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Psychoanalysis (from
Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially the Hellenic Republic, is a country located in Southeast Europe. Its population is approximately 10.7 million as of ...
: + ) is a set of
theories A theory is a reason, rational type of abstraction, abstract thinking about a phenomenon, or the results of such thinking. The process of contemplative and rational thinking is often associated with such processes as observational study or researc ...

theories
and
therapeutic A therapy or medical treatment (often abbreviated tx, Tx, or Tx) is the attempted remediation of a health Health is a state of physical, mental and social well-being Well-being, also known as ''wellness'', ''prudential value'' or ''quality ...
techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things — a theory, a research method, a therapy, a body of knowledge. In what might be considered an unfortunately abbreviated description, Freud said that anyone who recognizes transference and resistance is a psychoanalyst, even if he comes to conclusions other than his own.… I prefer to think of the analytic situation more broadly, as one in which someone seeking help tries to speak as freely as he can to someone who listens as carefully as he can with the aim of articulating what is going on between them and why.
David Rapaport David A. Rapaport (September 30, 1911, Budapest Budapest (, ) is the capital and the List of cities and towns of Hungary, most populous city of Hungary, and the Largest cities of the European Union by population within city limits, ninth-larges ...
(1967a) once defined the analytic situation as carrying the method of interpersonal relationship to its last consequences." Gill, Merton M. 1999.
Psychoanalysis, Part 1: Proposals for the Future
" ''The Challenge for Psychoanalysis and Psychotherapy: Solutions for the Future''. New York:
American Mental Health FoundationThe American Mental Health Foundation (AMHF) is a not-for-profit organization dedicated to the welfare of individuals with emotional problems and advancing mental-health research. AMHF is established to organize educational seminars and to disseminat ...
. Archived 10 June 2009.
that deal in part with the
unconscious mind The unconscious mind (or the unconscious) consists of the processes in the mind which occur automatically and are not available to introspection and include thought processes, memories, interests, and motivations. Even though these processes exist ...
,"All psychoanalytic theories include the idea that unconscious thoughts and feelings are central in mental functioning." Milton, Jane, Caroline Polmear, and Julia Fabricius. 2011. ''A Short Introduction to Psychoanalysis''. SAGE. p. 27. and which together form a method of treatment for
mental disorder A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing In internal medici ...
s. The discipline was established in the early 1890s by Austrian
neurologist Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia ''-logy'' is a suffix in the English language, used with words originally adapted from Ancient Greek ending in (''-logia''). The earliest English example ...
Sigmund Freud Sigmund Freud ( , ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is a branch of medicine M ...

Sigmund Freud
, who developed the practice from his theoretical model of personality organization and development,
psychoanalytic theory Psychoanalytic theory is the theory of personality organization and the dynamics of personality development that guides psychoanalysis, a clinical method for treating psychopathology. First laid out by Sigmund Freud in the late 19th century, psycho ...
.Mitchell, Juliet. 2000. ''Psychoanalysis and Feminism: A Radical Reassessment of Freudian Psychoanalysis''. London:
Penguin Books Penguin Books was originally a British publishing house Publishing is the activity of making information, literature, music, software and other content available to the public for sale or for free. Traditionally, the term refers to the distr ...
. p. 341.
Freud's work stems partly from the clinical work of
Josef Breuer Josef Breuer (; 15 January 1842 – 20 June 1925) was a distinguished physician A physician (American English American English (AmE, AE, AmEng, USEng, en-US), sometimes called United States English or U.S. English, is the set of ...
and others. Psychoanalysis was later developed in different directions, mostly by students of Freud, such as
Alfred Adler Alfred Adler (; ; 7 February 1870 – 28 May 1937) was an Austrian medical doctor, psychotherapist Psychotherapy (also psychological therapy or talking therapy) is the use of Psychology, psychological methods, particularly when based on regu ...

Alfred Adler
and his collaborator,
Carl Gustav Jung Carl Gustav Jung ( ; born Karl Gustav Jung, ; 26 July 1875 – 6 June 1961), was a Swiss psychiatrist and psychoanalyst who founded analytical psychology. Jung's work has been influential in the fields of psychiatry Psychiatry is th ...

Carl Gustav Jung
,
Alfred Adler Alfred Adler (; ; 7 February 1870 – 28 May 1937) was an Austrian medical doctor, psychotherapist Psychotherapy (also psychological therapy or talking therapy) is the use of Psychology, psychological methods, particularly when based on regu ...

Alfred Adler
developed the school of thought known as
individual psychology Individual psychology is the psychological method or science founded by the VienneseViennese may refer to: * Vienna en, Viennese , iso_code = AT-9 , registration_plate = Vehicle registration plates of A ...
, while
Carl Jung Carl Gustav Jung ( ; born Karl Gustav Jung, ; 26 July 1875 – 6 June 1961), was a Swiss psychiatrist A psychiatrist is a physician A physician (American English), medical practitioner (English in the Commonwealth of Nations ...

Carl Jung
established
analytical psychology Analytical psychology ( de , Analytische Psychologie, sometimes translated as analytic psychology and referred to as Jungian analysis) is a term coined by Carl Jung, a Swiss psychiatrist, to describe research into his new "empirical science" o ...
.
as well as by
neo-FreudianNeo-Freudianism is a psychoanalytic approach derived from the influence of Sigmund Freud Sigmund Freud ( ; ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical ...
thinkers, such as
Erich Fromm Erich Seligmann Fromm (; ; March 23, 1900 – March 18, 1980) was a German social psychologist Social psychology is the scientific study of how the thoughts, feelings, and behavior Behavior (American English) or behaviour (Britis ...

Erich Fromm
,
Karen Horney Karen Horney (; ; 16 September 1885 – 4 December 1952) was a German psychoanalyst Psychoanalysis (from Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially t ...
, and
Harry Stack Sullivan Herbert "Harry" Stack Sullivan (February 21, 1892, Norwich, New York – January 14, 1949, Paris Paris () is the Capital city, capital and List of communes in France with over 20,000 inhabitants, most populous city of France, with an estimat ...
.Birnbach, Martin. 1961. ''Neo-Freudian Social Philosophy''. Stanford:
Stanford University Press Stanford University Press (SUP) is the publishing house Publishing is the activity of making information, literature, music, software and other content available to the public for sale or for free. Traditionally, the term refers to the distribut ...
. p. 3.
Psychoanalysis is a controversial discipline, and its effectiveness as a treatment has been contested. It has been largely replaced by the similar but broader
psychodynamic psychotherapy Psychodynamic psychotherapy or psychoanalytic psychotherapy is a form of depth psychologyDepth psychology (from the German term ''Tiefenpsychologie'') refers to the practice and research of the science of the unconscious, covering both psychoanalys ...
in the mid-20th century, although it retains a salient influence within
psychiatry Psychiatry is the specialty (medicine), medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to mood, behaviour, cognition, and perceptions. See glossary of psyc ...
."Psychoanalysis has existed before the turn of the 20th century and, in that span of years, has established itself as one of the fundamental disciplines within psychiatry. The science of psychoanalysis is the bedrock of psychodynamic understanding and forms the fundamental theoretical frame of reference for a variety of forms of therapeutic intervention, embracing not only psychoanalysis itself but also various forms of psychoanalytically oriented psychotherapy and related forms of therapy using psychodynamic concepts." Sadock, Benjamin J., and Virginia A. Sadock. 2007. ''Kaplan and Sadock's Synopsis of Psychiatry'' (10th ed.).
Lippincott Williams & Wilkins Lippincott Williams & Wilkins (LWW) is an imprint of the publishing conglomerate Wolters Kluwer Wolters Kluwer N.V. () is an American Dutch information services company. The company is headquartered in Alphen aan den Rijn, Netherlands (Global) a ...
. p. 190.
"Psychoanalysis continues to be an important paradigm 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 biologic psychiatry. As yet unresolved is the appropriate role of psychoanalytic thinking in organizing the treatment of patients and the training of psychiatrists after that biologic revolution has born fruit. Will treatments aimed at biologic defects or abnormalities become technical steps in a program organized in a psychoanalytic framework? Will psychoanalysis serve to explain and guide supportive intervention for individuals whose lives are deformed by biologic defect and therapeutic interventions, much as it now does for patients with chronic physical illness, with the psychoanalyst on the psychiatric dialysis program? Or will we look back on the role of psychoanalysis in the treatment of the seriously mentally ill as the last and most scientifically enlightened phase of the humanistic tradition in psychiatry, a tradition that became extinct when advances in biology allowed us to cure those we had so long only comforted?" Michels, Robert. 1999.
Psychoanalysis and Psychiatry: A Changing Relationship
" ''The Challenge for Psychoanalysis and Psychotherapy: Solutions for the Future''. New York:
American Mental Health FoundationThe American Mental Health Foundation (AMHF) is a not-for-profit organization dedicated to the welfare of individuals with emotional problems and advancing mental-health research. AMHF is established to organize educational seminars and to disseminat ...
. Archived 6 June 2009.
Psychoanalytic concepts are also widely used outside the therapeutic arena, in areas such as
psychoanalytic literary criticismPsychoanalytic literary criticism is literary criticism Literary criticism (or literary studies) is the study, evaluation, and interpretation of literature Literature broadly is any collection of Writing, written work, but it is also used ...
, as well as in the analysis of film, fairy tales, philosophical perspectives as
Freudo-Marxism Freudo-Marxism is a loose designation for philosophical perspectives informed by both the Marxist philosophy Marxist philosophy or Marxist theory are works in philosophy that are strongly influenced by Karl Marx's Historical materialism, materia ...
and other cultural phenomena.


Basic tenets

The basic tenets of psychoanalysis include: # A person's development is determined by often forgotten events in early childhood, rather than by
inherited traits
inherited traits
alone. #
Human behaviour Human behavior is the potential and expressed capacity (Energy (psychological), mentally, Physical activity, physically, and Social actions, socially) of human individuals or groups to respond to internal and external Stimulation, stimuli through ...
and
cognition Cognition () refers to "the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses". It encompasses many aspects of intellectual function Intellectual functioning refers to the "general men ...
are largely determined by instinctual drives that are rooted in the unconscious. # Attempts to bring such drives into awareness triggers
resistance Resistance may refer to: Arts, entertainment, and media Comics * Either of two similarly named but otherwise unrelated comic book series, both published by Wildstorm: ** ''Resistance'' (comics), based on the video game of the same title ** ''Th ...
in the form of
defense mechanisms In psychoanalytic theory, a defence mechanism (American English: defense mechanism), is an Unconscious mind, unconscious psychological mechanism that reduces anxiety arising from unacceptable or potentially harmful stimuli. Defence mechanisms ...
, particularly repression. # Conflicts between conscious and unconscious material can result in mental disturbances, such as
neurosis Neurosis is a class of functional mental disorders involving chronic distress, but neither delusion A delusion is a fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belie ...
, neurotic traits,
anxiety Anxiety is an emotion Emotions are mental state, psychological states brought on by neurophysiology, neurophysiological changes, variously associated with thoughts, feelings, behavioural responses, and a degree of pleasure or suffering, disp ...

anxiety
, and
depression Depression may refer to: Mental health * Depression (mood), a state of low mood and aversion to activity * Mood disorders characterized by depression are commonly referred to as simply ''depression'', including: ** Dysthymia ** Major depressive ...
. # Unconscious material can be found in
dreams A dream is a succession of images, ideas, emotions, and sensation (psychology), sensations that usually occur involuntarily in the mind during certain stages of sleep. Humans spend about two hours dreaming per night, and each dream lasts around ...

dreams
and unintentional acts, including mannerisms and
slips of the tongue A speech error, commonly referred to as a slip of the tongue (Latin: ''lapsus linguae'', or occasionally self-demonstratingly, ''lipsus languae'') or misspeaking, is a error (linguistics), deviation (conscious or unconscious) from the apparently i ...
. # Liberation from the effects of the unconscious is achieved by bringing this material into the conscious mind through therapeutic intervention. # The "centerpiece of the psychoanalytic process" is the
transference Transference (german: Übertragung) is a phenomenon within psychotherapy Psychotherapy (also psychological therapy or talking therapy) is the use of psychological methods, particularly when based on regular personal interaction with adult ...
, whereby patients relive their infantile conflicts by projecting onto the analyst feelings of love, dependence and anger.


