Psychoanalysis

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Psychoanalysis is a psychological therapy developed by Austrian physician Sigmund Freud and his associates, which is devoted to the study of human psychological functioning and behavior. It has three applications: 1) a method of investigation of the mind; 2) a systematized set of theories about human behavior; and 3) a method of treatment of psychological or emotional illness.

Under the broad umbrella of psychoanalysis there are at least 22 different theoretical orientations regarding the underlying theory of understanding the mind and how it develops. The various approaches in treatment called "psychoanalytic" vary as much as the different theories do.

In addition, the term refers to a method of studying the significance of factors in child development, and how they affect the person's adult life.

Freudian psychoanalysis refers to a specific type of treatment in which the "analysand" (analytic patient) verbalizes thoughts, including free associations, fantasies, and dreams, from which the analyst formulates the unconscious conflicts causing the patient's symptoms and character problems, and interprets them for the patient to create insight for resolution of the problems.

The specifics of the analyst's interventions typically include confronting and clarifying the patient's pathological defenses, wishes and guilt. Through the analysis of conflicts, including those contributing to resistance and those involving transference onto the analyst of distorted reactions, psychoanalytic treatment can clarify how patients unconsciously are their own worst enemies: how unconscious, symbolic reactions that have been stimulated by experience are causing symptoms.

In general terms the treatment is thought to work due to a process in which the patient develops a positive transference toward the psychoanalyst, and makes progress through assimilating dissociated parts of the personality.[1] Freud knew that by assimilation, repressed affections allowed to become conscious in the patient, symptoms known as compensation for the segmental cravings which were a result of their repression(usually of childhood memories), would be relieved over time.[2]

History of psychoanalysis

Psychoanalysis was developed in Vienna in the 1890s by Sigmund Freud, a neurologist interested in finding an effective treatment for patients with neurotic or hysterical symptoms.

Psychoanalytic theory

Since Freud's original work, generations of psychoanalysts have worked on developing the approach further. The predominant psychoanalytic theories can be grouped into several theoretical "schools". Although these theoretical "schools" differ, most of them continue to stress the strong influence of unconscious elements affecting people's mental lives.

Forms of psychoanalysis

The basic structure of psychoanalysis has three applications: 1) a method of investigation of the mind; 2) a systematized set of theories about human behavior; and 3) a method of treatment of psychological or emotional illness. Over time various forms of psychoanalysis have developed since the founding fathers first understood it, and different styles personified through new clinicians.

Interpersonal psychoanalysis

Interpersonal psychoanalysis accents the nuances of interpersonal interactions, particularly how individuals protect themselves from anxiety by establishing collusive interactions with others. Interpersonal theory was first introduced by Harry Stack Sullivan, MD, and developed further by Frieda Fromm-Reichmann.

Relational psychoanalysis

Relational psychoanalysis combines interpersonal psychoanalysis with object-relations theory and with Inter-subjective theory as critical for mental health, was introduced by Stephen Mitchell. Relational psychoanalysis emphasizes how the individual's personality is shaped by both real and imagined relationships with others, and how these relationship patterns are re-enacted in the interactions between analyst and patient. Fonagy and Target, in London, have propounded their view of the necessity of helping certain detached, isolated patients, develop the capacity for "mentalization" associated with thinking about relationships and themselves.

Intersubjective psychoanalysis

The term "intersubjectivity" was introduced in psychoanalysis by George E. Atwood and Robert Stolorow (1984). Intersubjective approaches emphasize how both personality development and the therapeutic process are influenced by the interrelationship between the patient's subjective perspective and that of others. The authors of the relational and intersubjective approaches: Heinz Kohut, Stephen A. Mitchell, Jessica Benjamin, Bernard Brandchaft, J. Fosshage, Donna M.Orange, Arnold Modell, Thomas Ogden, Owen Renik, Harold Searles, Colwyn Trewarthen, Edgar A. Levenson, J. R. 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 body of theoretical and clinical work undertaken from the 1950s onwards, with the aim of extending Freud's theories so as to make them applicable to the full spectrum of emotional disorders. Interventions based on this approach are primarily intended to provide an emotional-maturational communication to the patient, rather than to promote intellectual insight.

Psychopathology (mental disturbances)

Adult patients

The various psychoses involve deficits in the autonomous ego functions (see above) of integration (organization) of thought, in abstraction ability, in relationship to reality and in reality testing. In depressions with psychotic features, the self-preservation function may also be damaged (sometimes by overwhelming depressive affect). Because of the integrative deficits (often causing what general psychiatrists call "loose associations," "blocking," "flight of ideas," "verbigeration," and "thought withdrawal"), the development of self and object representations is also impaired. Clinically, therefore, psychotic individuals manifest limitations in warmth, 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 often falls into the category known as "borderline." Borderline patients also show deficits, often in controlling impulses, affects, or fantasies – but their ability to test reality remains more or less intact. Adults who do not experience guilt and shame, and who indulge in criminal behavior, are usually diagnosed as psychopaths, or, using DSM-IV-TR, antisocial personality disorder.

Panic, phobias, conversions, obsessions, compulsions and depressions (analysts call these "neurotic symptoms") are not usually caused by deficits in functions. Instead, they are caused by intrapsychic conflicts. The conflicts are generally among sexual and hostile-aggressive wishes, guilt and shame, and reality factors. The conflicts may be conscious or unconscious, but create anxiety, depressive affect, and anger. Finally, the various elements are managed by defensive operations – essentially shut-off brain mechanisms that make people unaware of that element of conflict. "Repression" is the term given to the mechanism that shuts thoughts out of consciousness. "Isolation of affect" is the term used for the mechanism that shuts sensations out of consciousness. Neurotic symptoms may occur with or without deficits in ego functions, object relations, and ego strengths. Therefore, it is not uncommon to encounter obsessive-compulsive schizophrenics, panic patients who also suffer with borderline personality disorder, etc.

