Discuss one Theory used in Psychotherapy
This paper will discuss psychoanalysis. It is both a therapeutic technique and a theory of mind. Psychoanalysis is important, as it is the founding theory behind psychotherapy. What psychoanalysis is will be examined, the theory behind the method, and how psychoanalytic ideas have changed over time as well as its purpose and goals. Its influence on more modern psychotherapy theories will be detailed. Finally, its usefulness in the modern day will be discussed and it will be argued that it still has value.
Firstly, what is psychoanalysis? In classical psychoanalysis two people – the patient and the psychoanalyst meet as much as five times a week at set times usually for fifty minutes each time. The patient lies on a couch and the analyst sits behind him without eye contact. The patient says whatever comes to mind. This is known as free association. The analyst is often silent but not passive. The aim is to act as a catalyst, clarifying and interpreting what is said. This exploration of the mind can bring about lasting change for the patient leading to improved mental health (Pick 2015).
Secondly, the theory that led to this method of therapy will be examined. Psychoanalysis was developed by Freud (1856-1939) in Vienna. Freud referred to his method as the ‘talking cure’ and he used it with his patients, who had been diagnosed with hysteria, beginning in the 1880s. These patients were suffering from psychological stress which affected their physical as well as mental health. His theory used empirical data from case studies of his patients, most famously Anna O, as he referred to one of them (Pick 2015). The main idea developed was that thoughts can exist of which we are unconscious. This unconscious is dynamic, full of conflicting forces trying to gain access to consciousness and ego defences preventing such access (Eagle 2018). Freud (1920) provided evidence for these unconscious processes from slips of the tongue, which reveal hidden intentions, as well as dreams. Freud (1920) also finds evidence of a sort from fantasies, or as he refers to them phantasies, which are disguised fulfilments of instinctual wishes. Listening to his patients led Freud to develop the concept of transference; baggage from the past is brought into present relationships. Patients can transfer feelings onto the analyst, which are really meant for someone else.
Freud believed that his patients repressed thoughts of unbearable early memories. Many patients described experiences of childhood sexual abuse often from family members. Freud later came to doubt that these were always real events but could be fears or fantasies. Freud held that children feel both hate and love for their parents and this leads to ambivalence which is necessary to separate from them to gain a sense of identity (Pick 2015). These ideas led to Freud developing the famous Oedipus Complex which includes: universal incestuous wishes towards the opposite sex parent and hostile wishes towards the same sex parent, the incest taboo, and choice of mate based on parental templates. How the individual resolves these conflicts determines their psychological development. The infant goes through stages of psychosexual development: oral, anal, phallic, latency and genital. People can become fixated which means they are stuck at one stage of development (Eagle 2018). Freud conceptualised the conflict between immediate gratification and the need to delay gratification as one between the pleasure principle and the reality principle. This leads to Freud’s model of the mind involving the superego (largely unconscious reproaches), the ego (mediates internal and external reality), and the id (unconscious instinctual urges and passions which can erupt and overtake us). Analysis can strengthen the ego and make the superego and the id less destructive. A very critical superego can lead to feelings of worthlessness and abjection (Pick 2015).
The concept of defence is also central to psychoanalysis. This occurs when there is an incompatibility between the ego and an idea presented to it. These unacceptable thoughts are banished from consciousness by an act of will; they are repressed. Not all Freud’s ideas concerned sex. He also believed in the death drive: a tendency to self-destruction and also aggression towards others. Coping with these internal and external forces leads to anxiety. The process of analysis between the analyst and patient can lead to a release of these conflicts and an understanding of them, which can provide relief for the patient, and a lessening of their ‘hysterical’ symptoms. Many of Freud’s patients reported an improvement in their conditions but the treatment was not always successful (Pick 2015).