Practice

During psychoanalytic sessions, typically lasting 50 minutes,Thompson, M. Guy. 2004. ''The Ethic of Honesty: The Fundamental Rule of Psychoanalysis''. Rodopi. p. 75. ideally 4–5 times a week, the patient (or ) may lie on a couch, and the analyst may sit just behind and out of sight. The patient expresses their thoughts, including free associations, fantasies, and dreams, from which the analyst infers the unconscious conflicts causing the patient's symptoms and character problems. Through the analysis of these conflicts, which includes interpreting the transference and
countertransference Countertransference is defined as redirection of a psychotherapist's feelings toward a client – or, more generally, as a therapist's emotional entanglement with a client. Early formulations The phenomenon of countertransference (german: Ge ...
(the analyst's feelings for the patient), the analyst confronts the patient's pathological defenses to help the patient gain
insight The Interior Exploration using Seismic Investigations, Geodesy and Heat Transport (''InSight'') mission is a robotic Robotics is an interdisciplinarity, interdisciplinary field that integrates computer science and engineering. Robotics in ...

insight
.


History

Sigmund Freud Sigmund Freud ( , ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is a branch of medicine M ...

Sigmund Freud
first used the term 'psychoanalysis' () in 1896, ultimately retaining the term for his own school of thought. In November 1899, he wrote the ''
Interpretation of Dreams ''The Interpretation of Dreams'' (german: Die Traumdeutung) is an 1899 book by Sigmund Freud Sigmund Freud ( ; ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a ...
'' (), which Freud thought of as his "most significant work". Psychoanalysis was later developed in different directions, mostly by students of Freud such as
Alfred Adler Alfred Adler (; ; 7 February 1870 – 28 May 1937) was an Austrian medical doctor, psychotherapist Psychotherapy (also psychological therapy or talking therapy) is the use of Psychology, psychological methods, particularly when based on regu ...

Alfred Adler
and
Carl Gustav Jung Carl Gustav Jung ( ; born Karl Gustav Jung, ; 26 July 1875 – 6 June 1961), was a Swiss psychiatrist and psychoanalyst who founded analytical psychology. Jung's work has been influential in the fields of psychiatry Psychiatry is th ...

Carl Gustav Jung
, and by neo-Freudians such as
Erich Fromm Erich Seligmann Fromm (; ; March 23, 1900 – March 18, 1980) was a German social psychologist Social psychology is the scientific study of how the thoughts, feelings, and behavior Behavior (American English) or behaviour (Britis ...

Erich Fromm
,
Karen Horney Karen Horney (; ; 16 September 1885 – 4 December 1952) was a German psychoanalyst Psychoanalysis (from Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially t ...
and
Harry Stack Sullivan Herbert "Harry" Stack Sullivan (February 21, 1892, Norwich, New York – January 14, 1949, Paris Paris () is the Capital city, capital and List of communes in France with over 20,000 inhabitants, most populous city of France, with an estimat ...
. Psychologist
Frank Sulloway Frank Jones Sulloway (born February 2, 1947) is an American psychologist A psychologist is a person who studies normal and abnormal mental states, perceptual, cognitive, emotional, and social processes and behavior by experimenting with, and ob ...
in his book ''Freud, Biologist of the Mind: Beyond the Psychoanalytic Legend'' argues that Freud's biological theories like libido were rooted in the biological hypothesis that accompanied the work of
Charles Darwin Charles Robert Darwin (; ; 12 February 1809 – 19 April 1882) was an English naturalist Natural history is a domain of inquiry involving organism In biology, an organism () is any organic, life, living system that fu ...

Charles Darwin
, citing theories of , Molland,
Havelock Ellis Henry Havelock Ellis (2 February 1859 – 8 July 1939) was an English physician, eugenicist Eugenics ( ; from Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially the He ...
,
Haeckel Ernst Heinrich Philipp August Haeckel (; 16 February 1834 – 9 August 1919) was a German zoologist Zoology ()The pronunciation of zoology as is usually regarded as nonstandard, though it is not uncommon. is the branch of biology that studie ...

Haeckel
,
Wilhelm Fliess Wilhelm Fliess (german: Wilhelm Fließ; 24 October 1858 – 13 October 1928) was a German otolaryngologist who practised in Berlin. He developed the pseudoscientific theory of human biorhythms and a possible nasogenital connection that have no ...
as influencing Freud.


1890s

The idea of psychoanalysis (german: psychoanalyse) first began to receive serious attention under
Sigmund Freud Sigmund Freud ( , ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is a branch of medicine M ...

Sigmund Freud
, who formulated his own theory of psychoanalysis in
Vienna Vienna ( ; german: Wien ; bar, Wean, label=Bavarian language, Austro-Bavarian ) is the Capital city, national capital, largest city, and one of States of Austria, nine states of Austria. Vienna is Austria's List of cities and towns in Austria, mos ...

Vienna
in the 1890s. Freud was a
neurologist Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia ''-logy'' is a suffix in the English language, used with words originally adapted from Ancient Greek ending in (''-logia''). The earliest English example ...
trying to find an effective treatment for patients with neurotic or symptoms. Freud realised that there were mental processes that were not conscious, whilst he was employed as a neurological consultant at the Children's Hospital, where he noticed that many
aphasic Aphasia is an inability to comprehend or formulate language because of damage to specific brain A brain is an organ (anatomy), organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is locate ...

aphasic
children had no apparent organic cause for their symptoms. He then wrote a
monograph A monograph is a specialist work of writing (in contrast to reference work A reference work is a work, such as a book A book is a medium for recording information Information is processed, organised and structured data. It pro ...

monograph
about this subject. In 1885, Freud obtained a grant to study with
Jean-Martin Charcot Jean-Martin Charcot (; 29 November 1825 – 16 August 1893) was a French neurologist Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is a branch of medicine Medicine is the Art (skill), ...

Jean-Martin Charcot
, a famed neurologist, at the Salpêtrière in Paris, where Freud followed the clinical presentations of Charcot, particularly in the areas of hysteria, paralyses and the anaesthesias. Charcot had introduced 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 ''Studies on Hysteria'' () is an 1895 book by Sigmund Freud Sigmund Freud ( ; ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for treating psychopa ...
'' (1895; german: Studien über Hysterie, label=none), co-authored with his mentor the distinguished physician
Josef Breuer Josef Breuer (; 15 January 1842 – 20 June 1925) was a distinguished physician A physician (American English American English (AmE, AE, AmEng, USEng, en-US), sometimes called United States English or U.S. English, is the set of ...
, which was generally seen as the birth of psychoanalysis. The work was based on Breuer's treatment of
Bertha Pappenheim Bertha Pappenheim (27 February 1859 – 28 May 1936) was an Austrians, Austrian-Jewish feminist, a social pioneer, and the founder of the Jewish Women's Association (Germany), Jewish Women's Association (''Jüdischer Frauenbund''). Under the pseud ...
, referred to in case studies by the
pseudonym A pseudonym () (originally: ψευδώνυμος in Greek) or alias () is a fictitious name that a person or group assumes for a particular purpose, which differs from their original or true name (orthonym). This also differs from a new name tha ...
"
Anna O.:''This article is concerned with Bertha Pappenheim as the patient Anna O. For her life before and after her treatment, see Bertha Pappenheim.'' Anna O. was the pseudonym A pseudonym () or alias () (originally: ψευδώνυμος in Greek) is ...
", treatment which Pappenheim herself had dubbed the "
talking cure ''The Talking Cure'' and ''chimney sweeping'' were terms Bertha Pappenheim Bertha Pappenheim (27 February 1859 – 28 May 1936) was an Austrians, Austrian-Jewish feminist, a social pioneer, and the founder of the Jewish Women's Association (German ...
". Breuer wrote that many factors could result in such symptoms, including various types of emotional trauma, and he also credited work by others such as
Pierre Janet Pierre Marie Félix Janet (; 30 May 1859 – 24 February 1947) was a pioneering French psychologist, physician, philosopher, and psychotherapist in the field of dissociation (psychology), dissociation and Psychological trauma, traumatic mem ...
; while Freud contended that at the root of hysterical symptoms were repressed memories of distressing occurrences, almost always having direct or indirect sexual associations.Freud, Sigmund, and
Josef Breuer Josef Breuer (; 15 January 1842 – 20 June 1925) was a distinguished physician A physician (American English American English (AmE, AE, AmEng, USEng, en-US), sometimes called United States English or U.S. English, is the set of ...
. 1955
895 ' __NOTOC__ Year 895 ( DCCCXCV) was a common year starting on Wednesday A common year starting on Wednesday is any non-leap year A leap year (also known as an intercalary year or wikt:bissextile, bissextile year) is a calendar year that conta ...
''
Studies on Hysteria ''Studies on Hysteria'' () is an 1895 book by Sigmund Freud Sigmund Freud ( ; ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for treating psychopa ...
'', '' Standard Editions'' 2, edited by . London:
Hogarth Press Image:Hogarth Press blue plaque, Richmond, London.jpg, 150px, Blue plaque The Hogarth Press was a British publishing house founded in 1917 by Leonard Woolf and Virginia Woolf. It was named after their house in London Borough of Richmond upon Th ...
.
Around the same time, Freud attempted to develop a neuro-physiological theory of unconscious mental mechanisms, which he soon gave up. It remained unpublished in his lifetime. The term 'psychoanalysis' () was first introduced by Freud in his essay titled "Heredity and etiology of neuroses" (""), written and published in French in 1896. In 1896, Freud also published his ''seduction theory'', claiming to have uncovered repressed memories of incidents of sexual abuse for all his current patients, from which he proposed that the preconditions for symptoms are sexual excitations in infancy.Freud, Sigmund. 1953 896 "
The Aetiology of Hysteria The Aetiology of Hysteria (german: Über die Ätiologie der Hysterie) is a paper by Sigmund Freud Sigmund Freud ( ; ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, ...
." Pp. 191–221 in '' The Standard Edition'' 3, edited by . London:
Hogarth Press Image:Hogarth Press blue plaque, Richmond, London.jpg, 150px, Blue plaque The Hogarth Press was a British publishing house founded in 1917 by Leonard Woolf and Virginia Woolf. It was named after their house in London Borough of Richmond upon Th ...

Lay summary
via
University of Washington The University of Washington (UW, simply Washington, or informally U-Dub) is a public In public relations Public relations (PR) is the practice of managing and disseminating information from an individual or an organization ...

University of Washington
.
However, by 1898 he had privately acknowledged to his friend and colleague
Wilhelm Fliess Wilhelm Fliess (german: Wilhelm Fließ; 24 October 1858 – 13 October 1928) was a German otolaryngologist who practised in Berlin. He developed the pseudoscientific theory of human biorhythms and a possible nasogenital connection that have no ...
that he no longer believed in his theory, though he did not state this publicly until 1906.Freud, Sigmund. 1953
906 __NOTOC__ Year 906 (Roman numerals, CMVI) was a common year starting on Wednesday (link will display the full calendar) of the Julian calendar. Events By place Europe * February 27 – Fritzlar, Battle of Fritzlar: The Conradines ...
"My Views on the Part Played by Sexuality in the Aetiology of the Neuroses." Pp. 269–79 in '' The Standard Edition'' 7, edited by . London:
Hogarth Press Image:Hogarth Press blue plaque, Richmond, London.jpg, 150px, Blue plaque The Hogarth Press was a British publishing house founded in 1917 by Leonard Woolf and Virginia Woolf. It was named after their house in London Borough of Richmond upon Th ...
.
Though in 1896 he had reported that his patients "had no feeling of remembering the nfantile sexualscenes", and assured him "emphatically of their unbelief", in later accounts he claimed that they had told him that they had been sexually abused in infancy. This became the received historical account until challenged by several Freud scholars in the latter part of the 20th century who argued that he had imposed his preconceived notions on his patients. However, building on his claims that the patients reported infantile sexual abuse experiences, Freud subsequently contended that his clinical findings in the mid-1890s provided evidence of the occurrence of unconscious fantasies, supposedly to cover up memories of infantile masturbation. Only much later did he claim the same findings as evidence for
Oedipal describes the riddle of the Sphinx'', by Jean-Auguste-Dominique Ingres, (ca. 1805) The Oedipus complex (also spelled Œdipus complex) is a concept of psychoanalytic theory. Sigmund Freud introduced the concept in his ''The Interpretation of Dream ...
desires. By 1899, Freud had theorised that dreams had symbolic significance, and generally were specific to the dreamer. Freud formulated his second psychological theory—which hypotheses that the unconscious has or is a "primary process" consisting of symbolic and condensed thoughts, and a "secondary process" of logical, conscious thoughts. This theory was published in his 1899 book, ''
The Interpretation of Dreams ''The Interpretation of Dreams'' (german: Die Traumdeutung) is an 1899 book by Sigmund Freud, the founder of psychoanalysis, in which the author introduces his theory of the Unconscious mind, unconscious with respect to dream interpretation, an ...
''. Chapter VII is a re-working of the earlier "Project" and Freud outlined his ''topographic theory''. In this theory, which was mostly later supplanted by the Structural Theory, unacceptable sexual wishes were repressed into the "System Unconscious", unconscious due to society's condemnation of premarital sexual activity, and this repression created anxiety. This "
topographic Topography is the study of the forms and features of land surfaces. The topography of an area could refer to the surface forms and features themselves, or a description (especially their depiction in maps). Topography is a field of geoscience ...
theory" is still popular in much of Europe, although it has fallen out of favour in much of North America.


