkofRonaldFairbairn,MichaelBalint,andJohnBowlby.Inthepast30yearsorso,thecriticisms
havecenteredontheissueofempiricalverification,[68]inspiteofmanyempirical,prospectiveresearch
studiesthathavebeenempiricallyvalidated(e.g.,SeethestudiesofBarbaraMilrod,atCornellUniversity
MedicalSchool,etal.).InthescientificliteraturetherearesomeresearchsupportingsomeofFreud'sideas,
e.g.unconsciousness,repressionetc.[69]
Psychoanalysishasbeenusedasaresearchtoolintochildhooddevelopment(cf.thejournalThe
PsychoanalyticStudyoftheChild),andhasdevelopedintoaflexible,effectivetreatmentforcertainmental
disturbances.[32]Inthe1960s,Freud'searly(1905)thoughtsonthechildhooddevelopmentoffemale
sexualitywerechallengedthischallengeledtomajorresearchinthe1970sand80s,andthentoa
reformulationoffemalesexualdevelopmentthatcorrectedsomeofFreud'sconcepts.[70]Alsoseethe
variousworksofEleanorGalenson,NancyChodorow,KarenHorney,FranoiseDolto,MelanieKlein,
SelmaFraiberg,andothers.Mostrecently,psychoanalyticresearcherswhohaveintegratedattachment
theoryintotheirwork,includingAliciaLieberman,SusanCoates,andDanielSchechterhaveexploredthe
roleofparentaltraumatizationinthedevelopmentofyoungchildren'smentalrepresentationsofselfand
others.[71]
Therearedifferentformsofpsychoanalysisandpsychotherapiesinwhichpsychoanalyticthinkingis
practiced.Besidesclassicalpsychoanalysisthereisforexamplepsychoanalyticpsychotherapy,a
therapeuticapproachwhichwidens"theaccessibilityofpsychoanalytictheoryandclinicalpracticesthat
hadevolvedover100plusyearstoalargernumberofindividuals."[72]Otherexamplesofwellknown
therapieswhichalsouseinsightsofpsychoanalysisarementalizationbasedtreatment(MBT),and
transferencefocusedpsychotherapy(TFP).[66]Thereisalsoacontinuinginfluenceofpsychoanalytic
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thinkingindifferentsettingsinthementalhealthcare.[73]Togiveanexample:inthepsychotherapeutic
trainingintheNetherlands,psychoanalyticandsystemtherapeutictheories,drafts,andtechniquesare
combinedandintegrated.OtherpsychoanalyticschoolsincludetheKleinian,Lacanian,andWinnicottian
schools.
Evaluationofeffectiveness
TheeffectivenessofstrictpsychoanalysisisdifficulttogaugetherapyasFreudintendeditreliestoomuch
ontheinterpretationofthetherapistwhichcannotbeproven.[74]Theeffectivenessofmoremodern,
developedtechniquescanbegauged.Metaanalysesin2012and2013cometotheconclusionthatthereis
supportorevidencefortheefficacyofpsychoanalytictherapy,thusfurtherresearchisneeded.[75][76]Other
metaanalysespublishedintherecentyearsshowedpsychoanalysisandpsychodynamictherapytobe
effective,withoutcomescomparableorgreaterthanotherkindsofpsychotherapyorantidepressant
drugs,[77][78][79]buttheseargumentshavealsobeensubjectedtovariouscriticisms.[80][81][82][83]
In2011,theAmericanPsychologicalAssociationmade103comparisonsbetweenpsychodynamic
treatmentandanondynamiccompetitorandfoundthat6weresuperior,5wereinferior,28hadno
differenceand63wereadequate.Thestudyfoundthatthiscouldbeusedasabasis"tomake
psychodynamicpsychotherapyan'empiricallyvalidated'treatment."[84]
MetaanalysesofShortTermPsychodynamicPsychotherapy(STPP)havefoundeffectsizesrangingfrom
.34.71comparedtonotreatmentandwasfoundtobeslightlybetterthanothertherapiesinfollowup.[85]
Otherreviewshavefoundaneffectsizeof.78.91forsomaticdisorderscomparedtonotreatment[86]and
.69fortreatingdepression.[87]A2012metaanalysisbytheHarvardReviewofPsychiatryofIntensive
ShortTermDynamicPsychotherapy(ISTPP)foundeffectsizesrangingfrom.84forinterpersonal
problemsto1.51fordepression.OverallISTPPhadaneffectsizeof1.18comparedtonotreatment.[88]
AsystemreviewofLongTermPsychodynamicPsychotherapyin2009foundanoveralleffectsizeof
.33.[89]Othershavefoundeffectsizesof.44.68.[90]
Accordingtoa2004FrenchreviewconductedbyINSERM,psychoanalysiswaspresumedorproven