Childhood origins

Freudian theories argue that adult problems can be traced to unresolved conflicts from certain phases of childhood and adolescence. Freud, based on the data gathered from his patients early in his career, suspected that neurotic disturbances occurred when children were sexually abused in childhood (the so-called seduction theory). Later, Freud came to realize that, although child abuse occurs, that not all neurotic symptoms were associated with this. He realized that neurotic people often had unconscious conflicts that involved incestuous fantasies deriving from different stages of development. He found the stage from about three to six years of age (preschool years, today called the "first genital stage") to be filled with fantasies about marriage with both parents. Although arguments were generated in early 20th-century Vienna about whether adult seduction of children was the basis of neurotic illness, there is virtually no argument about this problem in the 21st century.

Many psychoanalysts who work with children have studied the actual effects of child abuse, which include ego and object relations deficits and severe neurotic conflicts. Much research has been done on these types of trauma in childhood, and the adult sequelae of those. On the other hand, many adults with symptom neuroses and character pathology have no history of childhood sexual or physical abuse. In studying the childhood factors that start neurotic symptom development, Freud found a constellation of factors that, for literary reasons, he termed the Oedipus complex (based on the play by Sophocles, Oedipus Rex, where the protagonist unwittingly kills his father Laius and marries his mother Jocasta). The shorthand term, "oedipal," (later explicated by Joseph 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 make to their parents in the preschool years. These attachments involve fantasies of marriage to either (or both) parent, and, therefore, competitive fantasies toward either (or both) parents. Humberto Nagera (1975) has been particularly helpful in clarifying many of the complexities of the child through these years.

The terms "positive" and "negative" oedipal conflicts have been attached to the heterosexual and homosexual aspects, respectively. Both seem to occur in development of most children. Eventually, the developing child's concessions to reality (that they will neither marry one parent nor eliminate the other) lead to identifications with parental values. These identifications generally create a new set of mental operations regarding values and guilt, subsumed under the term "superego." Besides superego development, children "resolve" their preschool oedipal conflicts through channeling wishes into something their parents approve of ("sublimations") and the development, during the school-age years ("latency") of age-appropriate obsessive-compulsive defensive maneuvers (rules, repetitive games).

Treatment

Using the various analytic theories to assess mental problems, several particular constellations of problems are particularly suited for analytic techniques (see below) whereas other problems respond better to medicines and different interpersonal interventions. To be treated with psychoanalysis, whatever the presenting problem, the person requesting help must demonstrate a good capacity to organize thought (integrative function), good abstraction ability, and a reasonable ability to observe self and others. As well, they need to be able to have trust and empathy and they must be able to control emotion and urges. Potential patients must be in contact with reality, which excludes most psychotic patients with delusions, and they must feel some guilt and shame (this requirement excludes some criminals and sex offenders who do not feel remorse). Finally, a prospective patient must not be severely suicidal patients. If any of the above are faulty, then modifications of techniques, or completely different treatment approaches, must be instituted.

The more there are deficits of serious magnitude in any of the above mental operations (1-8), the more psychoanalysis as treatment is contraindicated, and the more medication and supportive approaches are indicated. In non-psychotic first-degree criminals, any treatment is often contraindicated. The problems treatable with analysis include: phobias, conversions, compulsions, obsessions, anxiety attacks, depressions, sexual dysfunctions, a wide variety of relationship problems (such as dating and marital strife), and a wide variety of character problems (for example, painful shyness, meanness, obnoxiousness, workaholism, hyperseductiveness, hyperemotionality, hyperfastidiousness). The fact that many of such patients also demonstrate deficits above makes diagnosis and treatment selection difficult.

Analytical organizations such as the International Psychoanalytical Association, the American Psychoanalytical Association, and the European Federation for Psychoanalytic Psychotherapy, have established procedures and models for the indication and practice of psychoanalytical therapy for trainees in analysis. The match between the analyst and the patient can be viewed 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, besides made on the usual indications and pathology, is also based to a certain degree by the "fit" between analyst and patient. When analysts utilize concrete, semi-standardized procedures to evaluate patients' suitability for analytic treatment, their associations' "defined protocols," may include (semi-) structured interviews, personality tests, projective tests, and/or psychological questionnaires. An evaluation may include one or more other analysts' independent opinions and will include discussion of the patient's financial situation and insurances.

Techniques

The basic method of psychoanalysis is interpretation of the patient's unconscious conflicts that are interfering with current-day functioning – conflicts that are causing painful symptoms such as phobias, anxiety, depression, and compulsions. Strachey (1936) stressed that figuring out ways the patient distorted perceptions about the analyst led to understanding what may have been forgotten (also see Freud's paper "Repeating, Remembering, and Working Through"). In particular, unconscious hostile feelings toward the analyst could be found in symbolic, negative reactions to what Robert Langs later called the "frame" of the therapy – the setup that included times of the sessions, payment of fees, and necessity of talking. In patients who made mistakes, forgot, or showed other peculiarities regarding time, fees, and talking, the analyst can usually find various unconscious "resistances" to the flow of thoughts (sometimes called free association).

