Psychoanalysis

Psychoanalysis is a theory of personality and psychopathology that deals with the unconscious mind. Psychoanalysts believe that all of us have unconscious thoughts, emotions, wants, drives and memories which influence our behavior and personality.

What Is Psychoanalysis?

Psychoanalysis refers to a collection of psychological theories and therapeutic strategies derived from the works and formulations of Austrian neurologist Sigmund Freud. “Psychoanalysis is a theory of psychopathology and a treatment for mental disorders,” explains a 2017 study [mfn] Paris J. Is Psychoanalysis Still Relevant to Psychiatry? The Canadian Journal of Psychiatry. 2017;62(5):308-312. doi:10.1177/0706743717692306 [/mfn]. It was developed during the 1890s by Freud, who is regarded as the founder of the discipline.

It is primarily a medical approach of using discussion to understand and treat emotional and mental disorders, like psychopathology. The discussion occurs between the patient and the psychoanalyst, who utilizes psychoanalytic theories and methods to uncover unconscious cognitive processes. It is also known as Depth Psychology.

This system of therapies [mfn] Solms M. (2018). The scientific standing of psychoanalysis. BJPsych international, 15(1), 5–8. https://doi.org/10.1192/bji.2017.4 [/mfn] and theories focus on treating mental illness, like psychopathology, by analyzing the interaction of unconscious, subconscious and conscious mental processes. It aims to highlight repressed thoughts and emotions and make the conscious mind aware of them through different strategies like free association [mfn] Aron L. (1990). Free association and changing models of mind. The Journal of the American Academy of Psychoanalysis, 18(3), 439–459. https://doi.org/10.1521/jaap.1.1990.18.3.439 [/mfn] of ideas and dream interpretation [mfn] Zhang, W., & Guo, B. (2018). Freud’s Dream Interpretation: A Different Perspective Based on the Self-Organization Theory of Dreaming. Frontiers in psychology, 9, 1553. https://doi.org/10.3389/fpsyg.2018.01553 [/mfn].

Here the patient is encouraged by the psychoanalyst to speak openly about their thoughts and feelings without worrying about criticism or judgment. Although the patient is asked to talk about anything that comes to their mind, a particular focus is given to early childhood experiences and dreams. Freud observed that negative experiences were typically repressed from conscious awareness and such experiences were often sexual in nature. The discipline aims to highlight and release repressed thoughts, feelings and experiences through cathartic healing. The cure is aimed at making people gain insight by becoming consciously aware of their unconscious thoughts and desires.

Freud’s groundbreaking theory of psychoanalysis laid the foundation for depth psychology and psychotherapy, but it remains criticized as a dated and controversial theoretical and clinical model in psychiatry. However, its psychodynamic theories and application in therapy and neuroscience have made it retain its relevance in the field of psychiatry.

Understanding Psychoanalysis

Devised in the 1890s by Sigmund Freud and consecutively developed by other researchers, psychoanalysis exerts a salient influence on psychiatry. It forms the basis for psychodynamic psychotherapy (comprising therapeutic techniques for mental disorders), as well as for critical analysis theories such as psychoanalytic literary criticism. However, despite its tenacity, psychoanalysis is a much embattled discipline, with concerns raised about its empirical adherence, therapeutic effectiveness, cost-effectiveness, and standing in psychiatric science and practice.

Recently, studies [mfn] Paris J. (2017). Is Psychoanalysis Still Relevant to Psychiatry?. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 62(5), 308–312. https://doi.org/10.1177/0706743717692306 [/mfn] have found that “Freud’s ideas concerning the unconscious mind are compatible with modern neuroscience” and psychoanalysis is capable of offering a coherent interpretation of psychological phenomena. Because of this, many recent studies on psychoanalysis have attempted at its revival.

It should be noted that while “psychoanalytic” and “psychodynamic” are interchangeably used in scholarly studies on psychoanalysis, the terms are different. The former narrowly refers to Freudian theory. On the other hand, the latter, as a broad umbrella term, encompasses ‘offshoot’ theories and clinical models derived from Freud’s original work..

