Psychoanalysis: The Definitive Guide!

Psychoanalysis  is a set of theories and therapeutic techniques  [1]  related to the study of  the unconscious mind ,  [2]  which together form a treatment method for mental health disorders. The discipline was established in the early 1890s by the Austrian neurologist  Sigmund Freud  and partly stemmed from the clinical work of Josef Breuer and others.

Freud first used the term “ psychoanalysis”  (in French) in 1896.  Die Traumdeutung  ( Interpretation of Dreams ), which Freud saw as his “most significant work”, appeared in November 1899.  [3] Psychoanalysis was developed later in different directions, mainly by Freud students, such as Alfred Adler and Carl Gustav Jung, [a]  and by neofreudians such as Erich Fromm, Karen Horney and Harry Stack Sullivan. [4]  Freud kept the term  psychoanalysis  for his own school of thought. [5]

The basic principles of psychoanalysis include:

  1. a person’s development is determined by events often overlooked in early childhood, not just inherited traits;
  2. human behavior and cognition are largely determined by irrational movements that are rooted in the unconscious;
  3. attempts to make these movements conscious trigger resistance in the form  of defense mechanisms , in particular  repression ;
  4. conflicts between conscious and unconscious material can result in mental disorders such as  neurosis , neurotic traits, anxiety and depression;
  5. unconscious material can be found in dreams and involuntary acts, including mannerisms and  lapses in speech ;
  6. liberation from the effects of the unconscious is achieved by bringing this material into the conscious mind through therapeutic intervention;
  7. the “centerpiece of the psychoanalytic process” is transference , by which patients relive their childhood conflicts when projecting feelings of love, dependence and anger to the analyst. [6] 

During psychoanalytic sessions, which usually last 50 minutes and ideally occur 4-5 times a week,  [7]  the patient (the “analysand”) may be lying on a couch, with the analyst often sitting just behind and out of sight . The patient expresses his thoughts, including  free associations , fantasies and dreams, from which the analyst infers the unconscious conflicts that cause the patient’s symptoms and character problems. Through the analysis of these conflicts, which includes the interpretation of transference and  countertransference [8]  (directing the analyst’s feelings towards the patient), the analyst confronts the patient’s pathological defenses to help him to discern.

Psychoanalysis is a controversial discipline and its validity as a science is contested. However, it remains a strong influence on psychology and psychiatry, even more in some places than others. [b]  [c] Psychoanalytic concepts are also widely used outside the therapeutic arena, in areas such as psychoanalytic literary criticism, as well as in the analysis and deconstruction of films, fairy tales and other cultural phenomena.

Content

    • History of Psychoanalysis
      • 1 | 1890
      • 2 | 1900-1940
      • 3 | 1940-present
    • Psychoanalytic theories
      • 1  Topographic theory
      • 2  Structural theory
      • 3  Psychology of the Ego
        • 3.1  Modern conflict theory
        • 3.2  Theory of object relations
        • 3.3  Psychology of the self
        • 3.4  Jacques Lacan and Lacanian psychoanalysis
        • 3.5  Interpersonal psychoanalysis
        • 3.6  Culturalist psychoanalysis
        • 3.7  Feminist psychoanalysis
        • 3.8  Adaptive paradigm of psychoanalysis and psychotherapy
        • 3.9  Relational psychoanalysis
        • 3.10  Interpersonal-relational psychoanalysis
        • 3.11  Intersubjective psychoanalysis
        • 3.12  Modern psychoanalysis
      • Psychopathology (mental disorders)
        • 1  Adult patients
        • 2  Origin in childhood
  • 4. Psychoanalytic treatment
  • 1  Techniques
    • 1.1  Variations in technique
  • 2  Group therapy and game therapy
  • 3  Cultural variations
  • 4  Cost and duration of treatment
  • 5.  Training and research
  • 1  United States
  • 2  United Kingdom
  • 3  Research
  • 6.  Evaluation of effectiveness
  • 7.  Criticism
  • 1  As a field of science
  • 2  Freudian theory
  • 8.  Notes
  • 9.  References

History of Psychoanalysis

1890s

The idea of ​​psychoanalysis (in German: Psychoanalyse ) began to receive serious attention by Sigmund Freud, who formulated his own theory of psychoanalysis in Vienna in the 1890s. Freud was a neurologist trying to find an effective treatment for patients with neurotic or hysterical symptoms. . Freud realized that there were mental processes that he was not aware of, while he was employed as a neurological consultant at a children’s hospital, where he realized that many aphasic children had no apparent organic cause for their symptoms. He then wrote a monograph on this subject. [11] In 1885, Freud obtained a scholarship to study with Jean-Martin Charcot, a famous neurologist, at Salpêtrière in Paris, where Freud attended Charcot’s clinical presentations, particularly in the areas of hysteria, paralysis and anesthesia. Charcot presented hypnotism as an experimental research tool and developed the photographic representation of clinical symptoms.

Freud’s first theory to explain hysterical symptoms was presented in  Studies on Hysteria  (1895), co-authoring his mentor, the distinguished physician Josef Breuer, which is generally seen as the birth of psychoanalysis . The work was based on the treatment of Bertha Pappenheim by Breuer, referred to in case studies with the pseudonym “Anna O.”, a treatment that Pappenheim herself had dubbed “speech cure”. Breuer wrote that many factors could result in such symptoms, including various types of emotional trauma, and he also credited the work of others, such as Pierre Janet; while Freud claimed that, at the root of hysterical symptoms, there were repressed memories of distressing occurrences, almost always with direct or indirect sexual associations.[12]

At the same time, Freud tried to develop a neurophysiological theory of unconscious mental mechanisms, which he soon gave up on. This remained unpublished during his lifetime. [13]

The first occurrence of the term “psychoanalysis” in written form ( psychoanalyse ) was in Freud’s essay “L’hérédité et l’étiologie des névroses” which was written and published in French in 1896. [14]  [15]

In 1896, Freud also published his so-called  seduction theory , which proposed that the preconditions for hysterical symptoms were sexual arousals in childhood, and claimed to have discovered repressed memories of sexual abuse incidents for all current patients. [16]  However, in 1898 he privately acknowledged to his friend and colleague Wilhelm Fliess that he no longer believed his theory, although he did not state this publicly until 1906. [17]  Although in 1896 he reported that his patients “They had no feeling or memory of the [child sexual] scenes, and assured him” emphatically their unbelief ” [18] in later reports, he said he was told that he had been sexually abused in childhood. This became historic, was received and even challenged by several Freud scholars in the latter part of the 20th century, who argued that he imposed his preconceived notions on his patients. [19]  [20]  [21]  However, based on his claims that patients reported experiences of child sexual abuse, Freud later claimed that his clinical findings in the mid-1890s provided evidence for the occurrence of unconscious fantasies, allegedly to cover memories of child masturbation. [22]  Only much later did he claim the same findings as evidence of Oedipal desires. [23]

1900-1940

International Psychoanalytic Congress. 1911. Freud and Jung in the center

In 1900, Freud theorized that dreams had symbolic significance and were generally specific to the dreamer. Freud formulated his second psychological theory – hypothesis that the unconscious has or is a “primary process” consisting of symbolic and condensed thoughts and a “secondary process” of logical and conscious thoughts. This theory was published in his 1900 book, ” The Interpretation of Dreams” . [24]  Chapter VII was a new work from the previous “Project” and Freud outlined his ” Topographic Theory “. In this theory, which was later superseded by the Structural Theory, unacceptable sexual desires were repressed in the “unconscious system”, due to society’s condemnation of premarital sexual activity.

This “topographic theory” is still popular in much of Europe, although it has fallen in popularity in much of North America. [25]  In 1905, Freud published  Three essays on the theory of sexuality [26],  in which he presented the discovery of the so-called  psychosexual phases of development :

  • oral phase (0-2 years old),
  • anal phase (2-4),
  • phallic-edipal phase (3-6),
  • latency phase (6 years-puberty) and
  • genital phase (puberty onwards).

Its early formulation included the idea that, due to social restrictions, sexual desires were repressed in an unconscious state and that the energy of those unconscious desires could be transformed into anxiety or physical symptoms. Therefore, early treatment techniques, including hypnotism and aberration , were designed to raise awareness of the unconscious to relieve pressure and the resulting symptoms. This method would later be set aside by Freud, giving free association to a larger role.