Next, how psychoanalytic theory has changed over time will be examined. Freud himself did not have static ideas but changed and developed his ideas over the course of his life. Freud worked with other psychoanalysts but many disagreed with many of his ideas and split from him and developed their own theories. Jung diverged from Freud and introduced a spiritual dimension (cited in Pick 2015). Adler and Klein (cited in Pick 2015) also split off from Freud. Klein did a lot of work with children and developed a theory of the relational dimension of the mind. Hartmann (cited in Pick 2015) developed ego psychology and became convinced that the ego could operate conflict free with the help of analysis. This view was also held by Anna Freud (cited in Pick 2015). Lacan (cited in Pick 2015) was interested in words and felt that the ego is constituted by our relationships to our own images. We are involved in a constant searching for others. Winnicott (cited in Pick 2015) became interested in the primacy of the relationship between mother and infant and developed the idea of the good enough mother. Bion (cited in Pick 2015) was interested in work with groups and introduced the concept of projective identification. Less desirable qualities in ourselves are projected onto others. Ferenczi (cited in Pick 2015) was concerned that there should be more warmth in the analyst. Psychoanalysis has developed differently in different countries. Currently it is in decline due to the rise in popularity of other therapies (Pick 2015).
In spite of this decline there are still practitioners today working as psychoanalysts though many do not fully accept all of Freud’s ideas. What remains accepted is that our behaviour, thoughts and feelings are influenced by factors outside of our conscious awareness and that we do indulge in defences and self-deceptions. These illusions protect our self-image. There is also much evidence supporting the idea of unconscious mental processing. However, there is not much evidence for Freud’s notion of a dynamic unconscious as a seething mass of primal desires. The unconscious in modern research is seen as consisting of internal working models which are acquired in childhood and can be difficult to change. There is little evidence for a universal Oedipus complex or that it has a role in psychological development. Modern psychoanalysts have reconceptualised this as a tension between the regressive lure of identification with the caregiver and the progressive urge for separation. How these tensions are resolved are important for healthy psychological development. Research evidence has provided support for viewing delay of gratification, affect regulation and executive functions as concerning the adequacy of an individual’s ego functions. In essence, modern psychoanalysis has moved from seeing psychopathology as resulting from repressed conflictual wishes and impulses towards seeing it as early acquisition of maladaptive representations. It is not always necessary to become aware of one’s representations and their influence on behaviour but these representations can be altered through the therapeutic relationship itself without interpretation. Therapy can provide emotional correction. However, it still seems that self-knowledge can be important in becoming a healthy individual (Eagle 2018).
Psychoanalysis has been criticised for lacking scientific rigour. It cannot be falsified. Freud only used a small sample of patients to generate his theories so they cannot be generalised to all human beings (Joseph 2010). However, Bergin (1971, cited in Lambert 2013) found that 80 % of patients undergoing psychoanalysis showed significant improvement, which suggests this style of therapy can have considerable value.
Next, the purpose and goals of psychoanalysis will be examined. The goal is better mental health by a patient understanding his or her neuroses. Freud’s patients often had physical symptoms such as paralysis. Through ‘working through’ how neuroses have developed through talking about painful memories and thoughts the patient can be helped to understand the condition and resolve it. Formerly unconscious material is brought into conscious awareness and reintegrated into the total structure of the personality. Symptoms are seen as having a psychological rather than a physical cause (Joseph 2015).
This paper has chosen to concentrate on psychoanalysis, as it is important as the founding father of psychotherapy. It brings in the notion that psychological processes rather than biological processes can sometimes result in psychological problems. Freud was the first to point out that unconscious motives and defence mechanisms influence behaviour and that early childhood experiences influence adult personality. The idea of transference is utilised by many therapists today.
Finally, other modern psychotherapy techniques will be examined to tease out the influence of psychoanalysis on them. Many modern therapists refer to themselves as psychodynamic. These therapists use many of the techniques of psychoanalysis but they have adapted them to a modern context. It is not considered necessary to see the therapist as much as five times a week and most have abandoned the couch and will sit face to face with the patient. They are more likely to intervene in the interaction in order to help the patient. Psychodynamic techniques like this are still recommended for some cases of depression and schizophrenia. They can also be useful for clients wanting to develop interpersonal skills, to enhance self-understanding and overcome self-defeating behaviour (Joseph 2010). Modern psychodynamic therapists do not usually support all of Freud’s ideas but will still work with inner conflict and transference to help their patients.
Humanistic approaches to psychotherapy emerged in the middle of the twentieth century. They were a reaction against the pessimistic view of human nature painted by psychoanalysis in which people are selfish, driven by sexual and aggressive impulses. The humanistic approach sees human nature as essentially positive and emphasises choices, values and purpose. Carl Rogers (1902-1987) is one of its most well known proponents. He developed the person-centred approach. The foundation of the theory is the actualizing tendency, which is a natural force in people directed towards constructive growth and development. This tendency in a child is thwarted by an internalized belief that he must please others. The therapist provides a supportive environment where the client can become their actualized self. This approach can be seen as a radical departure from the ideas of psychoanalysis. However, its echoes can still be felt. Person centred therapy is still a talking therapy and events in childhood are given prominence. Not much research has been done on the effectiveness of this therapy but some work has suggested it is just as effective as other forms (Joseph 2010).