Basic Tenets Of Psychoanalysis

The basic tenets of psychoanalysis include the following:

• A person’s development is determined by forgotten events in early childhood and not by inherited traits alone
• Human behavior and cognition are determined by instinctual drives rooted in the unconscious
• Attempts to bring these drives into awareness trigger resistance in the form of defense mechanisms, of which repression is the most common kind
• Mental disturbances can arise from a series of conflicts between the conscious and the unconscious materials in the mind
• Unconscious material can be found in unintentional acts, dreams, and mannerisms
• Therapeutic intervention brings unconscious material into the conscious mind and liberates mental turbulences from the effects of the unconscious
• The “centerpiece of the psychoanalytic process” is the patient’s transference and the therapist’s countertransference in a prescribed setting for a fixed, often lengthy, tenure of time

Development Of Psychoanalysis

The origin of psychoanalysis, both as a school of thought and a form of therapy, can be traced in the decades of 1890s which Freud spent in “splendid isolation”, working on his now-famed discipline and academically conversing with European peers, namely, Karl Abraham, Sandor Ferenczi, and Carl Jung. He was influenced by the clinical work of Josef Breuer and the biological hypotheses of Charles Darwin, Ernst Haeckel, Richard von Krafft-Ebing, Wilhelm Fliess, and Havelock Ellis. In 1899, following the publication of his famed Die Traumdeutung (The Interpretation of Dreams) and in 1902, with the foundation of the Psychological Wednesday Society, psychoanalysis was established as a movement [mfn] Psychoanalysis theory and practice. (n.d.). Scribd. https://www.scribd.com/document/139386221/Psychoanalysis-Theory-and-Practice [/mfn].

Freud drew his theory from his work with hysterical patients and augmented it by several works such as Three Essays on the Theory of Sexuality (1905), On Narcissism (1915), Beyond the Pleasure Principle (1920), and The Ego and the Id (1923). Freud’s contemporary, Sandor Ferenczi, developed the Budapest school of psychoanalysis inspired by classical Freudian thought. Later Freud’s daughter, Anna Freud, refined it into Ego psychology in her book The Ego and the Mechanisms of Defence (1936). This was further systematized by Heinz Hartmann, Rudolph Loewenstein, David Rapaport, and Ernst Kris from the 1940s to the late 1960s.

Psychoanalysis remained in the realm of metapsychological assumptions, providing cross-sectional views of the complex human mental processes. Further variation of Ego psychology developed in Heinz Kohut’s self psychology in the 1960s and Charles Brenner’s revival-like modern conflict theory in the 1980s and 2000s.

Theoretical Fundamentals Of Psychoanalysis

Classical Freudian thought laid out the fundamental concepts of psychoanalysis, which have been refined in further psychodynamic discourse.

1. Classical Freudian Theory

Freud’s psychoanalysis can be divided into two theoretical models and phases, namely:

• Topographical Theory, modeled on metaphysical assumptions, that hypothesized that mental processes human psyche can be divided into the conscious, the preconscious, and the unconscious; and
• Structural Theory that replaced the aforementioned theory and hypothesized that the human psyche is divided into the id, the ego, and the super-ego.

The key concepts in Freudian psychoanalysis comprise:

A.The Conscious, The Unconscious, And The Preconscious

Freud believed that the mental apparatus operates in manners beyond what humans are conscious of or are preconscious of. A significant part of the human mind works out of the unconscious in every aspect of life, whether one is dormant or asleep. In fact, the unconscious influences all human actions without one’s knowledge.

B. The Id

The id is the part of the unconscious that seeks pleasure. It holds all of humankind’s most basic and primal instincts, as well as repressed material, and acts on the “pleasure principle”.

C. The Ego

Operating on the “reality principle”, the ego develops slowly and gradually, being concerned with mediating between the urging of the id and the realities of the external world. It is the “organized part of the personality structure that includes defensive, perceptual, intellectual-cognitive, and executive functions”. Conscious awareness is said to reside in the ego, although not all of the operations of the ego are conscious.