In About Narcissism  (1915) [27]  Freud turned his attention to the subject of narcissism. Still using an energy system, Freud characterized the difference between energy directed towards the self versus energy directed towards others, called  cathexis . In 1917, in ” Mourning and Melancholy “, he suggested that certain depressions were caused by returning a guilty wrath to himself. [28]  In 1919 in ” A child is beaten “, he began to address the problems of self-destructive behavior (moral masochism) and open sexual masochism. [29] Based on his experience with depressed and self-destructive patients, and pondering the carnage of World War I, Freud was dissatisfied with considering only oral and sexual motivations for behavior. In 1920, Freud addressed the power of identification (with the leader and with other members) in groups as a motivation for behavior ( Group Psychology and Ego Analysis /  Mass Psychology and Self Analysis ). [30]  That same year (1920) Freud suggested his theory of two instincts (drives) (sexuality and aggression) in Beyond the Pleasure Principle , to try to begin to explain human destruction. In addition, it was the first appearance of his “structural theory” composed of three new concepts:id, ego and superego . [31]

Three years later, he summarized the ideas of id, ego and superego in the book The Ego and the Id . [32]  In the book, he reviewed the whole theory of mental functioning, now considering that repression was only one of many defense mechanisms, and that this was done to reduce anxiety. For this reason, Freud characterized repression as the cause and result of anxiety. In 1926, in  Inhibitions, Symptoms and Anxiety,  Freud characterized how the intrapsychic conflict between the impulse and the superego (desires and guilt) causes anxiety and how that anxiety could lead to an inhibition of mental functions, such as intellect and speech. [33]  Inhibitions, Symptoms and Anxiety  was written in response to Otto Rank, who, in 1924, published Das Trauma der Geburt  (translated into English in 1929 as  Trauma of Birth and which would be translated into Portuguese as something like “Birth trauma” ), analyzing how art, myth, religion, philosophy and therapy were illuminated by separation anxiety in the “phase before the development of the Oedipus complex”. [34]  Freud’s theories, however, did not characterize this phase. According to Freud, the Oedipus complex it was at the center of the neurosis and was the fundamental source of all art, myth, religion, philosophy, therapy – indeed, of all human culture and civilization. It was the first time that someone in the inner circle characterized something different from the Oedipus complex as contributing to intrapsychic development, a notion that was rejected by Freud and his followers at that time.

In 1936, the “Principle of Multiple Function” was clarified by Robert Waelder. [36]  He extended the formulation that psychological symptoms were caused and alleviated simultaneously. In addition, symptoms (such as phobias and compulsions) represented elements of some instinctive desire (sexual and / or aggressive), the superego, anxiety, reality and defenses. Also in 1936, Sigmund’s daughter, Anna Freud, published her seminal book,  The Ego and the Mechanisms of Defense , describing countless ways in which the mind could silence disturbing things outside of consciousness. [36]

1940s – Present

When Hitler’s power grew, the Freud family and many of his colleagues fled to London. Within a year, Sigmund Freud died. [37]  In the United States, also after Freud’s death, a new group of psychoanalysts began to explore the function of the ego. Directed by Heinz Hartmann, Kris, Rappaport and Lowenstein, the group was based on the understanding of the synthetic function of the ego as a mediator in psychic functioning. Hartmann, in particular, distinguished between autonomous functions of the ego (such as memory and intellect that could be secondarily affected by conflict) and synthetic functions that were the result of a formation of compromise . These “ ego psychologists”From the 1950s paved the way for focusing on analytical work by addressing defenses (mediated by the ego) before exploring the deeper roots of unconscious conflicts. In addition, there was a growing interest in child psychoanalysis. Despite being criticized from the beginning, psychoanalysis has been used as a research tool in childhood development  [38]  and is still used to treat certain mental disorders. [39] In the 1960s, Freud’s first thoughts on the child development of female sexuality were challenged; this challenge led to the development of a variety of understandings of female sexual development, many of which modified the timing and normality of various Freud’s theories (which were extracted from the treatment of women with mental disorders). Several researchers  [40]  followed Karen Horney’s studies of the social pressures that influence women’s development.

In the first decade of the 21st century, there were approximately 35 training institutes for psychoanalysis in the United States accredited by the American Psychoanalytic Association (APsaA), which is a component organization of the International Psychoanalytic Association (IPA), and there are more than 3000 graduate psychoanalysts practicing in the States United. IPA believes in psychoanalytic training centers through “component organizations” across the rest of the world, including countries like Serbia, France, Germany, Austria, Italy, Switzerland, [41]  and many others, as well as about six institutes directly in the United States.

Psychoanalytic theories

The prevailing psychoanalytic theories can be organized in several theoretical schools. Although these theoretical schools differ, most of them emphasize the influence of unconscious elements on consciousness. There has also been considerable work in consolidating elements of conflicting theories (see work by Theodore Dorpat, B. Killingmo and S. Akhtar). [42] There are some persistent conflicts over specific causes of certain syndromes and disputes over ideal treatment techniques. In the 21st century, psychoanalytic ideas are embedded in Western culture, especially in fields such as childcare, education, literary criticism, cultural studies, mental health and particularly psychotherapy. Although there is a mainstream of evolved psychoanalytic ideas, there are groups that follow the precepts of one or more of the latter theorists. Psychoanalytic ideas also play roles in some types of literary analysis, such as archetypal literary criticism.

Topographic theory

Topographic theory was first named and described by Sigmund Freud in  The Interpretation of Dreams  (1900). [24]  [43]  The theory hypothesizes that the mental apparatus can be divided into the Conscious, Preconscious and Unconscious systems. These systems are not anatomical structures of the brain, but mental processes. Although Freud maintained this theory throughout his life, he largely replaced it with structural theory. [44]  Topographic theory remains one of the metapsychological points of view to describe how the mind works in classical psychoanalytic theory.

Structural theory

Structural theory divides the psyche into id, ego and superego (or That , Me and Superego ).

  • The id is present at birth as the repository of basic instincts, which Freud called ” Trieb ” (“drives” or “instincts”, depending on the translation): disorganized and unconscious, operates only on the “pleasure principle”, without realism or forecast.
  • The ego develops slowly and gradually, concerned with the mediation between the impulse of the id and the realities of the external world; it thus operates on the “principle of reality”.
  • The superego is considered the part of the ego in which self-observation, self-criticism and other reflective and critical faculties develop. The ego and the superego are both partly conscious and partly unconscious. [44]

Psychology of the  Ego

The psychology of the ego was initially suggested by Freud in  Inhibitions, Symptoms and Anxiety  (1926). The theory was refined by Hartmann, Loewenstein and Kris in a series of articles and books from 1939 until the late 1960s. Leo Bellak was a later contributor. This series of constructions, paralleled with some of the later developments of cognitive theory, includes the notions of autonomous functions of the ego: mental functions not dependent, at least in origin, on intrapsychic conflicts. Such functions include: sensory perception, motor control, symbolic thinking, logical thinking, speech, abstraction, integration (synthesis), orientation, concentration, judgment about danger, reality test, adaptive capacity, executive decision making, hygiene and self-preservation. Freud noted that inhibition is a method that the mind can use to interfere with any of these functions in order to avoid painful emotions. Hartmann (1950) pointed out that there may be delays or deficits in such functions.

Frosch (1964) described differences in people who demonstrated damage to their relationship with reality, but who seemed able to test it. Deficits in the ability to organize thinking are sometimes referred to as blocking or loose associations (Bleuler), and are characteristic of schizophrenia. Deficits in the capacity for abstraction and self-preservation also suggest psychosis in adults. Deficits in orientation and sensorium are often indicative of a disease that affects the brain (and therefore autonomous functions of the ego). Deficits in certain functions of the ego are routinely found in children who are severely abused physically or sexually, where the powerful effects generated throughout childhood appear to have eroded some functional development.