effectiveattreatingpanicdisorder,posttraumaticstressandpersonalitydisorders.[91]
Theworld'slargestrandomizedcontrolledtrialontherapywithanorexiaoutpatients,theANTOPStudy,
published2013inTheLancet,provedmodifiedpsychodynamictherapytobemoreeffectivethancognitive
behavioraltherapyinthelongterm.[92]
A2001systematicreviewofthemedicalliteraturebytheCochraneCollaborationconcludedthatnodata
existdemonstratingthatpsychodynamicpsychotherapyiseffectiveintreatingschizophreniaandsevere
mentalillness,andcautionedthatmedicationshouldalwaysbeusedalongsideanytypeoftalktherapyin
schizophreniacases.[93]AFrenchreviewfrom2004foundthesame.[91]TheSchizophreniaPatient
OutcomesResearchTeamadvisesagainsttheuseofpsychodynamictherapyincasesofschizophrenia,
arguingthatmoretrialsarenecessarytoverifyitseffectiveness.[94][95]
Criticism
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Asafieldofscience
Psychoanalysiscontinuestobepracticedbypsychiatrists,social
workers,andothermentalhealthprofessionals,however,itspractice
islesscommontodaythaninyearspast.[97]"Ithinkmostpeople
wouldagreethatpsychoanalysisasaformoftreatmentisonitslast
legs",saysBradleyPeterson,apsychoanalyst,childpsychiatristand
thedirectoroftheInstitutefortheDevelopingMindatChildren's
HospitalLosAngeles.[98]Thetheoreticalfoundationsof
psychoanalysislieinthesamephilosophicalcurrentsthatleadto
interpretivephenomenologyratherthaninthosethatleadtoscientific
positivism,makingthetheorylargelyincompatiblewithpositivist
approachestothestudyofthemind.[99]
Thestrongestreasonforconsidering
Freudapseudoscientististhathe
claimedtohavetestedandthusto
haveprovidedthemostcogent
groundsforacceptingtheories
whichareeitheruntestableoreven
iftestablehadnotbeentested.Itis
spuriousclaimstohavetestedan
untestableoruntestedtheorywhich
arethemostpertinentgroundsfor
deemingFreudandhisfollowers
pseudoscientists...
FrankCioffi[96]
Earlycriticsofpsychoanalysisbelievedthatitstheorieswerebased
toolittleonquantitativeandexperimentalresearch,andtoomuchon
theclinicalcasestudymethod.SomehaveaccusedFreudoffabrication,mostfamouslyinthecaseofAnna
O.[100]Othershavespeculatedthatpatientssufferedfromnoweasilyidentifiableconditionsunrelatedto
psychoanalysisforinstance,AnnaO.isthoughttohavesufferedfromanorganicimpairmentsuchas
tuberculousmeningitisortemporallobeepilepsyandnothysteria(seemoderninterpretations).[101]
E.FullerTorrey,writinginWitchdoctorsandPsychiatrists(1986),statedthatpsychoanalytictheorieshave
nomorescientificbasisthanthetheoriesoftraditionalnativehealers,"witchdoctors"ormodern"cult"
alternativessuchasest.[102]FrankCioffi,authorofFreudandtheQuestionofPseudoscience,citesfalse
claimsofasoundscientificverificationofthetheoryanditselementsasthestrongestbasisforclassifying
theworkofFreudandhisschoolaspseudoscience.[103]
PsychologistAliceMillerchargedpsychoanalysiswithbeingsimilartothepoisonouspedagogies,which
shedescribedinherbookForYourOwnGood.ShescrutinizedandrejectedthevalidityofFreud'sdrive
theory,includingtheOedipuscomplex,which,accordingtoherandJeffreyMasson,blamesthechildfor
theabusivesexualbehaviorofadults.[104]
PsychologistJoelKupfersmidinvestigatedthevalidityoftheOedipuscomplex,examiningitsnatureand
origins.HeconcludedthatthereislittleevidencetosupporttheexistenceoftheOedipuscomplex.[62]
Cognitivescientistshavealsocriticizedpsychoanalysis.LinguistNoamChomskyhascriticized
psychoanalysisforlackingascientificbasis.[105]StevenPinkerconsideredFreudiantheoryunscientificfor
understandingthemind.[106]EvolutionarybiologistStevenJayGouldconsideredpsychoanalysisas
influencedbypseudoscientifictheoriessuchasrecapitulationtheory.PsychologistsHansEysenck[107]and
JohnF.Kihlstrom[108]havealsocriticizedthefieldaspseudoscience.