File:Freud Sofa.JPG

Freud's patients would lie on this couch during psychoanalysis

When the patient reclines on a couch with the analyst out of view, the patient tends to remember more, experience more resistance and transference, and be able to reorganize thoughts after the development of insight – through the interpretive work of the analyst. Although fantasy life can be understood through the examination of dreams, masturbation fantasies (cf. Marcus, I. and Francis, J. (1975), Masturbation from Infancy to Senescence) are also important. The analyst is interested in how the patient reacts to and avoids such fantasies (cf. Paul Gray (1994), The Ego and the Analysis of Defense). Various memories of early life are generally distorted – Freud called them "screen memories" – and in any case, very early experiences (before age two) – can not be remembered (See the child studies of Eleanor Galenson on "evocative memory").

Variations in technique

There is what is known among psychoanalysts as "classical technique," although Freud throughout his writings deviated from this considerably, depending on the problems of any given patient. Classical technique was summarized by Allan Compton, MD, as comprising instructions (telling the patient to try to say what's on their mind, including interferences); exploration (asking questions); and clarification (rephrasing and summarizing what the patient has been describing). As well, the analyst can also use confrontation to bringing an aspect of functioning, usually a defense, to the patient's attention. The analyst then uses a variety of interpretation methods, such as dynamic interpretation (explaining how being too nice guards against guilt, e.g. - defense vs. affect); genetic interpretation (explaining how a past event is influencing the present); resistance interpretation (showing the patient how they are avoiding their problems); transference interpretation (showing the patient ways old conflicts arise in current relationships, including that with the analyst); or dream interpretation (obtaining the patient's thoughts about their dreams and connecting this with their current problems). Analysts can also use reconstruction to estimate what may have happened in the past that created some current issue.

These techniques are primarily based on conflict theory (see above). As object relations theory evolved, grass supplemented by the work of Bowlby, Ainsorth, and Beebe, techniques with patients who had more severe problems with basic trust (Erikson, 1950) and a history of maternal deprivation (see the works of Augusta Alpert) led to new techniques with adults. These have sometimes been called interpersonal, intersubjective (cf. Stolorow), relational, or corrective object relations techniques. These techniques include expressing an empathic attunement to the patient or warmth; exposing a bit of the analyst's personal life or attitudes to the patient; allowing the patient autonomy in the form of disagreement with the analyst (cf. I.H. Paul, Letters to Simon.); and explaining the motivations of others which the patient misperceives. Ego psychological concepts of deficit in functioning led to refinements in supportive therapy. These techniques are particularly applicable to psychotic and near-psychotic (cf., Eric Marcus, "Psychosis and Near-psychosis") patients. These supportive therapy techniques include discussions of reality; encouragement to stay alive (including hospitalization); psychotropic medicines to relieve overwhelming depressive affect or overwhelming fantasies (hallucinations and delusions); and advice about the meanings of things (to counter abstraction failures).

The notion of the "silent analyst" has been criticized. Actually, the analyst listens using Arlow's approach as set out in "The Genesis of Interpretation"), using active intervention to interpret resistances, defenses creating pathology, and fantasies. Silence and non-responsiveness was a technique promulgated by Carl Rogers, in his development of so-called "Client Centered Therapy" – and is not a technique of psychoanalysis (also see the studies and opinion papers of Owen Renik, MD). "Analytic Neutrality" is a concept that does not mean the analyst is silent. It refers to the analyst's position of not taking sides in the internal struggles of the patient. For example, if a patient feels guilty, the analyst might explore what the patient has been doing or thinking that causes the guilt, but not reassure the patient not to feel guilty. The analyst might also explore the identifications with parents and others that led to the guilt.

Group therapy and play therapy

Although single-client sessions remain the norm, psychoanalytic theory has been used to develop other types of psychological treatment. Psychoanalytic group therapy was pioneered by Trigant Burrow, Joseph Pratt, Paul F. Schilder, Samuel R. Slavson, Harry Stack Sullivan, and Wolfe. Child-centered counseling for parents was instituted early in analytic history by Freud, and was later further developed by Irwin Marcus, Edith Schulhofer, and Gilbert Kliman. Psychoanalytically based couples therapy has been promulgated and explicated by Fred Sander, MD. Techniques and tools developed in the 2000s have made psychoanalysis available to patients who were not treatable by earlier techniques.. This meant that the analytic situation was modified so that it would be more suitable and more likely to be helpful for these patients. M.N. Eagle (2007) believes that psychoanalysis cannot be a self-contained discipline but instead must be open to influence from and integration with findings and theory from other disciplines.

Psychoanalytic constructs have been adapted for use with children with treatments such as play therapy, art therapy, and storytelling. Throughout her career, from the 1920s through the 1970s, Anna Freud adapted psychoanalysis for children through play. This is still used today for children, especially those who are preadolescent (see Leon Hoffman, New York Psychoanalytic Institute Center for Children). Using toys and games, children are able to demonstrate, symbolically, their fears, fantasies, and defenses; although not identical, this technique, in children, is analogous to the aim of free association in adults. Psychoanalytic play therapy allows the child and analyst to understand children's conflicts, particularly defenses such as disobedience and withdrawal, that have been guarding against various unpleasant feelings and hostile wishes. In art therapy, the counselor may have a child draw a portrait and then tell a story about the portrait. The counselor watches for recurring themes—regardless of whether it is with art or toys.

Cultural variations

Psychoanalysis can be adapted to different cultures, as long as the therapist or counseling understands the client's culture. For example, Tori and Blimes found that defense mechanisms were valid in a normative sample of 2,624 Thais. The use of certain defense mechanisms was related to cultural values. For example Thais value calmness and collectiveness (because of Buddhist beliefs), so they were low on regressive emotionality. Psychoanalysis also applies because Freud used techniques that allowed him to get the subjective perceptions of his patients. He takes an objective approach by not facing his clients during his talk therapy sessions. He met with his patients where ever they were, such as when he used free association—where clients would say whatever came to mind without self-censorship. His treatments had little to no structure for most cultures, especially Asian cultures. Therefore, it is more likely that Freudian constructs will be used in structured therapy (Thompson, et al., 2004). In addition, Corey postulates that it will be necessary for a therapist to help clients develop a cultural identity as well as an ego identity.