According to ego psychology, ego forces, later described by Otto F. Kernberg (1975), include the ability to control oral, sexual and destructive impulses; to tolerate painful conditions without collapsing; and to avoid the eruption in the consciousness of strange symbolic fantasy. Synthetic functions, in contrast to autonomous functions, arise from ego development and serve the purpose of managing conflict processes. Defenses are synthetic functions that protect the conscious mind from awareness of prohibited impulses and thoughts. One purpose of ego psychology has been to emphasize that some mental functions can be considered basic, rather than derived from desires, affections or defenses. However, the autonomous functions of the ego can be secondarily affected due to unconscious conflict. For example,

Taken together, the above theories present a group of metapsychological premises. Therefore, the inclusive group of different classical theories provides a cross-sectional view of the human mentality. There are six “points of view”, five described by Freud and a sixth added by Hartmann. Unconscious processes can, therefore, be assessed from each of these six points of view:

  1. Topographic
  2. Dynamic (conflict theory)
  3. Economic (energy flow theory)
  4. Structural
  5. Genetic (propositions about the origin and development of psychological functions)
  6. Adaptation (psychological phenomena related to the external world). [45]

Modern conflict theory

Modern conflict theory, a variation of ego psychology, is a revised version of structural theory, but remarkably different, changing concepts related to where repressed thoughts were stored (Freud, 1923, 1926). Modern conflict theory addresses emotional symptoms and character traits as complex solutions to mental conflict. [46]  Dispenses with the concepts of fixed id, ego and superego and instead places conscious and unconscious conflict between desires (dependent, controlling, sexual and aggressive), guilt and shame, emotions (especially anxiety and depressive illness), and defensive operations that disconnected some aspect of others from consciousness. In addition, healthy (adaptive) functioning is also largely determined by conflict resolutions.

One of the main objectives of modern psychoanalytic conflict theory is to change the balance of conflict in a patient, making aspects of less adaptive solutions (also called “compromise formations”) aware so that more adaptable solutions can be rethought and found. Current theorists followed many of Brenner’s suggestions (see especially Brenner’s 1982 book  The Mind in Conflict ) including Sandor Abend (Abend, Porder, & Willick, (1983),  Borderline Patients: Clinical Perspectives ), Jacob Arlow (Arlow and Brenner (1964),  Psychoanalytic Concepts and the Structural Theory ) and Jerome Blackman (2003), 101 Defenses: How the Mind Shields Itself .

Theory of object relations

The theory of object relations tries to explain the ups and downs of human relationships by studying how internal representations of self and others are organized. Clinical symptoms that suggest object relationship problems (usually developmental delays throughout life) include disturbances in an individual’s ability to empathize, trust, sense of security, identity stability, consistent emotional closeness and stability in relationships with other people important. (It is not suggested that everyone should be trusted, for example). Concepts related to internal representations (also sometimes called “introspections”, “representations of oneself and objects”, or “internalization of oneself”), although often attributed to Melanie Klein,Three Essays on the Theory of Sexuality,  1905). Freud’s 1917 article, “Mourning and Melancholy”, for example, raised the hypothesis that the unresolved suffering was caused by the internalized image of the deceased merging with that of the survivor and then the survivor transforming unacceptable anger by the deceased in the now complex self-image. [47]

Vamik Volkan, in “Linking Objects and Linking Phenomena”, expanded Freud’s thoughts on this, describing the syndromes of “Established pathological grief” versus “reactive depression” based on similar dynamics. Melanie Klein’s hypotheses regarding internalization during the first year of life, leading to paranoid and depressive positions, were later challenged by René Spitz (for example,  The First Year of Life , 1965), who divided the first year of life into a cenesthetic phase of the first six months, and then a diacritical phase for the second six months. Margaret Mahler and her group (Mahler, Fine and Bergman, The Psychological Birth of the Human Infant , 1975) ,first in New York, then in Philadelphia, they described different phases and subphases of child development leading to “separation-individuation” during the first three years of life, emphasizing the importance of the constancy of parental figures, in the face of the child’s destructive aggression, internalizations of the child, stability of affect management and capacity to develop healthy autonomy.

John Frosch, Otto Kernberg, Salman Akhtar and Sheldon Bach developed the theory of self-confidence and object constancy, as it affects adult psychiatric problems, such as psychosis and borderline states. Peter Blos described (in a book entitled  On Adolescence , 1960), how similar separation-individuation struggles occur in adolescence, of course, with a different outcome from the first three years of life: the teenager usually eventually leaves his parents’ home (this varies with culture). During adolescence, Erik Erikson (1950-1960) described the “identity crisis”, which involves identity anxiety / identity confusion. For an adult to experience a “warm ethics” (empathy, trust, holding environment(Winnicott), identity, closeness and stability) in relationships (see Blackman, 101 Defenses: How the Mind Shields Itself , 2001), the adolescent must solve problems with identity and resize the constancy of the self and the object.

Psychology of the Self

The psychology of the self emphasizes the development of a stable and integrated sense of the self through empathic contacts with other human beings, other primary signifiers conceived as “self-objects”. Self-objects meet the needs of the developing self of mirroring, idealization and twinship , and thus strengthen the development of the self. The treatment process proceeds through “transmuting internalizations” in which the patient gradually internalizes the self-object functions provided by the therapist. The psychology of the self was originally proposed by Heinz Kohut, and was developed by Arnold Goldberg, Frank Lachmann, Paul and Anna Ornstein, Marian Tolpin and others.

Jacques Lacan and Lacanian psychoanalysis

Lacanian psychoanalysis, which integrates psychoanalysis with structural linguistics and Hegelian philosophy, is especially popular in France and parts of Latin America. Lacanian psychoanalysis is a departure from traditional British and American psychoanalysis, which is predominantly ego psychology. Jacques Lacan often used the phrase “retourner à Freud” (“return to Freud”) in his seminars and writings, claiming that his theories were an extension of Freud’s own, contrary to Anna Freud’s, the Psychology of the Ego, the relations of object and theories of the self, and also claims the need to read the complete works of Freud, not just a part of them. Lacan’s concepts concern, for example, the “ mirror stadium ”, the “ Real ”, the “ Imaginary”And” Symbolic “, and the statement that” the unconscious is structured as a language “. [48]

Although Lacan and his ideas had a great influence on psychoanalysis in France and parts of Latin America, it took longer to translate into English and therefore had less impact on psychoanalysis and psychotherapy in the English-speaking world. In the United Kingdom and the United States, his ideas are widely used to analyze texts in literary theory. [49]  Due to his increasingly critical position in relation to Freud’s deviation from thought, often highlighting private texts and readings from his colleagues, Lacan was excluded from acting as a training analyst at IPA, leading him to create his own school to maintain an institutional structure for the many candidates who wished to continue their analysis with him. [50]

Interpersonal psychoanalysis

Interpersonal psychoanalysis emphasizes the nuances of interpersonal interactions, particularly how individuals protect themselves from anxiety, establishing collusive interactions with others and the relevance of real experiences with other developing people (eg family and peers), as well as in the present . This contrasts with the primacy of intrapsychic forces, as in classical psychoanalysis. Interpersonal theory was first introduced by Harry Stack Sullivan, and developed by Frieda Fromm-Reichmann, Clara Thompson, Erich Fromm and others who contributed to the founding of the William Alanson White Institute and to Interpersonal Psychoanalysis in general.

Culturalist psychoanalysis

Some psychoanalysts have been labeled  culturalists , due to the prominence they attributed to culture in the genesis of behavior. [51]  Among others, Erich Fromm, Karen Horney and Harry Stack Sullivan, were called  culturalist psychoanalysts . [51]  They were famous for their conflict with orthodox psychoanalysts. [52]

Feminist psychoanalysis

Feminist theories of psychoanalysis emerged towards the second half of the 20th century, in an effort to articulate difference and feminine, maternal and sexual development from the point of view of women. For Freud, Winnicott and the theories of object relations, the mother is structured as the object of the baby’s rejection (Freud) and destruction (Winnicott). For Lacan, the “woman” can accept the phallic symbol as an object or embody a lack in the symbolic dimension that informs the structure of the human subject. Feminist psychoanalysis is mainly post-Freudian and post-Lacanian with theorists like Toril Moi, Joan Copjec, Juliet Mitchell, [53]  Teresa Brennan  [54]  and Griselda Pollock who rethink Art and Mythology [55]  following French feminist psychoanalysis[56],  the look and the sexual difference, from aa from the feminine. [57]  French theorists like Luce Irigaray defy phallogocentrism. [58]  [59]  Bracha Ettinger offers a dimension of the “matrix” subject that takes into account the prenatal stage (matrix connectivity)  [60]  and suggests a feminine-maternal Eros, a matrix look and primary maternal fantasies. [61]  Jessica Benjamin addresses the issue of the feminine and love. [62]  Feminist psychoanalysis informs and includes gender, queer and post-feminist theories.