1900–1940s

In 1905, Freud published ''
Three Essays on the Theory of Sexuality ''Three Essays on the Theory of Sexuality'' (german: Drei Abhandlungen zur Sexualtheorie), sometimes titled ''Three Contributions to the Theory of Sex'', is a 1905 work by Sigmund Freud Sigmund Freud ( , ; born Sigismund Schlomo Freud; 6 May ...
'' in which he laid out his discovery of the ''psychosexual phases'': * Oral (ages 0–2); * Anal (2–4); * Phallic-oedipal or First genital (3–6); * Latency (6–puberty); and * Mature genital (puberty–onward). His early formulation included the idea that because of societal restrictions, sexual wishes were repressed into an unconscious state, and that the energy of these unconscious wishes could be turned into anxiety or physical symptoms. Therefore, the early treatment techniques, including hypnotism and abreaction, were designed to make the unconscious conscious in order to relieve the pressure and the apparently resulting symptoms. This method would later on be left aside by Freud, giving free association a bigger role. In ''
On Narcissism ''On Narcissism'' (german: Zur Einführung des Narzißmus) is a 1914 essay by Sigmund Freud Sigmund Freud ( , ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist Neurology (from el, νεῦρον ...
'' (1915), Freud turned his attention to the titular subject of
narcissism Narcissism is a self-centered personality style characterized as having an excessive interest in one's physical appearance and an excessive pre-occupation with one's own needs, often at the expense of others. It is human nature to be selfish ...

narcissism
. Still using an energic system, Freud characterized the difference between energy directed at the self versus energy directed at others, called ''
cathexis In psychoanalysis Psychoanalysis (from Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially the Hellenic Republic, is a country located in Southeast Europe. Its population ...
''. By 1917, in " Mourning and Melancholia", he suggested that certain depressions were caused by turning guilt-ridden anger on the self.Freud, Sigmund. 1955
917 __NOTOC__ Year 917 ( CMXVII) was a common year starting on Wednesday A common year starting on Wednesday is any non-leap year (a year with 365 days) that begins on Wednesday, 1 January, and ends on Wednesday, 31 December. Its dominical letter ...

917

Mourning and Melancholia
." Pp. 243–58 in ''Standard Edition'' 17, edited by . London:
Hogarth Press Image:Hogarth Press blue plaque, Richmond, London.jpg, 150px, Blue plaque The Hogarth Press was a British publishing house founded in 1917 by Leonard Woolf and Virginia Woolf. It was named after their house in London Borough of Richmond upon Th ...
. – via
University of Pennsylvania The University of Pennsylvania (Penn or UPenn) is a in , Pennsylvania. The university, established as the College of Philadelphia in 1740, is one of the nine chartered prior to the . , Penn's founder and first president, advocated an edu ...

University of Pennsylvania
. Also available vi
Internet Archive
In 1919, through "A Child is Being Beaten", he began to address the problems of
self-destructive behavior Self-destructive behavior is any behavior that is harmful or potentially harmful towards the person who engages in the behavior. Self-destructive behaviors have been shown by many people throughout the years. It is on a continuum, with one ext ...
(moral masochism) and frank sexual masochism. Based on his experience with depressed and self-destructive patients, and pondering the carnage of
World War I World War I, often abbreviated as WWI or WW1, also known as the First World War or the Great War, was a global war A world war is "a war engaged in by all or most of the principal nations of the world". The term is usually reserved for ...

World War I
, Freud became dissatisfied with considering only oral and sexual motivations for behavior. By 1920, Freud addressed the power of identification (with the leader and with other members) in groups as a motivation for behavior (in ''Group Psychology and the Analysis of the Ego''). In that same year, Freud suggested his dual drive' theory'' of sexuality and aggression in ''Beyond the Pleasure Principle'', to try to begin to explain human destructiveness. Also, it was the first appearance of his "structural theory" consisting of three new concepts
id, ego, and superego The id, ego, and super-ego are a set of three concepts in psychoanalytic theoryPsychoanalytic theory is the theory of personality organization and the dynamics of personality development that guides psychoanalysis, a clinical method for treating ...
. Three years later, in 1923, he summarised the ideas of id, ego, and superego in ''The Ego and the Id''.Freud, Sigmund. 1955
923 __NOTOC__ Year 923 (Roman numerals, CMXXIII) was a common year starting on Wednesday (link will display the full calendar) of the Julian calendar. Events By place Europe * June 15 – Battle of Soissons (923), Battle of Soissons: ...
"
The Ego and the Id ''The Ego and the Id'' (german: Das Ich und das Es) is a prominent paper by Sigmund Freud, the founder of psychoanalysis. It is an analytical study of the human Psyche (psychology), psyche outlining his theories of the psychodynamics of the id, e ...
." In ''Standard Edition'' 19, edited by . London:
Hogarth Press Image:Hogarth Press blue plaque, Richmond, London.jpg, 150px, Blue plaque The Hogarth Press was a British publishing house founded in 1917 by Leonard Woolf and Virginia Woolf. It was named after their house in London Borough of Richmond upon Th ...
. Lay summaries vi
Simply Psychology
an
JSTOR Daily RoundtableGlossary
via University of Notre Dame.
In the book, he revised the whole theory of mental functioning, now considering that repression was only one of many defense mechanisms, and that it occurred to reduce anxiety. Hence, Freud characterised repression as both a cause and a result of anxiety. In 1926, in "Inhibitions, Symptoms and Anxiety", Freud characterised how intrapsychic conflict among drive and superego (wishes and guilt) caused
anxiety Anxiety is an emotion Emotions are mental state, psychological states brought on by neurophysiology, neurophysiological changes, variously associated with thoughts, feelings, behavioural responses, and a degree of pleasure or suffering, disp ...

anxiety
, and how that anxiety could lead to an inhibition of mental functions, such as intellect and speech.Freud, Sigmund. 1955
926 Year 926 ( CMXXVI) was a common year starting on Sunday A common year starting on Sunday is any non-leap year A leap year (also known as an intercalary year or wikt:bissextile, bissextile year) is a calendar year that contains an additional ...
"Inhibitions, Symptoms and Anxiety." In ''Standard Edition'' 20, edited by . London:
Hogarth Press Image:Hogarth Press blue plaque, Richmond, London.jpg, 150px, Blue plaque The Hogarth Press was a British publishing house founded in 1917 by Leonard Woolf and Virginia Woolf. It was named after their house in London Borough of Richmond upon Th ...
. . .
"Inhibitions, Symptoms and Anxiety" was written in response to
Otto Rank Otto Rank (; ; né Rosenfeld; 22 April 1884 – 31 October 1939) was an Austrian psychoanalyst, writer, and teacher. Born in Vienna en, Viennese , iso_code = AT-9 , registration_plate = Vehicle regis ...
, who, in 1924, published ''Das Trauma der Geburt'' ('' The Trauma of Birth''), analysing how art, myth, religion, philosophy and therapy were illuminated by separation anxiety in the "phase before the development of the Oedipus complex". Freud's theories, however, characterized no such phase. According to Freud, the Oedipus complex, was at the centre of neurosis, and was the foundational source of all art, myth, religion, philosophy, therapy—indeed of all human culture and civilization. It was the first time that anyone in the inner circle had characterised something other than the Oedipus complex as contributing to intrapsychic development, a notion that was rejected by Freud and his followers at the time. By 1936 the "Principle of Multiple Function" was clarified by Robert Waelder. He widened the formulation that psychological symptoms were caused by and relieved conflict simultaneously. Moreover, symptoms (such as
phobia A phobia is a type of anxiety disorder Anxiety disorders are a cluster of mental disorder A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or i ...
s and
compulsions ''Compulsions'' is a drama web series which debuted Dec 01, 2009 on Dailymotion.com. Compulsions is the internal character story of Mark Sandler (Craig Frank), an admitted Sadist leading a life with a dull desk job. At night, he channels his inner ...
) each represented elements of some drive wish (sexual and/or aggressive), superego, anxiety, reality, and defenses. Also in 1936,
Anna Freud Anna Freud (3 December 1895 – 9 October 1982) was a British psychoanalyst of Austrian-Jewish descent. She was born in Vienna en, Viennese , iso_code = AT-9 , registration_plate = Vehicle registrat ...
, Sigmund's daughter, published her seminal book, ''The Ego and the Mechanisms of Defense'', outlining numerous ways the mind could shut upsetting things out of consciousness. Freud, Anna. 1968
937 Year 937 ( CMXXXVII) was a common year starting on Sunday (link will display the full calendar) of the Julian calendar The Julian calendar, proposed by Julius Caesar in , was a reform of the Roman calendar. It took effect on , by edict. It ...
''The Ego and the Mechanisms of Defence'' (revised ed.). London:
Hogarth Press Image:Hogarth Press blue plaque, Richmond, London.jpg, 150px, Blue plaque The Hogarth Press was a British publishing house founded in 1917 by Leonard Woolf and Virginia Woolf. It was named after their house in London Borough of Richmond upon Th ...
.


1940s–present

When
Hitler Adolf Hitler (; 20 April 188930 April 1945) was an Austrian-born German politician who was the dictator of Nazi Germany, Germany from 1933 to 1945. Adolf Hitler's rise to power, He rose to power as the leader of the Nazi Party, becoming Cha ...

Hitler
's power grew, the Freud family and many of their colleagues fled to London. Within a year, Sigmund Freud died. In the United States, also following the death of Freud, a new group of psychoanalysts began to explore the function of the ego. Led by
Heinz Hartmann Heinz Hartmann (November 4, 1894 in Vienna en, Viennese , iso_code = AT-9 , registration_plate = Vehicle registration plates of Austria, W , postal_code_type = Postal code , postal_code ...
, the group built upon understandings of the ''synthetic'' function of the ego as a mediator in psychic functioning, distinguishing such from ''autonomous'' ego functions (e.g. memory and intellect, which could be secondarily affected by conflict). These "Ego Psychologists" of the 1950s paved a way to focus analytic work by attending to the defenses (mediated by the ego) before exploring the deeper roots to the unconscious conflicts. In addition, there was burgeoning interest in child psychoanalysis. Although criticized since its inception, psychoanalysis has been used as a research tool into childhood development,cf. ''
The Psychoanalytic Study of the Child The Psychoanalytic Study of the Child is an annual journal, published by Taylor & Francis, which contains scholarly articles on topics related to child psychiatry and psychoanalysis. The journal was founded in 1945 by Anna Freud, Heinz Hartmann, and ...
'', academic journal
and is still used to treat certain mental disturbances.Wallerstein. 2000. ''Forty-Two Lives in Treatment: A Study of Psychoanalysis and Psychotherapy''. In the 1960s, Freud's early thoughts on the childhood development of
female sexuality Human female sexuality encompasses a broad range of behaviors and processes, including female sexual identity and sexual behavior, the physiological Physiology (; ) is the scientific study of functions and mechanisms in a living system. As ...
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 several of Freud's theories (which had been gleaned from the treatment of women with mental disturbances). Several researchers followed
Karen Horney Karen Horney (; ; 16 September 1885 – 4 December 1952) was a German psychoanalyst Psychoanalysis (from Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially t ...
's studies of societal pressures that influence the development of women. 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 The American Psychoanalytic Association (APsaA) is an association of psychoanalysts in the United States. APsaA serves as a scientific and professional organization A professional association (also called a professional body, professional organ ...
(APsaA), which is a component organization of the
International Psychoanalytical Association The International Psychoanalytical Association (IPA) is an association including 12,000 psychoanalysts as members and works with 70 constituent organizations. It was founded in 1910 by Sigmund Freud Sigmund Freud ( ; ; born Sigismund Schlomo Fre ...
(IPA), and there are over 3000 graduated psychoanalysts practicing in the United States. The IPA accredits psychoanalytic training centers through such "component organisations" throughout the rest of the world, including countries such as Serbia, France, Germany, Austria, Italy, Switzerland, and many others, as well as about six institutes directly in the United States.


