Psychoanalysis

Psychoanalysis Assumptions

· Psychoanalytic psychologists see psychological problems as rooted in the unconscious mind.

· Manifest symptoms are caused by latent (hidden) disturbances.

· Typical causes include unresolved issues during development or repressed trauma.

· Treatment focuses on bringing the repressed conflict to consciousness, where the client can deal with it.

How can we understand the unconscious mind?

Remember, psychoanalysis is a therapy as well as a theory.

freud's couch

In psychoanalysis (therapy) Freud would have a patient lie on a couch to relax, and he would sit behind them taking notes while they told him about their dreams and childhood memories. Psychoanalysis would be a lengthy process, involving many sessions with the psychoanalyst.

Due to the nature of defence mechanisms and the inaccessibility of the deterministic forces operating in the unconscious, psychoanalysis in its classic form is a lengthy process often involving 2 to 5 sessions per week for several years. This approach assumes that the reduction of symptoms alone is relatively inconsequential as if the underlying conflict is not resolved, more neurotic symptoms will simply be substituted. The analyst typically is a 'blank screen', disclosing very little about themselves in order that the client can use the space in the relationship to work on their unconscious without interference from outside.

The psychoanalyst uses various techniques as encouragement for the client to develop insights into their behaviour and the meanings of symptoms, including ink blots, parapraxes, free association, interpretation (including dream interpretation), resistance analysis and transference analysis.

1) Rorschach ink blots

The ink blot itself doesn’t mean anything, it’s ambiguous (i.e. unclear).

It is what you “read” into it that is important.

Different people will “see” different things depending on what unconscious connections they make.

Click here to analyse your unconscious mind using ink blots.

The ink blot is known as a projective test as the patient 'projects' information from their unconscious mind to interpret the ink blot.

However, behavioural psychologists such as B.F. Skinner have criticised this method as being subjective and unscientific.

2) Freudian Slips

Unconscious thoughts and feelings can transfer to the conscious mind in the form of parapraxes, popularly known as “Freudian slips” or slips of the tongue. We reveal what is really on our mind by saying something we didn’t mean to.

For example, a nutritionist giving a lecture intended to say “We should always demand the best in bread”, but instead said “bed”. Another example is where a person may call a friend’s new partner by the name of a previous one, whom we liked better.

Freud believed that slips of the tongue provided an insight into the unconscious mind and that there were no accidents, every behaviour (including slips of the tongue) was significant (i.e. all behaviour is determined).

freudian slip cartoon

3) Freud's Dream Interpretaion

Freud considered dreams to be the 'royal road to the unconscious' as it is in dreams that the ego's defences are lowered so that some of the repressed material comes through to awareness, albeit in distorted form. Dreams both perform important functions for the unconscious mind and serve as valuable clues to how the unconscious mind operates. On 24 July 1895, Freud had his own dream that was to form the basis of his theory. He had been worried about a patient, Irma, who was not doing as well in treatment as he had hoped. Freud in fact blamed himself for this, and was feeling guilty.

freud dreams

Freud dreamed that he met Irma at a party and examined her. He then saw a chemical formula for a drug that another doctor had given Irma flash before his eyes and realised that her condition was caused by a dirty syringe used by the other doctor. Freud's guilt was thus relieved.

Freud interpreted this dream as wish-fulfilment. He had wished that Irma's poor condition was not his fault and the dream had fulfilled this wish by informing him that another doctor was at fault. Based on this dream, Freud (1900) went on to propose that a major function of dreams was the fulfilment of wishes.

Freud distinguished between the manifest content of a dream (what the dreamer remembers) and the latent content, the symbolic meaning of the dream (i.e. the underlying wish). The manifest content is often based on the events of the day. The process whereby the underlying wish is translated into the manifest content is called dream-work. The purpose of dream work is to transform the forbidden wish into a non-threatening form, thus reducing anxiety and allowing us to continuing sleeping. Dream work involves the process of displacement, condensation and secondary elaboration.