Adaptive paradigm of psychoanalysis and psychotherapy

The “adaptive paradigm of psychotherapy” develops from the work of Robert Langs. The adaptive paradigm interprets psychic conflict mainly in terms of conscious and unconscious adaptation to reality. Langs’ recent work to some extent goes back to an earlier Freud, in that Langs prefers a modified version of the topographic model of the mind (conscious, pre-conscious and unconscious) over the structural model (id, ego and super-ego) including the former’s emphasis on trauma (although Langs looks at death-related traumas rather than sexual traumas). [44]  At the same time, Langs’s model of mind differs from that of Freud in that it understands the mind in terms of evolutionary biological principles. [63]

Relational psychoanalysis

Relational psychoanalysis combines interpersonal psychoanalysis with the theory of object relations and with inter-subjective theory as critical to mental health. It was presented by Stephen Mitchell. [64] Relational psychoanalysis emphasizes how the individual’s personality is shaped by real and imagined relationships with others, and how these relationship patterns are reissued in interactions between analysts and patients. In New York, the main defenders of relational psychoanalysis include Lew Aron, Jessica Benjamin and Adrienne Harris. Fonagy and Target, in London, proposed their vision of the need to help certain separated and isolated patients to develop the capacity for “mentalization” associated with thinking about relationships and themselves. Arietta Slade, Susan Coates and Daniel Schechter, in New York, additionally contributed to the application of relational psychoanalysis to the treatment of the adult patient as a father, the clinical study of mentalization in the relationships between parents and babies and the intergenerational transmission of affections and trauma.

Interpersonal-relational psychoanalysis

The term interpersonal-relational psychoanalysis is often used as a professional identification. Psychoanalysts under this broader umbrella debate what precisely the differences between the two schools are, without any clear and current consensus.

Intersubjective psychoanalysis

The term “intersubjectivity” was introduced to psychoanalysis by George E. Atwood and Robert Stolorow (1984). Intersubjective approaches emphasize how personality development and the therapeutic process are influenced by the interrelationship between the patient’s subjective perspective and that of others. The authors of interpersonal-relational and intersubjective approaches: Otto Rank, Heinz Kohut, Stephen A. Mitchell, Jessica Benjamin, Bernard Brandchaft, J. Fosshage, Donna M. Orange, Arnold “Arnie” Mindell, Thomas Ogden, Owen Renik, Irwin Z Hoffman, Harold Searles, Colwyn Trevarthen, Edgar A. Levenson, Jay Greenberg, Edward R. Ritvo, Beatrice Beebe, Frank M. Lachmann, Herbert Rosenfeld and Daniel Stern.

Modern psychoanalysis

“Modern psychoanalysis” is a term coined by Hyman Spotnitz and his colleagues to describe a set of theoretical and clinical approaches that aim to broaden Freud’s theories in order to make them applicable to the entire spectrum of emotional disorders and to broaden the treatment potential for pathologies considered intractable by classical methods. Interventions based on this approach are mainly aimed at providing emotional-maturational communication to the patient, instead of promoting intellectual perception. These interventions, in addition to the targeted objectives, are used to resolve resistance that is presented in the clinical setting. This school of psychoanalysis has provided training opportunities for students in the United States and in countries around the world. His journal Modern Psychoanalysisit has been published since 1976.  [65]

Psychopathology (mental disorders)

Adult patients

The various psychoses involve deficits in the autonomous functions of the ego, of integration (organization) of thought, in the capacity for abstraction, in relation to reality and reality tests. In depressions with psychotic characteristics, the self-preservation function can also be impaired (sometimes by an overwhelming depressive effect). Due to integrative deficits (often causing what general psychiatrists call “loose associations”, “blocking”, “flight of ideas”, “verbiage” and “withdrawal of thought”), the development of representations of self and object is also harmed. Clinically, therefore, psychotic individuals manifest limitations of empathy, trust, identity, closeness and / or stability in relationships (due to problems with self-object fusion anxiety) as well.

In patients whose autonomous ego functions are more intact, but who still show problems with object relations, the diagnosis generally falls into the category known as “borderline”. Borderline patients also show deficits, often in controlling impulses, affections or fantasies – but their ability to test reality remains more or less intact. Adults who do not experience guilt and shame, and who engage in criminal behavior, are usually diagnosed as psychopaths or, using the DSM-IV-TR, with antisocial personality disorder.

Panic, phobias, conversions, obsessions, compulsions and depressions (analysts call these “neurotic symptoms”) are not usually caused by deficits in function, but are caused by intrapsychic conflicts. Conflicts are usually between sexual and hostile-aggressive desires, guilt and shame and factors of reality. Conflicts may be conscious or unconscious, but they create anxiety, depressive affect and anger. Finally, the various elements are managed by defensive operations – they essentially close mental mechanisms that make people unaware of that element of conflict. “Repression” is the term given to the mechanism that keeps thoughts out of consciousness. “Isolation from affection” is the term used for the mechanism that keeps sensations out of consciousness. Neurotic symptoms can occur with or without deficits in ego functions, object relations and ego forces. Therefore, it is not uncommon to find obsessive-compulsive schizophrenics, panic patients who also suffer from borderline personality disorder, etc.

Origin in childhood

Freudian theories believe that adult problems can be attributed to unresolved conflicts in certain phases of childhood and adolescence, caused by fantasy, arising from their own instincts. Freud, based on data collected from his patients early in his career, suspected that neurotic disorders occurred when children were sexually abused in childhood (the so-called  seduction theory). Later, Freud came to believe that, despite child abuse, neurotic symptoms were not associated with this. He believed that neurotic people generally had unconscious conflicts involving incestuous fantasies arising from different stages of development. He observed the phase of about three to six years of age (preschool years, now called “first genital stage”) being filled with fantasies of having romantic relationships with both parents. The arguments were quickly generated in Vienna in the early twentieth century about the seduction of children by adults, that is, child sexual abuse, was the basis of a neurotic disease. There is still no complete agreement, although professionals today recognize the negative effects of child sexual abuse on mental health. [66]

Many psychoanalysts who work with children have studied the real effects of child abuse, which include deficits in ego and object relationships and serious neurotic conflicts. Much research has been carried out on these types of trauma in childhood and the sequelae in adults. In studying the childhood factors that initiate the development of neurotic symptoms, Freud found a constellation of factors that, for literary reasons, he called the Oedipus complex (based on Sophocles’ play, Oedipus the King , where the protagonist involuntarily kills his father Laius and marries his mother Jocasta). The validity of the Oedipus complex is now widely contested. [67]  [68] The abbreviated term, “Oedipus” – later explained by Joseph J. Sandler in “On the Concept Superego” (1960) and modified by Charles Brenner in “The Mind in Conflict” (1982) – refers to the powerful attachments that children have for their parents in preschool years. These affects involve fantasies of sexual relations with one (or both) parents and, therefore, competitive fantasies for one (or both) parents. Humberto Nagera (1975) has been particularly helpful in clarifying many of the child’s complexities during these years.

The “positive” and “negative” Oedipal conflicts were associated with heterosexual and homosexual aspects, respectively. Both seem to occur in the development of most children. Eventually, the developing child’s concessions to reality (that he will not marry one parent or eliminate the other) lead to identifications with the parents’ values. These identifications generally create a new set of mental operations regarding values ​​and guilt, subsumed under the term “superego”. In addition to the development of the superego, children “resolve” their pre-school Oedipal conflicts by channeling desires into something that their parents approve of (“sublimation”) and the development, during school years (“latency”) of defense maneuvers obsessive-compulsive age-appropriate (rules, repetitive games).

Treatment

Using the various analytical and psychological techniques to assess mental problems, some believe that there are particular constellations of problems that are especially suitable for analytical treatment (see below), while other problems may respond better to medications and other interpersonal interventions. To be treated with psychoanalysis, whatever the problem presented, the person asking for help must demonstrate the desire to start an analysis. The person who wants to start an analysis must have some speech and communication skills. In addition, clients need to be able to have or develop confidence and insight within the psychoanalytic session. Potential patients must undergo a preliminary treatment stage to assess their capacity for psychoanalysis at that time, and also allow the analyst to form a psychological model that he will use to direct treatment. Psychoanalysts work mainly with neurosis and hysteria in particular; however, adapted forms of psychoanalysis are used in working with schizophrenia and other forms of psychosis or mental disorder. Finally, if a patient has a severely suicidal potential, a longer preliminary stage can be employed, sometimes with sessions that have a twenty-minute break in between. There are numerous changes in the technique under the title of psychoanalysis due to the individualistic nature of the personality in both the analyst and the patient. adapted forms of psychoanalysis are used in work with schizophrenia and other forms of psychosis or mental disorder. Finally, if a patient has a severely suicidal potential, a longer preliminary stage can be employed, sometimes with sessions that have a twenty-minute break in between. There are numerous changes in the technique under the title of psychoanalysis due to the individualistic nature of the personality in both the analyst and the patient. adapted forms of psychoanalysis are used in work with schizophrenia and other forms of psychosis or mental disorder. Finally, if a patient has a severely suicidal potential, a longer preliminary stage can be employed, sometimes with sessions that have a twenty-minute break in between. There are numerous changes in the technique under the title of psychoanalysis due to the individualistic nature of the personality in both the analyst and the patient.