Psychoanalysis as a movement

Freud founded the ''Psychological Wednesday Society'' in 1902, which
Edward Shorter Edward Shorter (1767-1836) was an English engineer and inventor of several useful inventions including an early screw propeller. Early life Edward was born in London on 3 December 1767 in the parish of St Sepulchre, Newgate to Robert and Ann Sh ...
argues was the beginning of psychoanalysis as a movement. This society became the
Vienna Psychoanalytic SocietyThe Vienna Psychoanalytic Society (, WPV), formerly known as the Wednesday Psychological Society, is the oldest psychoanalysis society in the world. In 1908, reflecting its growing institutional status as the international psychoanalytic authority of ...
in 1908 in the same year as the first international congress of psychoanalysis held in Salzburg, Austria.
Alfred Adler Alfred Adler (; ; 7 February 1870 – 28 May 1937) was an Austrian medical doctor, psychotherapist Psychotherapy (also psychological therapy or talking therapy) is the use of Psychology, psychological methods, particularly when based on regu ...

Alfred Adler
was one of the most active members in this society in its early years. The second congress of psychoanalysis took place in Nuremberg, Germany in 1910. At this congress, Ferenczi called for the creation of an International Psychoanalytic Association with
Jung Carl Gustav Jung ( ; born Karl Gustav Jung, ; 26 July 1875 – 6 June 1961), was a Swiss psychiatrist and psychoanalyst who founded analytical psychology. Jung's work has been influential in the fields of psychiatry, anthropology, archaeo ...

Jung
as president for life. A third congress was held in Weimar in 1911. The London Psychoanalytical Society was founded in 1913 by
Ernest Jones Alfred Ernest Jones (1 January 1879 – 11 February 1958) was a Welsh neurologist and psychoanalyst. A lifelong friend and colleague of Sigmund Freud from their first meeting in 1908, he became his official biographer. Jones was the first Eng ...

Ernest Jones
.


Developments of alternative forms of psychotherapy


Cognitive behavioural therapy (CBT)

In the 1950s, psychoanalysis was the main modality of
psychotherapy Psychotherapy (also psychological therapy or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interaction, to help a person change behavior, increase happiness, and ove ...
. Behavioural models of psychotherapy started to assume a more central role in psychotherapy in the 1960s. Aaron T. Beck, a psychiatrist trained in a psychoanalytic tradition, set out to test the psychoanalytic models of depression empirically and found that conscious ruminations of loss and personal failing were correlated with depression. He suggested that distorted and biased beliefs were a causal factor of depression, publishing an influential paper in 1967 after a decade of research using the construct of schemas to explain the depression. Beck developed this empirically supported hypothesis for the cause of depression into a talking therapy called
cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (e. ...
(CBT) in the early 1970s.


Attachment theory

Attachment theory Attachment theory is a psychological Psychology is the scientific Science () is a systematic enterprise that Scientific method, builds and organizes knowledge in the form of Testability, testable explanations and predictions abou ...
was developed theoretically by
John Bowlby Edward John Mostyn Bowlby, Order of the British Empire, CBE, Royal College of Physicians#Fellowship, FRCP, Royal College of Psychiatrists, FRCPsych (; 26 February 1907 – 2 September 1990) was a British psychologist, psychiatrist, and psychoa ...
and formalized empirically by
Mary Ainsworth Mary Dinsmore Ainsworth (; née Salter; December 1, 1913 – March 21, 1999) was an American-Canadian developmental psychologist known for her work in the development of the attachment theory. She designed the strange situation procedure to ob ...
. Bowlby was trained psychoanalytically but was concerned about some properties of psychoanalysis and in response developed an alternative conceptualization of child behaviour based on principles on
ethology Ethology is the scientific Science () is a systematic enterprise that Scientific method, builds and organizes knowledge in the form of Testability, testable explanations and predictions about the universe."... modern science is ...
. Holmes argues is that Attachment theories conceptualization is more testable than psychoanalysis. Bowlby's theory of attachment rejects Freud's model of
psychosexual development In Freudian psychology Psychology is the science of mind and behavior. Psychology includes the study of consciousness, conscious and Unconscious mind, unconscious phenomena, as well as feeling and thought. It is an academic discipline of i ...
based on the Oedipal model. In response to his publications Bowlby was shunned from psychoanalytical circles who did not accept his theories, but this conceptualization was taken by mother infant research in the 1970s. Bowlby's work on attachment largely ignores internal (intrapersonal/ psychodynamic) aspects of psychology. Holmes argues that the work of Winnocott and
Wilfred Bion Wilfred Ruprecht Bion DSO (; 8 September 1897 – 8 November 1979) was an influential English psychoanalyst, who became president of the British Psychoanalytical Society from 1962 to 1965. Early life and military service Bion was born in Ma ...
carried out analogous work intrapersonally within psychoanalysis. Bowlby joined the
British Psychoanalytical Society The British Psychoanalytical Society was founded by the British neurologist Ernest Jones as the London Psychoanalytical Society on 30 October 1913. It is one of two organizations in Britain training psychoanalysts, the other being the British P ...
in the 1930s and was trained by
Joan Riviere Joan Hodgson Riviere (28 June 1883 – 20 May 1962) was a British psychoanalyst, who was both an early translator of Freud into English and an influential writer on her own account. Life and career Riviere was born Joan Hodgson Verrall in Brigh ...
, a , during a time of conflict Kleinian and Freudian psychoanalysis. He became training secretary for the council, later becoming deputy president to
Donald Winnicott Donald Woods Winnicott (7 April 1896 – 25 January 1971) was an English paediatrician and psychoanalyst who was especially influential in the field of object relations theory and developmental psychology Developmental psychology is the ...
in 1956. Bowlby was troubled by the dogmatism of psychoanalysis at the time, its arcane terminology, the lack of attention to environment in child behaviour, and the concepts derived from talking therapy to child behaviour. In 1951, Bowlby published the
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations United Nations Specialized Agencies are autonomous organizations working with the United Nations and each other through the co-ordinating machinery of the Unit ...
report ''Maternal care and Mental Health'', which argued for the importance of childhood environmental factors in mental health. After reading ethologist
Konrad Lorenz Konrad Zacharias Lorenz (; 7 November 1903 – 27 February 1989) was an Austria Austria (, ; german: Österreich ), officially the Republic of Austria (german: Republik Österreich, links=no, ), is a landlocked Eastern Alps, East Alp ...

Konrad Lorenz
's book, ''King Solomon's Ring'', Bowlby saw the opportunity to refound psychoanalysis on the principles of
ethology Ethology is the scientific Science () is a systematic enterprise that Scientific method, builds and organizes knowledge in the form of Testability, testable explanations and predictions about the universe."... modern science is ...
, the study of animal behaviour. Bowlby published three papers expounding these theories, which were expanded into three books entitled Attachment, Separation and Loss. These papers introduced the idea of an innate relationship between a mother and their child distinct from the Freudian conception of "oral drive", which Holmes argues was similar to Winnicott's concept of "environmental" and "object" mother; and Fairbairn's concept of drives as signposts to objects. Bowlby also introduced the concept of separation anxiety, which Holmes argues is similar to Freud's later conceptualization of anxiety. Holmes argues that Bowlby's theory differs from psychoanalysis in that it was interpersonal, describing reality in terms of the relationship between individuals rather than the mental state; implied harmony between the mother and infant, rather than conflict, downplays the psychosexual model of child psychology replacing it with drives for play and nurturing.


Theories

The predominant psychoanalytic theories can be organised into several theoretical schools. Although these perspectives differ, most of them emphasize the influence of unconscious elements on the conscious. There has also been considerable work done on consolidating elements of conflicting theories. As in the field of
medicine Medicine is the science Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity, awareness, or understanding of someone or something, such as facts ( descriptive knowledge), skills (proced ...

medicine
, there are some persistent conflicts regarding specific causes of certain syndromes, and disputes regarding the ideal treatment techniques. In the 21st century, psychoanalytic ideas are embedded in
Western culture Western culture, also known as Western civilization, Occidental culture, or Western society, is the heritage Heritage may refer to: History and society * In history History (from Greek , ''historia'', meaning "inquiry; knowledge acquired ...
, especially in fields such as
childcare Child care, otherwise known as day care, is the care and supervision of a child or multiple children at a time, whose ages range from two weeks to twenty years. Child care is a broad topic that covers a wide spectrum of professionals, institutions ...
,
education Education is the process of facilitating learning, or the acquisition of knowledge, skills, value (ethics), values, morals, beliefs, habits, and personal development. Educational methods include teaching, training, storytelling, discussion ...

education
,
literary criticism Literary criticism (or literary studies) is the study, evaluation, and interpretation of literature. Modern literary criticism is often influenced by literary theory, which is the philosophical analysis, philosophical discussion of literature ...
,
cultural studies #REDIRECT Cultural studies #REDIRECT Cultural studies#REDIRECT Cultural studies Cultural studies is a field of theoretically, politically, and empirically engaged cultural analysis that concentrates upon the political dynamics of contemporary cul ...
,
mental health Mental health is "a state of well-being Well-being, also known as ''wellness'', ''prudential value'' or ''quality of life'', refers to what is intrinsically valuable relative ''to'' someone. So the well-being of a person is what is ultimatel ...

mental health
, and particularly
psychotherapy Psychotherapy (also psychological therapy or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interaction, to help a person change behavior, increase happiness, and ove ...
. Though there is a
mainstream The mainstream is the prevalent current thought In their most common sense, the terms thought and thinking refer to conscious cognitive processes that can happen independently of sensory stimulation. Their most paradigmatic forms are judging, r ...
of evolved analytic
idea In common usage and in philosophy Philosophy (from , ) is the study of general and fundamental questions, such as those about Metaphysics, existence, reason, Epistemology, knowledge, Ethics, values, Philosophy of mind, mind, and Philosoph ...

idea
s, there are groups who follow the
precept A precept (from the la, præcipere, to teach) is a wikt:commandment, commandment, instruction, or order intended as an authority, authoritative rule of action. Religious law In religion, precepts are usually commands respecting morality, moral co ...
s of one or more of the later theoreticians. Psychoanalytic ideas also play roles in some types of literary analysis such as
Archetypal literary criticism Archetypal literary criticism is a type of analytical theory that interprets a text by focusing on recurring myths and archetype The concept of an archetype (; from Greek: + ) appears in areas relating to behavior, History of psychology#Emergen ...
.


Topographic theory

''Topographic theory'' was named and first described by
Sigmund Freud Sigmund Freud ( , ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is a branch of medicine M ...

Sigmund Freud
in ''
The Interpretation of Dreams ''The Interpretation of Dreams'' (german: Die Traumdeutung) is an 1899 book by Sigmund Freud, the founder of psychoanalysis, in which the author introduces his theory of the Unconscious mind, unconscious with respect to dream interpretation, an ...
'' (1899). The theory hypothesizes that the mental apparatus can be divided into the systems
Conscious Consciousness, at its simplest, is sentience or awareness of internal and external existence. Despite millennia of analyses, definitions, explanations and debates by philosophers and scientists, consciousness remains puzzling and controversial ...

