Contemporary Variations on Psychoanalysis

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Chapter 13 Treatment of Psychological Disorders
Classical Psychoanalysis
During psychoanalytic sessions, Freud’s patients lay on this couch, free associating
or describing dreams and events in their
lives, while he sat in the chair behind
them. According to Freud, even apparently trivial actions may carry messages
from the unconscious. Forgetting a dream
or missing a therapy appointment might
reflect a client’s unconscious resistance to
treatment. Even accidents may be meaningful. The waiter who spills hot soup on
an older male customer might be seen as
acting out unconscious aggressive impulses against a father figure.
FREUD’S CONSULTING ROOM
Classical psychoanalysis developed mainly out of Freud’s medical practice. He was puzzled by patients who suffered from blindness, paralysis, or other disabilities that had no
physical cause (see our discussion of conversion disorders in the chapter on psychological disorders). Freud tried to cure these patients with hypnotic suggestions, but he found
this method to be only partially and temporarily successful. Later, he asked hypnotized
patients to recall events that might have caused their symptoms. Eventually, however, he
stopped using hypnosis and merely had patients lie on a couch and report whatever
thoughts, memories, or images came to mind. Freud called this process free association.
Freud’s “talking cure” produced surprising results. He was struck by how many
patients reported childhood memories of sexual abuse, usually by a parent or other
close relative (Esterson, 2001). Was child abuse rampant in Vienna, or were his patients’
reports distorted by psychological factors? Freud concluded that these reports of childhood seduction probably reflected unconscious impulses and fantasies, not reality. He
also concluded that his patients’ physical symptoms were based on unconscious conflicts about those fantasies. So psychoanalysis came to focus on exploring the unconscious and resolving the conflicts raging within it.
Classical psychoanalytic treatment involves the use of free association, dream analysis, and analysis of the client’s reactions to the therapist (called transference) to help the
client gain insight into problems. Clients are encouraged, first, to recognize unconscious
thoughts and emotions. Then they are encouraged to discover, or work through, the
many ways in which those unconscious elements continue to motivate maladaptive
thinking and behavior in everyday life. The treatment may require as many as three to
five sessions per week, usually over several years. Generally, the psychoanalyst remains
compassionate but neutral as the client slowly develops insight into how past conflicts
have shaped current problems (Gabbard, 2004).
Contemporary Variations on Psychoanalysis
Classical psychoanalysis is still practiced, but not as much as it was several decades ago
(Gabbard, 2004; Horgan, 1996). The decline is due in part to the growth of several
alternative forms of treatment, including variations on classical psychoanalysis. Many
of these variations were developed by neo-Freudian theorists. As noted in the personality chapter, these theorists placed less emphasis than Freud did on the past and on
unconscious impulses driven by the id. They focused instead on the role played by
social relationships in clients’ problems and on how the power of the ego can be harnessed to solve them. Psychotherapists who adopt various neo-Freudian treatment
methods tend to take a much more active role than classical analysts do—in particular,
by directing the client’s attention to evidence of certain conflicts in social relationships.
Many of these methods have come to be known as short-term psychodynamic
psychotherapy because they aim to provide benefits in far less time than is required in
classical psychoanalysis (Davanloo, 1999; Levenson, 2003; Rawson, 2003, 2006). In a
particularly popular short-term psychodynamic approach known as object relations
therapy (Scharff & Scharff, 2004; St. Clair, 1999), the powerful need for human contact
and support takes center stage. Object relations therapists believe that most of the problems that bring clients to treatment ultimately stem from their relationships with
others, especially their mothers or other early caregivers. (The term object usually refers
to a person who has emotional significance for the client.) Accordingly, these therapists
work to create a nurturing relationship in which the client’s problems can be understood and corrected (Kahn & Rachman, 2000; Lieberman & Pawl, 1988; Wallerstein,
2002). This relationship provides a “second chance” for the client to receive the
support that might have been missing in infancy and to counteract some of the consequences of maladaptive early attachment patterns. For example, object relations
therapists take pains to show that they will not abandon their clients, as might have
happened to these people in the past. Interpersonal therapy, too, is rooted partly in
neo-Freudian theory (Sullivan, 1954). Often used in cases of depression, it focuses on