IntroductionTo the majority of people, psychotherapy is synonymous with psychoanalysis. This may be because psychoanalysis is the most well known psychotherapy method practiced. In addition, the popular media-such as television and movies-continue to depict most psychiatrists and psychologists solely as practitioners of psychoanalysis. Most people are surprised to learn that psychoanalysis is only one of many therapeutic techniques currently used by clinicians. Also surprisingly, Sigmund Freud was not the first individual to apply principles of psychotherapy.
Historically psychoanalysis (of course developed by Freud) is one of the most influential methods of psychotherapy. The contributions of psychoanalysis to psychotherapeutic and counseling theories and practices are enormous. The main ideas of psychoanalysis have been instrumental in the development of many therapeutic methods that followed. Concepts such as unconscious, transference, and dream analysis continue to play a very prominent role with many clinicians who do not consider themselves psychoanalysts.
Personality TheoryBefore one can begin to explore techniques of psychoanalysis, it is important to review briefly Freud’s theory of personality structure and his theories of stages of psychological development. Freud divided the psychic structure into three parts. The "Id" is the first structure that an infant possesses at the time of birth. Freud believed that humans are born as a pool of energy. He called this energy the "libido," which contains all the instincts and reflexes that drive the Id. The Id does not act based on logic or reality, and its role is to gratify instinctual and biological needs of the infant, such as eating, and drinking, at any cost. As the child begins to gain experience and interacts with his/her environment, a new psychic structure, called "Ego," develops. While Id acts based on the "pleasure principle", Ego acts based upon "reality principle." Ego recognizes that certain instinctual needs lead to punishment and guilt. Consequently, Ego begins to "repress" such instincts and "the unconscious" begins to form. Eventually the child begins to internalize societal values and norms, and a new structure called "Superego" is differentiated from the Ego. Superego makes guilt possible and sets a limit on the types of gratification one would seek.
Freud’s theory of personality is considered to be a "conflict model" because there is a continuous conflict between the Ego and the other two structures. If Id wins its demands for gratification, Superego generates guilt. On the other hand, if Ego does not permit Id to gain gratification, a state of tension develops. In order to deal with the conflict, Ego develops elaborate defensive mechanisms to keep the conflicts in the unconscious. These defense mechanisms include, but are not limited to, "repression," "denial, " and "rationalization." Anxiety develops when defense mechanisms are unable to keep the conflict unconscious. Therefore, from a psychoanalytic viewpoint, anxiety is a signal that undesired wishes are beginning to surface.
Children experience conflicts in different stages of development. In each stage, conflict centers on a different theme. In the first stage (oral stage), between birth and one year, conflict centers on feeding. Children in this stage want to eat things that the Ego tells them is not good for them. In the second stage (Anal), in the second year of life, conflict centers on bowel training. The controversial "Oedipal" (for boys) or "Electra" (for girls) conflict occurs in the third stage and happens in years three through five. This is the stage where Freud proposed children compete with the same sex parent for the affection of the opposite sex parent. Fear of punishment forces repression of such desires and consequently Superego is developed. The fourth stage (Latency) occurs from age six years until puberty. In this stage sexual instincts are repressed and superego is fully developed. The fifth and last stage (genital) begins with puberty and continues for the rest of adult life. Mature sexuality is the theme of this stage.
If a child is able to successfully negotiate these stages, then healthy personality develops. However, if through "over-gratification" or "under-gratification", conflicts are not resolved adequately, specific traits and characters develop. For example, an "anal character" exhibits traits such as stinginess, stubbornness, or orderliness.
Psychoanalytic TherapyThe patient usually comes in contact with the psychoanalyst when defenses have failed and anxiety has developed. Therefore, the central focus of psychoanalytic therapy is on the unconscious part of the mind. The purpose is to uncover the unconscious motivations that regulate behavior, feeling, and attitudes and to bring about more control for the patient. The analyst employs a variety of techniques to tap into the patient’s unconscious. Through "free association", the patient is encouraged to verbalize all thoughts, feelings or images that come to mind, while the analyst is seated behind the patient. During free association, "resistance" may occur. This means that the patient is unable to recall traumatic past events. Therefore, one task of the analysis would be to overcome resistance. Another, and very important, idea associated with psychoanalysis, and related to the unconscious processes of mind, is "transference. " Transference occurs when the patient behaves or feels toward the analyst as he/she would have behaved or felt towards a significant figure from his/her past. Freud initially believed transference was a hurdle in therapy. However, he eventually recognized that transference is a universal phenomenon and also occurs outside of the therapy session. Through transference, the core neurotic characteristics of the patient are acted out. Consequently, the analyst attempts to clarify, interpret, confront, work through and resolve the transference. This is the cornerstone of psychoanalysis. Other techniques of highlighting unconscious motivations include analysis of dreams and slippage of tongue.
Freud continued to transform psychoanalysis throughout his life. As he matured, so did psychoanalysis. His techniques have been used for an array of problems, including personal, social, occupational, and familial issues. The major criticism directed towards psychoanalysis is the over-emphasis on sexual drives and motivations of children. Furthermore, Freud reasoned that personality is more or less developed by the age of six, and he put little emphasis on significant events that may shape a person’s attitudes, beliefs and sense of self in the later stages of life. In response to these shortcomings, psychoanalysis has continued to evolve over time to include other ideas and techniques. Current psychoanalysts, who are also referred to as "psychodynamic" therapists, have begun to consider the role of culture and have adapted traditional ideas to include culturally diverse clientele. Obviously, then, the classical psychoanalysis is practiced less and less by clinicians. The advent of managed care and the need to work with diverse clientele population has had a significant impact on this shift.