Read More About Ego Depletion Here

D. The Super-ego

The super-ego is the part of the ego in which self-observation, self-criticism and reflective and judgmental faculties develop. Along with the ego, the super-ego is partly conscious and partly unconscious.

2. Psychodynamic Theories And Clinical Models

The later psychodynamic theories and clinical models emerged in supplement or disputation of classical Freudian theory of psychoanalysis. Ego psychology maintained the metapsychological assumptions and refined psychoanalysis with new perspectives on defense mechanisms. Unconscious processes, however, came to be evaluated by six, not Freud’s five, points:

• Topographic
• Dynamic (the theory of conflict)
• Economic (the theory of energy flow)
• Structural
• Genetic (the propositions concerning origin and development of psychological functions)
• Adaptational (the psychological phenomena as it relates to the external world)

A variation of ego psychology, modern conflict theory, revised structural theory by altering concepts related to the location of repressed material in the human psyche. It emphasizes on the conflict of the conscious and the unconscious in defensive mental operations and maintains that the resolution of conflict determines the healthy functioning of the mind.

Heavily invested in child development, object relations theory inserted the concepts of introjections and projections, representation and self-image, and object-relations problems into its own brand of psychoanalysis. Self-psychology turned to self-objects, whereas the schools of French psychoanalysis focused on the unconscious and the source of psychic conflict.

The adaptive paradigm reflects on psychic conflict that arises from the adaptation of the conscious and the unconscious to reality. Relational psychoanalysis views a combination of interpersonal psychoanalysis, object-relations theory, and intersubjective theory to be critical for mental health, whereas interpersonal-relational psychoanalysis takes to multiple psychodynamic perspectives to study the mind and resolve psychic conflict.

Read More About Child Development Here

Techniques In Psychoanalysis

The following are some of the most common elements observed in psychoanalysis –

1. Method

Freud stated that psychoanalysis is a “talking cure”, based on the method of free association, dream interpretation, and recognizing resistance. A typical session of psychoanalysis takes place in a controlled setting wherein the patient demonstrates unrestricted transference (about dreams, fantasies, revisitations, thoughts, and feelings) and the analyst practices free hovering attention. The information from the transference gets integrated into an aggregated view of transference-counter-transference occurrences that coalesce into an emerging gestalt.

The countertransference interpretations from the therapist, when conveyed to the patient, provide new insights into the patient’s psychic conflicts and help the patient recognise the causes of the conflicts as well as resolve them. Freed from older inhibitions, the patient can make room for new choices in the aftermath of successful psychotherapy.

A 2016 study [mfn] Kernberg O. F. (2016). The four basic components of psychoanalytic technique and derived psychoanalytic psychotherapies. World psychiatry : official journal of the World Psychiatric Association (WPA), 15(3), 287–288. https://doi.org/10.1002/wps.20368 [/mfn] lists that four aspects jointly determine the very essence of psychoanalytic technique:

A. Interpretation

It is the verbal communication of unconscious conflict by the psychoanalyst that emerges in the patient’s communication during therapy.

B. Transference Analysis

It is a systematic transference analysis of the patient’s communications and manifestations to influence the psychoanalytic psychotherapist in a certain direction.

C. Technical Neutrality

It comprises an analyst’s distant attitude from the patient’s internal conflicts and prohibits personal involvement of the former in the latter’s issues.

D. Countertransference Analysis

It is a complex formation that is based on the patient’s transference and the psychoanalyst’s reaction to the reality and to specific transference dispositions.

2. Setting

In psychoanalysis, the method described above is applied in the classical setting: the patient comfortably lies on the couch, saying whatever comes to mind, without being distracted by the analyst, who usually sits behind the couch. Shorter sessions require both parties to sit on chairs. An analytic session lasts for 45 or 50 minutes and takes place three or more times in the course of a week. The timeframe for an analysis is expected to span three to five years on an average. All agreements about the setting (including the schedule, the fee, and the cancellation policy) are binding, yet subject to renegotiation if required, for both patient and analyst.

