What is Object Relations Theory?

Introduction

Object relations theory in psychoanalytic psychology is the process of developing a psyche in relation to others in the childhood environment. It designates theories or aspects of theories that are concerned with the exploration of relationships between real and external people as well as internal images and the relations found in them. It maintains that the infant’s relationship with the mother primarily determines the formation of its personality in adult life. Particularly, the need for attachment is the bedrock of the development of the self or the psychic organisation that creates the sense of identity.

The Theory

While object relations theory is based on psychodynamic theory, it modified it so that the role of biological drives in the formation of adult personality received less emphasis. The theory suggests that the way people relate to others and situations in their adult lives is shaped by family experiences during infancy. For example, an adult who experienced neglect or abuse in infancy would expect similar behaviour from others who remind them of the neglectful or abusive parent from their past. These images of people and events turn into objects in the unconscious that the “self” carries into adulthood, and they are used by the unconscious to predict people’s behaviour in their social relationships and interactions.

The first “object” in someone is usually an internalised image of one’s mother. Internal objects are formed by the patterns in one’s experience of being taken care of as a baby, which may or may not be accurate representations of the actual, external caretakers. Objects are usually internalised images of one’s mother, father, or primary caregiver, although they could also consist of parts of a person such as an infant relating to the breast or things in one’s inner world (one’s internalised image of others). Later experiences can reshape these early patterns, but objects often continue to exert a strong influence throughout life. Objects are initially comprehended in the infant mind by their functions and are termed part objects. The breast that feeds the hungry infant is the “good breast”, while a hungry infant that finds no breast is in relation to the “bad breast”. With a “good enough” facilitating environment, part object functions eventually transform into a comprehension of whole objects. This corresponds with the ability to tolerate ambiguity, to see that both the “good” and the “bad” breast are a part of the same mother figure.

Brief History

The initial line of thought emerged in 1917 with Ferenczi and, early in the 1930s, Sullivan, coiner of the term “interpersonal”. British psychologists Melanie Klein, Donald Winnicott, Harry Guntrip, Scott Stuart, and others extended object relations theory during the 1940s and 1950s. Ronald Fairbairn in 1952 independently formulated his theory of object relations.

The term has been used in many different contexts, which led to different connotations and denotations. While Fairbairn popularised the term “object relations”, Melanie Klein’s work tends to be most commonly identified with the terms “object relations theory” and “British object relations”, at least in contemporary North America, though the influence of ‘what is known as the British independent perspective, which argued that the primary motivation of the child is object seeking rather than drive gratification’, is becoming increasingly recognised. Klein felt that the psychodynamic battleground that Freud proposed occurs very early in life, during infancy. Furthermore, its origins are different from those that Freud proposed. The interactions between infant and mother are so deep and intense that they form the focus of the infant’s structure of drives. Some of these interactions provoke anger and frustration; others provoke strong emotions of dependence as the child begins to recognise the mother is more than a breast from which to feed. These reactions threaten to overwhelm the individuality of the infant. The way in which the infant resolves the conflict, Klein believed, is reflected in the adult’s personality.

Freud originally identified people in a subject’s environment with the term “object” to identify people as the object of drives. Fairbairn took a radical departure from Freud by positing that humans were not seeking satisfaction of the drive, but actually seek the satisfaction that comes in being in relation to real others. Klein and Fairbairn were working along similar lines, but unlike Fairbairn, Klein always held that she was not departing from Freudian theory, but simply elaborating early developmental phenomena consistent with Freudian theory.

Within the London psychoanalytic community, a conflict of loyalties took place between Klein and object relations theory (sometimes referred to as “id psychology”), and Anna Freud and ego psychology. In America, Anna Freud heavily influenced American psychoanalysis in the 1940s, 1950s, and 1960s. American ego psychology was furthered in the works of Hartmann, Kris, Loewenstein, Rapaport, Erikson, Jacobson, and Mahler. In London, those who refused to choose sides were termed the “middle school,” whose members included Michael Balint and D.W. Winnicott. A certain division developed in England between the school of Anna Freud and that of Melanie Klein, which later influenced psychoanalytic politics worldwide. Klein was popularised in South America while A. Freud garnered an American allegiance.

Fairbairn revised much of Freud’s model of the mind. He identified how people who were abused as children internalise that experience. Fairbairn’s “moral defence” is the tendency seen in survivors of abuse to take all the bad upon themselves, each believing he is morally bad so his caretaker object can be regarded as good. This is a use of splitting as a defence to maintain an attachment relationship in an unsafe world. Fairbairn introduced a four-year-old girl with a broken arm to a doctor friend of his. He told the little girl that they were going to find her a new mommy. “Oh no!” the girl cried. “I want my real mommy.” “You mean the mommy that broke your arm?” Fairbairn asked. “I was bad,” the girl replied. She needed to believe that her love object (mother) was all good, so that she could believe she would one day receive the love and nurturing she needed. If she accepted her mother was bad, then she would be bereft and alone in the world, an intolerable state. She used the Moral Defence to make herself bad, but preserve her mother’s goodness.

Kleinian Object Relations Theory

Unconscious Phantasy

Klein termed the psychological aspect of instinct unconscious phantasy (deliberately spelled with ‘ph’ to distinguish it from the word ‘fantasy’). Phantasy is a given of psychic life which moves outward towards the world. These image-potentials are given a priority with the drives and eventually allow the development of more complex states of mental life. Unconscious phantasy in the infant’s emerging mental life is modified by the environment as the infant has contact with reality.

From the moment the infant starts interacting with the outer world, he is engaged in testing his phantasies in a reality setting. I want to suggest that the origin of thought lies in this process of testing phantasy against reality; that is, that thought is not only contrasted with phantasy, but based on it and derived from it.

The role of unconscious phantasy is essential in the development of a capacity for thinking. In Bion’s terms, the phantasy image is a preconception that will not be a thought until experience combines with a realisation in the world of experience. The preconception and realization combine to take form as a concept that can be thought. The classic example of this is the infant’s observed rooting for the nipple in the first hours of life. The instinctual rooting is the preconception. The provision of the nipple provides the realisation in the world of experience, and through time, with repeated experience, the preconception and realisation combined to create the concept. Mental capacity builds upon previous experience as the environment and infant interact.

The first bodily experiences begin to build up the first memories, and external realities are progressively woven into the texture of phantasy. Before long, the child’s phantasies are able to draw upon plastic images as well as sensations – visual, auditory, kinaesthetic, touch, taste, smell images, etc. And these plastic images and dramatic representations of phantasy are progressively elaborated along with articulated perceptions of the external world.

With adequate care, the infant is able to tolerate increasing awareness of experience which is underlain by unconscious phantasy and leads to attainment of consecutive developmental achievements, “the positions” in Kleinian theory.

Projective Identification

As a specific term, projective identification is introduced by Klein in “Notes on some schizoid mechanisms.”

[Projection] helps the ego to overcome anxiety by ridding it of danger and badness. Introjection of the good object is also used by the ego as a defence against anxiety. . . .The processes of splitting off parts of the self and projecting them into objects are thus of vital importance for normal development as well as for abnormal object-relation. The effect of introjection on object relations is equally important. The introjection of the good object, first of all the mother’s breast, is a precondition for normal development . . . It comes to form a focal point in the ego and makes for cohesiveness of the ego. . . . I suggest for these processes the term ‘projective identification’.

Klein imagined this function as a defence which contributes to the normal development of the infant, including ego structure and the development of object relations. The introjection of the good breast provides a location where one can hide from persecution, an early step in developing a capacity to self-soothe.

Ogden identifies four functions that projective identification may serve. As in the traditional Kleinian model, it serves as a defence. Projective identification serves as a mode of communication. It is a form of object relations, and “a pathway for psychological change.” As a form of object relationship, projective identification is a way of relating with others who are not seen as entirely separate from the individual. Instead, this relating takes place “between the stage of the subjective object and that of true object relatedness”.

The Paranoid-Schizoid and Depressive Positions

The positions of Kleinian theory, underlain by unconscious phantasy, are stages in the normal development of ego and object relationships, each with its own characteristic defences and organizational structure. The paranoid-schizoid and depressive positions occur in the pre-oedipal, oral phase of development.

In contrast to Fairbairn and later Guntrip, Klein believed that both good and bad objects are introjected by the infant, the internalisation of good objects being essential to the development of healthy ego function. Klein conceptualised the depressive position as “the most mature form of psychological organisation”, which continues to develop throughout the life span.

The depressive position occurs during the second quarter of the first year. Prior to that the infant is in the paranoid-schizoid position, which is characterised by persecutory anxieties and the mechanisms of splitting, projection, introjection, and omnipotence – which includes idealising and denial – to defend against these anxieties. Depressive and paranoid-schizoid modes of experience continue to intermingle throughout the first few years of childhood.

Paranoid-Schizoid Position

The paranoid-schizoid position is characterised by part object relationships. Part objects are a function of splitting, which takes place in phantasy. At this developmental stage, experience can only be perceived as all good or all bad. As part objects, it is the function that is identified by the experiencing self, rather than whole and autonomous others. The hungry infant desires the good breast who feeds it. Should that breast appear, it is the good breast. If the breast does not appear, the hungry and now frustrated infant, in its distress, has destructive phantasies dominated by oral aggression towards the bad, hallucinated breast.

Klein notes that in splitting the object, the ego is also split. The infant who phantasies destruction of the bad breast is not the same infant that takes in the good breast, at least not until obtaining the depressive position, at which point good and bad can be tolerated simultaneously in the same person and the capacity for remorse and reparation ensue.

The anxieties of the paranoid schizoid position are of a persecutory nature, fear of the ego’s annihilation. Splitting allows good to stay separate from bad. Projection is an attempt to eject the bad in order to control through omnipotent mastery. Splitting is never fully effective, according to Klein, as the ego tends towards integration.

Depressive Position

Klein saw the depressive position as an important developmental milestone that continues to mature throughout the life span. The splitting and part object relations that characterise the earlier phase are succeeded by the capacity to perceive that the other who frustrates is also the one who gratifies. Schizoid defences are still in evidence, but feelings of guilt, grief, and the desire for reparation gain dominance in the developing mind.

In the depressive position, the infant is able to experience others as whole, which radically alters object relationships from the earlier phase. “Before the depressive position, a good object is not in any way the same thing as a bad object. It is only in the depressive position that polar qualities can be seen as different aspects of the same object.” Increasing nearness of good and bad brings a corresponding integration of ego.

In a development which Grotstein terms the “primal split”, the infant becomes aware of separateness from the mother. This awareness allows guilt to arise in response to the infant’s previous aggressive phantasies when bad was split from good. The mother’s temporary absences allow for continuous restoration of her “as an image of representation” in the infant mind. Symbolic thought may now arise, and can only emerge once access to the depressive position has been obtained. With the awareness of the primal split, a space is created in which the symbol, the symbolised, and the experiencing subject coexist. History, subjectivity, interiority, and empathy all become possible.

The anxieties characteristic of the depressive position shift from a fear of being destroyed to a fear of destroying others. In fact or phantasy, one now realises the capacity to harm or drive away a person who one ambivalently loves. The defences characteristic of the depressive position include the manic defences, repression and reparation. The manic defences are the same defences evidenced in the paranoid-schizoid position, but now mobilised to protect the mind from depressive anxiety. As the depressive position brings about an increasing integration in the ego, earlier defences change in character, becoming less intense and allowing for in increased awareness of psychic reality.

In working through depressive anxiety, projections are withdrawn, allowing the other more autonomy, reality, and a separate existence. The infant, whose destructive phantasies were directed towards the bad mother who frustrated, now begins to realise that bad and good, frustrating and satiating, it is always the same mother. Unconscious guilt for destructive phantasies arises in response to the continuing love and attention provided by caretakers.

[As] fears of losing the loved one become active, a very important step is made in the development. These feelings of guilt and distress now enter as a new element into the emotion of love. They become an inherent part of love, and influence it profoundly both in quality and quantity.

From this developmental milestone come a capacity for sympathy, responsibility to and concern for others, and an ability to identify with the subjective experience of people one cares about. With the withdrawal of the destructive projections, repression of the aggressive impulses takes place. The child allows caretakers a more separate existence, which facilitates increasing differentiation of inner and outer reality. Omnipotence is lessened, which corresponds to a decrease in guilt and the fear of loss.

When all goes well, the developing child is able to comprehend that external others are autonomous people with their own needs and subjectivity.

Previously, extended absences of the object (the good breast, the mother) was experienced as persecutory, and, according to the theory of unconscious phantasy, the persecuted infant phantasies destruction of the bad object. The good object who then arrives is not the object which did not arrive. Likewise, the infant who destroyed the bad object is not the infant who loves the good object.

In phantasy, the good internal mother can be psychically destroyed by the aggressive impulses. It is crucial that the real parental figures are around to demonstrate the continuity of their love. In this way, the child perceives that what happens to good objects in phantasy does not happen to them in reality. Psychic reality is allowed to evolve as a place separate from the literalness of the physical world.

Through repeated experience with good enough parenting, the internal image that the child has of external others, that is the child’s internal object, is modified by experience and the image transforms, merging experiences of good and bad which becomes more similar to the real object (e.g. the mother, who can be both good and bad). In Freudian terms, the pleasure principle is modified by the reality principle.

Melanie Klein saw this surfacing from the depressive position as a prerequisite for social life. Moreover, she viewed the establishment of an inside and an outside world as the start of interpersonal relationships.

Klein argued that people who never succeed in working through the depressive position in their childhood will, as a result, continue to struggle with this problem in adult life. For example: the cause that a person may maintain suffering from intense guilt feelings over the death of a loved one, may be found in the unworked- through depressive position. The guilt is there because of a lack of differentiation between phantasy and reality. It also functions as a defence mechanism to defend the self against unbearable feelings of sadness and sorrow, and the internal object of the loved one against the unbearable rage of the self, which, it is feared, could destroy the internal object forever.

Further Thinking Regarding the Positions

Wilfred Bion articulates the dynamic nature of the positions, a point emphasised by Thomas Ogden, and expanded by John Steiner in terms of ‘”The equilibrium between the paranoid-schizoid and the depressive positions”‘. Ogden and James Grotstein have continued to explore early infantile states of mind, and incorporating the work of Donald Meltzer, Ester Bick and others, postulate a position preceding the paranoid-schizoid. Grotstein, following Bion, also hypothesizes a transcendent position which emerges following attainment of the depressive position. This aspect of both Ogden and Grotstein’s work remains controversial for many within classical object relations theory.

Death Drive

Sigmund Freud developed the concept object relation to describe or emphasize that bodily drives satisfy their need through a medium, an object, on a specific focus. The central thesis in Melanie Klein’s object relations theory was that objects play a decisive role in the development of a subject and can be either part-objects or whole-objects, i.e. a single organ (a mother’s breast) or a whole person (a mother). Consequently, both a mother or just the mother’s breast can be the focus of satisfaction for a drive. Furthermore, according to traditional psychoanalysis, there are at least two types of drives, the libido (mythical counterpart: Eros), and the death drive, mortido (mythical counterpart: Thanatos). Thus, the objects can be receivers of both love and hate, the affective effects of the libido and the death drive.