The most common problems treatable with psychoanalysis include: phobias, conversions, compulsions, obsessions, anxiety attacks, depressions, sexual dysfunctions, a wide variety of relationship problems (such as marital conflicts) and a wide variety of character problems ( for example, painful shyness, disobedience, work addiction, hyperactivity, hyperemotionality). The fact that many of these patients also demonstrate the aforementioned deficits makes diagnosis and treatment selection difficult.

Analytical organizations like IPA, APsaA and the European Federation of Psychoanalytic Psychotherapy have established procedures and models for the indication and practice of psychoanalytic therapy for trainees under analysis. The combination between the analyst and the patient can be seen as another contributing factor for the indication and contraindication for psychoanalytic treatment. The analyst decides whether the patient is suitable for psychoanalysis. This decision made by the analyst, in addition to taking into account the usual indications and pathology, is also based on a certain degree by the “adjustment” between analyst and patient. A person’s suitability for analysis at any specific time is based on their desire to know something about the origin of the disease.

An assessment can include one or more independent opinions of other analysts and will include discussion of the patient’s financial situation.

Techniques

The basic method of psychoanalysis is the interpretation of the patient’s unconscious conflicts that interfere with current functioning – conflicts that are causing painful symptoms such as phobias, anxiety, depression and compulsions. Strachey (1936) emphasized that the discovery of ways in which the patient distorted perceptions about the analyst leads to the understanding of what may have been overlooked (see also Freud’s article “Remember, Repeat and Elaborate”). In particular, unconscious hostile feelings towards the analyst could be found in symbolic and negative reactions to what Robert Langs later called a “frame” in therapy  [69] – the configuration that includes session times, payment of fees and the need to speak. In patients who made mistakes, forgot or showed other peculiarities in relation to time, fees and speech, the analyst can usually find several unconscious “resistances” to the flow of thoughts (sometimes called free association).

When the patient reclines on a couch with the analyst out of sight, he tends to remember more, experiences less resistance and more transfer and is able to reorganize thoughts after the development of perception – through the analyst’s interpretive work. Although fantasy life can be understood through examining dreams, masturbation fantasies (Marcus, I. and Francis, J. (1975), Masturbation from Infancy to Senescence ) are also important. The analyst is interested in how the patient reacts and avoids such fantasies (see Paul Gray (1994),  The Ego and Analysis of Defense ). [70] Several early life memories are often distorted – Freud called them “screen memories” – and, in any case, very early experiences (before the age of two) – cannot be remembered (see Eleanor Galenson’s childhood studies on “ evocative memory ”).

Variations in technique

There is what is known among psychoanalysts as “classical technique”, although Freud, throughout his writings, deviated considerably, depending on the problems of any patient. The classic technique was summarized by Allan Compton as comprising instructions (telling the patient to try to say what is on his mind, including interference); exploration (questions); and clarification (reformulating and summarizing what the patient described). In addition, the analyst can also use confrontation to bring a functioning aspect, usually a defense, to the patient’s attention. The analyst then uses a variety of interpretation methods, such as:

  • dynamic interpretation (explaining how good defenses are against guilt, for example – defense versus affection);
  • genetic interpretation (explaining how a past event is influencing the present);
  • resistance interpretation (showing patients how they are avoiding their problems);
  • transference interpretation (showing the patient that old conflicts arise in current relationships, including with the analyst);
  • or dream interpretation (getting the patient’s thoughts about their dreams and connecting that to their current problems).

Analysts can also use reconstruction to estimate what may have happened in the past, which created some current problem.

These techniques are mainly based on conflict theory (see above). As the theory of object relations evolved, complemented by the work of John Bowlby and Mary Ainsworth, techniques with patients with more serious problems with basic confidence (Erikson, 1950) and a history of maternal deprivation (see Augusta’s works Alpert) led to new techniques with adults. These were sometimes called interpersonal, intersubjective (see Stolorow), relational or corrective. These techniques include expressing an empathetic attunement to the patient; exposing some of the analyst’s personal life or attitudes to the patient; allowing patient autonomy in the form of disagreement with the analyst (see IH Paul,  Letters to Simon); and explaining the motivations of others that the patient misunderstands. The egoic psychological concepts of deficit in functioning have led to refinements in supportive therapy. These techniques are particularly applicable to psychotic and quasi-psychotic patients (see Eric Marcus, “Psychosis and Near-psychosis”). These supportive therapy techniques include discussions about reality; incentive to stay alive (including hospitalization); psychotropic drugs to relieve overwhelming depressive affect or overwhelming fantasies (hallucinations and delusions); and advice on the meanings of things (to counter flaws in abstraction).

The notion of a “silent analyst” has been criticized. In fact, the analyst listens using Arlow’s approach as set out in “The Genesis of Interpretation”, using active intervention to interpret resistance, defenses creating pathology and fantasies. Silence is not a psychoanalysis technique (see also Owen Renik’s studies and opinion pieces). “Analytical neutrality” is a concept that does not mean that the analyst is silent. It refers to the analyst’s position of not taking sides in the patient’s internal struggles. For example, if a patient feels guilty, the analyst can explore what the patient has done or thought to be causing the guilt, but not reassure the patient not to feel guilty.

Interpersonal and relational psychoanalysts emphasize the notion that it is impossible to be neutral. Sullivan introduced the term “participant-observer” to indicate that the analyst inevitably interacts with the analysand and suggested detailed inquiry as an alternative to interpretation. The detailed survey involves observing where the analysand is setting aside important elements of a report, observing when the story is overshadowed and asking careful questions to open the dialogue.

Group therapy and game therapy

Although single client sessions remain the norm, psychoanalytic theory has been used to develop other types of psychological treatment. Psychoanalytic group therapy pioneered Trigant Burrow, Joseph Pratt, Paul F. Schilder, Samuel R. Slavson, Harry Stack Sullivan, and Wolfe. Child-centered parenting advice was instituted at the beginning of analytical history by Freud and was later developed by Irwin Marcus, Edith Schulhofer and Gilbert Kliman. Couple therapy based on psychoanalysis was enacted and explained by Fred Sander. The techniques and tools developed in the first decade of the 21st century made psychoanalysis available to patients who were not treatable by previous techniques. This means that the analytical situation has been modified to make it more suitable and more likely to be useful for these patients. MN Eagle (2007) believes that psychoanalysis cannot be an autonomous discipline, but it must be open to influence and integration with findings and theories from other disciplines. [71]

Psychoanalytic constructions have been adapted for use with children with treatments such as game therapy, art therapy and storytelling. Throughout her career, from the 1920s to the 1970s, Anna Freud adapted psychoanalysis for children through play. This is still used today for children, especially those who are pre-teens (see Leon Hoffman, New York Psychoanalytic Institute Center for Children). Using toys and games, children are able to symbolically demonstrate their fears, fantasies and defenses; although not identical, this technique in children is analogous to the goal of free association in adults. Psychoanalytic game therapy allows the analyst to understand children’s conflicts, in particular defenses, such as disobedience and withdrawal, who have held various unpleasant feelings and hostile desires. In art therapy, the analyst can see a child draw a portrait and then tell a story about the portrait. The analyst observes recurring themes – regardless of whether it is art or toys.

Cultural variations

Psychoanalysis can be adapted to different cultures, as long as the therapist understands the client’s culture. For example, Tori and Blimes found that the 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 tranquility and collectivity (because of Buddhist beliefs), so they were with low regressive emotion. Psychoanalysis also applies because Freud used techniques that allowed him to perceive the subjective perceptions of his patients. He takes an objective approach by not facing his clients during his psychotherapy sessions. He met with his patients wherever they were, like when he used free membership – where customers would say whatever came to mind without self-censorship. Their treatments had little or no structure for most cultures, especially Asian cultures. Therefore, Freudian constructions are more likely to be used in structured therapy (Thompson, et al., 2004). In addition, Corey postulates that it will be necessary for a therapist to help clients develop a cultural identity and an ego identity.