Dream interpretation involves the translation of the (inevitably distorted) manifest content into the (truthful) latent meaning. Understanding the various distorting processes would help us to understand the latent meaning of a dream. The process of condensation is the joining of two or more idea/images into one. For example, a dream about a man may be a dream about both one's father and one's lover. A dream about a house might be the condensation of worries about security as well as worries about one's appearance to the rest of the world.

Displacement takes place when we transform the person or object we are really concerned about to someone else. For example, one of Freud’s patients was extremely resentful of his sister-in-law and used to refer to her as a dog, dreamed of strangling a small white dog. Freud interpreted this as representing his wish to kill his sister-in-law. If the patient would have really dreamed of killing his sister-in-law, he would have felt guilty. The unconscious mind transformed her into a dog to protect him. Condensation takes place when we combine different factors into one aspect of the manifest content. Thus a woman who has feeling angry feelings forwards her husband and father might dream of pushing a man, who represents both the father and the husband. Secondary elaboration occurs when the unconscious mind strings together wish-fulfilling images in a logical order of events, further obscuring the latent content. According to Freud this is why the manifest content of dreams can be in the form of believable events.

In Freud’s later work on dreams he explored the possibility of universal symbols in dreams. Some of these were sexual in nature, including poles, guns and swords representing the penis and horse riding and dancing representing sexual intercourse. However, Freud was cautious about symbols and stated that general symbols are personal rather than universal. A person cannot interpret what the manifest content of a dream symbolised without knowing about the person’s circumstances.

'Dream dictionaries', which are still popular now, were a source of irritation to Freud. In an amusing example of the limitations of universal symbols, one of Freud's patients, after dreaming about holding a wriggling fish, said to him 'that's a Freudian symbol - it must be a penis!' Freud explored farther and it turned out that the woman's mother, who was a passionate astrologer and a Pisces, was on the patient's mind because she disapproved of her daughter being in analysis. It seems more plausible, as Freud suggested, that the fish represented the patient's mother rather than a penis!

4) Free Association

A simple technique of psychodynamic therapy is free association in which a patient talks of whatever comes into their mind. This technique involves a therapist reading a list of words (e.g. mother, childhood etc.) and the patient immediately responds with the first word that comes to mind. It is hoped that fragments of repressed memories will emerge in the course of free association. Free association may not prove useful if the client shows resistance, and is reluctant to say what he or she is thinking. On the other hand, the presence of resistance (e.g. an excessively long pause) often provides a strong clue that the client is getting close to some important repressed idea in his or her thinking, and that further probing by the therapist is called for.

Freud reported that his free associating patients occasionally experienced such an emotionally intense and vivid memory that they almost relived the experience. This is like a "flashback" from a war or a rape experience. Such a stressful memory, so real it feels like it is happening again, is called an abreaction. If such a disturbing memory occurred in therapy or with a supportive friend and one felt better--relieved or cleansed--later, it would be called a catharsis.

Frequently, these intensely emotional experiences provided Freud a valuable insight into the patient's problems.

Psychoanalysis Psychotherapy

Psychoanalyis views current psychological difficulties as arising from earlier childhood emotional trauma. Each personal history is the history of a series of conflicts, some of which we may be aware, the majority of which we will be totally unaware due to the operation of defence mechanisms. Freud believed that psychological disorders arise from intrapersonal conflicts of which we are unaware, conflicts which have been repressed to the unconscious.

Particularly important conflicts in Freud's view are the conflicts between the ego and super-ego and between Eros and Thanatos, that is, between the sexual and aggressive drives. The key assumption here is that a person's present disorder can be successfully resolved only by understanding their unconscious basis in the early relationships with parents.