Ronald Fairbairn’s Six Ego Positions

Fairbairn posited six ego positions or inner voices, or 3 pairs:

  • The Whole Ego relating to the Good Object, is the healthy inner child relating to the patient and nurturing inner parent.
    • This is the part of the inner world that object relations therapists try to expand and grow.
  • The Antilibidinal Ego relating to the Bad Object, is the depressed, angry or hopeless inner child relating to the rejecting or neglectful inner parent.
    • Whenever someone speaks in a tantrum-like way they are speaking from the Antilibidinal Ego, and they are speaking to the Bad Object.
    • Whenever someone is overly critical and harshly judgmental they are speaking from the Bad Object part of their personality, and are speaking to the Antilibidinal Ego (hopeless inner child).
  • The Libidinal Ego relating to the Exciting Object, is the gullible and overly hopeful inner child relating to the exciting over-promising inner parent.
    • Whenever a person goes back to their cheating or abusive spouse they are operating from their Libidinal Ego and relating to the Exciting Object in their inner worlds.
    • Whenever they are in an addiction they are treating whatever they are addicted to as if it were an Exciting Object.

The Fairbairnian object relations therapist imagines that all interactions between the client and the therapist are occurring in the client’s inner object relations world, in one of the three dyads. If the client thinks the therapist is wise and compassionate the therapist sees this as an interaction between the client’s Libidinal Ego and Exciting Object. If the client is angry at the therapist for not meeting the client’s needs, the therapist might see it as an interaction between the client’s Antilibidinal Ego and the Bad Object. The therapist might ask the client if this particular interaction reminds the client of something from childhood.

The Fairbairnian object relations therapist also uses his/her own emotional reactions as therapeutic cues. If the therapist is feeling irritated at the client, or bored, he/she might interpret that as a re-enactment of the Antilibidinal Ego and the Bad Object, with the therapist cast in the role of Bad Object. If the therapist can patiently be an empathic therapist through the client’s re-enactment, then the client has a new experience to incorporate into their inner object world, hopefully expanding their inner picture of their Good Object. Cure is seen as the client being able to receive from their inner Good Object often enough to have a more stable peaceful life.

The Fairbairnian object relations Therapist also uses their mistakes in the therapy. If the therapist has absent mindedly made a mistake that hurts the client, the therapist admits the mistake, and empathizes with the client’s pain, but instead of apologising, the therapist asks: How did this mistake in therapy re-enact a childhood scene?

Numerous research studies have found that most all models of psychotherapy are equally helpful, the difference mainly being the quality of the individual therapist, not the theory the therapist subscribes to. Object Relations Theory attempts to explain this phenomenon via the theory of the Good Object. If a therapist can be patient and empathic, most clients improve their functioning in their world. The client carries with them a picture of the empathic therapist that helps them cope with the stressors of daily life, regardless of what theory of psychology they subscribe to.

Continuing Developments in the Theory

Attachment theory, researched by John Bowlby and others, has continued to deepen our understanding of early object relationships. While a different strain of psychoanalytic theory and research, the findings in attachment studies have continued to support the validity of the developmental progressions described in object relations. Recent decades in developmental psychological research, for example on the onset of a “theory of mind” in children, has suggested that the formation of the mental world is enabled by the infant-parent interpersonal interaction which was the main thesis of British object-relations tradition (e.g. Fairbairn, 1952).

While object relations theory grew out of psychoanalysis, it has been applied to the general fields of psychiatry and psychotherapy by such authors as N. Gregory Hamilton and Glen O. Gabbard. In making object relations theory more useful as a general psychology N. Gregory Hamilton added the specific ego functions to Otto F. Kernberg’s concept of object relations units.

What is the Journal of the American Psychoanalytic Association?

Introduction

The Journal of the American Psychoanalytic Association is a bi-monthly peer-reviewed healthcare journal covering all aspects of psychoanalysis and is the official journal of the American Psychoanalytic Association.

Details

  • 1953 to present.
  • Bi-monthly.
  • English language.

Abstracting and Indexing

Journal of the American Psychoanalytic Association is abstracted and indexed in, among other databases: SCOPUS, and the Social Sciences Citation Index.

According to the Journal Citation Reports, the journal has a 2017 impact factor of 0.538, ranking it 4th out of 12 journals in the category “Psychology, Psychoanalysis”, and 130th out of 142 journals in the category “Psychiatry (SSCI)”.

Website

What is Integrative Psychotherapy?

Introduction

Integrative psychotherapy is the integration of elements from different schools of psychotherapy in the treatment of a client.

Integrative psychotherapy may also refer to the psychotherapeutic process of integrating the personality: uniting the “affective, cognitive, behavioural, and physiological systems within a person”.

Background

Initially, Sigmund Freud developed a talking cure called psychoanalysis; then he wrote about his therapy and popularised psychoanalysis. After Freud, many different disciplines splintered off. Some of the more common therapies include: psychodynamic psychotherapy, transactional analysis, cognitive behavioural therapy, gestalt therapy, body psychotherapy, family systems therapy, person-centred psychotherapy, and existential therapy. Hundreds of different theories of psychotherapy are practiced (Norcross, 2005, p.5).

A new therapy is born in several stages. After being trained in an existing school of psychotherapy, the therapist begins to practice. Then, after follow up training in other schools, the therapist may combine the different theories as a basis of a new practice. Then, some practitioners write about their new approach and label this approach with a new name.

A pragmatic or a theoretical approach can be taken when fusing schools of psychotherapy. Pragmatic practitioners blend a few strands of theory from a few schools as well as various techniques; such practitioners are sometimes called eclectic psychotherapists and are primarily concerned with what works. Alternatively, other therapists consider themselves to be more theoretically grounded as they blend their theories; they are called integrative psychotherapists and are not only concerned with what works, but why it works (Norcross, 2005, p.8).

For example, an eclectic therapist might experience a change in their client after administering a particular technique and be satisfied with a positive result. In contrast, an integrative therapist is curious about the “why and how” of the change as well. A theoretical emphasis is important: for example, the client may only have been trying to please the therapist and was adapting to the therapist rather than becoming more fully empowered in themselves.

Different Routes to Integration

The most recent edition of the Handbook of Psychotherapy Integration (Norcross & Goldfried, 2005) recognized four general routes to integration: common factors, technical eclecticism, theoretical integration, and assimilative integration (Norcross, 2005).

Common Factors

The first route to integration is called common factors and “seeks to determine the core ingredients that different therapies share in common” (Norcross, 2005, p.9). The advantage of a common factors approach is the emphasis on therapeutic actions that have been demonstrated to be effective. The disadvantage is that common factors may overlook specific techniques that have been developed within particular theories. Common factors have been described by Jerome Frank (Frank & Frank, 1991), Bruce Wampold (Wampold & Imel, 2015), and Miller, Duncan and Hubble (2005). Common factors theory asserts it is precisely the factors common to the most psychotherapies that make any psychotherapy successful.

Some psychologists have converged on the conclusion that a wide variety of different psychotherapies can be integrated via their common ability to trigger the neurobiological mechanism of memory reconsolidation in such a way as to lead to deconsolidation (Ecker, Ticic & Hulley 2012; Lane et al. 2015; Welling 2012 – but for a more hesitant view of the role of memory reconsolidation in psychotherapy see the objections in some of the invited comments in: Lane et al. 2015).

Technical Eclecticism

The second route to integration is technical eclecticism which is designed “to improve our ability to select the best treatment for the person and the problem…guided primarily by data on what has worked best for others in the past” (Norcross, 2005, p.8). The advantage of technical eclecticism is that it encourages the use of diverse strategies without being hindered by theoretical differences. A disadvantage is that there may not be a clear conceptual framework describing how techniques drawn from divergent theories might fit together. The most well known model of technical eclectic psychotherapy is Arnold Lazarus’ (2005) multimodal therapy. Another model of technical eclecticism is Larry E. Beutler and colleagues’ systematic treatment selection (Beutler, Consoli, & Lane, 2005).

Theoretical Integration

The third route to integration commonly recognised in the literature is theoretical integration in which “two or more therapies are integrated in the hope that the result will be better than the constituent therapies alone” (Norcross, 2005, p.8). Some models of theoretical integration focus on combining and synthesizing a small number of theories at a deep level, whereas others describe the relationship between several systems of psychotherapy. One prominent example of theoretical synthesis is Paul Wachtel’s model of cyclical psychodynamics that integrates psychodynamic, behavioural, and family systems theories (Wachtel, Kruk, & McKinney, 2005). Another example of synthesis is Anthony Ryle’s model of cognitive analytic therapy, integrating ideas from psychoanalytic object relations theory and cognitive psychotherapy (Ryle, 2005). Another model of theoretical integration is specifically called integral psychotherapy (Forman, 2010; Ingersoll & Zeitler, 2010). The most notable model describing the relationship between several different theories is the transtheoretical model (Prochaska & DiClemente, 2005).

Assimilative Integration

Assimilative integration is the fourth route and acknowledges that most psychotherapists select a theoretical orientation that serves as their foundation but, with experience, incorporate ideas and strategies from other sources into their practice. “This mode of integration favours a firm grounding in any one system of psychotherapy, but with a willingness to incorporate or assimilate, in a considered fashion, perspectives or practices from other schools” (Messer, 1992, p.151). Some counsellors may prefer the security of one foundational theory as they begin the process of integrative exploration. Formal models of assimilative integration have been described based on a psychodynamic foundation (Frank, 1999; Stricker & Gold, 2005) and based on cognitive behavioural therapy (Castonguay, Newman, Borkovec, Holtforth, & Maramba, 2005).

Govrin (2015) pointed out a form of integration, which he called “integration by conversion”, whereby theorists import into their own system of psychotherapy a foreign and quite alien concept, but they give the concept a new meaning that allows them to claim that the newly imported concept was really an integral part of their original system of psychotherapy, even if the imported concept significantly changes the original system. Govrin gave as two examples Heinz Kohut’s novel emphasis on empathy in psychoanalysis in the 1970s and the novel emphasis on mindfulness and acceptance in “third-wave” cognitive behavioural therapy in the 1990s to 2000s.

Other Models that Combine Routes

In addition to well-established approaches that fit into the five routes mentioned above, there are newer models that combine aspects of the traditional routes.

Clara E. Hill’s (2014) three-stage model of helping skills encourages counsellors to emphasize skills from different theories during different stages of helping. Hill’s model might be considered a combination of theoretical integration and technical eclecticism. The first stage is the exploration stage. This is based on client-centred therapy. The second stage is entitled insight. Interventions used in this stage are based on psychoanalytic therapy. The last stage, the action stage, is based on behavioural therapy.

Good and Beitman (2006) described an integrative approach highlighting both core components of effective therapy and specific techniques designed to target clients’ particular areas of concern. This approach can be described as an integration of common factors and technical eclecticism.

Multitheoretical psychotherapy (Brooks-Harris, 2008) is an integrative model that combines elements of technical eclecticism and theoretical integration. Therapists are encouraged to make intentional choices about combining theories and intervention strategies.

An approach called integral psychotherapy (Forman, 2010; Ingersoll & Zeitler, 2010) is grounded in the work of theoretical psychologist and philosopher Ken Wilber (2000), who integrates insights from contemplative and meditative traditions. Integral theory is a meta-theory that recognises that reality can be organised from four major perspectives: subjective, intersubjective, objective, and interobjective. Various psychotherapies typically ground themselves in one these four foundational perspectives, often minimising the others. Integral psychotherapy includes all four. For example, psychotherapeutic integration using this model would include subjective approaches (cognitive, existential), intersubjective approaches (interpersonal, object relations, multicultural), objective approaches (behavioural, pharmacological), and interobjective approaches (systems science). By understanding that each of these four basic perspectives all simultaneously co-occur, each can be seen as essential to a comprehensive view of the life of the client. Integral theory also includes a stage model that suggests that various psychotherapies seek to address issues arising from different stages of psychological development (Wilber, 2000).

The generic term, integrative psychotherapy, can be used to describe any multi-modal approach which combines therapies. For example, an effective form of treatment for some clients is psychodynamic psychotherapy combined with hypnotherapy. Kraft & Kraft (2007) gave a detailed account of this treatment with a 54-year-old female client with refractory IBS in a setting of a phobic anxiety state. The client made a full recovery and this was maintained at the follow-up a year later.

Comparison with Eclecticism

In Integrative and Eclectic Counselling and Psychotherapy (Woolfe & Palmer, 2000, pp.55 & 256), the authors make clear the distinction between integrative and eclectic psychotherapy approaches: “Integration suggests that the elements are part of one combined approach to theory and practice, as opposed to eclecticism which draws ad hoc from several approaches in the approach to a particular case.” Psychotherapy’s eclectic practitioners are not bound by the theories, dogma, conventions or methodology of any one particular school. Instead, they may use what they believe or feel or experience tells them will work best, either in general or suiting the often immediate needs of individual clients; and working within their own preferences and capabilities as practitioners (Norcross & Goldfried, 2005, pp.3-23).

References

  • Beutler, L.E., Consoli, A.J. & Lane, G. (2005). Systematic treatment selection and prescriptive psychotherapy: an integrative eclectic approach. In J.C. Norcross & M.R. Goldfried (Eds.), Handbook of Psychotherapy Integration (2nd Ed, pp.121-143). New York: Oxford.
  • Brooks-Harris, J.E. (2008). Integrative Multitheoretical Psychotherapy. Boston: Houghton-Mifflin.
  • Castonguay, L.G., Newman, M.G., Borkovec, T.D., Holtforth, M.G. & Maramba, G.G. (2005). Cognitive-behavioral assimilative integration. In J.C. Norcross & M.R. Goldfried (Eds.), Handbook of Psychotherapy Integration (2nd Ed, pp.241-260). New York: Oxford.
  • Ecker, B., Ticic, R. & Hulley, L. (2012). Unlocking the Emotional Brain: Eliminating Symptoms at Their Roots Using Memory Reconsolidation. New York: Routledge.
  • Forman, M.D. (2010). A Guide to Integral Psychotherapy: Complexity, Integration, and Spirituality in Practice. Albany, NY: SUNY Press.
  • Frank, J.D. & Frank, J.B. (1991). Persuasion and Healing: A Comparative Study of Psychotherapy (3rd Ed). Baltimore, MD: Johns Hopkins University.
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  • Good, G.E. & Beitman, B.D. (2006). Counseling and Psychotherapy Essentials: Integrating Theories, Skills, and Practices. New York: W.W. Norton.
  • Govrin, A. (2015). Blurring the threat of ‘otherness’: integration by conversion in psychoanalysis and CBT. Journal of Psychotherapy Integration. 26(1), pp.78-90.
  • Hill, C.E. (2014). Helping Skills: Facilitating Exploration, Insight, and Action. 4th Ed. Washington, DC: American Psychological Association.
  • Ingersoll, E. & Zeitler, D. (2010). Integral Psychotherapy: Inside Out/Outside In. Albany, NY: SUNY Press.
  • Kraft T. & Kraft D. (2007). Irritable bowel syndrome: symptomatic treatment approaches versus integrative psychotherapy. Contemporary Hypnosis, 24(4), pp.161-177.
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On This Day … 22 January

People (Births)

  • 1913 – Henry Bauchau, Belgian psychoanalyst and author (d. 2012).
  • 1932 – Berthold Grünfeld, Norwegian psychiatrist and academic (d. 2007).

Henry Bauchau

Henry Bauchau (22 January 1913 to 21 September 2012) was a Belgian psychoanalyst, lawyer, and author of French prose and poetry.

He became a trial lawyer in Brussels in 1936 and was a member of the Belgian Resistance in the Ardennes during World War II.

Berthold Grunfeld

Berthold Grünfeld (22 January 1932 to 20 August 2007) was a Norwegian psychiatrist, sexologist, and professor of social medicine at the University of Oslo. He was also a recognised expert in forensic psychiatry, often employed by Norwegian courts to examine insanity defence pleas.

Grünfeld was born in Bratislava in what was then Czechoslovakia. In 1939, when he was seven, he and 34 other Jewish children were separated from their families in an attempt by Nansenhjelpen to rescue them from the early manifestations of the Holocaust. The group of children was sent by train to Norway via Berlin, after having been told they would never again see their parents.