Another humanistic approach is Perl’s Gestalt therapy. The client experiences the total configuration of who they are. It emphasises choice and responsibility. It is a more confrontational approach than that of Rogers, encouraging the client to heighten their emotions. Little research has been done into the effectiveness of Gestalt (Joseph 2010). Its emphasis on the here and now suggests a clear break with the approach of psychoanalysis.
Berne (Joseph 2010) introduced a form of humanistic counselling called transactional analysis. This approach assumes people are ‘ok’. The therapist values and esteems the client. Each person can make decisions about their life and the way they think is their own choice. It is closer than the other humanistic approaches to psychoanalysis and can be seen as a development of this theory as Berne himself trained in psychoanalysis. Berne developed a model of the mind consisting of the child, the parent and the adult. In many ways this model echoes Freud’s ideas of the id, ego and superego. The approach also echoes the Freudian idea that problems have their roots in childhood.
The transpersonal approach is associated with Maslow. He saw human beings as striving to achieve their potential. Maslow described a hierarchy of human needs with physical needs such as food at the bottom and self-actualisation at the top. Actualized individuals are self-directed, creative and independent. Self-actualized individuals can have peak experiences, which transcend ordinary human consciousness and can be regarded as spiritual in nature. This approach has little in common with Freud. There has not been much research into the effectiveness of the transpersonal approach (Joseph 2010).
Cognitive Behavioural Therapy is a widely used approach used today both in the NHS and in private practice. This is a merging of cognitive and behaviourist ideas about the human mind. The approach works on changing a client’s behaviour and the way they think about themselves through checking their internal dialogue and removing negative, critical thoughts. Much research has backed up this approach and it has gained respectability by adopting psychiatric language. However, it has been criticised for being overly simplistic with scientific experiments not always relevant to complex, intractable problems of patients (Smail 1996, cited in Joseph 2010). This approach with its emphasis on the present shows a resounding rejection of the ideas of psychoanalysis.
Now, psychoanalysis in the present day will be examined. Classical psychoanalysis as described by Freud is rare today. It is still possible to train in at various institutions around the world. As the client is required to come for sessions as much as five times a week and the therapy can go on for years it remains too expensive, time consuming and impractical for many people. Many of Freud’s key ideas have also been severely criticised as having no scientific basis. As a result of this psychoanalysis is in decline. It survives in private practice and is rarely used in the NHS, which is constrained by economic factors. It has been overtaken in popularity by Cognitive Behavioural Therapy. However, it still survives in modified form in psychodynamic therapies in private practice. Many psychodynamic practitioners use psychoanalytic ideas of unconscious conflicts and transference in their work. They may follow other theorists more closely than Freud but who are still within the analytic tradition such as Jung, Klein, Adler and Erikson. This kind of approach can still be useful for deep-seated depression, which has not responded to other techniques. Modern therapy is moving towards an integrative approach where the therapist uses what works best for the client. In this way, psychoanalytic ideas still survive (Joseph 2010).
This paper has examined psychoanalysis discussing what it is, its purpose and goals and its influence on other psychotherapies. It has been seen that its legacy has been great though it is currently in decline. Psychoanalytic ideas have been much criticised but many practitioners have found their use in therapy to be beneficial in helping patients. New research into the effectiveness of different approaches may well show that psychoanalytic ideas still have value.
Eagle, M. N. (2018) Core Concepts in Classical Psychoanalysis Abingdon: Routledge
Freud, S. (1920) A General Introduction to Psychoanalysis New York: Boni and Liveright
Joseph, S. (2010) Theories of Counselling and Psychotherapy Basingstoke: Palgrave Macmillan
Lambert, M.J. (2013) ‘Outcome in Psychotherapy: The Past and Important Advances’ Psychotherapy American Psychological Association, Vol. 50, No. 1, 42–51
Pick, D. (2015) Psychoanalysis A Very Short Introduction. Oxford: Oxford University Press