Conscious
,
Preconscious In psychoanalysis Psychoanalysis (from Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially the Hellenic Republic, is a country located in Southeast Europe. Its population is ...
, and
Unconscious Unconscious may refer to: Physiology * Unconsciousness, the lack of consciousness or responsiveness to people and other environmental stimuli Psychology * Unconscious mind, the mind operating well outside the attention of the conscious mind as ...
. These systems are not
anatomical Anatomy (Greek ''anatomē'', 'dissection') is the branch of biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structure, Biochemistry, chemical processes, Molecular biology, mo ...

anatomical
structures of the brain but, rather, mental processes. Although Freud retained this theory throughout his life he largely replaced it with the ''structural theory''. Langs, Robert. 2010. ''Freud on a Precipice: How Freud's Fate pushed Psychoanalysis over the Edge''. Lanham, MD:
Jason Aronson Jason Aronson is an American publisher of book A book is a medium for recording information Information can be thought of as the resolution of uncertainty; it answers the question of "What an entity is" and thus defines both its essen ...
.
The Topographic theory remains as one of the meta-psychological points of view for describing how the mind functions in classical psychoanalytic theory.


Structural theory

Structural theory divides the psyche into the id, the ego, and the
super-ego The id, ego, and super-ego are a set of three concepts in psychoanalytic theoryPsychoanalytic theory is the theory of personality organization and the dynamics of personality development that guides psychoanalysis, a clinical method for treating ...
. The id is present at birth as the repository of basic instincts, which Freud called "''Triebe''" ("drives"): unorganized and unconscious, it operates merely on the 'pleasure principle', without realism or foresight. The ego develops slowly and gradually, being concerned with mediating between the urging of the id and the realities of the external world; it thus operates on the 'reality principle'. The super-ego is held to be the part of the ego in which self-observation, self-criticism and other reflective and judgmental faculties develop. The ego and the super-ego are both partly conscious and partly unconscious.


Theoretical and clinical approaches

During the twentieth century, many different clinical and theoretical models of psychoanalysis emerged.


Ego psychology

Ego psychology Ego psychology is a school of psychoanalysis Psychoanalysis (from Greek language, Greek: + ) is a set of Theory, theories and Therapy, therapeutic techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things ...
was initially suggested by Freud in ''Inhibitions, Symptoms and Anxiety'' (1926), while major steps forward would be made through
Anna Freud Anna Freud (3 December 1895 – 9 October 1982) was a British psychoanalyst of Austrian-Jewish descent. She was born in Vienna en, Viennese , iso_code = AT-9 , registration_plate = Vehicle registrat ...
's work on
defense mechanisms In psychoanalytic theory, a defence mechanism (American English: defense mechanism), is an Unconscious mind, unconscious psychological mechanism that reduces anxiety arising from unacceptable or potentially harmful stimuli. Defence mechanisms ...
, first published in her book ''The Ego and the Mechanisms of Defence'' (1936). The theory was refined by Hartmann, Loewenstein, and Kris in a series of papers and books from 1939 through the late 1960s. Leo Bellak was a later contributor. This series of constructs, paralleling some of the later developments of cognitive theory, includes the notions of autonomous ego functions: mental functions not dependent, at least in origin, on intrapsychic conflict. Such functions include: sensory perception, motor control, symbolic thought, logical thought, speech, abstraction, integration (synthesis), orientation, concentration, judgment about danger, reality testing, adaptive ability, executive decision-making, hygiene, and self-preservation. Freud noted that inhibition is one method that the mind may utilize to interfere with any of these functions in order to avoid painful emotions. Hartmann (1950s) pointed out that there may be delays or deficits in such functions. Frosch (1964) described differences in those people who demonstrated damage to their relationship to reality, but who seemed able to test it. According to ego psychology, ego strengths, later described by Otto F. Kernberg (1975), include the capacities to control oral, sexual, and destructive impulses; to tolerate painful affects without falling apart; and to prevent the eruption into consciousness of bizarre symbolic fantasy. Synthetic functions, in contrast to autonomous functions, arise from the development of the ego and serve the purpose of managing conflict processes. Defenses are synthetic functions that protect the conscious mind from awareness of forbidden impulses and thoughts. One purpose of ego psychology has been to emphasize that some mental functions can be considered to be basic, rather than derivatives of wishes, affects, or defenses. However, autonomous ego functions can be secondarily affected because of unconscious conflict. For example, a patient may have an hysterical amnesia (memory being an autonomous function) because of intrapsychic conflict (wishing not to remember because it is too painful). Taken together, the above theories present a group of metapsychological assumptions. Therefore, the inclusive group of the different classical theories provides a cross-sectional view of human mental processes. There are six "points of view", five described by Freud and a sixth added by Hartmann. Unconscious processes can therefore be evaluated from each of these six points of view: # Topographic # Dynamic (the theory of conflict) # Economic (the theory of energy flow) # Structural # Genetic (i.e. propositions concerning origin and development of psychological functions) # Adaptational (i.e. psychological phenomena as it relates to the external world)


Modern conflict theory

''Modern conflict theory'', a variation of
ego psychology Ego psychology is a school of psychoanalysis Psychoanalysis (from Greek language, Greek: + ) is a set of Theory, theories and Therapy, therapeutic techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things ...
, is a revised version of structural theory, most notably different by altering concepts related to where repressed thoughts were stored. Modern conflict theory addresses emotional symptoms and character traits as complex solutions to mental conflict. It dispenses with the concepts of a fixed
id, ego and superego The id, ego, and super-ego are a set of three concepts in psychoanalytic theory Psychoanalytic theory is the theory A theory is a reason, rational type of abstraction, abstract thinking about a phenomenon, or the results of such thinking. The p ...
, and instead posits conscious and unconscious conflict among wishes (dependent, controlling, sexual, and aggressive), guilt and shame, emotions (especially anxiety and depressive affect), and defensive operations that shut off from consciousness some aspect of the others. Moreover, healthy functioning (adaptive) is also determined, to a great extent, by resolutions of conflict. A major objective of modern conflict-theory psychoanalysis is to change the balance of conflict in a patient by making aspects of the less adaptive solutions (also called "compromise formations") conscious so that they can be rethought, and more adaptive solutions found. Current theoreticians who follow the work of
Charles Brenner Charles Brenner born October 30, 1961 is the chair of the new Department of Diabetes & Cancer Metabolism at the Beckman Research Institute of the City of Hope National Medical Center. He is a major contributor to work on nicotinamide adenine dinucl ...
, especially ''The Mind in Conflict'' (1982), include Sandor Abend, Jacob Arlow, and Jerome Blackman.Blackman, Jerome. 2003. ''101 Defenses: How the Mind Shields Itself''.


Object relations theory

''
Object relations theory Object relations theory in psychoanalytic psychology is the process of developing a psyche Psyche (''Psyché'' in French) is the Greek term for "soul" or "spirit" (ψυχή). It may also refer to: Psychology * Psyche (psychology), the totali ...
'' attempts to explain human relationships through a study of how mental representations of the self and others are organized. The clinical symptoms that suggest object relations problems (typically developmental delays throughout life) include disturbances in an individual's capacity to feel: warmth, empathy, trust, sense of security, identity stability, consistent emotional closeness, and stability in relationships with significant others. Klein discusses the concept of
introjectionIn psychoanalysis Psychoanalysis (from Greek language, Greek: + ) is a set of Theory, theories and Therapy, therapeutic techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things — a theory, a research method, ...
, creating a mental representation of external objects; and projection, applying this mental representation to reality.
Wilfred Bion Wilfred Ruprecht Bion DSO (; 8 September 1897 – 8 November 1979) was an influential English psychoanalyst, who became president of the British Psychoanalytical Society from 1962 to 1965. Early life and military service Bion was born in Ma ...
introduced the concept of ''containment'' of projections in the mother-child relationship where a mother understands an infants projections, modifies them and returns them to the child. Concepts regarding internal representation (aka 'introspect', 'self and object representation', or 'internalization of self and other'), although often attributed to
Melanie Klein Melanie Klein (née Reizes; 30 March 1882 – 22 September 1960) was an Austrian-British author and psychoanalyst Psychoanalysis (from Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, ...

Melanie Klein
, were actually first mentioned by Sigmund Freud in his early concepts of drive theory (''
Three Essays on the Theory of Sexuality ''Three Essays on the Theory of Sexuality'' (german: Drei Abhandlungen zur Sexualtheorie), sometimes titled ''Three Contributions to the Theory of Sex'', is a 1905 work by Sigmund Freud Sigmund Freud ( , ; born Sigismund Schlomo Freud; 6 May ...
'', 1905). Freud's 1917 paper " Mourning and Melancholia", for example, hypothesized that unresolved grief was caused by the survivor's internalized image of the deceased becoming fused with that of the survivor, and then the survivor shifting unacceptable anger toward the deceased onto the now complex
self-image Self-image is the mental picture, generally of a kind that is quite resistant to change, that depicts not only details that are potentially available to an objective investigation by others (height, weight, hair color, etc.), but also items that h ...
. Vamik Volkan, in "Linking Objects and Linking Phenomena", expanded on Freud's thoughts on this, describing the syndromes of "established pathological mourning" vs. "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 (e.g., ''The First Year of Life'', 1965), who divided the first year of life into a coenesthetic phase of the first six months, and then a diacritic phase for the second six months. Margaret Mahler, Mahler, Fine, and Bergman (1975) describe distinct phases and subphases of child development leading to "separation-individuation" during the first three years of life, stressing the importance of constancy of parental figures in the face of the child's destructive aggression, internalizations, stability of affect management, and ability to develop healthy autonomy. John Frosch, Otto Kernberg, Salman Akhtar, and Sheldon Bach have developed the theory of self and object constancy as it affects adult psychiatric problems such as psychosis and borderline states. Peter Blos, Blos (1960) described how similar separation-individuation struggles occur during adolescence, of course with a different outcome from the first three years of life: the teen usually, eventually, leaves the parents' house (varying with culture). During adolescence, Erik Erikson (1950–1960s) described the 'identity crisis', that involves identity-diffusion anxiety. In order for an adult to be able to experience "Warm-ETHICS: (warmth, Empathy, Trust, Donald Winnicott, Holding environment, Identity, Closeness, and Stability) in relationships, the teenager must resolve the problems with identity and redevelop self and object constancy.


Self psychology

''Self psychology'' emphasizes the development of a stable and integrated Self (psychology), sense of self through empathic contacts with other humans, primary significant others conceived of as 'Self-objectification, selfobjects'. ''Selfobjects'' meet the developing self's needs for mirroring, idealization, and twinship, and thereby strengthen the developing self. The process of treatment proceeds through "transmuting internalizations" in which the patient gradually internalizes the selfobject functions provided by the therapist. Self psychology was proposed originally by Heinz Kohut, and has been further developed by Arnold Goldberg, Frank Lachmann, Paul Ornstein, Paul and Anna Ornstein, Marian Tolpin, and others.


Lacanian psychoanalysis

Lacanianism, 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 the traditional British and American psychoanalysis. Jacques Lacan frequently used the phrase "retourner à Freud" ("return to Freud") in his seminars and writings, as he claimed that his theories were an extension of Freud's own, contrary to those of Anna Freud, the Ego Psychology, object relations and "self" theories and also claims the necessity of reading Freud's complete works, not only a part of them. Lacan's concepts concern the "mirror stage", The Real, the "Real", The Imaginary (psychoanalysis), the "Imaginary", and The Symbolic, the "Symbolic", and the claim that "the unconscious is structured as a language." Though a major influence on psychoanalysis in France and parts of Latin America, Lacan and his ideas have taken longer to be translated into English and he has thus had a lesser impact on psychoanalysis and psychotherapy in the English-speaking world. In the United Kingdom and the United States, his ideas are most widely used to analyze texts in literary theory. Due to his increasingly critical stance towards the deviation from Freud's thought, often singling out particular texts and readings from his colleagues, Lacan was excluded from acting as a training analyst in the IPA, thus leading him to create his own school in order to maintain an Lacanian movement, institutional structure for the many candidates who desired to continue their analysis with him.


Adaptive paradigm

The ''adaptive paradigm'' of psychotherapy develops out of the work of Robert Langs. The ''adaptive paradigm'' interprets psychic conflict primarily in terms of conscious and unconscious adaptation to reality. Langs’ recent work in some measure returns to the earlier Freud, in that Langs prefers a modified version of the id, ego, and super-ego, topographic model of the mind (conscious, preconscious, and unconscious) over the id, ego, and super-ego, structural model (id, ego, and super-ego), including the former's emphasis on trauma (though Langs looks to death-related traumas rather than sexual traumas). At the same time, Langs’ model of the mind differs from Freud's in that it understands the mind in terms of evolutionary biological principles.