AFrench2004reportfromINSERMsaidthatpsychoanalytictherapyislesseffectivethanother
psychotherapies(includingcognitivebehavioraltherapy)forcertaindiseases.Itusedametaanalysisof
numerousotherstudiestofindwhetherthetreatmentwas"proven"or"presumed"tobeeffectiveon
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differentdiseases.[91]Numerousstudieshaveshownthatitsefficacyisrelatedtothequalityofthetherapist,
ratherthanthepsychoanalyticschoolortechniqueortraining,.[109]
BothFreudandpsychoanalysishavebeencriticizedinveryextremeterms.[110]Exchangesbetweencritics
anddefendersofpsychoanalysishaveoftenbeensoheatedthattheyhavecometobecharacterizedasthe
FreudWars.[111]TheclassicdismissalstillbelongstoRichardFeynman,whowroteoffpsychoanalystsas
"witchdoctors":
Ifyoulookatallofthecomplicatedideasthattheyhavedevelopedinaninfinitesimalamount
oftime,ifyoucomparetoanyotherofthescienceshowlongittakestogetoneideaafterthe
other,ifyouconsiderallthestructuresandinventionsandcomplicatedthings,theidsandthe
egos,thetensionsandtheforces,andthepushesandthepulls,Itellyoutheycan'tallbethere.
It'stoomuchforonebrainorafewbrainstohavecookedupinsuchashorttime.[112]
KarlPopperarguedthatpsychoanalysisisapseudosciencebecauseitsclaimsarenottestableandcannotbe
refutedthatis,theyarenotfalsifiable.[113]KarlKraus,anAustriansatirist,wasthesubjectofabook
writtenbynotedlibertarianauthorThomasSzasz.ThebookAntiFreud:KarlKraus'sCriticismof
PsychoanalysisandPsychiatry,originallypublishedunderthenameKarlKrausandtheSoulDoctors,
portrayedKrausasaharshcriticofSigmundFreudandofpsychoanalysisingeneral.Othercommentators,
suchasEdwardTimms,authorofKarlKrausApocalypticSatirist,havearguedthatKrausrespected
Freud,thoughwithreservationsabouttheapplicationofsomeofhistheories,andthathisviewswerefar
lessblackandwhitethanSzaszsuggests.AdolfGrnbaumarguesthatpsychoanalyticbasedtheoriesare
falsifiable,butthatthecausalclaimsofpsychoanalysisareunsupportedbytheavailableclinicalevidence.
Aprominentacademicinpositivepsychologywrotethat'Thirtyyearsago,thecognitiverevolutionin
psychologyoverthrewbothFreudandthebehaviorists,atleastinacademia....[T]hinking...isnotjusta
[result]ofemotionorbehavior....[E]motionisalwaysgeneratedbycognition,nottheotherway
around.'[114]
MichelFoucaultandGillesDeleuzeclaimedthattheinstitutionofpsychoanalysishasbecomeacenterof
powerandthatitsconfessionaltechniquesresembletheChristiantradition.[115]JacquesLacancriticizedthe
emphasisofsomeAmericanandBritishpsychoanalyticaltraditionsonwhathehasviewedasthe
suggestionofimaginary"causes"forsymptoms,andrecommendedthereturntoFreud.[116]Togetherwith
Deleuze,FlixGuattaricriticisedtheOedipalstructure.[117]LuceIrigaraycriticisedpsychoanalysis,
employingJacquesDerrida'sconceptofphallogocentrismtodescribetheexclusionofthewomanfrom
FreudianandLacanianpsychoanalyticaltheories.[118]DeleuzeandGuattari,intheir1972workAnti
dipus,takethecasesofGrardMendel,BelaGrunbergerandJanineChasseguetSmirgel,prominent
membersofthemostrespectedassociations(IPa),tosuggestthat,traditionally,psychoanalysis
enthusiasticallyembracesapolicestate.[119]
Freudiantheory
Anincreasingamountofempiricalresearchfromacademicpsychologistsandpsychiatristshasbegunto
addressthiscriticism.Asurveyofscientificresearchsuggestedthatwhilepersonalitytraitscorresponding
toFreud'soral,anal,Oedipal,andgenitalphasescanbeobserved,theydonotnecessarilymanifestasstages
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inthedevelopmentofchildren.Thesestudiesalsohavenotconfirmed
thatsuchtraitsinadultsresultfromchildhoodexperiences(Fisher&
Greenberg,1977,p.399).However,thesestagesshouldnotbe
viewedascrucialtomodernpsychoanalysis.Whatiscrucialto
modernpsychoanalytictheoryandpracticeisthepowerofthe
unconsciousandthetransferencephenomenon.