Once in Norway, Grünfeld was first placed at the Jewish children’s home in Oslo, then lived as a foster child with a Jewish family in Trondheim before returning to the orphanage. During the occupation of Norway, Grünfeld avoided capture and deportation by fleeing with members of the Norwegian Resistance in 1942 to neutral Sweden, where he stayed until the war ended. He returned to the children’s home in 1946. The Jewish community funded his education.

Berthold Grünfeld earned his medical degree in 1960, when he also met his future wife Gunhild. He was awarded his doctorate in medicine in 1973 based on a dissertation on abortion. In 1993, he was made professor of social medicine at the University of Oslo.

Grünfeld was noted for his academic contributions within sexology, on the issues of abortion and euthanasia, and within forensic psychology. In addition to his advocacy and teaching, he acted as an expert witness in criminal cases, and as a consultant on human relations and sexology for Oslo Helseråd. His dissertation influenced the reform of abortion laws in Norway.

Grünfeld and his wife had three children and six grandchildren. In 2005, his daughter Nina Grünfeld made a film, Origin Unknown, about her efforts to research her father’s background and heritage. Among other things, she found that his mother had worked as a prostitute and was murdered in the death camp at Sobibor.

On This Day … 17 January

People (Deaths)

  • 1881 – Harry Price, English psychologist and author (d. 1948).
  • 1887 – Ola Raknes, Norwegian psychoanalyst and philologist (d. 1975).
  • 1945 – Anne Cutler, Australian psychologist and academic.

Harry Price

Harry Price (17 January 1881 to 29 March 1948) was a British psychic researcher and author, who gained public prominence for his investigations into psychical phenomena and his exposing fraudulent spiritualist mediums. He is best known for his well-publicised investigation of the purportedly haunted Borley Rectory in Essex, England.

Ola Raknes

Ola Raknes (17 January 1887 to 28 January 1975) was a Norwegian psychologist, philologist and non-fiction writer. Born in Bergen, Norway, he was internationally known as a psychoanalyst in the Reichian tradition. He has been described as someone who spent his entire life working with the conveying of ideas through many languages and between different epistemological systems of reference, science and religion (Dannevig, 1975). For large portions of his life he was actively contributing to the public discourse in Norway. He has also been credited for his contributions to strengthening and enriching the Nynorsk language and its use in the public sphere.

Raknes was known as a thorough philologist and a controversial therapist. Internationally he was known as one of Wilhelm Reich’s closest students and defenders.

Anne Cutler

(Elizabeth) Anne Cutler (1945 to Present) FRS is a Research Professor at the MARCS Institute for Brain, Behaviour and Development, Western Sydney University and Emeritus Director of the Max Planck Institute for Psycholinguistics in Nijmegen.

On This Day … 14 January

People (Deaths)

Harry Stack Sullivan

Herbert “Harry” Stack Sullivan (21 February 1892 to 14 January 1949) was an American Neo-Freudian psychiatrist and psychoanalyst who held that “personality can never be isolated from the complex interpersonal relationships in which [a] person lives” and that “[t]he field of psychiatry is the field of interpersonal relations under any and all circumstances in which [such] relations exist”.

Having studied therapists Sigmund Freud, Adolf Meyer, and William Alanson White, he devoted years of clinical and research work to helping people with psychotic illness.

Early Life

Sullivan was a child of Irish immigrants and grew up in the then anti-Catholic town of Norwich, New York, resulting in a social isolation which may have inspired his later interest in psychiatry. He attended the Smyrna Union School, then spent two years at Cornell University from 1909, receiving his medical degree in Chicago College of Medicine and Surgery in 1917.

Work

Along with Clara Thompson, Karen Horney, Erich Fromm, Otto Allen Will, Jr., Erik H. Erikson, and Frieda Fromm-Reichmann, Sullivan laid the groundwork for understanding the individual based on the network of relationships in which they are enmeshed. He developed a theory of psychiatry based on interpersonal relationships where cultural forces are largely responsible for mental illnesses (see also social psychiatry). In his words, one must pay attention to the “interactional”, not the “intrapsychic”. This search for satisfaction via personal involvement with others led Sullivan to characterise loneliness as the most painful of human experiences. He also extended the Freudian psychoanalysis to the treatment of patients with severe mental disorders, particularly schizophrenia.

Besides making the first mention of the significant other in psychological literature, Sullivan developed the idea of the “Self System”, a configuration of the personality traits developed in childhood and reinforced by positive affirmation and the security operations developed in childhood to avoid anxiety and threats to self-esteem. Sullivan further defined the Self System as a steering mechanism toward a series of I-You interlocking behaviours; that is, what an individual does is meant to elicit a particular reaction.

Sullivan called these behaviours Parataxical Integrations and he noted that such action-reaction combinations can become rigid and dominate an adult’s thinking pattern, limiting their actions and reactions toward the world as the adult sees the world and not as it really is. The resulting inaccuracies in judgment Sullivan termed parataxic distortion, when other persons are perceived or evaluated based on the patterns of previous experience, similar to Freud’s notion of transference. Sullivan also introduced the concept of “prototaxic communication” as a more primitive, needy, infantile form of psychic interchange and of “syntactic communication” as a mature style of emotional interaction.

Sullivan’s work on interpersonal relationships became the foundation of interpersonal psychoanalysis, a school of psychoanalytic theory and treatment that stresses the detailed exploration of the nuances of patients’ patterns of interacting with others.

Sullivan was the first to coin the term “problems in living” to describe the difficulties with self and others experienced by those with mental illnesses. This phrase was later picked up and popularised by Thomas Szasz, whose work was a foundational resource for the antipsychiatry movement. “Problems in living” went on to become the movement’s preferred way to refer to the manifestations of mental disturbances.

In 1927, he reviewed the controversial, anonymously published The Invert and his Social Adjustment and in 1929 called it “a remarkable document by a homosexual man of refinement; intended primarily as a guide to the unfortunate sufferers of sexual inversion, and much less open to criticism than anything else of the kind so far published.”

He was one of the founders of the William Alanson White Institute, considered by many to be the world’s leading independent psychoanalytic institute, and of the journal Psychiatry in 1937. He headed the Washington, DC School of Psychiatry from 1936 to 1947.

In 1940, he and colleague Winfred Overholser, serving on the American Psychiatric Society’s committee on Military Mobilisation, formulated guidelines for the psychological screening of inductees to the United States military. He believed, writes one historian, “that sexuality played a minimal role in causing mental disorders and that adult homosexuals should be accepted and left alone.” Despite his best efforts, others included homosexuality as a disqualification for military service.

Beginning on 05 December 1940, Sullivan served as psychiatric adviser to Selective Service director Clarence A. Dykstra, but resigned in November 1941 after General Lewis B. Hershey, who was hostile to psychiatry, became the director. Sullivan then took part in establishing the Office of War Information in 1942. Beginning in 1927, Sullivan had a 22-year relationship with James Inscoe Sullivan, known as “Jimmie”, who was 20 years younger than Sullivan.

Although some contemporaries and historians have regarded Inscoe as an unofficially adopted son, and Sullivan as closeted, one should remember that to be open about it would have made his professional interest in the area and further research very difficult. His colleague Helen Swick Perry’s biography of Sullivan mentions the relationship and it is clear his close friends were well aware they were partners.

Writings

Although Sullivan published little in his lifetime, he influenced generations of mental health professionals, especially through his lectures at Chestnut Lodge in Rockville, Maryland, outside Washington, DC. Leston Havens called him the most important underground influence in American psychoanalysis. His ideas were collected and published posthumously, edited by Helen Swick Perry, who also published a detailed biography in 1982 (Perry, 1982, Psychiatrist of America).

Works

The following works are in Special Collections (MSA SC 5547) at the Maryland State Archives in Annapolis: Conceptions of Modern Psychiatry, Soundscriber Transcriptions (February 1945 to May 1945); Lectures 1-97 (begins 02 October 1942); Georgetown University Medical School Lectures (1939); Personal Psychopathology (1929-1933); The Psychiatry of Character and its Deviations-undated notes.

His writings include:

  • The Interpersonal Theory of Psychiatry (1953).
  • “The Psychiatric Interview” (1954).
  • Conceptions of Modern Psychiatry (1947/1966).
  • Schizophrenia as a Human Process (1962).

Associates

After Sullivan’s death, Saul B. Newton and his wife Dr. Jane Pearce (a psychiatrist who studied with Sullivan in the late 1940s) established the Sullivan Institute for Research in Psychoanalysis in New York City.

What is Psychology?

Introduction

Psychology is the science of mind and behaviour. Psychology includes the study of conscious and unconscious phenomena, as well as feeling and thought. It is an academic discipline of immense scope. Psychologists seek an understanding of the emergent properties of brains, and all the variety of phenomena linked to those emergent properties, joining this way the broader neuro-scientific group of researchers. As a social science, it aims to understand individuals and groups by establishing general principles and researching specific cases. Not to be confused with psychiatry.

In this field, a professional practitioner or researcher is called a psychologist and can be classified as a social, behavioural, or cognitive scientist. Psychologists attempt to understand the role of mental functions in individual and social behaviour, while also exploring the physiological and biological processes that underlie cognitive functions and behaviours.

Psychologists explore behaviour and mental processes, including perception, cognition, attention, emotion, intelligence, subjective experiences, motivation, brain functioning, and personality. This extends to interaction between people, such as interpersonal relationships, including psychological resilience, family resilience, and other areas. Psychologists of diverse orientations also consider the unconscious mind. Psychologists employ empirical methods to infer causal and correlational relationships between psychosocial variables. In addition, or in opposition, to employing empirical and deductive methods, some – especially clinical psychologists and counselling psychologists – at times rely upon symbolic interpretation and other inductive techniques. Psychology has been described as a “hub science” in that medicine tends to draw psychological research via neurology and psychiatry, whereas social sciences most commonly draws directly from sub-disciplines within psychology.

While psychological knowledge is often applied to the assessment and treatment of mental health problems, it is also directed towards understanding and solving problems in several spheres of human activity. By many accounts, psychology ultimately aims to benefit society. The majority of psychologists are involved in some kind of therapeutic role, practicing in clinical, counselling, or school settings. Many do scientific research on a wide range of topics related to mental processes and behaviour, and typically work in university psychology departments or teach in other academic settings (e.g. medical schools, hospitals). Some are employed in industrial and organizational settings, or in other areas such as human development and aging, sports, health, and the media, as well as in forensic investigation and other aspects of law.

Etymology and Definitions

The word psychology derives from Greek roots meaning study of the psyche, or soul (ψυχή psychē, “breath, spirit, soul” and -λογία -logia, “study of” or “research”).The Latin word psychologia was first used by the Croatian humanist and Latinist Marko Marulić in his book, Psichiologia de ratione animae humanae in the late 15th century or early 16th century. The earliest known reference to the word psychology in English was by Steven Blankaart in 1694 in The Physical Dictionary which refers to “Anatomy, which treats the Body, and Psychology, which treats of the Soul.”

In 1890, William James defined psychology as “the science of mental life, both of its phenomena and their conditions”. This definition enjoyed widespread currency for decades. However, this meaning was contested, notably by radical behaviourists such as John B. Watson, who in his 1913 manifesto defined the discipline of psychology as the acquisition of information useful to the control of behaviour. Also since James defined it, the term more strongly connotes techniques of scientific experimentation. Folk psychology refers to the understanding of ordinary people, as contrasted with that of psychology professionals.

Brief History

The ancient civilizations of Egypt, Greece, China, India, and Persia all engaged in the philosophical study of psychology. In Ancient Egypt the Ebers Papyrus mentioned depression and thought disorders. Historians note that Greek philosophers, including Thales, Plato, and Aristotle (especially in his De Anima treatise), addressed the workings of the mind. As early as the 4th century BC, Greek physician Hippocrates theorised that mental disorders had physical rather than supernatural causes.

In China, psychological understanding grew from the philosophical works of Laozi and Confucius, and later from the doctrines of Buddhism. This body of knowledge involves insights drawn from introspection and observation, as well as techniques for focused thinking and acting. It frames the universe as a division of, and interaction between, physical reality and mental reality, with an emphasis on purifying the mind in order to increase virtue and power. An ancient text known as The Yellow Emperor’s Classic of Internal Medicine identifies the brain as the nexus of wisdom and sensation, includes theories of personality based on yin-yang balance, and analyses mental disorder in terms of physiological and social disequilibria. Chinese scholarship focused on the brain advanced in the Qing Dynasty with the work of Western-educated Fang Yizhi (1611-1671), Liu Zhi (1660-1730), and Wang Qingren (1768-1831). Wang Qingren emphasized the importance of the brain as the centre of the nervous system, linked mental disorder with brain diseases, investigated the causes of dreams and insomnia, and advanced a theory of hemispheric lateralisation in brain function.

Distinctions in types of awareness appear in the ancient thought of India, influenced by Hinduism. A central idea of the Upanishads is the distinction between a person’s transient mundane self and their eternal unchanging soul. Divergent Hindu doctrines, and Buddhism, have challenged this hierarchy of selves, but have all emphasized the importance of reaching higher awareness. Yoga is a range of techniques used in pursuit of this goal. Much of the Sanskrit corpus was suppressed under the British East India Company followed by the British Raj in the 1800s. However, Indian doctrines influenced Western thinking via the Theosophical Society, a New Age group which became popular among Euro-American intellectuals.

Psychology was a popular topic in Enlightenment Europe. In Germany, Gottfried Wilhelm Leibniz (1646-1716) applied his principles of calculus to the mind, arguing that mental activity took place on an indivisible continuum – most notably, that among an infinity of human perceptions and desires, the difference between conscious and unconscious awareness is only a matter of degree. Christian Wolff identified psychology as its own science, writing Psychologia empirica in 1732 and Psychologia rationalis in 1734. This notion advanced further under Immanuel Kant, who established the idea of anthropology, with psychology as an important subdivision. However, Kant explicitly and notoriously rejected the idea of experimental psychology, writing that “the empirical doctrine of the soul can also never approach chemistry even as a systematic art of analysis or experimental doctrine, for in it the manifold of inner observation can be separated only by mere division in thought, and cannot then be held separate and recombined at will (but still less does another thinking subject suffer himself to be experimented upon to suit our purpose), and even observation by itself already changes and displaces the state of the observed object.” In 1783, Ferdinand Ueberwasser (1752-1812) designated himself Professor of Empirical Psychology and Logic and gave lectures on scientific psychology, though these developments were soon overshadowed by the Napoleonic Wars, after which the Old University of Münster was discontinued by Prussian authorities. Having consulted philosophers Hegel and Herbart, however, in 1825 the Prussian state established psychology as a mandatory discipline in its rapidly expanding and highly influential educational system. However, this discipline did not yet embrace experimentation. In England, early psychology involved phrenology and the response to social problems including alcoholism, violence, and the country’s well-populated mental asylums.

The Beginning of Experimental Psychology

Gustav Fechner began conducting psychophysics research in Leipzig in the 1830s, articulating the principle (Weber-Fechner law) that human perception of a stimulus varies logarithmically according to its intensity. Fechner’s 1860 Elements of Psychophysics challenged Kant’s stricture against quantitative study of the mind. In Heidelberg, Hermann von Helmholtz conducted parallel research on sensory perception, and trained physiologist Wilhelm Wundt. Wundt, in turn, came to Leipzig University, establishing the psychological laboratory which brought experimental psychology to the world. Wundt focused on breaking down mental processes into the most basic components, motivated in part by an analogy to recent advances in chemistry, and its successful investigation of the elements and structure of material. Paul Flechsig and Emil Kraepelin soon created another influential psychology laboratory at Leipzig, this one focused on more on experimental psychiatry.

