| Psychoanalysis
Psychoanalysis is a family of psychological theories and methods
that claim to elucidate connections among unconscious components
of patients' mental processes, and to do so in a systematic way
through a process of tracing out associations. The fundamental subject
matter of psychoanalysis is the unconscious patterns of life as
they become revealed through the analysand's (the patient's) free
associations. 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.
History
Psychoanalysis was first devised in Vienna in the 1890s by Sigmund
Freud, an M.D. 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 the death instinct/Thanatos. Freud's description
of Eros/Libido included all creative, life-furthering 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,
interpersonal and intersubjective sense of self.
Prominent current schools of psychoanalysis include ego psychology,
which emphasizes defense mechanisms and unconscious fantasies, 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, analytical psychology, which has a more spiritual
approach, object relations theory, which stresses the dynamics of
ones relationships with internal, fantasized, others, interpersonal
psychoanalysis, which accents the nuances of interpersonal interactions,
and relational psychoanalysis, which combines interpersonal psychoanalysis
with object-relations theory. Although these schools have dramatically
different theories, most of them continue to stress the strong influence
of self-deception and the effects of past relationships on present
relationships.
A few of the most influential psychoanalysts are Sigmund Freud,
Sandor Ferenzci, Carl Jung, Melanie Klein, Heinz Hartmann, David
Rapaport, Ernst Kris, Jacques Lacan, Donald Winnicott, Margaret
Mahler, Theodor Reik, Harry Stack Sullivan, Heinz Kohut, Slavoj
Zizek, Otto Kernberg, Charles Brenner, Roy Schafer, and Stephen
A. Mitchell.
Techniques
The basic method of psychoanalysis is the transference and resistance
analysis of free association. The patient, in a relaxed posture,
is directed to say whatever comes to mind. Dreams, hopes, wishes,
and fantasies are of interest, as are recollections of early family
life. Generally the analyst simply listens, making comments only
when, in his or her professional judgment, an opportunity for insight
on the part of the patient arises. In listening, the analyst attempts
to maintain an attitude of empathic neutrality, a nonjudgmental
stance designed to create a safe environment. The analyst asks that
the analysand speak with utter honesty about whatever comes to awareness
while interpreting the patterns and inhibitions that appear in the
patient's speech and other behavior.
A general rule of thumb in psychoanalytic treatment is that more
insight-oriented techniques are to be used with healthier patients,
whereas more supportive techniques are to be used with more disturbed
patients. The most common example of an insight-oriented technique
is an interpretation, in which the analyst delivers a comment to
the patient that describes one or more cluster of unconscious wishes,
anxieties, and defenses. An example of a supportive technique might
be reassurance, in which the analyst tries to lower the patient's
level of anxiety by assuring her that what she fears will not come
to pass, or will be manageable. Analysts usually prefer to make
more insight-oriented interventions when possible, as they feel
that such interventions are generally the least judgmental, because
when done correctly they simply describe what is going on in the
patient's mind.
Although psychoanalytic techniques have sometimes been adapted
to treatment of 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 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).
Much recent psychoanalytic work has been devoted to exploring the
use of psychoanalytic principles and techniques in shorter face-to-face
psychodynamic psychotherapy, and integrating psychoanalysis with
other psychotherapeutic techniques such as those of cognitive behavior
therapy. Empirical research on the efficacy of psychoanalysis and
psychoanalytic psychotherapy has also become prominent.
Training
Throughout the history of psychoanalysis, most psychoanalytic organizations
have existed outside of the university setting, with a few notable
exceptions.
Psychoanalytic training usually occurs at a psychoanalytic institute
and may last approximately 4-10 years. Training includes coursework,
supervised psychoanalytic treatment of patients, and personal psychoanalysis
lasting 4 or more years.
Most psychoanalytic institutes require that applicants already
possess a graduate degree. Applicants usually have degrees in clinical
social work (MSW or DSW), clinical psychology (PhD or Psy.D), or
medicine (MD). A small number of institutes also accept applicants
who have graduate degrees in nonclinical disciplines, such as literature
or philosophy.
Other definitions Psychoanalysis is
- A therapeutic technique for the treatment of neurosis.
- A technique used to train psychoanalysts. A basic requirement
of psychoanalytic training is to undergo a successful analysis.
- A technique of critical observation. The successors and contemporaries
of Freud—Carl Jung, Alfred Adler, Wilhelm Reich, Melanie
Klein, Wilfred Bion, Jacques Lacan, and many others—have
developed Freud's theories and advanced new theories using the
basic method of quiet critical observation and study of individual
patients and other events.
- A body of knowledge so acquired.
- A clinical theory. See, for example, "Ordinary Language
Essentials of Clinical Psychoanalytic Theory" by Wynn Schwartz.
- A movement, particularly as led by Freud, to secure and defend
acceptance of the theories and techniques.