Cost and length of treatment

The cost to the patient of psychoanalytic treatment ranges widely from place to place and between practitioners. Low-fee analysis is often available in a psychoanalytic training clinic and graduate schools. Otherwise, the fee set by each analyst varies with the analyst's training and experience. Since, in most locations in the United States, unlike in Ontario and Germany, classical analysis (which usually requires sessions three to five times per week) is not covered by health insurance, many analysts may negotiate their fees with patients whom they feel they can help, but who have financial difficulties. The modifications of analysis, which include dynamic therapy, brief therapies, and certain types of group therapy (cf. Slavson, S. R., A Textbook in Analytic Group Therapy), are carried out on a less frequent basis - usually once, twice, or three times a week - and usually the patient sits facing the therapist.

Many studies have also been done on briefer "dynamic" treatments; these are more expedient to measure, and shed light on the therapeutic process to some extent. Brief Relational Therapy (BRT), Brief Psychodynamic Therapy (BPT), and Time-Limited Dynamic Therapy (TLDP) limit treatment to 20-30 sessions. On average, classical analysis may last 5.7 years, but for phobias and depressions uncomplicated by ego deficits or object relations deficits, analysis may run for a shorter period of time. Longer analyses are indicated for those with more serious disturbances in object relations, more symptoms, and more ingrained character pathology (such as obnoxiousness, severe passivity, or heinous procrastination).

Psychoanalytic training

Psychoanalytic training generally involves personal analytic treatment for the trainee, conducted confidentially, with no report to the Education Committee of the Analytic Training Institute; approximately 600 hours of class instruction, with a standard curriculum, over a four-year period. Classes are often a few hours per week, or for a full day or two every other weekend during the academic year; this varies with the institute; and supervision once per week, with a senior analyst, on each analytic treatment case the trainee has. The minimum number of cases varies between institutes, often two to four cases. Male and female cases are required. Supervision must go on for at least a few years on one or more cases. Supervision is done in the supervisor's office, where the trainee presents material from the analytic work that week, examines the unconscious conflicts with the supervisor, and learns, discusses, and is advised about technique.

History of psychoanalysis in the United Kingdom

The London Psychoanalytical Society was founded by Ernest Jones on 30th October 1913. With the expansion of psychoanalysis in the United Kingdom the Society was renamed the [British Psychoanalytical Society] in 1919. Soon after, the Institute of Psychoanalysis was established to administer the Society’s activities. These include: the training of psychoanalysts, the development of the theory and practice of psychoanalysis, the provision of treatment through The London Clinic of Psychoanalysis, the publication of books in the The New Library of Psychoanalysis and Psychoanalytic Ideas. The Institute of Psychoanalysis also publishes The International Journal of Psychoanalysis, maintains a library, furthers research, and holds public lectures. The Society has a Code of Ethics and an Ethical Committee. The Society, the Institute and the Clinic are all located at Byron House.

Research

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Over a hundred years of case reports and studies in the journal Modern Psychoanalysis, the Psychoanalytic Quarterly, the International Journal of Psychoanalysis and the Journal of the American Psychoanalytic Association have analyzed efficacy of analysis in cases of neurosis and character or personality problems. Psychoanalysis modified by object relations techniques has been shown to be effective in many cases of ingrained problems of intimacy and relationship (cf. the many books of Otto Kernberg). As a therapeutic treatment, psychoanalytic techniques may be useful in a one-session consultation. Psychoanalytic treatment, in other situations, may run from about a year to many years, depending on the severity and complexity of the pathology.

Psychoanalytic theory has, from its inception, been the subject of criticism and controversy. Freud remarked on this early in his career, when other physicians in Vienna ostracized him for his findings that hysterical conversion symptoms were not limited to women. Challenges to analytic theory began with Otto Rank and Adler (turn of the 20th century), continued with behaviorists (e.g. Wolpe) into the 1940s and '50s, and have persisted. Criticisms come from those who object the notion that there are mechanisms, thoughts or feelings in the mind that could be unconscious. Criticisms also have been leveled against the discovery of "infantile sexuality" (the recognition that children between ages two and six imagine things about procreation). Criticisms of theory have led to variations in analytic theories, such as the work of Fairbairn, Balint, and Bowlby. In the past 30 years or so, the criticisms have centered on the issue of empirical verification, in spite of many empirical, prospective research studies that have been empirically validated (e.g., See the studies of Barbara Milrod, at Cornell University Medical School, et al.).

Psychoanalysis has been used as a research tool into childhood development (cf. the journal The Psychoanalytic Study of the Child), and has developed into a flexible, effective treatment for certain mental disturbances. In the 1960s, Freud's early (1905) thoughts on the childhood development of female sexuality were challenged; this challenge led to major research in the 1970s and 80s, and then to a reformulation of female sexual development that corrected some of Freud's concepts. Also see the various works of Eleanor Galenson, Nancy Chodorow, Karen Horney, Francoise Dolto, Melanie Klein, and others.

A 2005 review of randomized controlled trials found that "psychoanalytic therapy is (1) more effective than no treatment or treatment as usual, and (2) more effective than shorter forms of psychodynamic therapy". Empirical research on the efficacy of psychoanalysis and psychoanalytic psychotherapy has also become prominent among psychoanalytic researchers.