Psychologists in Germany, Denmark, Austria, England, and the United States soon followed Wundt in setting up laboratories. G. Stanley Hall who studied with Wundt, formed a psychology lab at Johns Hopkins University in Maryland, which became internationally influential. Hall, in turn, trained Yujiro Motora, who brought experimental psychology, emphasizing psychophysics, to the Imperial University of Tokyo. Wundt’s assistant, Hugo Münsterberg, taught psychology at Harvard to students such as Narendra Nath Sen Gupta – who, in 1905, founded a psychology department and laboratory at the University of Calcutta. Wundt students Walter Dill Scott, Lightner Witmer, and James McKeen Cattell worked on developing tests for mental ability. Catell, who also studied with eugenicist Francis Galton, went on to found the Psychological Corporation. Wittmer focused on mental testing of children; Scott, on selection of employees.

Another student of Wundt, Edward Titchener, created the psychology program at Cornell University and advanced a doctrine of “structuralist” psychology. Structuralism sought to analyse and classify different aspects of the mind, primarily through the method of introspection. William James, John Dewey and Harvey Carr advanced a more expansive doctrine called functionalism, attuned more to human-environment actions. In 1890, James wrote an influential book, The Principles of Psychology, which expanded on the realm of structuralism, memorably described the human “stream of consciousness”, and interested many American students in the emerging discipline. Dewey integrated psychology with social issues, most notably by promoting the cause progressive education to assimilate immigrants and inculcate moral values in children.

A different strain of experimentalism, with more connection to physiology, emerged in South America, under the leadership of Horacio G. Piñero at the University of Buenos Aires. Russia, too, placed greater emphasis on the biological basis for psychology, beginning with Ivan Sechenov’s 1873 essay, “Who Is to Develop Psychology and How?” Sechenov advanced the idea of brain reflexes and aggressively promoted a deterministic viewpoint on human behaviour.

Wolfgang Kohler, Max Wertheimer and Kurt Koffka co-founded the school of Gestalt psychology (not to be confused with the Gestalt therapy of Fritz Perls). This approach is based upon the idea that individuals experience things as unified wholes. Rather than breaking down thoughts and behaviour into smaller elements, as in structuralism, the Gestaltists maintained that whole of experience is important, and differs from the sum of its parts. Other 19th-century contributors to the field include the German psychologist Hermann Ebbinghaus, a pioneer in the experimental study of memory, who developed quantitative models of learning and forgetting at the University of Berlin, and the Russian-Soviet physiologist Ivan Pavlov, who discovered in dogs a learning process that was later termed “classical conditioning” and applied to human beings.

Consolidation and Funding

One of the earliest psychology societies was La Société de Psychologie Physiologique in France, which lasted 1885-1893. The first meeting of the International Congress of Psychology sponsored by the International Union of Psychological Science took place in Paris, in August 1889, amidst the World’s Fair celebrating the centennial of the French Revolution. William James was one of three Americans among the four hundred attendees. The American Psychological Association (APA) was founded soon after, in 1892. The International Congress continued to be held, at different locations in Europe, with wider international participation. The Sixth Congress, Geneva 1909, included presentations in Russian, Chinese, and Japanese, as well as Esperanto. After a hiatus for World War I, the Seventh Congress met in Oxford, with substantially greater participation from the war-victorious Anglo-Americans. In 1929, the Congress took place at Yale University in New Haven, Connecticut, attended by hundreds of members of the APA. Tokyo Imperial University led the way in bringing new psychology to the East, and from Japan these ideas diffused into China.

American psychology gained status during World War I, during which a standing committee headed by Robert Yerkes administered mental tests (“Army Alpha” and “Army Beta”) to almost 1.8 million soldiers. Subsequent funding for behavioural research came in large part from the Rockefeller family, via the Social Science Research Council. Rockefeller charities funded the National Committee on Mental Hygiene, which promoted the concept of mental illness and lobbied for psychological supervision of child development. Through the Bureau of Social Hygiene and later funding of Alfred Kinsey, Rockefeller foundations established sex research as a viable discipline in the U.S.[41] Under the influence of the Carnegie-funded Eugenics Record Office, the Draper-funded Pioneer Fund, and other institutions, the eugenics movement also had a significant impact on American psychology; in the 1910s and 1920s, eugenics became a standard topic in psychology classes.

During World War II and the Cold War, the US military and intelligence agencies established themselves as leading funders of psychology – through the armed forces and in the new Office of Strategic Services intelligence agency. University of Michigan psychologist Dorwin Cartwright reported that university researchers began large-scale propaganda research in 1939-1941, and “the last few months of the war saw a social psychologist become chiefly responsible for determining the week-by-week-propaganda policy for the United States Government.” Cartwright also wrote that psychologists had significant roles in managing the domestic economy. The Army rolled out its new General Classification Test and engaged in massive studies of troop morale. In the 1950s, the Rockefeller Foundation and Ford Foundation collaborated with the Central Intelligence Agency (CIA) to fund research on psychological warfare. In 1965, public controversy called attention to the Army’s Project Camelot – the “Manhattan Project” of social science – an effort which enlisted psychologists and anthropologists to analyse foreign countries for strategic purposes.

In Germany after World War I, psychology held institutional power through the military, and subsequently expanded along with the rest of the military under the Third Reich. Under the direction of Hermann Göring’s cousin Matthias Göring, the Berlin Psychoanalytic Institute was renamed the Göring Institute. Freudian psychoanalysts were expelled and persecuted under the anti-Jewish policies of the Nazi Party, and all psychologists had to distance themselves from Freud and Adler. The Göring Institute was well-financed throughout the war with a mandate to create a “New German Psychotherapy”. This psychotherapy aimed to align suitable Germans with the overall goals of the Reich; as described by one physician: “Despite the importance of analysis, spiritual guidance and the active cooperation of the patient represent the best way to overcome individual mental problems and to subordinate them to the requirements of the Volk and the Gemeinschaft.” Psychologists were to provide Seelenführung, leadership of the mind, to integrate people into the new vision of a German community. Harald Schultz-Hencke melded psychology with the Nazi theory of biology and racial origins, criticising psychoanalysis as a study of the weak and deformed. Johannes Heinrich Schultz, a German psychologist recognised for developing the technique of autogenic training, prominently advocated sterilisation and euthanasia of men considered genetically undesirable, and devised techniques for facilitating this process. After the war, some new institutions were created and some psychologists were discredited due to Nazi affiliation. Alexander Mitscherlich founded a prominent applied psychoanalysis journal called Psyche and with funding from the Rockefeller Foundation established the first clinical psychosomatic medicine division at Heidelberg University. In 1970, psychology was integrated into the required studies of medical students.

After the Russian Revolution, psychology was heavily promoted by the Bolsheviks as a way to engineer the “New Man” of socialism. Thus, university psychology departments trained large numbers of students, for whom positions were made available at schools, workplaces, cultural institutions, and in the military. An especial focus was paedology, the study of child development, regarding which Lev Vygotsky became a prominent writer. The Bolsheviks also promoted free love and embraced the doctrine of psychoanalysis as an antidote to sexual repression. Although paedology and intelligence testing fell out of favour in 1936, psychology maintained its privileged position as an instrument of the Soviet Union. Stalinist purges took a heavy toll and instilled a climate of fear in the profession, as elsewhere in Soviet society. Following World War II, Jewish psychologists past and present (including Lev Vygotsky, A.R. Luria, and Aron Zalkind) were denounced; Ivan Pavlov (posthumously) and Stalin himself were aggrandised as heroes of Soviet psychology. Soviet academics was speedily liberalised during the Khrushchev Thaw, and cybernetics, linguistics, genetics, and other topics became acceptable again. There emerged a new field called “engineering psychology” which studied mental aspects of complex jobs (such as pilot and cosmonaut). Interdisciplinary studies became popular and scholars such as Georgy Shchedrovitsky developed systems theory approaches to human behaviour.

Twentieth-century Chinese psychology originally modelled the US, with translations from American authors like William James, the establishment of university psychology departments and journals, and the establishment of groups including the Chinese Association of Psychological Testing (1930) and the Chinese Psychological Society (1937). Chinese psychologists were encouraged to focus on education and language learning, with the aspiration that education would enable modernisation and nationalisation. John Dewey, who lectured to Chinese audiences in 1918-1920, had a significant influence on this doctrine. Chancellor T’sai Yuan-p’ei introduced him at Peking University as a greater thinker than Confucius. Kuo Zing-yang who received a PhD at the University of California, Berkeley, became President of Zhejiang University and popularised behaviourism. After the Chinese Communist Party gained control of the country, the Stalinist Soviet Union became the leading influence, with Marxism-Leninism the leading social doctrine and Pavlovian conditioning the approved concept of behaviour change. Chinese psychologists elaborated on Lenin’s model of a “reflective” consciousness, envisioning an “active consciousness” (pinyin: tzu-chueh neng-tung-li) able to transcend material conditions through hard work and ideological struggle. They developed a concept of “recognition” (pinyin: jen-shih) which referred the interface between individual perceptions and the socially accepted worldview (failure to correspond with party doctrine was “incorrect recognition”). Psychology education was centralized under the Chinese Academy of Sciences, supervised by the State Council. In 1951, the Academy created a Psychology Research Office, which in 1956 became the Institute of Psychology. Most leading psychologists were educated in the United States, and the first concern of the Academy was re-education of these psychologists in the Soviet doctrines. Child psychology and pedagogy for nationally cohesive education remained a central goal of the discipline.

Disciplinary Organisation

Institutions

In 1920, Édouard Claparède and Pierre Bovet created a new applied psychology organisation called the International Congress of Psychotechnics Applied to Vocational Guidance, later called the International Congress of Psychotechnics and then the International Association of Applied Psychology. The IAAP is considered the oldest international psychology association. Today, at least 65 international groups deal with specialized aspects of psychology. In response to male predominance in the field, female psychologists in the US formed National Council of Women Psychologists in 1941. This organisation became the International Council of Women Psychologists after World War II, and the International Council of Psychologists in 1959. Several associations including the Association of Black Psychologists and the Asian American Psychological Association have arisen to promote non-European racial groups in the profession.

The world federation of national psychological societies is the International Union of Psychological Science (IUPsyS), founded in 1951 under the auspices of UNESCO, the United Nations cultural and scientific authority. Psychology departments have since proliferated around the world, based primarily on the Euro-American model. Since 1966, the Union has published the International Journal of Psychology. IAAP and IUPsyS agreed in 1976 each to hold a congress every four years, on a staggered basis.

The International Union recognises 66 national psychology associations and at least 15 others exist. The American Psychological Association is the oldest and largest. Its membership has increased from 5,000 in 1945 to 100,000 in the present day. The APA includes 54 divisions, which since 1960 have steadily proliferated to include more specialties. Some of these divisions, such as the Society for the Psychological Study of Social Issues and the American Psychology-Law Society, began as autonomous groups.

The Interamerican Society of Psychology, founded in 1951, aspires to promote psychology and coordinate psychologists across the Western Hemisphere. It holds the Interamerican Congress of Psychology and had 1,000 members in year 2000. The European Federation of Professional Psychology Associations, founded in 1981, represents 30 national associations with a total of 100,000 individual members. At least 30 other international groups organize psychologists in different regions.

In some places, governments legally regulate who can provide psychological services or represent themselves as a “psychologist”. The APA defines a psychologist as someone with a doctoral degree in psychology.

Boundaries

Early practitioners of experimental psychology distinguished themselves from parapsychology, which in the late nineteenth century enjoyed great popularity (including the interest of scholars such as William James), and indeed constituted the bulk of what people called “psychology”. Parapsychology, hypnotism, and psychism were major topics of the early International Congresses. But students of these fields were eventually ostracised, and more or less banished from the Congress in 1900-1905. Parapsychology persisted for a time at Imperial University, with publications such as Clairvoyance and Thoughtography by Tomokichi Fukurai, but here too it was mostly shunned by 1913.

As a discipline, psychology has long sought to fend off accusations that it is a “soft” science. Philosopher of science Thomas Kuhn’s 1962 critique implied psychology overall was in a pre-paradigm state, lacking the agreement on overarching theory found in mature sciences such as chemistry and physics. Because some areas of psychology rely on research methods such as surveys and questionnaires, critics asserted that psychology is not an objective science. Sceptics have suggested that personality, thinking, and emotion, cannot be directly measured and are often inferred from subjective self-reports, which may be problematic. Experimental psychologists have devised a variety of ways to indirectly measure these elusive phenomenological entities.

Divisions still exist within the field, with some psychologists more oriented towards the unique experiences of individual humans, which cannot be understood only as data points within a larger population. Critics inside and outside the field have argued that mainstream psychology has become increasingly dominated by a “cult of empiricism” which limits the scope of its study by using only methods derived from the physical sciences. Feminist critiques along these lines have argued that claims to scientific objectivity obscure the values and agenda of (historically mostly male) researchers. Jean Grimshaw, for example, argues that mainstream psychological research has advanced a patriarchal agenda through its efforts to control behaviour.

Major Schools of Thought

Biological

Psychologists generally consider the organism the basis of the mind, and therefore a vitally related area of study. Psychiatrists and neuropsychologists work at the interface of mind and body. Biological psychology, also known as physiological psychology, or neuropsychology is the study of the biological substrates of behaviour and mental processes. Key research topics in this field include comparative psychology, which studies humans in relation to other animals, and perception which involves the physical mechanics of sensation as well as neural and mental processing. For centuries, a leading question in biological psychology has been whether and how mental functions might be localised in the brain. From Phineas Gage to H.M. and Clive Wearing, individual people with mental issues traceable to physical damage have inspired new discoveries in this area. Modern neuropsychology could be said to originate in the 1870s, when in France Paul Broca traced production of speech to the left frontal gyrus, thereby also demonstrating hemispheric lateralisation of brain function. Soon after, Carl Wernicke identified a related area necessary for the understanding of speech.

The contemporary field of behavioural neuroscience focuses on physical causes underpinning behaviour. For example, physiological psychologists use animal models, typically rats, to study the neural, genetic, and cellular mechanisms that underlie specific behaviours such as learning and memory and fear responses. Cognitive neuroscientists investigate the neural correlates of psychological processes in humans using neural imaging tools, and neuropsychologists conduct psychological assessments to determine, for instance, specific aspects and extent of cognitive deficit caused by brain damage or disease. The biopsychosocial model is an integrated perspective toward understanding consciousness, behaviour, and social interaction. It assumes that any given behaviour or mental process affects and is affected by dynamically interrelated biological, psychological, and social factors.

Evolutionary psychology examines cognition and personality traits from an evolutionary perspective. This perspective suggests that psychological adaptations evolved to solve recurrent problems in human ancestral environments. Evolutionary psychology offers complementary explanations for the mostly proximate or developmental explanations developed by other areas of psychology: that is, it focuses mostly on ultimate or “why?” questions, rather than proximate or “how?” questions. “How?” questions are more directly tackled by behavioural genetics research, which aims to understand how genes and environment impact behaviour.

The search for biological origins of psychological phenomena has long involved debates about the importance of race, and especially the relationship between race and intelligence. The idea of white supremacy and indeed the modern concept of race itself arose during the process of world conquest by Europeans. Carl von Linnaeus’s four-fold classification of humans classifies Europeans as intelligent and severe, Americans as contented and free, Asians as ritualistic, and Africans as lazy and capricious. Race was also used to justify the construction of socially specific mental disorders such as drapetomania and dysaesthesia aethiopica – the behaviour of uncooperative African slaves. After the creation of experimental psychology, “ethnical psychology” emerged as a subdiscipline, based on the assumption that studying primitive races would provide an important link between animal behaviour and the psychology of more evolved humans.