Psychoanalysis involves extended exploration of the self, a realization
of the Delphian motto, "Know thyself". In this it resembles
the extended meditative practices of Buddhist monastic schools such
as Zen. If successful, it gives a person the capacity to be present
in the moment, responding authentically to circumstances, being
free of infantile responses inappropriate to the situation.
Today psychoanalytic ideas are imbedded in the culture, especially
in childcare, education, literary criticism, and in psychiatry,
particularly medical and non-medical psychotherapy. Though there
is a mainstream of evolved analytic ideas, there are groups who
more specifically follow the precepts of one or more of the later
theoreticians.
Psychoanalyses in groups
Though the most commonly held image of a psychoanalytic session
is one in which a single analyst works with a single client, 'group'
sessions with two or more clients are not unknown. Carrying out
psychoanalysis in groups can be motivated by economic factors (individual
analysis is time-consuming and expensive) or by the belief that
clients may benefit from witnessing the various client-client and
analyst-client interactions. In most forms of group-based analysis,
the group is initially an artefact created by the analyst selecting
the various members; the assumption is that the common relationship
to the analyst will lead to the formation of a genuine group situation.
Group psychotherapy of 'natural' groups (e.g. of whole families)
seems to be a relative rarity.
Cultural Adaptations
Psychoanalysis can be adapted to different cultures, as long as
the therapist or counseling understands the client’s culture.
For example, Tori and Blimes found that defense mechanisms were
valid in a normative sample of 2,624 Thais. The use of certain defense
mechanisms was related to cultural values. For example Thais value
calmness and collectiveness (because of Buddhist beliefs), so they
were low on regressive emotionality. Psychoanalysis also applies
because Freud used techniques that allowed him to get the subjective
perceptions of his patients. He takes an objective approach by not
facing his clients during his talk therapy sessions. He met with
his patients’ where ever they were, such as when he used free
association—where clients would say whatever came to mind
without self-censorship. His treatments had little to no structure
for most cultures, especially Asian cultures. Therefore, it is more
likely that Freudian constructs will be used in structured therapy
(Thompson, et al., 2004). In addition, Corey postulates that it
will be necessary for therapist to help clients develop a cultural
identity as well as an ego identity. Since Freud has been criticized
for not accounting for external/societal forces, it seems logical
that therapist or counselors using his premises will work with the
family more. Psychoanalytic constructs fit with constructs of other
more structured therapies, and Firestone (2002) thinks psychotherapy
should have more depth and involve both psychodynamic and cogitative-behavioral
approaches. For example, Corey states, that Ellis, the founder of
Rational Emotive Behavioral Therapy (REBT) would allow his clients
to experience depression over a loss, such an emotion would be rational—often
people will be irrational deny their feelings. Since Freudian constructs
can fit with other psychotherapeutic and counseling approaches,
it can also be adapted to a variety of cultures, but it can not
be employed in its widest use as Freud and Firestone would advocate
(Firestone, 2002; Tori and Blimes 2002,).
Adaptations for age and managed care
Play Therapy for different ages
Psychoanalytic constructs can be adapted and modified to both age
and managed care through the use of play therapy such as art therapy,
creative writing, 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.
Criticisms
Psychonalysis has been criticized on a variety of grounds by Karl
Popper, Adolf Grünbaum, Peter Medawar, Ernest Gellner, Frank
Cioffi, Frederick Crews, and others. Popper argues that it is not
scientific because it is not falsifiable. Grünbaum argues that
it is falsifiable, and in fact turns out to be false. Exchanges
between critics and defenders of psychoanalysis have often been
so heated that they have come to be characterized as the Freud Wars.
Some defenders of psychoanalysis suggest that its logics and formulations
are more akin to those found in the humanities than those proper
to the physical and biological sciences, though Freud himself tried
to base his clinical formulations on a hypothetical neurophysiology
of energy transformations. 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.
A related early criticism of psychoanalysis was that its theories
were based on little quantitative and experimental research, and
instead relied almost exclusively on the clinical case study method.
This criticism has been addressed by an increasing amount of psychoanalytic
research from academic psychologists and psychiatrists who have
worked to quantify and measure psychoanalytic concepts. Some of
the most well-known current psychoanalytic researchers include Wilma
Bucci, Peter Fonagy, Robert Holt, Mary Main, Joseph Masling, Mark
Solms, and Daniel Stern.
Psychoanalysts have often complained about the significant lack
of theoretical agreement among analysts of different schools. Many
authors have attempted to integrate the various theories, with limited
success. In this regard, psychoanalysis is similar to the related
discipline of psychology.
An important consequence of the wide variety of psychoanalytic
theories is that psychoanalysis is difficult to criticize as a whole.
Many critics have attempted to offer criticisms of psychoanalysis
that were in fact only criticisms of specific ideas present only
in one or more theories, rather than in all of psychoanalysis.
Although the popularity of psychoanalysis was in decline during
the 1980's and early 1990's, prominent psychoanalytic institutes
have experienced an increase in the number of applicants in recent
years. link to article.
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