Theideaof"unconscious"iscontestedbecausehumanbehaviorcan
beobservedwhilehumanmentalactivityhastobeinferred.However,
theunconsciousisnowapopulartopicofstudyinthefieldsof
experimentalandsocialpsychology(e.g.,implicitattitudemeasures,
fMRI,andPETscans,andotherindirecttests).Theideaof
unconscious,andthetransferencephenomenon,havebeenwidely
researchedand,itisclaimed,validatedinthefieldsofcognitive
psychologyandsocialpsychology(Westen&Gabbard2002),though
aFreudianinterpretationofunconsciousmentalactivityisnotheldby
themajorityofcognitivepsychologists.Recentdevelopmentsin
neurosciencehaveresultedinonesidearguingthatithasprovideda
biologicalbasisforunconsciousemotionalprocessinginlinewith
psychoanalytictheoryi.e.,neuropsychoanalysis(Westen&Gabbard
2002),whiletheothersidearguesthatsuchfindingsmake
psychoanalytictheoryobsoleteandirrelevant.
ManyaspectsofFreudiantheoryare
indeedoutofdate,andtheyshould
be:Freuddiedin1939,andhehas
beenslowtoundertakefurther
revisions.Hiscritics,however,are
equallybehindthetimes,attacking
Freudianviewsofthe1920sasif
theycontinuetohavesomecurrency
intheiroriginalform.
Psychodynamictheoryandtherapy
haveevolvedconsiderablysince
1939whenFreud'sbearded
countenancewaslastsightedin
earnest.Contemporary
psychoanalystsandpsychodynamic
therapistsnolongerwritemuch
aboutidsandegos,nordothey
conceiveoftreatmentfor
psychologicaldisordersasan
archaeologicalexpeditioninsearch
oflostmemories.
DrewWesten[120]
ShlomoKaloexplainsthatMaterialismthatflourishedinthe19thCenturyseverelyharmedreligionand
rejectedwhatevercalledspiritual.Theinstitutionoftheconfessionpriestinparticularwasbadlydamaged.
Theemptyvoidthatthisinstitutionleftbehindwasswiftlyoccupiedbythenewbornpsychoanalysis.Inhis
writingsKaloclaimsthatpsychoanalysisbasicapproachiserroneous.Itrepresentsthemainlinewrong
assumptionsthathappinessisunreachableandthatthenaturaldesireofahumanbeingistoexploithis
fellowmenforhisownpleasureandbenefit.[121]
Freud'spsychoanalysiswascriticizedbyhiswife,Martha.RenLaforguereportedMarthaFreudsaying,"I
mustadmitthatifIdidnotrealizehowseriouslymyhusbandtakeshistreatments,Ishouldthinkthat
psychoanalysisisaformofpornography."ToMarthatherewassomethingvulgaraboutpsychoanalysis,
andshedissociatedherselffromit.AccordingtoMarieBonaparte,Marthawasupsetwithherhusband's
workandhistreatmentofsexuality.[122]
JacquesDerridaincorporatedaspectsofpsychoanalytictheoryintohistheoryofdeconstructioninorderto
questionwhathecalledthe'metaphysicsofpresence'.DerridaalsoturnssomeoftheseideasagainstFreud,
torevealtensionsandcontradictionsinhiswork.Forexample,althoughFreuddefinesreligionand
metaphysicsasdisplacementsoftheidentificationwiththefatherintheresolutionoftheOedipalcomplex,
DerridainsistsinThePostcard:FromSocratestoFreudandBeyondthattheprominenceofthefatherin
Freud'sownanalysisisitselfindebtedtotheprominencegiventothefatherinWesternmetaphysicsand
theologysincePlato.[123]
Seealso
ChicagoInstituteforPsychoanalysis
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Neutrality
Ontologicalhermeneutics
Psychoanalyticsociology
Psychoanalysisandmusic
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Khler,Thomas1996:AntiFreudLiteraturvonihrenAnfngenbisheute.ZurwissenschaftlichenFundierung
vonPsychoanalyseKritik.Stuttgart:W.Kohlhammer.ISBN3170142070
Ollinheimo,AriVuorinen,Risto(1999):MetapsychologyandtheSuggestionArgument:AReplyto
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ofScienceandLetters.ISBN9516532977
Robinson,Paul(1993).FreudandhisCritics.Berkeley&LosAngeles:UniversityofCaliforniaPress.ISBN0
520080297
Externallinks
InternationalPsychoanalyticalAssociation(IPA)
(http://www.ipa.org.uk)worldsprimaryregulatorybodyfor
psychoanalysis,foundedbySigmundFreud
PsychoanalysisDivision39AmericanPsychological
Association(http://www.apa.org/about/division/div39.aspx)
Retrievedfrom"https://en.wikipedia.org/w/index.php?
title=Psychoanalysis&oldid=691463672"
Lookuppsychoanalysisin
Wiktionary,thefree
dictionary.
WikimediaCommonshas
mediarelatedto
Psychoanalysis.
Categories: Psychoanalysis
Thispagewaslastmodifiedon20November2015,at00:23.
TextisavailableundertheCreativeCommonsAttributionShareAlikeLicenseadditionaltermsmay
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