Behavioural

Psychologists take human behaviour as a main area of study. Much of the research in this area began with tests on mammals, based on the idea that humans exhibit similar fundamental tendencies. Behavioural research ever aspires to improve the effectiveness of techniques for behaviour modification.

Early behavioural researchers studied stimulus-response pairings, now known as classical conditioning. They demonstrated that behaviours could be linked through repeated association with stimuli eliciting pain or pleasure. Ivan Pavlov – known best for inducing dogs to salivate in the presence of a stimulus previously linked with food – became a leading figure in the Soviet Union and inspired followers to use his methods on humans. In the United States, Edward Lee Thorndike initiated “connectionism” studies by trapping animals in “puzzle boxes” and rewarding them for escaping. Thorndike wrote in 1911: “There can be no moral warrant for studying man’s nature unless the study will enable us to control his acts.” From 1910-1913 the American Psychological Association went through a sea change of opinion, away from mentalism and towards “behaviouralism”, and in 1913 John B. Watson coined the term behaviourism for this school of thought. Watson’s famous Little Albert experiment in 1920 demonstrated that repeated use of upsetting loud noises could instil phobias (aversions to other stimuli) in an infant human. Karl Lashley, a close collaborator with Watson, examined biological manifestations of learning in the brain.

Embraced and extended by Clark L. Hull, Edwin Guthrie, and others, behaviourism became a widely used research paradigm. A new method of “instrumental” or “operant” conditioning added the concepts of reinforcement and punishment to the model of behaviour change. Radical behaviourists avoided discussing the inner workings of the mind, especially the unconscious mind, which they considered impossible to assess scientifically. Operant conditioning was first described by Miller and Kanorski and popularised in the US by B.F. Skinner, who emerged as a leading intellectual of the behaviourist movement.

Noam Chomsky delivered an influential critique of radical behaviourism on the grounds that it could not adequately explain the complex mental process of language acquisition. Martin Seligman and colleagues discovered that the conditioning of dogs led to outcomes (“learned helplessness”) that opposed the predictions of behaviourism. Skinner’s behaviourism did not die, perhaps in part because it generated successful practical applications. Edward C. Tolman advanced a hybrid “cognitive behavioural” model, most notably with his 1948 publication discussing the cognitive maps used by rats to guess at the location of food at the end of a modified maze.

The Association for Behaviour Analysis International was founded in 1974 and by 2003 had members from 42 countries. The field has been especially influential in Latin America, where it has a regional organization known as ALAMOC: La Asociación Latinoamericana de Análisis y Modificación del Comportamiento. Behaviourism also gained a strong foothold in Japan, where it gave rise to the Japanese Society of Animal Psychology (1933), the Japanese Association of Special Education (1963), the Japanese Society of Biofeedback Research (1973), the Japanese Association for Behaviour Therapy (1976), the Japanese Association for Behaviour Analysis (1979), and the Japanese Association for Behavioural Science Research (1994). Today the field of behaviourism is also commonly referred to as behaviour modification or behaviour analysis.

Cognitive

Cognitive psychology studies cognition, the mental processes underlying mental activity. Perception, attention, reasoning, thinking, problem solving, memory, learning, language, and emotion are areas of research. Classical cognitive psychology is associated with a school of thought known as cognitivism, whose adherents argue for an information processing model of mental function, informed by functionalism and experimental psychology.

Starting in the 1950s, the experimental techniques developed by Wundt, James, Ebbinghaus, and others re-emerged as experimental psychology became increasingly cognitivist – concerned with information and its processing – and, eventually, constituted a part of the wider cognitive science. Some called this development the cognitive revolution because it rejected the anti-mentalist dogma of behaviourism as well as the strictures of psychoanalysis.

Social learning theorists, such as Albert Bandura, argued that the child’s environment could make contributions of its own to the behaviours of an observant subject.

Technological advances also renewed interest in mental states and representations. English neuroscientist Charles Sherrington and Canadian psychologist Donald O. Hebb used experimental methods to link psychological phenomena with the structure and function of the brain. The rise of computer science, cybernetics and artificial intelligence suggested the value of comparatively studying information processing in humans and machines. Research in cognition had proven practical since World War II, when it aided in the understanding of weapons operation.

A popular and representative topic in this area is cognitive bias, or irrational thought. Psychologists (and economists) have classified and described a sizeable catalogue of biases which recur frequently in human thought. The availability heuristic, for example, is the tendency to overestimate the importance of something which happens to come readily to mind.

Elements of behaviourism and cognitive psychology were synthesized to form cognitive behavioural therapy, a form of psychotherapy modified from techniques developed by American psychologist Albert Ellis and American psychiatrist Aaron T. Beck.

On a broader level, cognitive science is an interdisciplinary enterprise of cognitive psychologists, cognitive neuroscientists, researchers in artificial intelligence, linguists, human-computer interaction, computational neuroscience, logicians and social scientists. The discipline of cognitive science covers cognitive psychology as well as philosophy of mind, computer science, and neuroscience.[citation needed] Computer simulations are sometimes used to model phenomena of interest.

Social

Social psychology is the study of how humans think about each other and how they relate to each other. Social psychologists study such topics as the influence of others on an individual’s behaviour (e.g. conformity, persuasion), and the formation of beliefs, attitudes, and stereotypes about other people. Social cognition fuses elements of social and cognitive psychology in order to understand how people process, remember, or distort social information. The study of group dynamics reveals information about the nature and potential optimisation of leadership, communication, and other phenomena that emerge at least at the microsocial level. In recent years, many social psychologists have become increasingly interested in implicit measures, mediational models, and the interaction of both person and social variables in accounting for behaviour. The study of human society is therefore a potentially valuable source of information about the causes of psychiatric disorder. Some sociological concepts applied to psychiatric disorders are the social role, sick role, social class, life event, culture, migration, social, and total institution.

Psychoanalysis

Psychoanalysis comprises a method of investigating the mind and interpreting experience; a systematised set of theories about human behaviour; and a form of psychotherapy to treat psychological or emotional distress, especially conflict originating in the unconscious mind. This school of thought originated in the 1890s with Austrian medical doctors including Josef Breuer (physician), Alfred Adler (physician), Otto Rank (psychoanalyst), and most prominently Sigmund Freud (neurologist). Freud’s psychoanalytic theory was largely based on interpretive methods, introspection and clinical observations. It became very well known, largely because it tackled subjects such as sexuality, repression, and the unconscious. These subjects were largely taboo at the time, and Freud provided a catalyst for their open discussion in polite society. Clinically, Freud helped to pioneer the method of free association and a therapeutic interest in dream interpretation.

Swiss psychiatrist Carl Jung, influenced by Freud, elaborated a theory of the collective unconscious – a primordial force present in all humans, featuring archetypes which exerted a profound influence on the mind. Jung’s competing vision formed the basis for analytical psychology, which later led to the archetypal and process-oriented schools. Other well-known psychoanalytic scholars of the mid-20th century include Erik Erikson, Melanie Klein, D.W. Winnicott, Karen Horney, Erich Fromm, John Bowlby, and Sigmund Freud’s daughter, Anna Freud. Throughout the 20th century, psychoanalysis evolved into diverse schools of thought which could be called Neo-Freudian. Among these schools are ego psychology, object relations, and interpersonal, Lacanian, and relational psychoanalysis.

Psychologists such as Hans Eysenck and philosophers including Karl Popper criticised psychoanalysis. Popper argued that psychoanalysis had been misrepresented as a scientific discipline, whereas Eysenck said that psychoanalytic tenets had been contradicted by experimental data. By the end of 20th century, psychology departments in American universities mostly marginalised Freudian theory, dismissing it as a “desiccated and dead” historical artefact. However, researchers in the emerging field of neuro-psychoanalysis today defend some of Freud’s ideas on scientific grounds, while scholars of the humanities maintain that Freud was not a “scientist at all, but … an interpreter”.

Existential-Humanistic Theories

Humanistic psychology developed in the 1950s as a movement within academic psychology, in reaction to both behaviourism and psychoanalysis. The humanistic approach sought to glimpse the whole person, not just fragmented parts of the personality or isolated cognitions. Humanism focused on uniquely human issues, such as free will, personal growth, self-actualisation, self-identity, death, aloneness, freedom, and meaning. It emphasized subjective meaning, rejection of determinism, and concern for positive growth rather than pathology. Some founders of the humanistic school of thought were American psychologists Abraham Maslow, who formulated a hierarchy of human needs, and Carl Rogers, who created and developed client-centred therapy. Later, positive psychology opened up humanistic themes to scientific modes of exploration.

The American Association for Humanistic Psychology, formed in 1963, declared:

Humanistic psychology is primarily an orientation toward the whole of psychology rather than a distinct area or school. It stands for respect for the worth of persons, respect for differences of approach, open-mindedness as to acceptable methods, and interest in exploration of new aspects of human behaviour. As a “third force” in contemporary psychology, it is concerned with topics having little place in existing theories and systems: e.g., love, creativity, self, growth, organism, basic need-gratification, self-actualization, higher values, being, becoming, spontaneity, play, humour, affection, naturalness, warmth, ego-transcendence, objectivity, autonomy, responsibility, meaning, fair-play, transcendental experience, peak experience, courage, and related concepts.

In the 1950s and 1960s, influenced by philosophers Søren Kierkegaard and Martin Heidegger and, psychoanalytically trained American psychologist Rollo May pioneered an existential branch of psychology, which included existential psychotherapy: a method based on the belief that inner conflict within a person is due to that individual’s confrontation with the givens of existence. Swiss psychoanalyst Ludwig Binswanger and American psychologist George Kelly may also be said to belong to the existential school. Existential psychologists differed from more “humanistic” psychologists in their relatively neutral view of human nature and their relatively positive assessment of anxiety. Existential psychologists emphasized the humanistic themes of death, free will, and meaning, suggesting that meaning can be shaped by myths, or narrative patterns, and that it can be encouraged by an acceptance of the free will requisite to an authentic, albeit often anxious, regard for death and other future prospects.

Austrian existential psychiatrist and Holocaust survivor Viktor Frankl drew evidence of meaning’s therapeutic power from reflections garnered from his own internment. He created a variation of existential psychotherapy called logotherapy, a type of existentialist analysis that focuses on a will to meaning (in one’s life), as opposed to Adler’s Nietzschean doctrine of will to power or Freud’s will to pleasure.

Themes

Personality

Personality psychology is concerned with enduring patterns of behaviour, thought, and emotion – commonly referred to as personality – in individuals. Theories of personality vary across different psychological schools and orientations. They carry different assumptions about such issues as the role of the unconscious and the importance of childhood experience. According to Freud, personality is based on the dynamic interactions of the id, ego, and super-ego. In order to develop a taxonomy of personality constructs, trait theorists, in contrast, attempt to describe the personality sphere in terms of a discrete number of key traits using the statistical data-reduction method of factor analysis. Although the number of proposed traits has varied widely, an early biologically-based model proposed by Hans Eysenck, the 3rd mostly highly cited psychologist of the 20th Century (after Freud, and Piaget respectively), suggested that at least three major trait constructs are necessary to describe human personality structure: extraversion–introversion, neuroticism-stability, and psychoticism-normality. Raymond Cattell, the 7th most highly cited psychologist of the 20th Century (based on the scientific peer-reviewed journal literature) empirically derived a theory of 16 personality factors at the primary-factor level, and up to 8 broader second-stratum factors (at the Eysenckian level of analysis), rather than the “Big Five” dimensions. Dimensional models of personality are receiving increasing support, and a version of dimensional assessment has been included in the DSM-V. However, despite a plethora of research into the various versions of the “Big Five” personality dimensions, it appears necessary to move on from static conceptualisations of personality structure to a more dynamic orientation, whereby it is acknowledged that personality constructs are subject to learning and change across the lifespan.

An early example of personality assessment was the Woodworth Personal Data Sheet, constructed during World War I. The popular, although psychometrically inadequate Myers-Briggs Type Indicator sought to assess individuals’ “personality types” according to the personality theories of Carl Jung. Behaviourist resistance to introspection led to the development of the Strong Vocational Interest Blank and Minnesota Multiphasic Personality Inventory (MMPI), in an attempt to ask empirical questions that focused less on the psychodynamics of the respondent. However, the MMPI has been subjected to critical scrutiny, given that it adhered to archaic psychiatric nosology, and since it required individuals to provide subjective, introspective responses to the hundreds of items pertaining to psychopathology.

Unconscious Mind

Study of the unconscious mind, a part of the psyche outside the awareness of the individual which nevertheless influenced thoughts and behaviour was a hallmark of early psychology. In one of the first psychology experiments conducted in the United States, C.S. Peirce and Joseph Jastrow found in 1884 that subjects could choose the minutely heavier of two weights even if consciously uncertain of the difference. Freud popularised this concept, with terms like Freudian slip entering popular culture, to mean an uncensored intrusion of unconscious thought into one’s speech and action. His 1901 text The Psychopathology of Everyday Life catalogues hundreds of everyday events which Freud explains in terms of unconscious influence. Pierre Janet advanced the idea of a subconscious mind, which could contain autonomous mental elements unavailable to the scrutiny of the subject.

Behaviourism notwithstanding, the unconscious mind has maintained its importance in psychology. Cognitive psychologists have used a “filter” model of attention, according to which much information processing takes place below the threshold of consciousness, and only certain processes, limited by nature and by simultaneous quantity, make their way through the filter. Copious research has shown that subconscious priming of certain ideas can covertly influence thoughts and behaviour. A significant hurdle in this research is proving that a subject’s conscious mind has not grasped a certain stimulus, due to the unreliability of self-reporting. For this reason, some psychologists prefer to distinguish between implicit and explicit memory. In another approach, one can also describe a subliminal stimulus as meeting an objective but not a subjective threshold.

The automaticity model, which became widespread following exposition by John Bargh and others in the 1980s, describes sophisticated processes for executing goals which can be selected and performed over an extended duration without conscious awareness. Some experimental data suggests that the brain begins to consider taking actions before the mind becomes aware of them. This influence of unconscious forces on people’s choices naturally bears on philosophical questions free will. John Bargh, Daniel Wegner, and Ellen Langer are some prominent contemporary psychologists who describe free will as an illusion.

Motivation

Psychologists such as William James initially used the term motivation to refer to intention, in a sense similar to the concept of will in European philosophy. With the steady rise of Darwinian and Freudian thinking, instinct also came to be seen as a primary source of motivation. According to drive theory, the forces of instinct combine into a single source of energy which exerts a constant influence. Psychoanalysis, like biology, regarded these forces as physical demands made by the organism on the nervous system. However, they believed that these forces, especially the sexual instincts, could become entangled and transmuted within the psyche. Classical psychoanalysis conceives of a struggle between the pleasure principle and the reality principle, roughly corresponding to id and ego. Later, in Beyond the Pleasure Principle, Freud introduced the concept of the death drive, a compulsion towards aggression, destruction, and psychic repetition of traumatic events. Meanwhile, behaviourist researchers used simple dichotomous models (pleasure/pain, reward/punishment) and well-established principles such as the idea that a thirsty creature will take pleasure in drinking. Clark Hull formalised the latter idea with his drive reduction model.

Hunger, thirst, fear, sexual desire, and thermoregulation all seem to constitute fundamental motivations for animals. Humans also seem to exhibit a more complex set of motivations – though theoretically these could be explained as resulting from primordial instincts – including desires for belonging, self-image, self-consistency, truth, love, and control.