Cost and duration of treatment

The cost to the patient of psychoanalytic treatment varies widely from place to place and among practitioners. The cheapest analysis is generally available at a psychoanalytic training clinic and at undergraduate and graduate courses at universities. Otherwise, the price set by each analyst varies with the analyst’s training and experience. Since, in most locations in the United States, unlike Ontario and Germany, classic analysis (which usually requires sessions three to five times a week) is not covered by health insurance, many analysts can negotiate their prices with patients that they feel they can help, but who have financial difficulties. Analysis modifications, which include psychodynamic therapy, brief therapies, and certain types of group therapy (see Slavson, SR, Textbook in Analytic Group Therapy ), are performed less frequently – usually once, twice or three times a week – and the patient usually faces the therapist. As a result of defense mechanisms and the lack of access to the unfathomable elements of the unconscious, psychoanalysis can be an expansive process that involves 2 to 5 sessions per week for several years. This type of therapy is based on the belief that reducing symptoms will not really help with root causes or irrational units. The analyst is typically a “blank canvas”, revealing very little about himself so that the client can use the space in the relationship to work on his unconscious without outside interference.

The psychoanalyst uses several methods to help the patient become more aware of himself and to develop insights into his behavior and the meanings of the symptoms. First, the psychoanalyst tries to develop a confidential atmosphere in which the patient can feel safe informing his feelings, thoughts and fantasies. The analysands (as the people in analysis are called) are asked to report what comes to mind without fear of reprisals. Freud called this a “fundamental rule”. The analysands are invited to talk about their lives, including their past, current life, hopes and aspirations for the future. They are encouraged to report their fantasies, “flash of thoughts” and dreams. In fact, Freud believed that dreams were “the real road to the unconscious”; he dedicated an entire volume to the interpretation of dreams. In addition, psychoanalysts encourage their patients to recline on a couch – the famous couch. Usually, the psychoanalyst sits, out of sight, behind the patient.

The psychoanalyst’s task, in collaboration with the analysand, is to help deepen the analysand’s understanding of these factors, outside his awareness, that drive his behaviors. In the safe environment of the psychoanalytic scenario, the analysand becomes attached to the analyst and soon begins to experience the same conflicts with his analyst that he experiences with key figures in his life, such as his parents, his boss, the significant other, etc. It is the role of the psychoanalyst to point out these conflicts and to interpret them. The transfer of these internal conflicts to the analyst is called “transference”.

Many studies have also been done on shorter “dynamic” treatments; these are easier to measure and shed light on the therapeutic process to some extent. Brief Relational Therapy (TRB) and Brief Psychodynamic Therapy (TPB) limit treatment to 20-30 sessions. On average, classical analysis can last for several years, but for phobias and depressions without complications from ego deficits or deficits in object relations, the analysis can take place for a short period of time. Longer analyzes are indicated for those with more serious disturbances in the relations of objects, more symptoms and more pathology of rooted character.

Training and research

U.S

Psychoanalytic training in the United States involves personal psychoanalysis for the intern, approximately 600 hours of class, with a standard curriculum, over a period of four or five years.

Usually, this psychoanalysis should be conducted by a Supervision and Training Analyst. Most (but not all) institutes within the American Psychoanalytic Association require that Supervision and Training Analysts be certified by the American Board of Psychoanalysts. Certification implies a blind review in which the work of psychoanalysts is examined by psychoanalysts outside their local community. After obtaining certification, these psychoanalysts are evaluated by senior members of their own institute. Supervisory and training analysts are maintained to the highest clinical and ethical standards. In addition, they are required to have extensive experience in performing psychoanalysis.

Likewise, class instruction for psychoanalytic candidates is rigorous. Typically, classes last several hours a week, or for an entire day or two, every other weekend during the school year; This varies with the institute.

Applicants generally have one hour of supervision each week, with a Supervision and Training Analyst, in each psychoanalytic case. The minimum number of cases varies between institutes, often two to four cases. Male and female cases are needed. Supervision should last at least a few years in one or more cases. Supervision takes place at the supervisor’s office, where the intern presents material from the psychoanalytic work that week. In supervision, the patient’s unconscious conflicts are explored, in addition, the transference and countertransference constellations are examined. In addition, clinical technique is taught.

Many psychoanalytic training centers in the United States have been accredited by special APsaA or IPA committees. Due to theoretical differences, there are independent institutes, usually founded by psychologists, who until 1987 had no access to APsaA psychoanalytic training institutes. There are currently between 75 and 100 independent institutes in the United States. In addition, other institutes are affiliated with other organizations, such as the American Academy of Psychoanalysis and Dynamic Psychiatry, and the National Association for the Advancement of Psychoanalysis. At most psychoanalytic institutes in the United States, qualifications for entry include a degree in a mental health field, such as Ph.D., Psy.D., MSW or MD. Few institutes restrict candidates to those who already have an MD or Ph.D., and most institutes in Southern California award a Ph.D. or Psy.D. in psychoanalysis after graduation, which involves completing the necessary requirements for state councils that award the doctorate. The first training institute in America to educate non-medical psychoanalysts was The National Psychological Association for Psyanalysis (1978) in New York City. It was founded by the analyst Theodor Reik. The Contemporary Freudian (originally the New York Freudian Society), a branch of the National Psychological Association, has a branch in Washington, DC. The first training institute in America to educate non-medical psychoanalysts was The National Psychological Association for Psyanalysis (1978) in New York City. It was founded by the analyst Theodor Reik. The Contemporary Freudian (originally the New York Freudian Society), a branch of the National Psychological Association, has a branch in Washington, DC. The first training institute in America to educate non-medical psychoanalysts was The National Psychological Association for Psyanalysis (1978) in New York City. It was founded by analyst Theodor Reik. The Contemporary Freudian (originally the New York Freudian Society), a branch of the National Psychological Association, has a branch in Washington, DC.

There is psychoanalytic training as a postdoctoral fellowship in university settings, such as Duke University, Yale University, New York University, Adelphi University and Columbia University. Other psychoanalytic institutes may not be directly associated with universities, but the faculty at these institutes generally hold positions in Ph.D. programs in psychology and / or with psychiatric residency programs at the medical school.

IPA is the main psychoanalysis accreditation and regulation body in the world. Their mission is to ensure the continued vigor and development of psychoanalysis for the benefit of psychoanalytic patients. It works in partnership with 70 constituent organizations in 33 countries to support 11,500 members. In the United States, there are 77 psychoanalytic organizations and institute associations. APSaA has 38 affiliated companies that have 10 or more active members who practice in a given geographic area. The objectives of APSaA and other psychoanalytic organizations are: to provide ongoing educational opportunities to its members, to stimulate the development and research of psychoanalysis, to provide training and to organize conferences. There are eight affiliated study groups in the United States.

The American Psychological Association (APA) Division of Psychoanalysis (39) was established in the early 1980s by several psychologists. Until the establishment of the Psychoanalysis Division, psychologists who had trained at independent institutes had no national organization. The Psychoanalysis Division has approximately 4,000 members and approximately 30 local divisions in the United States. The Psychoanalysis Division holds two annual meetings or conferences and offers continuing education in theory, research and clinical technique, as well as its affiliated local divisions. The European Federation of Psychoanalysis (EPF) is the organization that consolidates all European psychoanalytic societies. This organization is affiliated with the IPA. In 2002, there were approximately 3,900 individual members in 22 countries, speaking 18 different languages.

The American Association of Psychoanalysis in Clinical Social Work (AAPCSW) was created by Crayton Rowe in 1980 as a division of the Federation of Clinical Social Work Societies and became an independent entity in 1990. Until 2007 it was known as the National Members Committee about Psychoanalysis. The organization was founded because, although social workers represented the largest number of people who were training to be psychoanalysts, they were underrepresented as supervisors and teachers at the institutes in which they participated. AAPCSW now has more than 1000 members and has more than 20 divisions. It holds a biannual national conference and numerous annual local conferences.

Experiences of psychoanalysts and psychoanalytic psychotherapists and research on child development led to new knowledge. Theories have been developed and the results of empirical research are now more integrated into psychoanalytic theory. [72]

UK

The London Psychoanalytic Society was founded by Ernest Jones on October 30, 1913. With the expansion of psychoanalysis in the United Kingdom, the Society was renamed the British Psychoanalytic Society in 1919. Soon after, the Psychoanalytic Institute was created to manage the activities of society. These include: training psychoanalysts, developing the theory and practice of psychoanalysis, providing treatment through the London Psychoanalysis Clinic, publishing books in The New Library of Psychoanalysis and Psychoanalytic Ideas. The Psychoanalysis Institute also publishes  The International Journal of Psychoanalysis, maintains a library, promotes research and conducts public lectures. The company has a Code of Ethics and an Ethics Committee. The society, the institute and the clinic are located in Byron House.