Psychoanalysis In Practice

Psychoanalysis has been applied in varied forms and some of them are described below –

1. Psychoanalytic Or Psychodynamic Psychotherapy

A type of depth-psychology therapy, psychotherapy is used to reveal the unconscious contents in a person’s psyche to find relief from psychic content or tension. Psychodynamic therapies are based on psychoanalytic approaches but tend to be less intensive and shorter in duration. The techniques used in interpersonal psychotherapy, short-term or long-term, were standardized in 2000 [mfn] Blagys, Matthew & Hilsenroth, Mark. (2000). Distinctive Features of Short‐Term Psychodynamic‐Interpersonal Psychotherapy: A Review of the Comparative Psychotherapy Process Literature. Clinical Psychology: Science and Practice. 7. 167 – 188. 10.1093/clipsy.7.2.167. [/mfn]. These include –

• Unstructured, open-ended dialogue between patient and therapist
• Identifying recurring themes in the patient’s experience
• Linking the patient’s feelings and perceptions to past experiences
• Drawing attention to feelings regarded by the patient as unacceptable
• Pointing out ways in which the patient avoids such feelings
• Focusing on the here-and-now therapy relationship
• Drawing connections between the therapy relationship and other relationships

This therapy is used to treat mental disorders such as adjustment disorders, panic disorders, personality disorders, eating disorders, phobias, and trauma. This therapy has been used in individual psychotherapy, group psychotherapy, couple therapy, and family therapy. Studies have found that this therapy is more effective when accompanied by medication.

Read More About Panic Disorder Here

2. Neuropsychoanalysis

With the progress in neuroscience, much advance has been made in the knowledge of the mind-brain system and a better observation of the psychoanalytical theories and their relationship [mfn] Solms M. L. (2018). The Neurobiological Underpinnings of Psychoanalytic Theory and Therapy. Frontiers in behavioral neuroscience, 12, 294. https://doi.org/10.3389/fnbeh.2018.00294 [/mfn] with neurobiology. Psychoanalysis has united with neuroscience in neuropsychiatry, particularly in neuropsychoanalysis, neuroplasticity, and cognitive neuroscience. Such development emphasizes the reconciliation of the perspectives and methods of psychoanalysis with scientific methods based on empirical testing. These include:

A. Neuropsychoanalysis

It seeks to observe subjective experience and the unconscious mind through neuroimaging. This field believes that Freud’s theory about dreams is consistent with neuroscience research based on rapid eye movement (REM) activity. Research [mfn] Fonagy P. (2003). Psychoanalysis today. World psychiatry : official journal of the World Psychiatric Association (WPA), 2(2), 73–80. [/mfn] also seems to show that the changes after successful treatment by psychoanalysis are visualizable with brain imaging.

B. Neuroplasticity

It believes that psychoanalytic therapies produce brain changes that can be captured using brain imaging. These changes can be researched and the information can help develop therapies and mental exercises to reverse neurological degradation and treat severe neurological and psychiatric problems.

C. Cognitive neuroscience

It is the cross-road between psychotherapy, electrical stimulation, and pharmacotherapy. Psychotherapy technology models are used by cognitive neuroscience [mfn] Morgenstern, J., Naqvi, N. H., Debellis, R., & Breiter, H. C. (2013). The contributions of cognitive neuroscience and neuroimaging to understanding mechanisms of behavior change in addiction. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors, 27(2), 336–350. https://doi.org/10.1037/a0032435 [/mfn] to make improvements in treatment efficacy and the dissemination of evidence-based practices surrounding the treatment of addictions, schizoaffective disorders, etc.

3. Psychoanalytic Psychodrama

Psychodrama is an action method in psychotherapy, wherein clients use role-playing and spontaneous dramatization, and dramatic self-presentation to gain insight into their conflicted psyche and develop newer, more effective behaviors. Developed by Jacob L. Moreno, psychodrama includes elements of theater and is often conducted in a group. The fundamental techniques include mirroring, doubling, soliloquy, and role reversal.