Research on psychodynamic treatment of some populations shows mixed results. Research by analysts such as Bertram Karon and colleagues at Michigan State University had suggested that when trained properly, psychodynamic therapists can be effective with schizophrenic patients. More recent research casts doubt on these claims. The Schizophrenia Patient Outcomes Research Team (PORT) report argues in its Recommendation 22 against the use of psychodynamic therapy in cases of schizophrenia, noting that more trials are necessary to verify its effectiveness. However, the PORT recommendation is based on the opinions of clinicians rather than on empirical data, and empirical data exist that contradict this recommendation (link to abstract).

A review of current medical literature in The Cochrane Library, (the updated abstract of which is available online) reached the conclusion that no data exist that demonstrate that psychodynamic psychotherapy is effective in treating schizophrenia. Dr. Hyman Spotnitz and the practitioners of his theory known as Modern Psychoanalysis, a specific sub-specialty, still report (2007) much success in using their enhanced version of psychoanalytic technique in the treatment of schizophrenia. Further data also suggest that psychoanalysis is not effective (and possibly even detrimental) in the treatment of sex offenders. Experiences of psychoanalysts and psychoanalytic psychotherapists and research into infant and child development have led to new insights. Theories have been further developed and the results of empirical research are now more integrated in the psychoanalytic theory.

There are different forms of psychoanalysis and psychotherapies in which psychoanalytic thinking is practiced. Besides classical psychoanalysis there is for example psychoanalytic psychotherapy. Other examples of well known therapies which also use insights of psychoanalysis are Mentalization-Based Treatment (MBT), and Transference-Focused Psychotherapy (TFP). There is also a continuing influence of psychoanalytic thinking in different settings in the mental health care. To give an example: in the psychotherapeutic training in the Netherlands, psychoanalytic and system therapeutic theories, drafts, and techniques are combined and integrated. Other psychoanalytic schools include the Kleinian, Lacanian, and Winnicottian schools.

Criticism

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Exchanges between critics and defenders of psychoanalysis have often been so heated that they have come to be characterized as the Freud Wars. Popper argued that psychoanalysis is a pseudoscience because its claims are not testable and cannot be refuted, that is, they are not falsifiable. For example, if a client's reaction was not consistent with the psychosexual theory then an alternate explanation would be given (e.g. defense mechanisms, reaction formation). Karl Kraus, an Austrian satirist, was the subject of a book written by noted libertarian author Thomas Szasz. The book Anti-Freud: Karl Kraus's Criticism of Psychoanalysis and Psychiatry, originally published under the name Karl Kraus and the Soul Doctors, portrayed Kraus as a harsh critic of Sigmund Freud and of psychoanalysis in general. Other commentators, such as Edward Timms, author of Karl Kraus - Apocalyptic Satirist, have argued that Kraus respected Freud, though with reservations about the application of some of his theories, and that his views were far less black-and-white than Szasz suggests.

Grünbaum argues that psychoanalytic based theories are falsifiable, but that the causal claims of psychoanalysis are unsupported by the available clinical evidence. Other schools of psychology have produced alternative methods for psychotherapy, including behavior therapy, cognitive therapy, Gestalt therapy and person-centered psychotherapy. Hans Eysenck determined that improvement was no greater than spontaneous remission. Between two-thirds and three-fourths of “neurotics” would recover naturally; this was no different from therapy clients. Prioleau, Murdock, Brody reviewed several therapy-outcome studies and determined that psychotherapy is no different than placebo controls.

Michel Foucault and Gilles Deleuze claimed that the institution of psychoanalysis has become a center of power and that its confessional techniques resemble the Christian tradition. Strong criticism of certain forms of psychoanalysis is offered by psychoanalytical theorists. Jacques Lacan criticized the emphasis of some American and British psychoanalytical traditions on what he has viewed as the suggestion of imaginary "causes" for symptoms, and recommended the return to Freud. Together with Gilles Deleuze, Felix Guattari criticised the Oedipal structure. Luce Irigaray criticised what she called the phallogocentrism of the Freudian and Lacanian psychoanalytical theories.

Due to the wide variety of psychoanalytic theories, varying schools of psychoanalysis often internally criticize each other. One consequence is that some critics offer criticism of specific ideas present only in one or more theories, rather than in all of psychoanalysis while not rejecting other premises of psychoanalysis. Defenders of psychoanalysis argue that many critics (such as feminist critics of Freud) have attempted to offer criticisms of psychoanalysis that were in fact only criticisms of specific ideas present only in one or more theories, rather than in all of psychoanalysis. As the psychoanalytic researcher Drew Westen puts it, "Critics have typically focused on a version of psychoanalytic theory—circa 1920 at best—that few contemporary analysts find compelling... In so doing, however, they have set the terms of the public debate and have led many analysts, I believe mistakenly, down an indefensible path of trying to defend a 75 to 100-year-old version of a theory and therapy that has changed substantially since Freud laid its foundations at the turn of the century." link to Westen article. A further consideration with respect to cost is that in circumstances when lower cost treatment is provided to the patient as the analyst is funded by the government, then psychoanalytic treatment occurs at the expense other forms of more effective treatment.