The aims of psychoanalysis therefore, are:

• to free the id's impulses from excessive control by the ego

• to strengthen the ego

• to alter the contents of the super-ego so that it becomes less oppressive and more accepting

• release repressed emotions and experiences, i.e. make the unconscious conscious

These amount to a re-education of the ego. Freud considered this possible and effective for a range of disorders in which the person has a degree of appreciation of reality, such as anxiety disorders like phobias, anorexia, bulimia and depression as well as obsessive compulsive disorders. He did not think it would help the psychotic but could be used with the neurotic. The neurotic is someone who uses defence mechanisms excessively and whose libido gains expression through bodily symptoms such as slips of the tongue and other 'mistakes' (so-called parapraxes), ritualistic compulsions, temporary paralyses and so on. The neurotic has a distorted perception of reality and in order to remove the symptoms must gain access to the repressed feelings that give rise to them. By gaining this insight, the conflict will be reduced or resolved and the symptoms removed. This is the recovery of unconscious memories, achieved by various techniques (outlined above).

Catharis, Abreaction and Insight

Freud believed that people could be cured by making conscious their unconscious thoughts and motivations, thus gaining “insight”.

The aim of psychotherapy is to release repressed emotions and experiences, i.e. make the unconscious conscious. It is only having a cathartic (i.e. healing) experience can the person be helped.

Frequently, these intensely emotional experiences provided Freud a valuable insight into the patient's problems.

A cathartic experience leads to the patient gaining insight and understanding the cause of their problem. Put simply: seeing and understanding the true nature of something. After the cathartic experience the person must learn to understand the reasons for their problems.

Freud at first thought that gaining insight into your unconscious patterns would be sufficient to change them. Unfortunately he found that his patients were able to gain insight into why they did what they did without changing their behaviors at all. So then he came up with the idea of "working through".

Working through was the name Freud gave to the process whereby these insights could become so well integrated into the personality, both intellectually and emotionally, that the patient could give up old neurotic patterns.

It involves examining the problem or conflict many times in the face of insight gained. The patient can no longer deny the reality which they may have done in the past.

Freud thought that the way to permit the patient to work through insights was to have her encounter them over and over in one context after another. That means that your therapist points out to you these patterns as you tell him the events in your life or reactions to people.

Applications of Psychoanalysis

Psychoanalysis (along with Rogerian humanistic counselling) is an example of a global therapy (Comer 1995 p 143) which has the aim of helping clients to bring about major change in their whole perspective on life. This rests on the assumption that the current maladaptive perspective is tied to deep-seated personality factors. Global therapies stand in contrast to approaches which focus mainly on a reduction of symptoms, such as cognitive and behavioural approaches, so-called problem-based therapies.

Anxiety disorders such as phobias, panic attacks, obsessive-compulsive disorders and post-traumatic stress disorder are obvious areas where psychoanalysis might be assumed to work. The aim is to assist the client in coming to terms with their own id impulses or to recognise the origin of their current anxiety in childhood relationships that are being relived in adulthood. Svartberg and Stiles (1991) and Prochaska (1984) point out that the evidence for its effectiveness is equivocal. Salzman (1980) suggests that psychodynamic therapies generally are of little help to clients with specific anxiety disorders such as phobias or OCDs but may be of more help with general anxiety disorders. Salzman (1980) in fact expresses concerns that psychoanalysis may increase the symptoms of OCDs because of the tendency of such clients to be overly concerned with their actions and to ruminate on their plight (Noonan 1971).

Depression may be treated with a psychoanalytic approach to some extent. Psychoanalysts relate depression back to the loss every child experiences when realising our separateness from our parents early in childhood. An inability to come to terms with this may leave the person prone to depression or depressive episodes in later life. Treatment then involves encouraging the client to recall that early experience and to untangle the fixations that have built up around it. Particular care is taken with transference when working with depressed clients due to their overwhelming need to be dependent on others. The aim is for clients to become less dependent and to develop a more functional way of understanding and accepting loss/rejection/change in their lives. Shapiro et al (1991) report that psychodynamic therapies have been successful only occasionally. One reason might be that depressed people may be too inactive or unmotivated to participate in the session. In such cases a more directive, challenging approach might be beneficial. Another reason might be that depressives may expect a quick cure and as psychoanalysis does not offer this, the client may leave or become overly involved in devising strategies to maintain a dependent transference relationship with the analyst.