Relational psychoanalysis

''Relational psychoanalysis'' combines interpersonal psychoanalysis with object-relations theory and with inter-subjective theory as critical for mental health. It was introduced by Stephen A. Mitchell (psychologist), Stephen Mitchell. Relational psychoanalysis stresses 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. In New York, key proponents of relational psychoanalysis include Lew Aron, Jessica Benjamin, and Adrienne Harris. Peter Fonagy, 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. Arietta Slade, Susan Coates, and Daniel Schechter in New York have additionally contributed to the application of relational psychoanalysis to treatment of the adult patient-as-parent, the clinical study of mentalization in parent-infant relationships, and the intergenerational transmission of attachment and trauma.


Interpersonal-relational psychoanalysis

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


Psychopathology (mental disturbances)


Adults

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 with psychopathy or antisocial personality disorder. neurosis, ''Neurotic symptoms''—including panic, phobias, conversions, obsessions, compulsions and depressions—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. This section above is partial to ego psychoanalytic theory ''autonomous ego functions''.


Childhood origins

Freudian theories hold that adult problems can be traced to unresolved conflicts from certain phases of childhood and adolescence, caused by fantasy, stemming from their own drives. 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 (i.e. ''seduction theory''). Later, Freud came to believe that, although child abuse occurs, neurotic symptoms were not associated with this. He believed 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 of having romantic relationships with both parents. Arguments were quickly generated in early 20th-century Vienna about whether adult seduction of children, i.e. child sexual abuse, was the basis of neurotic illness. There still is no complete agreement, although nowadays professionals recognize the negative effects of child sexual abuse on mental health.


Oedipal conflicts

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. 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'', in which the protagonist unwittingly kills his father and marries his mother. The validity of the ''Oedipus complex'' is now widely disputed and rejected.Miller, Alice. 1984. ''Thou Shalt Not Be Aware: Society's Betrayal of the Child''. New York: Farrar, Straus and Giroux, Farrar Straus and Giroux. pp. 105–227.Kupfersmid, Joel. 1995. ''Does the Oedipus complex exist?'' American Psychological Association. The shorthand term, ''oedipal''—later explicated by Joseph J. Sandler in "On the Concept Superego" (1960) and modified by
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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 sexual relationships with 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. "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 ("sublimation") and the development, during the school-age years ("latency") of age-appropriate obsessive-compulsive defensive maneuvers (rules, repetitive games).


Treatment

Using the various analytic and psychological techniques to Psychological Evaluation, assess mental problems, some believe that there are particular constellations of problems that are especially suited for analytic treatment (see below) whereas other problems might respond better to medicines and other interpersonal interventions. To be treated with psychoanalysis, whatever the presenting problem, the person requesting help must demonstrate a desire to start an analysis. The person wishing to start an analysis must have some capacity for speech and communication. As well, they need to be able to have or develop trust and insight within the psychoanalytic session. Potential patients must undergo a preliminary stage of treatment to assess their amenability to psychoanalysis at that time, and also to enable the analyst to form a working psychological model, which the analyst will use to direct the treatment. Psychoanalysts mainly work 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 prospective patient is severely suicidal a longer preliminary stage may be employed, sometimes with sessions which have a twenty-minute break in the middle. There are numerous modifications in technique under the heading of psychoanalysis due to the individualistic nature of personality in both analyst and patient. The most common problems treatable with psychoanalysis include:
phobia A phobia is a type of anxiety disorder Anxiety disorders are a cluster of mental disorder A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or i ...
s, Conversion syndrome, conversions,
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, Fixation (psychology), obsessions, anxiety attacks, depression (mood), 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 IPA, APsaA 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. A person's suitability for analysis at any particular time is based on their desire to know something about where their illness has come from. Someone who is not suitable for analysis expresses no desire to know more about the root causes of their illness. 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. James Strachey, 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 (aka free association (psychology), free association). When the patient reclines on a couch with the analyst out of view, the patient tends to remember more experiences, more resistance and transference, and is 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 fantasiescf. Marcus, I. and J. Francis. 1975. ''Masturbation from Infancy to Senescence''. are also important. The analyst is interested in how the patient reacts to and avoids such fantasies. Various memories of early life are generally distorted—what Freud called Screen Memories (Freud), ''screen memories''—and in any case, very early experiences (before age two)—cannot 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 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 theories, ''conflict theory'' (see above). As ''object relations theory'' evolved, supplemented by the work of
John Bowlby Edward John Mostyn Bowlby, Order of the British Empire, CBE, Royal College of Physicians#Fellowship, FRCP, Royal College of Psychiatrists, FRCPsych (; 26 February 1907 – 2 September 1990) was a British psychologist, psychiatrist, and psychoa ...
and
Mary Ainsworth Mary Dinsmore Ainsworth (; née Salter; December 1, 1913 – March 21, 1999) was an American-Canadian developmental psychologist known for her work in the development of the attachment theory. She designed the strange situation procedure to ob ...
, techniques with patients who had more severe problems with basic trust (Erik Erikson, 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. Robert Stolorow, 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 is not a technique of psychoanalysis (see also the studies and opinion papers of Owen Renik). "Neutrality (psychoanalysis), 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. Interpersonal–relational psychoanalysts emphasize the notion that it is impossible to be neutral. Harry Stack Sullivan, Sullivan introduced the term ''Participant observation, participant-observer'' to indicate the analyst inevitably interacts with the analysand, and suggested the detailed inquiry as an alternative to interpretation. The detailed inquiry involves noting where the analysand is leaving out important elements of an account and noting when the story is obfuscated, and asking careful questions to open up the dialogue.


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 Ferdinand Schilder, Paul F. Schilder, Samuel Slavson, Samuel R. Slavson,
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, 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. Techniques and tools developed in the first decade of the 21st century 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. 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,
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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 symbolically demonstrate 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 counselor understands the client's culture. For example, Tori and Blimes found that defense mechanisms were valid in a normative sample of 2,624 Thai people, Thais. The use of certain defense mechanisms was related to cultural values. For example, Thais value calmness and collectiveness (because of Buddhism, 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 wherever 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. 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.


Psychodynamic therapy

Psychodynamic therapies refer therapies that draw from psychoanalytic approaches but are designed to be shorter in duration or less intensive.


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 psychodynamic 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. As a result of the 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 relies on the belief that reducing the symptoms will not actually help with the root causes or irrational drives. 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 methods to help the patient to become more self-aware and to develop insights into their behavior and into the meanings of symptoms. First and foremost, the psychoanalyst attempts to develop a confidential atmosphere in which the patient can feel safe reporting his feelings, thoughts and fantasies. Analysands (as people in analysis are called) are asked to report whatever comes to mind without fear of reprisal. Freud called this the "fundamental rule". Analysands are asked to talk about their lives, including their early life, current life and hopes and aspirations for the future. They are encouraged to report their fantasies, "flash thoughts" and dreams. In fact, Freud believed that dreams were, "the royal road to the unconscious"; he devoted an entire volume to the interpretation of dreams. Freud had his patients lay on a couch in a dimly lit room and would sit out of sight, usually directly behind them, as to not influence the patients thoughts by his gestures or expressions. The psychoanalyst's task, in collaboration with the analysand, is to help deepen the analysand's understanding of those factors, outside of his awareness, that drive his behaviors. In the safe environment of the psychoanalytic setting, the analysand becomes attached to the analyst and pretty soon he begins to experience the same conflicts with his analyst that he experiences with key figures in his life such as his parents, his boss, his significant other, etc. It is the psychoanalyst's role to point out these conflicts and to interpret them. The transferring of these internal conflicts onto the analyst is called "transference". 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.


Training and research

Psychoanalysis continues to be practiced by psychiatrists, social workers, and other mental health professionals; however, its practice has declined. It has been largely replaced by the similar but broader
psychodynamic psychotherapy Psychodynamic psychotherapy or psychoanalytic psychotherapy is a form of depth psychologyDepth psychology (from the German term ''Tiefenpsychologie'') refers to the practice and research of the science of the unconscious, covering both psychoanalys ...
in the mid-20th century. Psychoanalytic approaches continue to be listed by the UK National Health Service as possibly helpful for depression.


United States

Psychoanalytic training in the United States involves a personal psychoanalysis for the trainee, approximately 600 hours of class instruction, with a standard curriculum, over a four or five-year period. Typically, this psychoanalysis must be conducted by a Supervising and Training Analyst. Most institutes (but not all) within the American Psychoanalytic Association, require that Supervising and Training Analysts become certified by the American Board of Psychoanalysts. Certification entails a blind review in which the psychoanalyst's work is vetted by psychoanalysts outside of their local community. After earning certification, these psychoanalysts undergo another hurdle in which they are specially vetted by senior members of their own institute. Supervising and Training analysts are held to the highest clinical and ethical standards. Moreover, they are required to have extensive experience conducting psychoanalyses. Similarly, class instruction for psychoanalytic candidates is rigorous. Typically classes meet several hours a week, or for a full day or two every other weekend during the academic year; this varies with the institute. Candidates generally have an hour of supervision each week, with a Supervising and Training Analyst, on each psychoanalytic case. 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 psychoanalytic work that week. In supervision, the patient's unconscious conflicts are explored, also, transference-countertransference constellations are examined. Also, clinical technique is taught. Many psychoanalytic training centers in the United States have been accredited by special committees of the APsaA or the IPA. Because of theoretical differences, there are independent institutes, usually founded by psychologists, who until 1987 were not permitted access to psychoanalytic training institutes of the APsaA. Currently there are between 75 and 100 independent institutes in the United States. As well, other institutes are affiliated to 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 terminal degree in a mental health field, such as Ph.D., Psy.D., M.S.W., or M.D. A few institutes restrict applicants to those already holding an M.D. or Ph.D., and most institutes in Southern California confer a Ph.D. or Psy.D. in psychoanalysis upon graduation, which involves completion of the necessary requirements for the state boards that confer that doctoral degree. The first training institute in America to educate non-medical psychoanalysts was The National Psychological Association for Psychoanalysis (1978) in New York City. It was founded by the analyst Theodor Reik. The Contemporary Freudian (originally the New York Freudian Society) an offshoot of the National Psychological Association has a branch in Washington, DC. It is a component society/institute or the IPA. Some psychoanalytic training has been set up as a post-doctoral fellowship in university settings, such as at 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 those institutes usually hold contemporaneous faculty positions with psychology Ph.D. programs and/or with medical school psychiatry residency programs. The IPA is the world's primary accrediting and regulatory body for psychoanalysis. Their mission is to assure the continued vigor and development of psychoanalysis for the benefit of psychoanalytic patients. It works in partnership with its 70 constituent organizations in 33 countries to support 11,500 members. In the US, there are 77 psychoanalytical organizations, institutes associations in the United States, which are spread across the states of America. APSaA has 38 affiliated societies which have 10 or more active members who practice in a given geographical area. The aims of APSaA and other psychoanalytical organizations are: provide ongoing educational opportunities for its members, stimulate the development and research of psychoanalysis, provide training and organize conferences. There are eight affiliated study groups in the United States. A study group is the first level of integration of a psychoanalytical body within the IPA, followed by a provisional society and finally a member society. The Division of Psychoanalysis (39) of the American Psychological Association (APA) was established in the early 1980s by several psychologists. Until the establishment of the Division of Psychoanalysis, psychologists who had trained in independent institutes had no national organization. The Division of Psychoanalysis now has approximately 4,000 members and approximately 30 local chapters in the United States. The Division of Psychoanalysis holds two annual meetings or conferences and offers continuing education in theory, research and clinical technique, as do their affiliated local chapters. The European Psychoanalytical Federation (EPF) is the organization which 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. There are also 25 psychoanalytic societies. The American Association of Psychoanalysis in Clinical Social Work (AAPCSW) was established by Crayton Rowe in 1980 as a division of the Federation of Clinical Societies of Social Work and became an independent entity in 1990. Until 2007 it was known as the National Membership Committee on Psychoanalysis. The organization was founded because although social workers represented the larger number of people who were training to be psychoanalysts, they were underrepresented as supervisors and teachers at the institutes they attended. AAPCSW now has over 1000 members and has over 20 chapters. It holds a bi-annual national conference and numerous annual local conferences. 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 Psychoanalytic theory is the theory of personality organization and the dynamics of personality development that guides psychoanalysis, a clinical method for treating psychopathology. First laid out by Sigmund Freud in the late 19th century, psycho ...
.