Scientific criticism

An early and important criticism of psychoanalysis was that its theories were based on little quantitative and experimental research, and instead relied almost exclusively on the clinical case study method. In comparison, brief psychotherapy approaches such as behavior therapy and cognitive therapy have shown much more concern for empirical validation (Morley et al. 1999). Some even accused Freud of fabrication, most famously in the case of Anna O. (Borch-Jacobsen 1996). An increasing amount of empirical research from academic psychologists and psychiatrists has begun to address this criticism. A survey of scientific research showed that while personality traits corresponding to Freud's oral, anal, Oedipal, and genital phases can be observed, they cannot be observed as stages in the development of children, nor can it be confirmed that such traits in adults result from childhood experiences (Fisher & Greenberg, 1977, p. 399). However, these stages should not be viewed 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 psychology has to be guessed at. However, the unconscious is now a hot topic of study in the fields of experimental and social psychology (e.g., implicit attitude measures, fMRI, and PET scans, and other indirect tests). One would be hard pressed to find scientists who still think of the mind as a "black box". Currently, the field of psychology embraces the study of things outside one's awareness. Even strict behaviorists acknowledge that a vast amount of classical conditioning is unconscious and that this has profound effects on our emotional life. The idea of unconscious, and the transference phenomenon, have been widely researched and, it is claimed, validated in the fields of cognitive psychology and social psychology (Westen & Gabbard 2002), though such claims are also contested. Recent developments in neuroscience have resulted in one side arguing that it has provided a biological basis for unconscious emotional processing in line with psychoanalytic theory i.e., neuropsychoanalysis (Westen & Gabbard 2002), while the other side argues that such findings make psychoanalytic theory obsolete and irrelevant.

E. Fuller Torrey, writing in Witchdoctors and Psychiatrists (1986), stated that psychoanalytic theories have no more scientific basis than the theories of traditional native healers, "witchdoctors" or modern "cult" alternatives such as est. Some scientists regard psychoanalysis as a pseudoscience (Cioffi, 1998). Among philosophers, Karl Popper argued that Freud's theory of the unconscious was not falsifiable and therefore not scientific. Popper did not object to the idea that some mental processes could be unconscious but to investigations of the mind that were not falsifiable. In other words, if it were possible to connect every conceivable experimental outcome with Freud's theory of the unconscious mind, then no experiment could refute the theory. Anthropologist Roy Wagner, in The Invention of Culture, ridicules psychoanalysis and tries to account for personality and emotional disorder in terms of invention and convention.

Some proponents of psychoanalysis suggest that its concepts and theories are more akin to those found in the humanities than those proper to the physical and biological/medical sciences, though Freud himself tried to base his clinical formulations on a hypothetical neurophysiology of energy transformations. For example, the philosopher Paul Ricoeur argued that psychoanalysis can be considered a type of textual interpretation or hermeneutics. Like cultural critics and literary scholars, Ricoeur contended, psychoanalysts spend their time interpreting the nuances of language — the language of their patients. Ricoeur claimed that psychoanalysis emphasizes the polyvocal or many-voiced qualities of language, focusing on utterances that mean more than one thing. Ricoeur classified psychoanalysis as a hermeneutics of suspicion. By this he meant that psychoanalysis searches for deception in language, and thereby destabilizes our usual reliance on clear, obvious meanings. Despite criticism regarding the validity of psychoanalytic therapeutic technique, numerous outcome studies have shown that its efficacy is equal to that of other mainstream therapy modalities such as cognitive-behavioral therapy.

Theoretical criticism

Psychoanalysts have often complained about the significant lack of theoretical agreement among analysts of different schools. Many authors have attempted to integrate the various theories, with limited success. However, with the publication of the Psychodynamic Diagnostic Manual much of this lack of cohesion has been resolved.

Jacques Derrida incorporated aspects of psychoanalytic theory into deconstruction in order to question what he called the 'metaphysics of presence'. Freud's insistence, in the first chapter of The Ego and the Id, that philosophers will recoil from his theory of the unconscious is clearly a forbear to Derrida's understanding of metaphysical 'self-presence'. Derrida also turns some of these ideas against Freud, to reveal tensions and contradictions in his work. These tensions are the conditions upon which Freud's work can operate. For example, although Freud defines religion and metaphysics as displacements of the identification with the father in the resolution of the Oedipal complex, Derrida insists in The Postcard: From Socrates to Freud and Beyond that the prominence of the father in Freud's own analysis is itself indebted to the prominence given to the father in Western metaphysics and theology since Plato. Thus Derrida thinks that even though Freud remains within a theologico-metaphysical tradition^{[How to reference and link to summary or text]} of 'phallologocentrism', Freud nonetheless criticizes that tradition.

The purpose of Derrida's analysis is not to refute Freud, which would only reaffirm traditional metaphysics, but to reveal an undecidability at the heart of his project. This deconstruction of Freud casts doubt upon the possibility of delimiting psychoanalysis as a rigorous science. Yet it celebrates the side of Freud which emphasises the open-ended and improvisatory nature of psychoanalysis, and its methodical and ethical demand that the testimony of the analysand should be given prominence in the practice of analysis. Psychoanalysis, or at least the dominant version of it, has been denounced as patriarchal or phallocentric by some proponents of feminist theory.^{[How to reference and link to summary or text]} Other feminist scholars have argued that Freud opened up society to female sexuality.^{[How to reference and link to summary or text]}

Dictionaries

• English H.B. & English A.C. (1958). A Comprehensive dictionary of psychological and psychoanalytic terms: A guide to usage. New YorkDavid McKay.
• A Critical Dictionary of Psychoanalysis. Rycroft, Charles. 2nd ed. London and New York: Penguin Books, 1995.
• Freud: Dictionary of Psychoanalysis. Freud, Sigmund. Westport: Greenwood, 1969.
• International Dictionary of Psychoanalysis = Dictionnaire international de la psychanalyse / Alain de Mijolla, editor in chief. c2005. Detroit : Macmillan Reference USA, ISBN 0028659244ISBN 0028659945 (set : ebook)