Recently, this aspect of psychoanalysis has been employed in child therapy techniques (via role-playing, art therapy, and storytelling) for treating mental disorders (such as emotional abuse and trauma) and in post-divorce counseling for children. This also forms the basis of creative arts therapy, specifically drama therapy.

4. Psychoanalytic Research

Research into psychoanalysis, for many years, has served to enrich its theoretical aspects and its applied ones. This research has also enriched the guidelines around the different psychoanalytic training in physicians, psychologists, and social workers. There are three different training models (the Eitingon model, the French model, and the Uruguay model) – all of which require the personal analysis of the candidate; attendance at theoretical, technical, and clinical seminars; and the supervision of the trainee’s work.

5. Applied Psychoanalysis

Applied psychoanalysis is described as the practice of using psychoanalytic theories and methods to explain social, cultural and political phenomena. Freud himself contributed to psychoanalytic literary criticism with his analysis of Sophocles’ Oedipus Rex and Shakespeare’s Hamlet. He also analyzed works of art and literature, social behaviors, and phenomena like war, religion, mass-movements, working of social institutions, etc. His approach has stimulated applying psychoanalytic thinking in critical analysis in multiple disciplines such as cinema, anthropology, and political science.

Relevance Of Psychoanalysis

Psychoanalysis has been subjected to much criticism for taking recourse to “fabricated” metaphysical assumptions rather than empirical studies for the resolution of psychic conflicts in mental disorders. Its lack of evidence-based theoretical foundations has delegated it to the realm of pseudoscience. Its tenets have been contested by its very own psychodynamic theories. This has been aggravated by its self-imposed isolation from the sciences and refusal to indulge in interaction with other disciplines.

However, despite the hostile clinical and academic environment, it is impossible to refute the fact that psychoanalysis paved the path for depth psychology therapies. Its influence on psychiatric research and cultural studies is tenacious. Studies ensuring a future for psychoanalysis and psychoanalytic therapies within psychiatry tend to assist the movement of psychoanalysis toward science. A 2003 study [mfn] Fonagy P. (2003). Psychoanalysis today. World psychiatry: official journal of the World Psychiatric Association (WPA), 2(2), 73–80.[/mfn] states how psychoanalysis can modify itself and retain its relevance:

1. The evidence base of psychoanalysis should be strengthened by adopting additional data-gathering methods that are now widely available in biological and social science. New evidence may assist psychoanalysts in resolving theoretical differences.
2. The logic of psychoanalytic discourse needs to change from its overdependence on rhetoric and global constructs to using specific constructs that allow for cumulative data-gathering.
3. Flaws in psychoanalytic scientific reasoning should be overcome and in particular, the issue of genetic and social influence should be approached with increased sophistication.
4. The isolation of psychoanalysis should be replaced by active collaboration with other mental health disciplines.

Takeaway

Psychoanalysis is considered to be a dated and controversial theoretical and clinical model in psychiatry. However, its psychodynamic theories and application in therapy and neuroscience have made it retain its relevance in the field of psychiatry.

Psychoanalysis At A Glance

1. Psychoanalysis refers to a collection of psychological theories & therapeutic strategies derived from the works and formulations of Austrian neurologist Sigmund Freud.
2. Psychoanalysis is primarily a medical approach of using discussion to understand and treat emotional and mental disorders, like psychopathology. The discussion occurs between the patient and the psychoanalyst, who utilizes psychoanalytic theories and methods to uncover unconscious cognitive processes. It is also known as Depth Psychology.
3. Psychoanalysis is based on the method of free association, dream interpretation, and recognizing resistance in the mind’s conscious, the paraconscious, and the unconscious.
4. Psychoanalysis paved the path for depth psychology therapies. Its influence on psychiatric research, neuroscience, and cultural studies is tenacious.
5. Psychoanalysis is considered to be a dated and controversial theoretical and clinical model in psychiatry. However, its psychodynamic theories and application in therapy and neuroscience have made it retain its relevance in the field of psychiatry.