United Kingdom

The London Psychoanalytical Society was founded by
Ernest Jones Alfred Ernest Jones (1 January 1879 – 11 February 1958) was a Welsh neurologist and psychoanalyst. A lifelong friend and colleague of Sigmund Freud from their first meeting in 1908, he became his official biographer. Jones was the first Eng ...

Ernest Jones
on 30 October 1913. After
World War I World War I, often abbreviated as WWI or WW1, also known as the First World War or the Great War, was a global war A world war is "a war engaged in by all or most of the principal nations of the world". The term is usually reserved for ...

World War I
with the expansion of psychoanalysis in the United Kingdom, the Society was reconstituted and named the
British Psychoanalytical Society The British Psychoanalytical Society was founded by the British neurologist Ernest Jones as the London Psychoanalytical Society on 30 October 1913. It is one of two organizations in Britain training psychoanalysts, the other being the British P ...
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 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'' in West London. The Society is a constituent society of the
International Psychoanalytical Association The International Psychoanalytical Association (IPA) is an association including 12,000 psychoanalysts as members and works with 70 constituent organizations. It was founded in 1910 by Sigmund Freud Sigmund Freud ( ; ; born Sigismund Schlomo Fre ...
(IPA) a body with members on all five continents which safeguards professional and ethical practice. The Society is a member of the British Psychoanalytic Council (BPC); the BPC publishes a register of British psychoanalysts and psychoanalytical psychotherapists. All members of the British Psychoanalytic Council are required to undertake continuing professional development, CPD. Members of the Society teach and hold posts on other approved psychoanalytic courses, e.g.: British Psychotherapy Foundation and in academic departments, e.g.University College London. Members of the Society have included: Michael Balint,
Wilfred Bion Wilfred Ruprecht Bion DSO (; 8 September 1897 – 8 November 1979) was an influential English psychoanalyst, who became president of the British Psychoanalytical Society from 1962 to 1965. Early life and military service Bion was born in Ma ...
,
John Bowlby Edward John Mostyn Bowlby, Order of the British Empire, CBE, Royal College of Physicians#Fellowship, FRCP, Royal College of Psychiatrists, FRCPsych (; 26 February 1907 – 2 September 1990) was a British psychologist, psychiatrist, and psychoa ...
, Ronald Fairbairn,
Anna Freud Anna Freud (3 December 1895 – 9 October 1982) was a British psychoanalyst of Austrian-Jewish descent. She was born in Vienna en, Viennese , iso_code = AT-9 , registration_plate = Vehicle registrat ...
, Harry Guntrip,
Melanie Klein Melanie Klein (née Reizes; 30 March 1882 – 22 September 1960) was an Austrian-British author and psychoanalyst Psychoanalysis (from Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, ...

Melanie Klein
, Donald Meltzer, Joseph J. Sandler, Hanna Segal, J. D. Sutherland and
Donald Winnicott Donald Woods Winnicott (7 April 1896 – 25 January 1971) was an English paediatrician and psychoanalyst who was especially influential in the field of object relations theory and developmental psychology Developmental psychology is the ...
. The British Psychoanalytical Society, Institute of Psychoanalysis is the foremost publisher of psychoanalytic literature. The 24-volume ''Standard Edition of the Complete Psychological Works of Sigmund Freud'' 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 leading theorists and practitioners. ''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 journal.


India

Psychoanalytical practice is emerging slowly in India, but is not yet recognised by the government. In 2016, India decriminalised suicide in its mental health bill.


Psychoanalytic psychotherapy

There are different forms of psychoanalysis and psychotherapies in which psychoanalytic thinking is practiced. Besides classical psychoanalysis there is for example psychoanalytic psychotherapy, a therapeutic approach which widens "the accessibility of psychoanalytic theory and clinical practices that had evolved over 100 plus years to a larger number of individuals." 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 mental health care.


Research

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 the efficacy of analysis in cases of
neurosis Neurosis is a class of functional mental disorders involving chronic distress, but neither delusion A delusion is a fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belie ...
and character or Wiktionary:personality, 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). 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 Otto Rank (; ; né Rosenfeld; 22 April 1884 – 31 October 1939) was an Austrian psychoanalyst, writer, and teacher. Born in Vienna en, Viennese , iso_code = AT-9 , registration_plate = Vehicle regis ...
and
Alfred Adler Alfred Adler (; ; 7 February 1870 – 28 May 1937) was an Austrian medical doctor, psychotherapist Psychotherapy (also psychological therapy or talking therapy) is the use of Psychology, psychological methods, particularly when based on regu ...

Alfred Adler
(turn of the 20th century), continued with behaviorists (e.g. Joseph Wolpe, Wolpe) into the 1940s and '50s, and have persisted (e.g. Alice Miller (psychologist), Miller). Criticisms come from those who object to the notion that there are mechanisms, thoughts or feelings in the mind that could be unconscious. Criticisms also have been leveled against the idea 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 Ronald Fairbairn, Michael Balint, and
John Bowlby Edward John Mostyn Bowlby, Order of the British Empire, CBE, Royal College of Physicians#Fellowship, FRCP, Royal College of Psychiatrists, FRCPsych (; 26 February 1907 – 2 September 1990) was a British psychologist, psychiatrist, and psychoa ...
. In the past 30 years or so, the criticisms have centered on the issue of empirical verification. 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 Human female sexuality, 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 Karen Horney (; ; 16 September 1885 – 4 December 1952) was a German psychoanalyst Psychoanalysis (from Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially t ...
, Françoise Dolto,
Melanie Klein Melanie Klein (née Reizes; 30 March 1882 – 22 September 1960) was an Austrian-British author and psychoanalyst Psychoanalysis (from Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, ...

Melanie Klein
, Selma Fraiberg, and others. Most recently, psychoanalytic researchers who have integrated attachment theory into their work, including Alicia Lieberman, Susan Coates, and Daniel Schechter have explored the role of parental traumatization in the development of young children's mental representations of self and others.


Effectiveness

The psychoanalytic profession has been resistant to researching efficacy. Evaluations of effectiveness based on the interpretation of the therapist alone cannot be proven.Myers, D. G. (2014). ''Psychology: Tenth edition in modules''. New York: Worth Publishers.


Research results

Numerous studies have shown that the efficacy of therapy is primarily related to the quality of the therapist, rather than the school or technique or training.Horvath, A. 2001. "The Alliance." ''Psychotherapy (journal), Psychotherapy: Theory, Research, Practice, Training'' 38(4):365–72. . Meta-analysis, Meta-analyses in 2012 and 2013 found support or evidence for the efficacy of psychoanalytic therapy, thus further research is needed. Other meta-analyses published in the recent years showed psychoanalysis and psychodynamic psychotherapy, psychodynamic therapy to be effective, with outcomes comparable or greater than other kinds of
psychotherapy Psychotherapy (also psychological therapy or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interaction, to help a person change behavior, increase happiness, and ove ...
or antidepressant drugs, but these arguments have also been subjected to various criticisms. In particular, the inclusion of pre/post studies rather than randomized controlled trials, and the absence of adequate comparisons with control treatments is a serious limitation in interpreting the results. A French 2004 report from INSERM concluded that psychoanalytic therapy is less effective than other psychotherapies (including
cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (e. ...
) for certain diseases. 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." Meta-analyses of Short Term Psychodynamic Psychotherapy (STPP) have found effect sizes (Effect size#Cohen's d, Cohen's d) ranging from 0.34 to 0.71 compared to no treatment and was found to be slightly better than other therapies in follow up. Other reviews have found an effect size of 0.78 to 0.91 for Somatoform disorder, somatic disorders compared to no treatment and 0.69 for treating depression. A 2012 ''Harvard Review of Psychiatry'' meta-analysis of Intensive Short-Term Dynamic Psychotherapy (ISTDP) found effect sizes ranging from 0.84 for interpersonal problems to 1.51 for depression. Overall ISTDP had an effect size of 1.18 compared to no treatment. A meta-analysis of Long Term Psychodynamic Psychotherapy in 2012 found an overall effect size of 0.33, which is modest. This study concluded the recovery rate following LTPP was equal to control treatments, including treatment as usual, and found the evidence for the effectiveness of LTPP to be limited and at best conflicting. Others have found effect sizes of 0.44–0.68. According to a 2004 French review conducted by Inserm, INSERM, psychoanalysis was presumed or proven effective at treating panic disorder, post-traumatic stress, and personality disorders, but did not find evidence of its effectiveness in treating schizophrenia, obsessive compulsive disorder, specific phobia, bulimia and anorexia.INSERM Collective Expertise Centre. 2004.
Psychotherapy: Three approaches evaluated
" ''INSERM Collective Expert Reports.'' Paris: Inserm, Institut National de la Santé et de la Recherche Médicale (2000). . National Center for Biotechnology Information, NCBI .
A 2001 systematic review of the medical literature by the Cochrane Collaboration concluded that no data exist demonstrating that psychodynamic psychotherapy is effective in treating schizophrenia and severe mental illness, and cautioned that medication should always be used alongside any type of psychotherapy, talk therapy in schizophrenia cases. A French review from 2004 found the same. The Schizophrenia Patient Outcomes Research Team advises against the use of Psychodynamic psychotherapy, psychodynamic therapy in cases of schizophrenia, arguing that more trials are necessary to verify its effectiveness.


Criticism

Both Freud and psychoanalysis have been criticized in extreme terms. Exchanges between critics and defenders of psychoanalysis have often been so heated that they have come to be characterized as the ''Freud Wars''. Linguist Noam Chomsky has criticized psychoanalysis for lacking a scientific basis. Evolutionary biologist Stephen Jay Gould considered psychoanalysis influenced by pseudoscientific theories such as recapitulation theory. Psychologists Hans Eysenck (1985), John Kihlstrom, John F. Kihlstrom (2012/2000) and others have also criticized the field as pseudoscience.


Debate over status as scientific

The theoretical foundations of psychoanalysis lie in the same philosophical currents that lead to interpretive Phenomenology (psychology), phenomenology rather than in those that lead to science, scientific positivism, making the theory largely incompatible with positivist approaches to the study of the mind.Karl Popper, Popper, Karl R. 1990. "Science: Conjectures and Refutations." Pp. 104–10 in ''Philosophy of Science and the Occult'', edited by P. Grim. Albany, p. 109
Preview Google Books
See also ''Conjectures and Refutations''.
Richard Webster (British author), Webster, Richard. 1996. ''Why Freud was wrong. Sin, science and psychoanalysis''. London: Harper Collins. Early critics of psychoanalysis believed that its theories were based too little on quantitative and experimental research, and too much on the clinical case study method. Philosopher Frank Cioffi cites false claims of a sound scientific verification of the theory and its elements as the strongest basis for classifying the work of Freud and his school as pseudoscience. Karl Popper argued that psychoanalysis is a pseudoscience because its claims are not testable and cannot be refuted; that is, they are not falsifiable:
....those "clinical observations" which analysts naively believe confirm their theory cannot do this any more than the daily confirmations which astrologers find in their practice. And as for Freud's epic of the Ego, the Super-ego, and the Id, no substantially stronger claim to scientific status can be made for it than for Homer's collected stories from the Olympus.
In addition, Imre Lakatos wrote that "Freudians have been nonplussed by Popper's basic challenge concerning scientific honesty. Indeed, they have refused to specify experimental conditions under which they would give up their basic assumptions." In ''Sexual Desire (book), Sexual Desire'' (1986), philosopher Roger Scruton rejects Popper's arguments pointing to the theory of repression as an example of a Freudian theory that does have testable consequences. Scruton nevertheless concluded that psychoanalysis is not genuinely scientific, on the grounds that it involves an unacceptable dependence on metaphor. The philosopher and physicist Mario Bunge argued that psychoanalysis is a pseudoscience because it violates the ontology and scientific method, methodology inherent to science. According to Bunge, most psychoanalytic theories are either untestable or unsupported by evidence. Cognitive science, Cognitive scientists, in particular, have also weighed in. Martin Seligman, a prominent academic in positive psychology, wrote that:
Thirty years ago, the cognitive revolution in psychology overthrew both Freud and the behaviorists, at least in academia.… The imperialistic Freudian view claims that emotion always drives thought, while the imperialistic cognitive view claims that thought always drives emotion. The evidence, however, is that each drives the other at times.
Adolf Grünbaum argues in ''Validation in the Clinical Theory of Psychoanalysis'' (1993) that psychoanalytic based theories are falsifiable, but that the causal claims of psychoanalysis are unsupported by the available clinical evidence.Adolf Grünbaum, Grünbaum, Adolf. 1993. ''Validation in the Clinical Theory of Psychoanalysis: A Study in the Philosophy of Psychoanalysis''. Madison, CT: International Universities Press. . . Historian Henri Ellenberger, who wrote researched the history of Freud, Jung, Adler, and Janet, writing his book ''The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry'', argued that psychoanalysis was not scientific on the grounds of both its methodology and social structure:


Freud

Some have accused Freud of fabrication, most famously in the case of Anna O., Anna O. Others have speculated that patients suffered from now easily identifiable conditions unrelated to psychoanalysis; for instance, Anna O. is thought to have suffered from an organic impairment such as tuberculous meningitis or temporal lobe epilepsy and not hysteria (see Anna O.#Modern interpretations, modern interpretations). Henri Ellenberger and
Frank Sulloway Frank Jones Sulloway (born February 2, 1947) is an American psychologist A psychologist is a person who studies normal and abnormal mental states, perceptual, cognitive, emotional, and social processes and behavior by experimenting with, and ob ...
argue that Freud and his followers created an inaccurate "Legend" of Freud as his work of Freud to popularize psychoanalysis. Borch-Jacobson and Shamdasani argue that this legend is adapted to different times and situations. Isabelle Stengers states that psychoanalytic circles have tried to stop historians from accessing documents about the life of Freud.