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See also

• Analysis of Subjective Logics
• Adlerian psychotherapy
• Catharsis
• Dream analysis
• Defence mechanism
• Erik H. Erikson
• Free association
• Hypnotherapy
• List of psychoanalytic organizations
• Negative therapeutic reaction
• Neo-Freudian
• [[Psychoanalytic sociology
• Psychoanalytic theory
• Psychotherapeutic neutrality
• Psychotherapeutic processes
• Psychotherapy
• Self analysis
• Transactional analysis

References

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• Important publications in psychoanalysis & psychotherapy
• Berman, J. (2003). [Review of the book The writing cure: How expressive writing promotes health and well-being. [Electronic version]. Psychoanalytic psychology, 20(3), 575-578.
• Brenner, C. (1954). An elementary textbook of psychoanalysis.
• Corey, G. (2001). Theory and practice of counseling and psychotherapy. (6th ed.). Belmont, CA: Brooks/Cole Thompson Learning
• Seymour Fisher,, The Scientific Credibility of Freud's Theories and Therapy, Columbia University Press (October, 1985), trade paperback, ISBN 023106215X
• Firestone, R.W. (2002). "The death of psychoanalysis and depth therapy." [Electronic version]. Psychotherapy: Theory, Research, Practice, and Training, 39(3), 223-232.
• Kramer, Peter D., Listening to Prozac: A Psychiatrist Explores Antidepressant Drugs and the Remaking of the Self ISBN 0670841838.
• Luhrmann, T.M., Of Two Minds: The Growing Disorder in American Psychiatry ISBN 0679421912.
• Parker, I. (2004) ‘Psychoanalysis and critical psychology’, in D. Hook (ed.), with N. Mkhize, P. Kiguwa and A. Collins (section eds) and E. Burman and I. Parker (consulting eds) (2004) Critical Psychology. Cape Town: UCT Press.
• Thomson, C.L, Rudolph L.B., & Henderson, D. (2004). Counseling children. (6th ed.). Belmont, CA: Brooks/Cole Thompson.
• Tori, C.D. & Blimes, M. (Fall 2002). "Cross-cultural and Psychoanalytic Psychology: The Validation of defense measure in an Asian population." [Electronic version]. Psychoanalytic psychology, 19(4), 701-421.
• E. Fuller Torrey, Witchdoctors and Psychiatrists: The Common Roots of Psychotherapy and Its Future, Perennial Library, Harper & Row (1986), trade paperback, 320 pages, ISBN 0060970243
• Psychoanalytic Theory: An Introduction, by Anthony Elliott, an introduction that explains psychoanalytic theory with interpretations of major theorists [3]
• The Psychoanalytic Movement: The Cunning of Unreason, by Ernest Gellner. A critical view of Freudian theory. ISBN 0810113708
• Mitchell, S. & Black, M. (1995). Freud and Beyond: A History of Modern Psychoanalytic Thought
• Wachtel, P. (1989). Psychoanalysis and Cognitive Behavior Therapy: Toward an Integration. New York: Basic Books.

Literature

Introductions

• Brenner, Charles (1954). An elementary textbook of psychoanalysis.
• Elliott, Anthony (2002). Psychoanalytic Theory: An Introduction, Second Edition, Duke University Press - an introduction that explains psychoanalytic theory with interpretations of major theorists.

Reference works

• International dictionary of psychoanalysis : [enhanced American version], ed. by Alain de Mijolla, 3 vls., Detroit [etc.] : Thomson/Gale, 2005
• Jean Laplanche and J.B. Pontalis: "The Language of Psycho-Analysis", W. W. Norton & Company, 1974, ISBN 0-393-01105-4

General

• Horacio Etchegoyen, The Fundamentals of Psychoanalytic Technique, Karnac Books ed., New Ed, 2005, ISBN 1-85575-455-X
• Ernest Gellner, The Psychoanalytic Movement: The Cunning of Unreason, . A critical view of Freudian theory. ISBN 0-8101-1370-8
• André Green : "Psychoanalysis: A Paradigm For Clinical Thinking", Free Association Books, 2005, ISBN 1-85343-773-5
• Luce Irigaray, "Key Writings". Continuum, 2004, ISBN 0-8264-6940-X
• Edith Jacobson : "Depression; Comparative Studies of Normal, Neurotic, and Psychotic Conditions", Publisher: International Universities Press, 1976, ISBN 0-8236-1195-7
• Otto Kernberg : "Severe Personality Disorders: Psychotherapeutic", Yale University Press; edition 1993, ISBN 0-300-05349-5
• Heinz Kohut : "Analysis of the Self: Systematic Approach to Treatment of Narcissistic Personality Disorders", International Universities Press, 2000, ISBN 0-8236-8002-9
• Julia Kristeva, "The Kristeva Reader", edited by Toril Moi, Columbia University Press, 1986. ISBN 0-231-06235-3
• Donald Meltzer The Kleinian Development (New edition), Karnac Books; Reprint edition 1998, ISBN 1-85575-194-1
• Donald Meltzer : "Dream-Life: A Re-Examination of the Psycho-Analytical Theory and Technique" Publisher: Karnac Books, 1983, ISBN 0-902965-17-4
• Mitchell, S.A., & Black, M.J. (1995). Freud and beyond: a history of modern psychoanalytic thought. Basic Books, New York. xviii-xx.
  