Society is a component of IPA, a body with members on all five continents that protects professional and ethical practice. The company is a member of the British Psychoanalytic Council (BPC); The BPC publishes a register of British psychoanalysts and psychoanalytic psychotherapists. All members of the British Psychoanalytical Society are required to undertake continuous professional development.

Society members included Michael Balint, Wilfred Bion, John Bowlby, Anna Freud, Melanie Klein, Joseph J. Sandler and Donald Winnicott.

The Psychoanalysis Institute is the main editor of psychoanalytic literature. The  standard  24-volume  edition of Sigmund Freud’s Complete Psychological Works  was conceived, translated and produced under the direction of the British Psychoanalytical Society. The Society, in conjunction with Random House, will soon publish a new, revised and expanded standard edition. With the New Library of Psychoanalysis, the Institute continues to publish the books of theoretical and practical leaders. The International Journal of Psychoanalysis  is published by the Institute of Psychoanalysis. Now, in its 84th year, it has one of the largest circulations of any psychoanalytic magazine.

Search

Over a hundred years of case reports and studies in the magazine  Modern Psychoanalysis , Psychoanalytic Quarterly  , International Journal of Psychoanalysis  and  Journal of the American Psychoanalytic Association have  analyzed the effectiveness of analysis in cases of neurosis and personality or character problems. Psychoanalysis modified by the techniques of object relations has proved effective in many cases of deep-seated problems of intimacy and relationship (see many books by Otto Kernberg). As a therapeutic treatment, psychoanalytic techniques can be useful in a session consultation. [73] Psychoanalytic treatment, in other situations, can vary from about a year to many years, depending on the severity and complexity of the pathology.

Psychoanalytic theory has been the object of criticism and controversy since the beginning. Freud noted this early in his career, when other doctors in Vienna scorned him for his findings that hysterical conversion symptoms were not limited to women. The challenges of analytical theory started with Otto Rank and Alfred Adler (turn of the 20th century), continued with behaviorists (for example, Wolpe) in the 1940s and 1950s and persisted (for example, Miller). Criticism comes from those who oppose the notion that there are mechanisms, thoughts or feelings in the mind that may be unconscious. The idea of ​​“child sexuality” was also criticized (the recognition that children between two and six years old imagine things about procreation). Criticisms of the theory led to variations in analytical theories, like the work of Ronald Fairbairn, Michael Balint and John Bowlby. Over the past 30 years, criticism has focused on the issue of empirical verification [74]  , despite many empirical and prospective research studies that have been empirically validated (for example, see the studies by Barbara Milrod et al., Cornell University Medical School). In the scientific literature, there is some research that supports some of Freud’s ideas, for example, unconsciousness, repression, etc. [75]

Psychoanalysis has been used as a research tool in childhood development (see  The Psychoanalytic Study of the Child ) and has been developed for flexible and effective treatment for certain mental disorders. [39]  In the 1960s, Freud’s (1905) earlier thoughts on child development of female sexuality were challenged; this challenge led to important research in the 70s and 80s, and then to a reformulation of female sexual development that corrected some of Freud’s concepts. [76] See also the various works by Eleanor Galenson, Nancy Chodorow, Karen Horney, Françoise Dolto, Melanie Klein, Selma Fraiberg, and others. More recently, psychoanalytic researchers who have integrated attachment theory into their work, including Alicia Lieberman, Susan Coates and Daniel Schechter, explored the role of traumatizing parents in developing mental representations of themselves and others. [77]

There are different forms of psychoanalysis and psychotherapies in which psychoanalytic thinking is practiced. In addition to classical psychoanalysis, there is, for example,  psychoanalytic psychotherapy , a therapeutic approach that expands “the accessibility of psychoanalytic theory and clinical practices that have evolved in more than 100 years for a greater number of individuals”. [78]  Other examples of well-known therapies that also use insights into psychoanalysis are mentalization-based treatment (TBM) and transfer-centered psychotherapy (PCT). [72]  There is also a continuing influence of psychoanalytic thinking on mental health care. [79]

Effectiveness evaluation

The effectiveness of rigorous psychoanalysis is difficult to assess; therapy as Freud intended it to depend too much on the therapist’s interpretation cannot be proved. [80]  The effectiveness of more modern and developed techniques can be assessed. The meta-analyzes in 2012 and 2013 concluded that there is support or evidence for the effectiveness of psychoanalytic therapy, which is why more research is needed. [81]  [82]  Other meta-analyzes published in recent years have shown that psychoanalysis and psychodynamic therapy can be effective, with results comparable or superior to other types of psychotherapy or antidepressant drugs,  [83]  [84] [85],  but these arguments have also been subjected to various criticisms. [86] [87]  [88]  [89]

In 2011, the American Psychological Association made 103 comparisons between psychodynamic treatment and a non-dynamic competitor and found that 6 were superior, 5 were inferior, 28 had no difference and 63 were adequate. The study found that this could be used as a basis “to make psychodynamic psychotherapy an empirically validated treatment”. [90]

Short-Term Psychodynamic Psychotherapy (STPP) meta-analyzes found effect sizes that ranged from .34-.71 compared to no treatment and was seen as slightly better than other therapies in the follow-up. [91]  Other evaluations found a size effect of .78-.91 for somatic disorders compared to no treatment  [92]  and .69 for treating depression. [93]  A 2012 meta-analysis by the  Harvard Review of Psychiatry  for Short-Term Intensive Dynamic Psychotherapy (ISTDP) found effect sizes ranging from 0.84 for interpersonal problems to 1.51 for depression. The general ISTDP had an effect size of 1.18 compared to no treatment. [94]

A review of the long-term psychodynamic psychotherapy system in 2009 found an overall effect size of .33. [95]  Others found effect sizes of .44-.68. [96]

According to a 2004 French review carried out by INSERM, psychoanalysis has been presumed or proven to be effective in the treatment of panic disorder, post-traumatic stress disorder and personality disorders. [97]

The world’s largest randomized controlled trial in therapy with anorexia nervosa outpatients, the ANTOP-Study, published in 2013 in  The Lancet, found evidence that modified psychodynamic therapy is effective in increasing the body mass index after a 10-month treatment and that the effect is persistent until at least one year after the completion of treatment. Regarding other assigned treatments, it was found to be as effective in increasing body mass index as cognitive behavioral therapy and as a standard treatment protocol (which consisted of referral to a list of psychotherapists experienced in the treatment of eating disorders, as well as close monitoring and treatment by a family doctor). Furthermore, considering that the result is the recovery rate one year after treatment, measured by the proportion of patients who no longer met the diagnostic criteria for anorexia nervosa, [98]

A 2001 systematic review of the medical literature by the Cochrane Collaboration concluded that there are no data to demonstrate that psychodynamic psychotherapy is effective in treating schizophrenia and severe mental illness and warned that medication should always be used alongside any type of psychotherapy in cases schizophrenia. [99]  A French review in 2004 found the same. [97]  The results research team of patients with schizophrenia advises against using psychodynamic therapy in cases of schizophrenia, arguing that further trials are needed to verify its effectiveness. [100]  [101]

Review

As a field of science

“The strongest reason for considering Freud a pseudoscientist is that he claimed to have tested – and therefore provided the most convincing reasons for acceptance – theories that are not testable or even if testable have not been tested.”