Witch doctors

Richard Feynman wrote off psychoanalysts as mere "witch doctors": Likewise, psychiatrist E. Fuller Torrey, in ''Witchdoctors and Psychiatrists'' (1986), agreed that psychoanalytic theories have no more scientific basis than the theories of traditional native healers, "witchdoctors" or modern "cult" alternatives such as Erhard Seminars Training, EST.E. Fuller Torrey, Torrey, E. Fuller. 1986. ''Witchdoctors and Psychiatrists''. p. 76. Psychologist Alice Miller (psychologist), Alice Miller charged psychoanalysis with being similar to the poisonous pedagogy, poisonous pedagogies, which she described in her book ''For Your Own Good''. She scrutinized and rejected the validity of Freud's Drive theory (psychoanalysis), drive theory, including the Oedipus complex, which, according to her and Jeffrey Masson, blames the child for the abusive sexual behavior of adults. 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.


Critical perspectives

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. 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 Deleuze, Félix Guattari criticised the Oedipal structure. Luce Irigaray criticised psychoanalysis, employing Jacques Derrida's concept of phallogocentrism to describe the exclusion of the woman from Freudian and Lacanian psychoanalytical theories. Deleuze and Guattari (1972), in ''Anti-Oedipus, Anti-Œdipus'', take the cases of Gérard Mendel, Bela Grunberger and Janine Chasseguet-Smirgel, prominent members of the most respected associations (International Psychoanalytical Association, IPA), to suggest that, traditionally, psychoanalysis enthusiastically embraces a police state.


Freudian theory

A survey of scientific research suggested that while personality traits corresponding to Freud's oral, anal, Oedipal, and genital phases can be observed, they do not necessarily manifest as stages in the development of children. These studies also have not confirmed that such traits in adults result from childhood experiences. 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 mental activity has to be inferred. However, the unconscious is now a popular topic of study in the fields of experimental and social psychology (e.g., implicit attitude measures, fMRI, and Positron emission tomography, PET scans, and other indirect tests). 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, and Gabbard. 2002. though a Freudian interpretation of unconscious mental activity is not held by the majority of cognitive psychologists. 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, while the other side argues that such findings make psychoanalytic theory obsolete and irrelevant. Shlomo Kalo explains that the scientific materialism that flourished in the 19th century severely harmed religion and rejected whatever called spiritual. The institution of the Confession (religion), confession priest in particular was badly damaged. The empty void that this institution left behind was swiftly occupied by the newborn psychoanalysis. In his writings, Kalo claims that psychoanalysis basic approach is erroneous. It represents the mainline wrong assumptions that happiness is unreachable and that the natural desire of a human being is to exploit his fellow men for his own pleasure and benefit. Jacques Derrida incorporated aspects of psychoanalytic theory into his theory of deconstruction in order to question what he called the '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 the identification with the father in the resolution of the Oedipal complex, Derrida (The Post Card, 1987) insists 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.Jacques Derrida, Derrida, Jacques, and Alan Bass. 1987. ''The Post Card, The Post Card: From Socrates to Freud and Beyond''. Chicago: University of Chicago.


See also

* Analytical psychology * List of schools of psychoanalysis * Psychoanalytic sociology * Psychoanalysis and music * Training analysis


References


Notes


Citations


Further reading


Introductions

*Brenner, Charles (1954). ''An Elementary Textbook of Psychoanalysis''. *Elliott, Anthony (2002). ''Psychoanalytic Theory: An Introduction'' (2nd ed.). Duke University Press. --
An introduction that explains psychoanalytic theory with interpretations of major theorists. * Fine, Reuben (1990). ''The History of Psychoanalysis.'' (expanded ed.). Northvale: Jason Aronson. * Samuel, Lawrence R. (2013). ''Shrink: A Cultural History of Psychoanalysis in America''. University of Nebraska Press. 253 pp. *Freud, Sigmund (2014)
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Psychoanalysis
" ''Encyclopædia Britannica''.


Reference works

*Alain de Mijolla, de Mijolla, Alain, ed. (2005). ''International dictionary of psychoanalysis'' [enhanced American version] 1,2,&3. Detroit: Thomson/Gale. *Jean Laplanche, Laplanche, Jean, and J. B. Pontalis (1974). "The Language of Psycho-Analysis". W. W. Norton & Company. *Freud, Sigmund (1940). ''An Outline of Psychoanalysis''. ePenguin.;General *Edelson, Marshall (1984). ''Hypothesis and Evidence in Psychoanalysis''. Chicago: Chicago University Press. *Horacio Etchegoyen, Etchegoyen, Horacio (2005). ''The Fundamentals of Psychoanalytic Technique'' (new ed.). Karnac Books. *Ernest Gellner, Gellner, Ernest. ''The Psychoanalytic Movement: The Cunning of Unreason'', . A critical view of Freudian theory. *André Green (psychoanalyst), Green, André (2005). "Psychoanalysis: A Paradigm For Clinical Thinking". Free Association Books. *Luce Irigaray, Irigaray, Luce (2004). ''Key Writings''. Continuum. *Edith Jacobson, Jacobson, Edith (1976). ''Depression; Comparative Studies of Normal, Neurotic, and Psychotic Conditions''. International Universities Press. * Otto Kernberg, Kernberg, Otto (1993). ''Severe Personality Disorders: Psychotherapeutic Strategies''. Yale University Press. *Heinz Kohut, Kohut, Heinz (2000). ''Analysis of the Self: Systematic Approach to Treatment of Narcissistic Personality Disorders''. International Universities Press. *Filip Kovacevic, Kovacevic, Filip (2007). ''Liberating Oedipus? Psychoanalysis as Critical Theory''. Lexington Books. *Julia Kristeva, Kristeva, Julia (1986). ''The Kristeva Reader'', edited by T. Moi. Columbia University Press. *Donald Meltzer, Meltzer, Donald (1983). ''Dream-Life: A Re-Examination of the Psycho-Analytical Theory and Technique''. Karnac Books. *— (1998). ''The Kleinian Development'' (new ed.). Karnac Books; reprint: *Mitchell, S. A., and M. J. Black (1995). ''Freud and beyond: a history of modern psychoanalytic thought.'' New York: Basic Books. pp. xviii–xx. *Griselda Pollock, Pollock, Griselda (2006). "Beyond Oedipus. Feminist Thought, Psychoanalysis, and Mythical Figurations of the Feminine." In ''Laughing with Medusa'', edited by V. Zajko and M. Leonard. Oxford: Oxford University Press. *Sabina Spielrein, Spielrein, Sabina (1993). ''Destruction as cause of becoming''. *Robert Stoller, Stoller, Robert (1993). ''Presentations of Gender''. Yale University Press. *Stolorow, Robert, George Atwood, and Donna Orange (2002). ''Worlds of Experience: Interweaving Philosophical and Clinical Dimensions in Psychoanalysis''. New York: Basic Books. *René Spitz, Spitz, René (2006). ''The First Year of Life: Psychoanalytic Study of Normal and Deviant Development of Object Relations''. International Universities Press. *Tähkä, Veikko (1993). ''Mind and Its Treatment: A Psychoanalytic Approach.'' Madison, CT: International Universities Press.


Book series

*''Contemporary Psychoanalytic Studies''. Amsterdam & New York: Rodopi.


Analyses, discussions and critiques

*Aziz, Robert (2007). ''The Syndetic Paradigm: The Untrodden Path Beyond Freud and Jung''. Albany: State University of New York Press. . *Mikkel Borch-Jacobsen, Borch-Jacobsen, Mikkel (1991). ''Lacan: The Absolute Master'', Stanford: Stanford University Press. *— (1996). ''Remembering Anna O: A century of mystification'' London: Routledge. * * Burnham, John, ed. ''After Freud Left: A Century of Psychoanalysis in America'' (University of Chicago Press, 2012) 274 pp. *Frank Cioffi, Cioffi, Frank. (1998). ''Freud and the Question of Pseudoscience'', Open Court Publishing Company. *Frederick Crews, Crews, Frederick (1995). ''The Memory Wars: Freud's Legacy in Dispute'', New York: New York Review of Books. *Crews, Frederick, ed. (1998). ''Unauthorized Freud: Doubters Confront a Legend'', New York: Viking. *Dufresne, Todd (2000). ''Tales From the Freudian Crypt: The Death Drive in Text and Context'', Stanford: Stanford University Press. *— (2007). ''Against Freud: Critics Talk Back'', Stanford: Stanford University Press. *Erwin, Edward, ''A Final Accounting: Philosophical and Empirical Issues in Freudian Psychology'' *Esterson, Allen. ''Seductive Mirage: An Exploration of the Work of Sigmund Freud.'' Chicago: Open Court, 1993. *Fisher, Seymour, and Roger P. Greenberg (1977). ''The Scientific Credibility of Freud's Theories and Therapy''. New York: Basic Books. *— (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'', * *— (1985). ''The Foundations of Psychoanalysis: A Philosophical Critique'' *Macmillan, Malcolm, ''Freud Evaluated: The Completed Arc'' * *Roustang, Francois (1982). Dire Mastery: Discipleship From Freud to Lacan, Baltimore: Johns Hopkins University Press. *Richard Webster (British author), Webster, Richard. (1995). ''Why Freud Was Wrong'', New York: Basic Books, Harper Collins. *Richard Wollheim, Wollheim, Richard, editor. (1974). ''Freud: A Collection of Critical Essays.'' New York: Anchor Books.


Responses to critiques

* Köhler, Thomas 1996: ''Anti-Freud-Literatur von ihren Anfängen bis heute. Zur wissenschaftlichen Fundierung von Psychoanalyse-Kritik.'' Stuttgart: Kohlhammer Verlag. * Ollinheimo, Ari — Vuorinen, Risto (1999): Metapsychology and the Suggestion Argument: A Reply to Grünbaum's Critique of Psychoanalysis. ''Commentationes Scientiarum Socialium'', 53. Helsinki: Finnish Academy of Science and Letters. *Robinson, Paul (1993). ''Freud and his Critics.'' Berkeley & Los Angeles: University of California Press. *Gomez, Lavinia
''The Freud Wars: An Introduction to the Philosophy of Psychoanalysis''
Routledge, 2005
Review
''Psychodynamic Practice'' 14(1):108–111. Feb., 2008. 


External links


International Psychoanalytical Association (IPA)
– world's primary regulatory body for psychoanalysis, founded by Sigmund Freud
Psychoanalysis – Division 39 – American Psychological Association (APA)
{{Authority control Psychoanalysis, Branches of psychology