Motivation can be modulated or manipulated in many different ways. Researchers have found that eating, for example, depends not only on the organism’s fundamental need for homeostasis – an important factor causing the experience of hunger – but also on circadian rhythms, food availability, food palatability, and cost. Abstract motivations are also malleable, as evidenced by such phenomena as goal contagion: the adoption of goals, sometimes unconsciously, based on inferences about the goals of others. Vohs and Baumeister suggest that contrary to the need-desire-fulfilment cycle of animal instincts, human motivations sometimes obey a “getting begets wanting” rule: the more you get a reward such as self-esteem, love, drugs, or money, the more you want it. They suggest that this principle can even apply to food, drink, sex, and sleep.

Development

Mainly focusing on the development of the human mind through the life span, developmental psychology seeks to understand how people come to perceive, understand, and act within the world and how these processes change as they age. This may focus on cognitive, affective, moral, social, or neural development. Researchers who study children use a number of unique research methods to make observations in natural settings or to engage them in experimental tasks. Such tasks often resemble specially designed games and activities that are both enjoyable for the child and scientifically useful, and researchers have even devised clever methods to study the mental processes of infants. In addition to studying children, developmental psychologists also study aging and processes throughout the life span, especially at other times of rapid change (such as adolescence and old age). Developmental psychologists draw on the full range of psychological theories to inform their research.

Genes and Environment

All researched psychological traits are influenced by both genes and environment, to varying degrees. These two sources of influence are often confounded in observational research of individuals or families. An example is the transmission of depression from a depressed mother to her offspring. Theory may hold that the offspring, by virtue of having a depressed mother in his or her (the offspring’s) environment, is at risk for developing depression. However, risk for depression is also influenced to some extent by genes. The mother may both carry genes that contribute to her depression but will also have passed those genes on to her offspring thus increasing the offspring’s risk for depression. Genes and environment in this simple transmission model are completely confounded.

Experimental and quasi-experimental behavioural genetic research uses genetic methodologies to disentangle this confound and understand the nature and origins of individual differences in behaviour. Traditionally this research has been conducted using twin studies and adoption studies, two designs where genetic and environmental influences can be partially un-confounded. More recently, the availability of microarray molecular genetic or genome sequencing technologies allows researchers to measure participant DNA variation directly, and test whether individual genetic variants within genes are associated with psychological traits and psychopathology through methods including genome-wide association studies.

One goal of such research is similar to that in positional cloning and its success in Huntington’s: once a causal gene is discovered biological research can be conducted to understand how that gene influences the phenotype. One major result of genetic association studies is the general finding that psychological traits and psychopathology, as well as complex medical diseases, are highly polygenic, where a large number (on the order of hundreds to thousands) of genetic variants, each of small effect, contribute to individual differences in the behavioural trait or propensity to the disorder. Active research continues to understand the genetic and environmental bases of behaviour and their interaction.

Applications

Psychology encompasses many subfields and includes different approaches to the study of mental processes and behavior:

Mental Testing

Psychological testing has ancient origins, such as examinations for the Chinese civil service dating back to 2200 BC. Written exams began during the Han dynasty (202 BC-AD 200). By 1370, the Chinese system required a stratified series of tests, involving essay writing and knowledge of diverse topics. The system was ended in 1906. In Europe, mental assessment took a more physiological approach, with theories of physiognomy – judgement of character based on the face – described by Aristotle in 4th century BC Greece. Physiognomy remained current through the Enlightenment, and added the doctrine of phrenology: a study of mind and intelligence based on simple assessment of neuroanatomy.

When experimental psychology came to Britain, Francis Galton was a leading practitioner, and, with his procedures for measuring reaction time and sensation, is considered an inventor of modern mental testing (also known as psychometrics). James McKeen Cattell, a student of Wundt and Galton, brought the concept to the United States, and in fact coined the term “mental test”. In 1901, Cattell’s student Clark Wissler published discouraging results, suggesting that mental testing of Columbia and Barnard students failed to predict their academic performance. In response to 1904 orders from the Minister of Public Instruction, French psychologists Alfred Binet and Théodore Simon elaborated a new test of intelligence in 1905-1911, using a range of questions diverse in their nature and difficulty. Binet and Simon introduced the concept of mental age and referred to the lowest scorers on their test as idiots. Henry H. Goddard put the Binet-Simon scale to work and introduced classifications of mental level such as imbecile and feebleminded. In 1916 (after Binet’s death), Stanford professor Lewis M. Terman modified the Binet-Simon scale (renamed the Stanford–Binet scale) and introduced the intelligence quotient as a score report. From this test, Terman concluded that mental retardation “represents the level of intelligence which is very, very common among Spanish-Indians and Mexican families of the Southwest and also among negroes. Their dullness seems to be racial.”

Following the Army Alpha and Army Beta tests for soldiers in World War I, mental testing became popular in the US, where it was soon applied to school children. The federally created National Intelligence Test was administered to 7 million children in the 1920s, and in 1926 the College Entrance Examination Board created the Scholastic Aptitude Test to standardise college admissions. The results of intelligence tests were used to argue for segregated schools and economic functions – i.e. the preferential training of Black Americans for manual labour. These practices were criticised by black intellectuals such a Horace Mann Bond and Allison Davis. Eugenicists used mental testing to justify and organise compulsory sterilisation of individuals classified as mentally retarded. In the United States, tens of thousands of men and women were sterilised. Setting a precedent which has never been overturned, the US Supreme Court affirmed the constitutionality of this practice in the 1907 case Buck v. Bell.

Today mental testing is a routine phenomenon for people of all ages in Western societies. Modern testing aspires to criteria including standardisation of procedure, consistency of results, output of an interpretable score, statistical norms describing population outcomes, and, ideally, effective prediction of behaviour and life outcomes outside of testing situations.

Mental Health Care

The provision of psychological health services is generally called clinical psychology in the US The definitions of this term are various and may include school psychology and counselling psychology. Practitioners typically includes people who have graduated from doctoral programs in clinical psychology but may also include others. In Canada, the above groups usually fall within the larger category of professional psychology. In Canada and the US, practitioners get bachelor’s degrees and doctorates, then spend one year in an internship and one year in postdoctoral education. In Mexico and most other Latin American and European countries, psychologists do not get bachelor’s and doctorate degrees; instead, they take a three-year professional course following high school. Clinical psychology is at present the largest specialisation within psychology. It includes the study and application of psychology for the purpose of understanding, preventing, and relieving psychologically based distress, dysfunction or mental illness and to promote subjective well-being and personal development. Central to its practice are psychological assessment and psychotherapy although clinical psychologists may also engage in research, teaching, consultation, forensic testimony, and program development and administration.

Credit for the first psychology clinic in the United States typically goes to Lightner Witmer, who established his practice in Philadelphia in 1896. Another modern psychotherapist was Morton Prince. For the most part, in the first part of the twentieth century, most mental health care in the United States was performed by specialised medical doctors called psychiatrists. Psychology entered the field with its refinements of mental testing, which promised to improve diagnosis of mental problems. For their part, some psychiatrists became interested in using psychoanalysis and other forms of psychodynamic psychotherapy to understand and treat the mentally ill. In this type of treatment, a specially trained therapist develops a close relationship with the patient, who discusses wishes, dreams, social relationships, and other aspects of mental life. The therapist seeks to uncover repressed material and to understand why the patient creates defences against certain thoughts and feelings. An important aspect of the therapeutic relationship is transference, in which deep unconscious feelings in a patient reorient themselves and become manifest in relation to the therapist.

Psychiatric psychotherapy blurred the distinction between psychiatry and psychology, and this trend continued with the rise of community mental health facilities and behavioural therapy, a thoroughly non-psychodynamic model which used behaviourist learning theory to change the actions of patients. A key aspect of behaviour therapy is empirical evaluation of the treatment’s effectiveness. In the 1970s, cognitive-behaviour therapy arose, using similar methods and now including the cognitive constructs which had gained popularity in theoretical psychology. A key practice in behavioural and cognitive-behavioural therapy is exposing patients to things they fear, based on the premise that their responses (fear, panic, anxiety) can be deconditioned.

Mental health care today involves psychologists and social workers in increasing numbers. In 1977, National Institute of Mental Health director Bertram Brown described this shift as a source of “intense competition and role confusion”. Graduate programmes issuing doctorates in psychology (PhD or PsyD) emerged in the 1950s and underwent rapid increase through the 1980s. This degree is intended to train practitioners who might conduct scientific research.

Some clinical psychologists may focus on the clinical management of patients with brain injury – this area is known as clinical neuropsychology. In many countries, clinical psychology is a regulated mental health profession. The emerging field of disaster psychology (see crisis intervention) involves professionals who respond to large-scale traumatic events.

The work performed by clinical psychologists tends to be influenced by various therapeutic approaches, all of which involve a formal relationship between professional and client (usually an individual, couple, family, or small group). Typically, these approaches encourage new ways of thinking, feeling, or behaving. Four major theoretical perspectives are psychodynamic, cognitive behavioural, existential-humanistic, and systems or family therapy. There has been a growing movement to integrate the various therapeutic approaches, especially with an increased understanding of issues regarding culture, gender, spirituality, and sexual orientation. With the advent of more robust research findings regarding psychotherapy, there is evidence that most of the major therapies have equal effectiveness, with the key common element being a strong therapeutic alliance. Because of this, more training programmes and psychologists are now adopting an eclectic therapeutic orientation.

Diagnosis in clinical psychology usually follows the Diagnostic and Statistical Manual of Mental Disorders (DSM), a handbook first published by the American Psychiatric Association in 1952. New editions over time have increased in size and focused more on medical language. The study of mental illnesses is called abnormal psychology.

Education

Educational psychology is the study of how humans learn in educational settings, the effectiveness of educational interventions, the psychology of teaching, and the social psychology of schools as organizations. The work of child psychologists such as Lev Vygotsky, Jean Piaget, and Jerome Bruner has been influential in creating teaching methods and educational practices. Educational psychology is often included in teacher education programmes in places such as North America, Australia, and New Zealand.

School psychology combines principles from educational psychology and clinical psychology to understand and treat students with learning disabilities; to foster the intellectual growth of gifted students; to facilitate prosocial behaviours in adolescents; and otherwise to promote safe, supportive, and effective learning environments. School psychologists are trained in educational and behavioural assessment, intervention, prevention, and consultation, and many have extensive training in research.

Work

Industrialists soon brought the nascent field of psychology to bear on the study of scientific management techniques for improving workplace efficiency. This field was at first called economic psychology or business psychology; later, industrial psychology, employment psychology, or psychotechnology. An important early study examined workers at Western Electric’s Hawthorne plant in Cicero, Illinois from 1924-1932. With funding from the Laura Spelman Rockefeller Fund and guidance from Australian psychologist Elton Mayo, Western Electric experimented on thousands of factory workers to assess their responses to illumination, breaks, food, and wages. The researchers came to focus on workers’ responses to observation itself, and the term Hawthorne effect is now used to describe the fact that people work harder when they think they are being watched.

The name industrial and organisational psychology (I-O) arose in the 1960s and became enshrined as the Society for Industrial and Organisational Psychology, Division 14 of the American Psychological Association, in 1973. The goal is to optimise human potential in the workplace. Personnel psychology, a subfield of I-O psychology, applies the methods and principles of psychology in selecting and evaluating workers. I-O psychology’s other subfield, organisational psychology, examines the effects of work environments and management styles on worker motivation, job satisfaction, and productivity. The majority of I-O psychologists work outside of academia, for private and public organisations and as consultants. A psychology consultant working in business today might expect to provide executives with information and ideas about their industry, their target markets, and the organisation of their company.

Military and Intelligence

One role for psychologists in the military is to evaluate and counsel soldiers and other personnel. In the US, this function began during World War I, when Robert Yerkes established the School of Military Psychology at Fort Oglethorpe in Georgia, to provide psychological training for military staff military. Today, US Army psychology includes psychological screening, clinical psychotherapy, suicide prevention, and treatment for post-traumatic stress, as well as other aspects of health and workplace psychology such as smoking cessation.

Psychologists may also work on a diverse set of campaigns known broadly as psychological warfare. Psychological warfare chiefly involves the use of propaganda to influence enemy soldiers and civilians. In the case of so-called black propaganda the propaganda is designed to seem like it originates from a different source. The CIA’s MKULTRA programme involved more individualised efforts at mind control, involving techniques such as hypnosis, torture, and covert involuntary administration of LSD. The US military used the name Psychological Operations (PSYOP) until 2010, when these were reclassified as Military Information Support Operations (MISO), part of Information Operations (IO). Psychologists are sometimes involved in assisting the interrogation and torture of suspects, though this has sometimes been denied by those involved and sometimes opposed by others.

Health, Well-Being, and Social Change

Medical facilities increasingly employ psychologists to perform various roles. A prominent aspect of health psychology is the psychoeducation of patients: instructing them in how to follow a medical regimen. Health psychologists can also educate doctors and conduct research on patient compliance.

Psychologists in the field of public health use a wide variety of interventions to influence human behaviour. These range from public relations campaigns and outreach to governmental laws and policies. Psychologists study the composite influence of all these different tools in an effort to influence whole populations of people.

Black American psychologists Kenneth and Mamie Clark studied the psychological impact of segregation and testified with their findings in the desegregation case Brown v. Board of Education (1954).

Positive psychology is the study of factors which contribute to human happiness and well-being, focusing more on people who are currently healthy. In 2010, Clinical Psychological Review published a special issue devoted to positive psychological interventions, such as gratitude journaling and the physical expression of gratitude. Positive psychological interventions have been limited in scope, but their effects are thought to be superior to that of placebos, especially with regard to helping people with body image problems.

Research Methods

Quantitative psychological research lends itself to the statistical testing of hypotheses. Although the field makes abundant use of randomised and controlled experiments in laboratory settings, such research can only assess a limited range of short-term phenomena. Thus, psychologists also rely on creative statistical methods to glean knowledge from clinical trials and population data. These include the Pearson product-moment correlation coefficient, the analysis of variance, multiple linear regression, logistic regression, structural equation modelling, and hierarchical linear modelling. The measurement and operationalisation of important constructs is an essential part of these research designs.

Controlled Experiments

A true experiment with random allocation of subjects to conditions allows researchers to make strong inferences about causal relationships. In an experiment, the researcher alters parameters of influence, called independent variables, and measures resulting changes of interest, called dependent variables. Prototypical experimental research is conducted in a laboratory with a carefully controlled environment.

Repeated-measures experiments are those which take place through intervention on multiple occasions. In research on the effectiveness of psychotherapy, experimenters often compare a given treatment with placebo treatments, or compare different treatments against each other. Treatment type is the independent variable. The dependent variables are outcomes, ideally assessed in several ways by different professionals. Using crossover design, researchers can further increase the strength of their results by testing both of two treatments on two groups of subjects.

Quasi-experimental design refers especially to situations precluding random assignment to different conditions. Researchers can use common sense to consider how much the non-random assignment threatens the study’s validity. For example, in research on the best way to affect reading achievement in the first three grades of school, school administrators may not permit educational psychologists to randomly assign children to phonics and whole language classrooms, in which case the psychologists must work with pre-existing classroom assignments. Psychologists will compare the achievement of children attending phonics and whole language classes.

Experimental researchers typically use a statistical hypothesis testing model which involves making predictions before conducting the experiment, then assessing how well the data supports the predictions. (These predictions may originate from a more abstract scientific hypothesis about how the phenomenon under study actually works.) Analysis of variance (ANOVA) statistical techniques are used to distinguish unique results of the experiment from the null hypothesis that variations result from random fluctuations in data. In psychology, the widely used standard ascribes statistical significance to results which have less than 5% probability of being explained by random variation.