– Frank Cioffi  [102]

Both Freud and psychoanalysis have been criticized in very extreme terms. [103] Exchanges between critics and defenders of psychoanalysis have often been so heated that they have come to be characterized as the  Freud Wars . [104]

The first criticisms of psychoanalysis believed that its theories were based very little on quantitative and experimental research, and too much on the method of clinical case study. Some accused Freud of fabrication, most famously in the case of Anna O.  [105]  Frank Cioffi, author of  Freud and the Question of Pseudoscience ( Freud and the Question of Pseudoscience) , cites false claims of a solid scientific verification of the theory and its elements as the strongest basis for classifying the work of Freud and his school as pseudoscience. [106] Others speculated that patients now suffered easily identifiable conditions unrelated to psychoanalysis; for example, Anna O. is thought to have suffered a dysfunction, such as tuberculous meningitis or temporal lobe epilepsy and not hysteria. [107]

Karl Popper argued that psychoanalysis is pseudoscience because its claims are not testable and cannot be refuted; that is, they are not counterfeit. [108] Later, Imre Lakatos noted: “Freudians were not plagued by Popper’s basic challenge to scientific honesty. In fact, they refused to specify experimental conditions under which they would abandon their basic assumptions ”. [109]

Cognitive scientists, in particular, also weighed. Martin Seligman, a prominent scholar in  positive psychology , wrote: “Thirty years ago, the cognitive revolution in psychology overthrew Freud and behaviorists, at least in academia. Thought… it’s not just a [result] of emotion or behavior… Emotion is always generated by cognition, not the other way around “. [110] Linguist Noam Chomsky criticized psychoanalysis for lack of a scientific basis. [111]  Steven Pinker considers Freudian theory unscientific to understand the mind. [112]  Evolutionary biologist Steven Jay Gould considered psychoanalysis to be influenced by pseudoscientific theories, such as the theory of recapitulation. Psychologists Hans Eysenck [113]  and John F. Kihlstrom  [114]  also criticized the field as pseudoscience.

Adolf Grünbaum argues that theories based on psychoanalysis are falsifiable, but that the causal claims of psychoanalysis are not supported by the available clinical evidence. [115]

Richard Feynman reduced psychoanalysts to mere “sorcerers”:

“If you look at all the complicated ideas that they developed in an infinitesimal amount of time, if you compare with any other science how long it takes to get one idea after another, if you consider all the structures and inventions and complicated things, the ids and the egos, the tensions and the forces, and the impulses and the pulls, I say they can’t all be there. It is too much for a brain or some brains to forge in such a short time. [116] “

  1. Fuller Torrey, in  Witchdoctors and Psychiatrists(1986), agrees that psychoanalytic theories have no more scientific basis than the theories of traditional native healers, “fetishists” or modern “cult” alternatives. [117]Psychologist Alice Miller accused psychoanalysis of being similar to poisonous pedagogies, which she described in her book  For Your Own Good . She examined and rejected the validity of Freud’s drive theory, including the Oedipus complex, which, according to her and Jeffrey Masson, blames the child for the abusive sexual behavior of adults. [118] Psychologist Joel Kupfersmid investigated the validity of the Oedipus complex, examining its nature and origins. He concluded that there is little evidence to support the existence of the Oedipus complex. [68]

Michel Foucault and Gilles Deleuze claimed that the institution of psychoanalysis became a center of power and that their confessional techniques resemble the Christian tradition. [119]  Jacques Lacan criticized the emphasis of some American and British psychoanalytic traditions on what he considered the suggestion of imaginary “causes” of symptoms and recommended a return to Freud. [120]  Together with Deleuze, Félix Guattari criticized the Oedipal structure. [121]  Luce Irigaray criticized psychoanalysis, using Jacques Derrida’s concept of phallogocentrism to describe the exclusion of women from Freudian and Lacanian psychoanalytic theories. [122]  Deleuze and Guattari, in their 1972 work,Anti-Oedipus: Capitalism and Schizophrenia , take the cases of Gérard Mendel, Bela Grunberger and Janine Chasseguet-Smirgel, prominent members of the most respected associations (IPa), to suggest that, traditionally, psychoanalysis enthusiastically embraces a police state. [123]

Psychoanalysis continues to be practiced by psychologists, psychiatrists, social workers and other mental health professionals; however, its practice is less common today than in years past. [124]  “I think most people agree that psychoanalysis as a form of treatment is on its last legs,” says Bradley Peterson, psychoanalyst, child psychiatrist and director of the Institute for the Developing Mind at Children’s Hospital Los Angeles. [125]  The theoretical foundations of psychoanalysis are found in the same philosophical currents that lead to interpretative phenomenology rather than those that lead to scientific positivism, making the theory incompatible with positivist approaches to the study of the mind. [126]  [127] [107]

A 2004 French report by INSERM said that psychoanalytic therapy is less effective than other psychotherapies (including cognitive behavioral therapy) for certain illnesses. It used a meta-analysis of numerous other studies to determine whether the treatment was “proven” or “assumed” to be effective in different diseases. [97]  Numerous studies have shown that its effectiveness is related to the quality of the therapist, rather than school, psychoanalytic technique or training. [128]

Freudian theory

“Many aspects of Freudian theory are in fact dated, and they must be: Freud died in 1939, and he was slow to make further revisions. Many of his critics, however, are equally dated, attacking Freudian views of the 1920s as if they continued to have some value in their original form. Psychodynamic theory and therapy have evolved considerably since 1939, when Freud’s bearded and serious countenance was last seen. Contemporary psychoanalysts and psychodynamics no longer write much about ids and egos, nor do they conceive of treatment for psychological disorders as an archaeological expedition in search of lost memories. ”

– Drew Westen  [129]

An increasing amount of empirical research by academic psychologists and psychiatrists has begun to address these criticisms. A survey carried out by scientific research suggested that, although personality traits corresponding to Freud’s oral, anal, oedipal and genital phases can be observed, they do not necessarily manifest themselves as stages in the development of children. These studies also did not confirm that such characteristics in adults result from childhood experiences (Fisher & Greenberg, 1977, 399). However, these steps should not be seen as crucial to modern psychoanalysis. What is crucial to modern psychoanalytic theory and practice is the power of the unconscious and the transference phenomenon.

The idea of ​​”unconscious” is contested because human behavior can be observed while human mental activity must be inferred. However, the unconscious is now a popular topic of study in the fields of experimental and social psychology (for example, implicit attitude measures, fMRI and PET scan, and other indirect tests). The idea of ​​the unconscious and the phenomenon of transference have been extensively researched and, according to them, are validated in the fields of cognitive psychology and social psychology (Westen & Gabbard 2002), although a Freudian interpretation of unconscious mental activity is not performed by most cognitive psychologists.

Shlomo Kalo explains that the scientific materialism that flourished in the 19th century severely damaged religion and rejected what was called spiritual. The institution of the priest of confession in particular was severely damaged. The vacuum that this institution left behind was quickly filled by newborn psychoanalysis. In his writings, Kalo claims that the basic approach to psychoanalysis is erroneous. It represents the main principle of wrong assumptions that happiness is inaccessible and that a human being’s natural desire is to exploit his fellow men for his own pleasure and benefit. [130]

Jacques Derrida incorporated aspects of psychoanalytic theory into his theory of deconstruction to question what he called “metaphysics of presence”. Derrida also turns some of these ideas against Freud, to reveal tensions and contradictions in his work. For example, although Freud defines religion and metaphysics as displacements of identification with the father in the resolution of the Oedipal complex, Derrida insists on  Postcard ( From Postcard: From Socrates to Freud and Beyond)  that the father’s prominence in the analysis of Freud owes the prominence given to the father in Western metaphysics and theology since Plato. [131]

Grades

  • The. Alfred Adler developed the school of thought known as individual psychology, while Carl Jung established analytical psychology.
  • B. Kaplan and Sadock’s Synopsis of Psychiatry , 2007: “Psychoanalysis existed before the turn of the 20th century and, in that period, established itself as one of the fundamental disciplines of psychiatry. The science of psychoanalysis is the fundamental support for psychodynamic understanding and forms the fundamental theoretical framework of reference for a variety of forms of therapeutic intervention, covering not only psychoanalysis itself, but also various forms of psychoanalytic psychotherapy and related forms of therapy using psychodynamic concepts ”. [9]
  • ç. Robert Michels, 2009: “Psychoanalysis remains an important paradigm in organizing the way many psychiatrists think about patients and treatment. However, its limitations are more widely recognized and it is assumed that many important advances in the future will come from other areas, particularly biological psychiatry. Still unresolved is the appropriate role of psychoanalytic thinking in organizing the treatment of patients and in training psychiatrists after the biological revolution has been born. Do treatments for biological defects or abnormalities become technical steps in a program organized within a psychoanalytic framework? Psychoanalysis will help to explain and guide supportive intervention for individuals whose lives are distorted by biological defects and therapeutic interventions, how is it the case of patients with chronic physical disease, with the psychoanalyst in the psychiatric dialysis program? Or will we analyze the role of psychoanalysis in the treatment of the severely mentally ill as the last and most scientifically enlightened phase of the humanistic tradition in psychiatry, a tradition that died out when advances in biology allowed us to cure those who for so long had only consoled us? “[10

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