• Griselda Pollock, "Beyond Oedipus. Feminist Thought, Psychoanalysis, and Mythical Figurations of the Feminine." In: Laughing with Medusa. Edited by Vanda Zajko and Miriam Leonard. Oxford University Press, 2006. ISBN 0-19-927438-X
• Sabina Spielrein : "Destruction as cause of becoming", 1993, OCLC 44450080

• Robert Stoller : "Presentations of Gender", Yale University Press, 1992, ISBN 0-300-05474-2
• Robert Stolorow, George Atwood, & Donna Orange: Worlds of Experience: Interweaving Philosophical and Clinical Dimensions in Psychoanalysis. New York: Basic Books, 2002
• Rene Spitz : "The First Year of Life: Psychoanalytic Study of Normal and Deviant Development of Object Relations", International Universities Press, 2006, ISBN 0-8236-8056-8

Online papers about psychoanalytic theory

• Benjamin, J. (1995). Recognition and destruction: An outline of intersubjectivity
• Boesky, D. (2005). Psychoanalytic controversies contextualized
• Boston Process of Change Study Group. (2005). The "something more" than interpretation
• Brenner, C. (1992). The mind as conflict and compromise formation
• Eagle, M. (1984). Developmental deficit versus dynamic conflict
• Gill, M. (1984). Psychoanalysis and psychotherapy: A revision
• Kernberg, O. (2000). Psychoanalysis, psychoanalytic psychotherapy and supportive psychotherapy: contemporary controversies
• Mitchell, Stephen A. (1984). Object relations theories and the developmental tilt
• Rubinstein, B. (1975). On the clinical psychoanalytic theory and its role in the inference and confirmation of particular clinical hypotheses

Online papers and links about psychoanalytic research

• Blatt, S. & Shahar, G. (2004). Psychoanalysis: With whom, for what, and how? Comparisons with psychotherapy
• Brakel, L. (2005). The psychoanalytic assumption of the primary process: Extrapsychoanalytic evidence and findings
• Fonagy, P.(1997). Attachment, the development of the self, and its pathology in personality disorders
• Freedman, N, Lasky, R., & Hurvich, M. (2001), Transformation Cycles as Organizers of Psychoanalytic Process: The Method of Sequential Specification

• Freud, Sigmund (1920). Dream Psychology: Psychoanalysis for Beginners

• Masling, J.(1999). An Evaluation of Empirical Research Linked to Psychoanalytic Theory
• Shaver, P. & Mikulincer, M. (2002). Attachment-Related Psychodynamics.
• Solms, M. (1999). The Interpretation of Dreams and the neurosciences
• Wallerstein,R.(2002). Psychoanalytic Therapy Research:An Overview
• Westen, D. (1999) The scientific status of unconscious processes: Is Freud really dead?
• Westen, D. Towards a clinically and empirically sound theory of motivation
• Wilczek, A. et al. (2005). Change after long term psychoanalytic psychotherapy
• Bulletin of the Psychoanalytic Research Society
• Psychoanalytic Research Consortium

Critiques of psychoanalysis

• Aziz, Robert (2007). The Syndetic Paradigm: The Untrodden Path Beyond Freud and Jung. Albany: State University of New York Press. ISBN 978-0-7914-6982-8.
• Borch-Jacobsen, Mikkel (1996). Remembering Anna O: A century of mystification London: Routledge. ISBN 0-415-91777-8
• Cioffi, Frank. (1998). Freud and the Question of Pseudoscience, Open Court Publishing Company. ISBN 0-8126-9385-X
• Erwin, Edward, A Final Accounting: Philosophical and Empirical Issues in Freudian Psychology ISBN 0-262-05050-1
• Esterson, Allen. Seductive Mirage: An Exploration of the Work of Sigmund Freud. Chicago: Open Court, 1993. ISBN 0-8126-9230-6
• Fisher, Seymour, Greenberg Roger P. (1977). The Scientific Credibility of Freud's Theories and Therapy. New York: Basic Books.
• Fisher, Seymour, Greenberg Roger P. (1996). Freud Scientifically Reappraised: Testing the Theories and Therapy. New York: John Wiley.
• Gellner, Ernest, The Psychoanalytic Movement: The Cunning of Unreason. A critical view of Freudian theory, ISBN 0-8101-1370-8
• Grünbaum, Adolf (1979), Is Freudian Psychoanalytic Theory Pseudo-Scientific by Karl Popper's Criterion of Demarcation? American Philosophical Quarterly, 16, 131-141.
• Grünbaum, Adolf (1985) The Foundations of Psychoanalysis: A Philosophical Critique ISBN 0-520-05017-7
• Macmillan, Malcolm, Freud Evaluated: The Completed Arc ISBN 0-262-63171-7
• Morley S, Eccleston C, Williams A. (1999) Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain, 80(1-2), 1-13.
• Webster, Richard. (1995). Why Freud Was Wrong, New York: Basic Books, Harper Collins. ISBN 0-465-09128-8
• Skeptic's dictionary entry on psychoanalysis

External links

• Journal of the American Psychoanalytic Association online
• A Glossary of Freudian Terms
• Abstracts of the Psychological Works of Sigmund Freud
• Sigmund Freud - Life and Work
• The Skeptic's Dictionary Entry on Psychoanalysis
• International Journal of Psychoanalysis
• International Psychoanalytical Studies Organization
• International Psychoanalytical Association
• Australian Psychoanalytical Society (component of IPA)
• Psychoanalysis Downunder - online journal of APAS
• The International Association for Relational Psychoanalysis and Psychotherapy
• The American Psychoanalytic Association
• The New York Psychoanalytic Society & Institute
• Essays about the pros and cons of psychoanalysis
• William Alanson White Institute
• New York Freudian Society
• website with links to many articles on psychoanalysis
• Columbia University Center for Psychoanalytic Training and Research
• NYU Postdoctoral Program in Psychotherapy and Psychoanalysis
• ">The British Psychoanalytic Society</a></dt>
• ">London Centre for Psychotherapy
• ">National Psychological Association for Psychoanalysis- UK based
• The San Fransisco Psychoanalytical Society and Institute
• ">Canadian Psychoanalytic Society
• ">International Psychoanalytic Association