Other Forms of Statistical Inference

Statistical surveys are used in psychology for measuring attitudes and traits, monitoring changes in mood, checking the validity of experimental manipulations, and for other psychological topics. Most commonly, psychologists use paper-and-pencil surveys. However, surveys are also conducted over the phone or through e-mail. Web-based surveys are increasingly used to conveniently reach many subjects.

Neuropsychological tests, such as the Wechsler scales and Wisconsin Card Sorting Test, are mostly questionnaires or simple tasks used which assess a specific type of mental function in the respondent. These can be used in experiments, as in the case of lesion experiments evaluating the results of damage to a specific part of the brain.

Observational studies analyse uncontrolled data in search of correlations; multivariate statistics are typically used to interpret the more complex situation. Cross-sectional observational studies use data from a single point in time, whereas longitudinal studies are used to study trends across the life span. Longitudinal studies track the same people, and therefore detect more individual, rather than cultural, differences. However, they suffer from lack of controls and from confounding factors such as selective attrition (the bias introduced when a certain type of subject disproportionately leaves a study).

Exploratory data analysis refers to a variety of practices which researchers can use to visualize and analyse existing sets of data. In Peirce’s three modes of inference, exploratory data analysis corresponds to abduction, or hypothesis formation. Meta-analysis is the technique of integrating the results from multiple studies and interpreting the statistical properties of the pooled dataset.

Technological Assays

A classic and popular tool used to relate mental and neural activity is the electroencephalogram (EEG), a technique using amplified electrodes on a person’s scalp to measure voltage changes in different parts of the brain. Hans Berger, the first researcher to use EEG on an unopened skull, quickly found that brains exhibit signature “brain waves”: electric oscillations which correspond to different states of consciousness. Researchers subsequently refined statistical methods for synthesizing the electrode data, and identified unique brain wave patterns such as the delta wave observed during non-REM sleep.

Newer functional neuroimaging techniques include functional magnetic resonance imaging and positron emission tomography, both of which track the flow of blood through the brain. These technologies provide more localised information about activity in the brain and create representations of the brain with widespread appeal. They also provide insight which avoids the classic problems of subjective self-reporting. It remains challenging to draw hard conclusions about where in the brain specific thoughts originate – or even how usefully such localisation corresponds with reality. However, neuroimaging has delivered unmistakable results showing the existence of correlations between mind and brain. Some of these draw on a systemic neural network model rather than a localized function model.

Psychiatric interventions such as transcranial magnetic stimulation and drugs also provide information about brain-mind interactions. Psychopharmacology is the study of drug-induced mental effects.

Computer Simulation

Computational modelling is a tool used in mathematical psychology and cognitive psychology to simulate behaviour. This method has several advantages. Since modern computers process information quickly, simulations can be run in a short time, allowing for high statistical power. Modelling also allows psychologists to visualise hypotheses about the functional organisation of mental events that could not be directly observed in a human. Computational neuroscience uses mathematical models to simulate the brain. Another method is symbolic modelling, which represents many mental objects using variables and rules. Other types of modelling include dynamic systems and stochastic modelling.

Animal Studies

Animal experiments aid in investigating many aspects of human psychology, including perception, emotion, learning, memory, and thought, to name a few. In the 1890s, Russian physiologist Ivan Pavlov famously used dogs to demonstrate classical conditioning. Non-human primates, cats, dogs, pigeons, rats, and other rodents are often used in psychological experiments. Ideally, controlled experiments introduce only one independent variable at a time, in order to ascertain its unique effects upon dependent variables. These conditions are approximated best in laboratory settings. In contrast, human environments and genetic backgrounds vary so widely, and depend upon so many factors, that it is difficult to control important variables for human subjects. There are pitfalls in generalizing findings from animal studies to humans through animal models.

Comparative psychology refers to the scientific study of the behaviour and mental processes of non-human animals, especially as these relate to the phylogenetic history, adaptive significance, and development of behaviour. Research in this area explores the behaviour of many species, from insects to primates. It is closely related to other disciplines that study animal behaviour such as ethology.[198] Research in comparative psychology sometimes appears to shed light on human behaviour, but some attempts to connect the two have been quite controversial, for example the Sociobiology of E.O. Wilson. Animal models are often used to study neural processes related to human behaviour, e.g. in cognitive neuroscience.

Qualitative and Descriptive Research

Research designed to answer questions about the current state of affairs such as the thoughts, feelings, and behaviours of individuals is known as descriptive research. Descriptive research can be qualitative or quantitative in orientation. Qualitative research is descriptive research that is focused on observing and describing events as they occur, with the goal of capturing all of the richness of everyday behaviour and with the hope of discovering and understanding phenomena that might have been missed if only more cursory examinations have been made.

Qualitative psychological research methods include interviews, first-hand observation, and participant observation. Creswell (2003) identifies five main possibilities for qualitative research, including narrative, phenomenology, ethnography, case study, and grounded theory. Qualitative researchers sometimes aim to enrich interpretations or critiques of symbols, subjective experiences, or social structures. Sometimes hermeneutic and critical aims can give rise to quantitative research, as in Erich Fromm’s study of Nazi voting or Stanley Milgram’s studies of obedience to authority.

Just as Jane Goodall studied chimpanzee social and family life by careful observation of chimpanzee behaviour in the field, psychologists conduct naturalistic observation of ongoing human social, professional, and family life. Sometimes the participants are aware they are being observed, and other times the participants do not know they are being observed. Strict ethical guidelines must be followed when covert observation is being carried out.

Program Evaluation

Program Evaluation is a systematic method for collecting, analysing, and using information to answer questions about projects, policies and programmes, particularly about their effectiveness and efficiency. In both the public and private sectors, stakeholders often want to know whether the programmes they are funding, implementing, voting for, receiving or objecting to are producing the intended effect. While programme evaluation first focuses around this definition, important considerations often include how much the programme costs per participant, how the programme could be improved, whether the programme is worthwhile, whether there are better alternatives, if there are unintended outcomes, and whether the programme goals are appropriate and useful.

Contemporary Issues in Methodology and Practice

Metascience

The field of metascience has revealed significant problems with the methodology of psychological research. Psychological research suffers from high bias, low reproducibility, and widespread misuse of statistics. These finding have led to calls for reform from within and from outside the scientific community.

Confirmation Bias

In 1959, statistician Theodore Sterling examined the results of psychological studies and discovered that 97% of them supported their initial hypotheses, implying a possible publication bias. Similarly, Fanelli (2010) found that 91.5% of psychiatry/psychology studies confirmed the effects they were looking for, and concluded that the odds of this happening (a positive result) was around five times higher than in fields such as space- or geosciences. Fanelli argues that this is because researchers in “softer” sciences have fewer constraints to their conscious and unconscious biases.

Replication

Over the subsequent few years, a replication crisis in psychology was identified, where it was publicly noted that many notable findings in the field had not been replicated and with some researchers being accused of outright fraud in their results. More systematic efforts to assess the extent of the problem, such as the Reproducibility Project of the Centre for Open Science, found that as many as two-thirds of highly publicised findings in psychology had failed to be replicated, with reproducibility being generally stronger in studies and journals representing cognitive psychology than social psychology topics, and the subfields of differential psychology (including general intelligence and Big Five personality traits research), behavioural genetics (except for candidate gene and candidate gene-by-environment interaction research on behaviour and mental illness), and the related field of behavioural economics being largely unaffected by the replication crisis. Other subfields of psychology that have been implicated by the replication crisis are clinical psychology, developmental psychology (particularly cognitive and personality development), and a field closely related to psychology that has also been implicated is educational research.

Focus on the replication crisis has led to other renewed efforts in the discipline to re-test important findings, and in response to concerns about publication bias and p-hacking, more than 140 psychology journals have adopted result-blind peer review where studies are accepted not on the basis of their findings and after the studies are completed, but before the studies are conducted and upon the basis of the methodological rigor of their experimental designs and the theoretical justifications for their statistical analysis techniques before data collection or analysis is done. In addition, large-scale collaborations between researchers working in multiple labs in different countries and that regularly make their data openly available for different researchers to assess have become much more common in the field. Early analysis of such reforms has estimated that 61% of result-blind studies have led to null results, in contrast to an estimated 5% to 20% in earlier research.

Misuse of Statistics

Some critics view statistical hypothesis testing as misplaced. Psychologist and statistician Jacob Cohen wrote in 1994 that psychologists routinely confuse statistical significance with practical importance, enthusiastically reporting great certainty in unimportant facts. Some psychologists have responded with an increased use of effect size statistics, rather than sole reliance on p-values.

WEIRD Bias

In 2008, Arnett pointed out that most articles in American Psychological Association journals were about US populations when US citizens are only 5% of the world’s population. He complained that psychologists had no basis for assuming psychological processes to be universal and generalizing research findings to the rest of the global population. In 2010, Henrich, Heine, and Norenzayan reported a systemic bias in conducting psychology studies with participants from “WEIRD” (western, educated, industrialized, rich and democratic) societies. Although only 1/8 people worldwide live in regions that fall into the WEIRD classification, the researchers claimed that 60-90% of psychology studies are performed on participants from these areas. The article gave examples of results that differ significantly between people from WEIRD and tribal cultures, including the Müller-Lyer illusion. Arnett (2008), Altmaier and Hall (2008), and Morgan-Consoli et al. (2018) saw the Western bias in research and theory as a serious problem considering psychologists are increasingly applying psychological principles developed in WEIRD regions in their research, clinical work, and consultation with populations around the world. In 2018, Rad, Martingano & Ginges showed that nearly a decade after Henrich et al.’s paper, over 80% of the samples used in studies published in the journal, Psychological Science, were from the WEIRD population. Moreover, their analysis showed that several studies did not fully disclose the origin of their samples, and the authors offer a set of recommendations to editors and reviewers to reduce the WEIRD bias.

From an anthropological perspective, scholars applied the WEIRD model to European history, arguing that a powerful Christian Church forced a radical change away from incest and cousin marriages that undermined the role of clans and created individualism in Europe by 1500 CE. They argue that a distinctive Western psychology thus emerged that valued agency, autonomy, and kindness towards strangers. Historians were not involved in that study, and have stated that it contains historical fallacies regarding an all-powerful Church at too early a point in time and a rejection of cousin marriage that did not happen.

Unscientific Mental Health Training

Some observers perceive a gap between scientific theory and its application – in particular, the application of unsupported or unsound clinical practices. Critics say there has been an increase in the number of mental health training programs that do not instil scientific competence. Practices such as “facilitated communication for infantile autism”; memory-recovery techniques including body work; and other therapies, such as rebirthing and reparenting, may be dubious or even dangerous, despite their popularity. In 1984, Allen Neuringer made a similar point[vague] regarding the experimental analysis of behaviour. Psychologists, sometimes divided along the lines of laboratory vs. clinic, continue to debate these issues.

Ethics

Ethical standards in the discipline have changed over time. Some famous past studies are today considered unethical and in violation of established codes (the Canadian Code of Conduct for Research Involving Humans, and the Belmont Report).

The most important contemporary standards are informed and voluntary consent. After World War II, the Nuremberg Code was established because of Nazi abuses of experimental subjects. Later, most countries (and scientific journals) adopted the Declaration of Helsinki. In the US, the National Institutes of Health established the Institutional Review Board in 1966, and in 1974 adopted the National Research Act (HR 7724). All of these measures encouraged researchers to obtain informed consent from human participants in experimental studies. A number of influential studies led to the establishment of this rule; such studies included the MIT and Fernald School radioisotope studies, the Thalidomide tragedy, the Willowbrook hepatitis study, and Stanley Milgram’s studies of obedience to authority.

Humans

University psychology departments have ethics committees dedicated to the rights and well-being of research subjects. Researchers in psychology must gain approval of their research projects before conducting any experiment to protect the interests of human participants and laboratory animals.

The ethics code of the American Psychological Association originated in 1951 as “Ethical Standards of Psychologists”. This code has guided the formation of licensing laws in most American states. It has changed multiple times over the decades since its adoption. In 1989, the APA revised its policies on advertising and referral fees to negotiate the end of an investigation by the Federal Trade Commission. The 1992 incarnation was the first to distinguish between “aspirational” ethical standards and “enforceable” ones. Members of the public have a five-year window to file ethics complaints about APA members with the APA ethics committee; members of the APA have a three-year window.

Some of the ethical issues considered most important are the requirement to practice only within the area of competence, to maintain confidentiality with the patients, and to avoid sexual relations with them. Another important principle is informed consent, the idea that a patient or research subject must understand and freely choose a procedure they are undergoing. Some of the most common complaints against clinical psychologists include sexual misconduct, and involvement in child custody evaluations.

Other Animals

Current ethical guidelines state that using non-human animals for scientific purposes is only acceptable when the harm (physical or psychological) done to animals is outweighed by the benefits of the research. Keeping this in mind, psychologists can use certain research techniques on animals that could not be used on humans.

  • An experiment by Stanley Milgram raised questions about the ethics of scientific experimentation because of the extreme emotional stress suffered by the participants.
    • It measured the willingness of study participants to obey an authority figure who instructed them to perform acts that conflicted with their personal conscience.
  • Comparative psychologist Harry Harlow drew moral condemnation for isolation experiments on rhesus macaque monkeys at the University of Wisconsin-Madison in the 1970s.
    • The aim of the research was to produce an animal model of clinical depression.
    • Harlow also devised what he called a “rape rack”, to which the female isolates were tied in normal monkey mating posture.
    • In 1974, American literary critic Wayne C. Booth wrote that, “Harry Harlow and his colleagues go on torturing their nonhuman primates decade after decade, invariably proving what we all knew in advance – that social creatures can be destroyed by destroying their social ties.”
    • He writes that Harlow made no mention of the criticism of the morality of his work.

What is Art Therapy?

Introduction

Art therapy (not to be confused with arts therapy, which includes other creative therapies such as drama therapy and music therapy) is a distinct discipline that incorporates creative methods of expression through visual art media. Art therapy, as a creative arts therapy profession, originated in the fields of art and psychotherapy and may vary in definition.

There are three main ways that art therapy is employed:

  • The first one is called analytic art therapy. Analytic art therapy is based on the theories that come from analytical psychology, and in more cases, psychoanalysis.
    • Analytic art therapy focuses on the client, the therapist, and the ideas that are transferred between the both of them through art.
  • Another way that art therapy is utilised is art psychotherapy.
    • This approach focuses more on the psychotherapist and their analysis of their clients artwork verbally.
  • The last way art therapy is looked at is through the lens of art as therapy.
    • Some art therapists practicing art as therapy believe that analysing the client’s artwork verbally is not essential, therefore they stress the creation process of the art instead.

In all of these different approaches to art therapy, the art therapist’s client/service user goes on the journey to delve into their inner thoughts and emotions by the use of paint, paper and pen, or even clay.

Art therapy can be used to help people improve cognitive and sensory motor function, self-esteem, self awareness, emotional resilience. It may also aide in resolving conflicts and reduce distress.

Current art therapy includes a vast number of other approaches such as person-centred, cognitive, behaviour, Gestalt, narrative, Adlerian, and family. The tenets of art therapy involve humanism, creativity, reconciling emotional conflicts, fostering self-awareness, and personal growth.

Brief History

In the history of mental health treatment, art therapy (combining studies of psychology and art) emerged much later as a new field. This type of unconventional therapy is used to cultivate self-esteem and awareness, improve cognitive and motor abilities, resolve conflicts or stress, and inspire resilience in patients. It invites sensory, kinaesthetic, perceptual, and sensory symbolisation to address issues that verbal psychotherapy cannot reach. Although art therapy is a relatively young therapeutic discipline, its roots lie in the use of the arts in the ‘moral treatment’ of psychiatric patients in the late 18th century.