Evaluation of Psychoanalysis Therapy

Fisher and Greenberg (1977), in a review of literature, conclude that psychoanalytic theory cannot be accepted or rejected as a package, 'it is a complete structure consisting of many parts, some of which should be accepted, others rejected and the others at least partially reshaped'.

Fonagy (1981) questions whether attempts to validate Freud's approach through laboratory tests have any validity themselves. Freud's theory questions the very basis of a rationalist, scientific approach and could well be seen as a critique of science, rather than science rejecting psychoanalysis because it is not susceptible to refutation.

The case study method is criticised as it is doubtful that generalisations can be valid since the method is open to many kinds of bias. However, psychoanalysis is concerned with offering interpretations to the current client, rather than devising abstract dehumanised principles. Anthony Storr (1987), the well-know psychoanalyst appearing on TV and Radio 4's 'All in the Mind', holds the view that whilst a great many psychoanalysts have a wealth of 'data' at their fingertips from cases, these observations are bound to be contaminated with subjective personal opinion and should not be considered scientific.

Conclusions

· Psychodynamic therapies work well with mild disturbances.

· They are better than no treatment, but not necessarily better than other forms of therapy.

· It is not clear whether the clients that benefit from psychoanalysis would eventually get better anyway.

· Psychoanalysis may speed up the rate at which clients get better.

· The nature of Psychoanalysis creates a power imbalance between therapist and client that could raise ethical issues.

Psychoanalysis Audio Broadcasts

Listen to a BBC radio broadcast about Dreams with Melvyn Bragg.

Listen to an ABC National Radio Broadcast: Who was the Wolf Man? Sigmund Freud, who was born 150 years ago this year, spent a long time analysing a patient he described as the Wolf man. But who was the Wolf man and what does Freud's treatment of him tell us about the philosophical question of the relationship between evidence and theory?

In Freudian Slips Lisa Appignanesi revisits five of Freud’s major works for their centenary.

Sexual Aberrations: Written in 1905, Freud's groundbreaking 'Three essays on the theory of sexuality' is one of the pillars on which modern psychoanalysis rests. In the first of these essays, 'Sexual Aberrations' Freud unravels the complex diversity of human desire. Lisa talks to author, Kathy Lette to find out why fetishism isn't too far from shopping and she meets writer and psychoanalyst, Adam Phillips to find out why Freud thought the sexual instinct is such an irresistible force.

Infantile Sexuality: The second of Freud's 'Three essays on the theory of sexuality' is his ground breaking and shocking exploration of the relationship between children and their parents. In 'Infantile Sexuality' Freud outlines why our experiences and frustrations in childhood form the basis for our adult neuroses. Lisa Appignanesi talks to psychoanalysts and writers to find out how Oedipus lives on today.

Transformations of Puberty: In The last of Freud's essays on sexuality he explains why the troubled adolescent has to relive childhood in a bid to leave home. Lisa talks to psychoanalysts working today to find out how the struggles of adolescence have changed over the course of hundred years. She also talks to writer, Sue Townsend to find out what inspired her to write about teenager Adrian Mole and what Freud might have made of him, now, aged 38 and 3/4.

Fragment of an Analysis of a Case of Hysteria: 'Fragment of an Analysis of a Case of Hysteria' is Freud's first great case history. Dora was brought to Freud for analysis by her father because of hysterical symptoms and threatened suicide. Dora rejected Freud's interpretations and fled before her treatment was over. Why did she leave and what did Freud learn from his apparent failure? Lisa talks to psychoanalyst and writer, Susie Orbach to find out why 'Dora' would lead to the invention of one of psychoanalysis's most important tools.

Wit and its Relation to the Unconscious: The Joke Book. In 'Wit and its relation to the Unconscious' Freud explained why the joke, like the dream provides a unique window into the unconscious. Lisa talks to comic Arnold Brown and therapist turned comedian Inder Manocha, to find out what drives the urge to make others laugh. She also talks to psychoanalysts David Bell to find out why we laugh, why we give ourselves away by our jokes and asks if there is a place for humour on the therapist's couch.

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