Art therapy as a profession began in the mid-20th century, arising independently in English-speaking and European countries. Art had been used at the time for various reasons: communication, inducing creativity in children, and in religious contexts. The early art therapists who published accounts of their work acknowledged the influence of aesthetics, psychiatry, psychoanalysis, rehabilitation, early childhood education, and art education, to varying degrees, on their practices.

The British artist Adrian Hill coined the term art therapy in 1942. Hill, recovering from tuberculosis in a sanatorium, discovered the therapeutic benefits of drawing and painting while convalescing. He wrote that the value of art therapy lay in “completely engrossing the mind (as well as the fingers)…releasing the creative energy of the frequently inhibited patient”, which enabled the patient to “build up a strong defence against his misfortunes”. He suggested artistic work to his fellow patients. That began his art therapy work, which was documented in 1945 in his book, Art Versus Illness.

The artist Edward Adamson, demobilised after WW2, joined Adrian Hill to extend Hill’s work to the British long stay mental hospitals. Other early proponents of art therapy in Britain include E.M. Lyddiatt, Michael Edwards, Diana Raphael-Halliday and Rita Simon. The British Association of Art Therapists was founded in 1964.

U.S. art therapy pioneers Margaret Naumburg and Edith Kramer began practicing at around the same time as Hill. Naumburg, an educator, asserted that “art therapy is psychoanalytically oriented” and that free art expression “becomes a form of symbolic speech which…leads to an increase in verbalisation in the course of therapy.” Edith Kramer, an artist, pointed out the importance of the creative process, psychological defences, and artistic quality, writing that “sublimation is attained when forms are created that successfully contain…anger, anxiety, or pain.” Other early proponents of art therapy in the United States include Elinor Ulman, Robert “Bob” Ault, and Judith Rubin. The American Art Therapy Association was founded in 1969.

National professional associations of art therapy exist in many countries, including Brazil, Canada, Finland, Lebanon, Israel, Japan, the Netherlands, Romania, South Korea, and Sweden. International networking contributes to the establishment of standards for education and practice.

Diverse perspectives exist on history of art therapy, which complement those that focus on the institutionalisation of art therapy as a profession in Britain and the United States.

Definitions

There are various definitions of the term art therapy.

The British Association of Art Therapists defines art therapy as “a form of psychotherapy that uses art media as its primary mode of expression and communication.”

The American Art Therapy Association defines art therapy as: “an integrative mental health and human services profession that enriches the lives of individuals, families, and communities through active art-making, creative process, applied psychological theory, and human experience within a psychotherapeutic relationship.”

What is Art Therapy Used For?

As a regulated mental health profession, art therapy is employed in many clinical and other settings with diverse populations. It is increasingly recognised as a valid form of therapy. Art therapy can also be found in non-clinical settings, as well as in art studios and in creativity development workshops. Licensing for art therapists can vary from state to state with some recognising art therapy as a separate license and some licensing under a related field such a professional counselling, mental health counsellor. Art therapists must have a master’s degree that includes training on the creative process, psychological development, group therapy, and must complete a clinical internship. Art therapists may also pursue additional credentialing through the Art Therapy Credentials Board. Art therapists work with populations of all ages and with a wide variety of disorders and diseases. Art therapists provide services to children, adolescents, and adults, whether as individuals, couples, families, or groups.

Using their evaluative and psychotherapy skills, art therapists choose materials and interventions appropriate to their clients’ needs and design sessions to achieve therapeutic goals and objectives. They use the creative process to help their clients increase insight, cope with stress, work through traumatic experiences, increase cognitive, memory and neurosensory abilities, improve interpersonal relationships and achieve greater self-fulfilment. The activities an art therapist chooses to do with clients depend on a variety of factors such as their mental state or age. Art therapists may draw upon images from resources such as ARAS (Archive for Research in Archetypal Symbolism) to incorporate historical art and symbols into their work with patients. Depending on the state, province, or country, the term “art therapist” may be reserved for those who are professionals trained in both art and therapy and hold a master or doctoral degree in art therapy or certification in art therapy obtained after a graduate degree in a related field. Other professionals, such as mental health counsellors, social workers, psychologists, and play therapists optionally combine art-making with basic psychotherapeutic modalities in their treatment. Therapists may better understand a client’s absorption of information after assessing elements of their artwork.

A systemic literature review compiled and evaluated different research studies, some of which are listed below. Overall, this survey publication revealed that both the high level of variability (such as incorporating talk therapy) and limited number of studies done with certified art therapists made it difficult to generalise over findings. Despite these limitations, art therapy has, to an extent, proved its efficacy in relieving symptoms and improving quality of life.

General Illness

Art-making is a common activity used by many people to cope with illness. Art and the creative process can alleviate many illnesses (cancer, heart disease, influenza, etc.). This form of therapy helps benefit those who suffer from mental illnesses as well (chronic depression, anxiety disorders, bipolar disorders, etc.). It is difficult to measure the efficacy of art therapy as it treats various mental illnesses to different degrees; although, people can escape the emotional effects of various illness through art making and many creative methods. Sometimes people cannot express the way they feel, as it can be difficult to put into words, and art can help people express their experiences. “During art therapy, people can explore past, present and future experiences using art as a form of coping”. Art can be a refuge for the intense emotions associated with illness; there are no limits to the imagination in finding creative ways to express emotions.

Hospitals have started studying the influence of arts on patient care and found that participants in art programs have better vitals and fewer complications sleeping. Artistic influence does not need to be participation in a programme, but studies have found that a landscape picture in a hospital room had reduced need for narcotic pain killers and less time in recovery at the hospital. In addition, either looking at or creating art in hospitals helped stabilise vital signs, speed up the healing process, and in general, bring a sense of hope and soul to the patient. Family, care workers, doctors and nurses are also positively affected.

Cancer Diagnosis

Many studies have been conducted on the benefits of art therapy on cancer patients. Art therapy has been found to be useful to support patients during the stress of such things as chemotherapy treatment.

Art therapists have conducted studies to understand why some cancer patients turned to art making as a coping mechanism and a tool to creating a positive identity outside of being a cancer patient. Women in the study participated in different art programs ranging from pottery and card making to drawing and painting. The programmes helped them regain an identity outside of having cancer, lessened emotional pain of their on-going fight with cancer, and also giving them hope for the future.

In a study involving women facing cancer-related difficulties such as fear, pain, altered social relationships, etc., it was found that:

Engaging in different types of visual art (textiles, card making, collage, pottery, watercolour, acrylics) helped these women in 4 major ways. First, it helped them focus on positive life experiences, relieving their ongoing preoccupation with cancer. Second, it enhanced their self-worth and identity by providing them with opportunities to demonstrate continuity, challenge, and achievement. Third, it enabled them to maintain a social identity that resisted being defined by cancer. Finally, it allowed them to express their feelings in a symbolic manner, especially during chemotherapy.

Another study showed those who participated in these types of activities were discharged earlier than those who did not participate.

Furthermore, another study revealed the healing effects of art therapy on female breast cancer patients. Studies revealed that relatively short-term art therapy interventions significantly improved patients’ emotional states and perceived symptoms.

Studies have also shown how the emotional distress of cancer patients has been reduced when utilising the creative process. The women made drawings of themselves throughout the treatment process while also doing yoga and meditating; these actions combined helped to alleviate some symptoms.

Another study looked at the efficacy of mindfulness-based art therapy, combining meditation with art, on a large study with 111 participants. The study used measurements such as quality of life, physical symptoms, depression, and anxiety to evaluate the efficacy of the intervention. This yielded optimistic results that there was a significant decrease in distress and significant improvement in quality of life.

A review of 12 studies investigating the use of art therapy in cancer patients by Wood, Molassiotis, and Payne (2010) investigated the symptoms of emotional, social, physical, global functioning, and spiritual controls of cancer patients. They found that art therapy can improve the process of psychological readjustment to the change, loss, and uncertainty associated with surviving cancer. It was also suggested that art therapy can provide a sense of “meaning-making” because of the physical act of creating the art. When given five individual sessions of art therapy once per week, art therapy was shown to be useful for personal empowerment by helping the cancer patients understand their own boundaries in relation to the needs of other people. In turn, those who had art therapy treatment felt more connected to others and found social interaction more enjoyable than individuals who did not receive art therapy treatment. Furthermore, art therapy improved motivation levels, abilities to discuss emotional and physical health, general well-being, and increased global quality of life in cancer patients.

In sum, relatively short-term intervention of art therapy that is individualised to various patients has the potential to significantly improve emotional state and quality of life, while reducing perceived symptoms relating to the cancer diagnosis.

Disaster Relief

Art therapy has been used in a variety of traumatic experiences, including disaster relief and crisis intervention. Art therapists have worked with children, adolescents and adults after natural and manmade disasters, encouraging them to make art in response to their experiences. Some suggested strategies for working with victims of disaster include: assessing for distress or posttraumatic stress disorder (PTSD), normalising feelings, modelling coping skills, promoting relaxation skills, establishing a social support network, and increasing a sense of security and stability.

Dementia

While art therapy helps with behavioural issues, it does not appear to affect worsening mental abilities. Tentative evidence supports benefits with respect to quality of life. Art therapy had no clear results on affecting memory or emotional well being scales. However, Alzheimer’s association states art and music can enrich people’s lives and allow for self expression.

Autism

Art therapy is increasingly recognised to help address challenges of people with autism, as evidenced through these sources. Art therapy may address core symptoms of the autism spectrum disorder by promoting sensory regulation, supporting psychomotor development and facilitating communication. Art therapy is also thought to promote emotional and mental growth by allowing self expression, visual communication, and creativity.

Schizophrenia

A 2005 systematic review of art therapy as an add on treatment for schizophrenia found unclear effects. Studies reveal that cognitive behavioural therapy has proven to be most effective for this disorder.

Geriatric Patients

Studies conducted by Regev reveal that geriatric art therapy has been significantly useful in helping depression for the elderly, although not particularly successful among dementia patients. Group therapy versus individual sessions proved to be more effective.

Trauma and Children

Art therapy may alleviate trauma-induced emotions, such as shame and anger. It is also likely to increase trauma survivors’ sense of empowerment and control by encouraging children to make choices in their artwork. Art therapy in addition to psychotherapy offered more reduction in trauma symptoms than just psychotherapy alone.

Because traumatic memories are encoded visually, creating art may be the most effective way to access them. Through art therapy, children may be able to make more sense of their traumatic experiences and form accurate trauma narratives. Gradual exposure to these narratives may reduce trauma-induced symptoms, such as flashbacks and nightmares. Repetition of directives reduces anxiety, and visually creating narratives help clients build coping skills and balanced nervous system responses. This only works in long-term art therapy interventions.

Children who have experienced trauma may benefit from group art therapy. The group format is effective in helping survivors develop relationships with others who have experienced similar situations. Group art therapy may also be beneficial in helping children with trauma regain trust and social self-esteem. Usually, participants who undergo art therapy through group interventions have positive experiences and give their internal feelings validation.

Veterans and Post-Traumatic Stress Disorder

Art therapy has an established history of being used to treat veterans, with the American Art Therapy Association documenting its use as early as 1945. As with other sources of trauma, combat veterans may benefit from art therapy to access memories and to engage with treatment. A 2016 randomised control trial found that art therapy in conjunction with cognitive processing therapy (CPT) was more beneficial than CPT alone. Walter Reed Army Medical Centre, the National Intrepid Centre of Excellence and other Veteran Association institutions use art therapy to help veterans with PTSD.

Eating Disorders

Art therapy may help people with anorexia with weight improvements and may help with depression level. Traumatic or negative childhood experiences can result in unintentionally harmful coping mechanisms, such as eating disorders. As a result, clients may be cut off from their emotions, self-rejecting, and detached from their strengths. Art therapy may provide an outlet for exploring these inaccessible strengths and emotions; this is important because persons with eating disorders may not know how to vocalise their emotions.

Art therapy may be beneficial for clients with eating disorders because clients can create visual representations with art material of progress made, represent alterations to the body, and provide a nonthreatening method of acting out impulses. Individuals with eating disorders tend to rely heavily on defence mechanisms to feel a sense of control; it is important that clients feel a sense of authority over their art products through freedom of expression and controllable art materials. Through controllable media, such as pencils, markers, and coloured pencils, along with freedom of choice with the media, clients with eating disorders can create boundaries around unsettling themes.

Another systematic literature review found conclusive evidence that art therapy resulted in significant weight loss in patients with obesity, as well as helping with a range of psychological symptoms.

Ongoing Daily Challenges

Those who do not suffer from a mental illness or physical disease were also tested, these patients have ongoing daily challenges such as high-intensity jobs, financial constraints, and other personal issues. Findings revealed that art therapy reduces levels of stress and burnout related to patients’ professions.

Containment

The term containment, within art therapy and other therapeutic settings, has been used to describe what the client/service user can experience within the safety and privacy of a trusting relationship between client and counsellor. This term has also been equated, within art therapy research, with the holding or confining of an issue within the boundaries of visual expression, like a border or the circumference of a mandala. The creation of mandalas for symptom regulation is not a new approach within the field of art therapy, and numerous studies have been conducted in order to assess their efficacy.[

What is the Purpose of Art Therapy?

The purpose of art therapy is essentially one of healing. Art therapy can be successfully applied to clients with physical, mental or emotional problems, diseases and disorders. Any type of visual art and art medium can be employed within the therapeutic process, including painting, drawing, sculpting, photography, and digital art. Art therapy may include creative exercises such as drawing or painting a certain emotion, creative journaling, or freestyle creation.

One proposed learning mechanism is through the increased excitation, and as a consequence, strengthening of neuronal connections.

Outline of a Typical Session

Art therapy can take place in a variety of different settings. Art therapists may vary the goals of art therapy and the way they provide art therapy, depending upon the institution’s or client’s/service user’s needs. After an assessment of the client’s strengths and needs, art therapy may be offered in either an individual or group format, according to which is better suited to the person. Art therapist Dr. Ellen G. Horovitz wrote, “My responsibilities vary from job to job. It is wholly different when one works as a consultant or in an agency as opposed to private practice. In private practice, it becomes more complex and far reaching. If you are the primary therapist then your responsibilities can swing from the spectrum of social work to the primary care of the patient. This includes dovetailing with physicians, judges, family members, and sometimes even community members that might be important in the caretaking of the individual.” Like other psychotherapists in private practice, some art therapists find it important to ensure, for the therapeutic relationship, that the sessions occur each week in the same space and at the same time.

Art therapy is often offered in schools as a form of therapy for children because of their creativity and interest in art as a means of expression. Art therapy can benefit children with a variety of issues, such as learning disabilities, speech and language disorders, behavioural disorders, and other emotional disturbances that might be hindering a child’s learning. Similar to other psychologists that work in schools, art therapists should be able to diagnose the problems facing their student clients, and individualize treatment and interventions. Art therapists work closely with teachers and parents in order to implement their therapy strategies.

Art-Based Assessments

Art therapists and other professionals use art-based assessments to evaluate emotional, cognitive, and developmental conditions. There are also many psychological assessments that utilise artmaking to analyse various types of mental functioning (Betts, 2005). Art therapists and other professionals are educated to administer and interpret these assessments, most of which rely on simple directives and a standardised array of art materials (Malchiodi 1998, 2003; Betts, 2005). The first drawing assessment for psychological purposes was created in 1906 by German psychiatrist Fritz Mohr (Malchiodi 1998). In 1926, researcher Florence Goodenough created a drawing test to measure the intelligence in children called the Draw-A-Man Test (Malchiodi 1998). The key to interpreting the Draw-A-Man Test was that the more details a child incorporated into the drawing, the MORE intelligent they were (Malchiodi, 1998). Goodenough and other researchers realised the test had just as much to do with personality as it did intelligence (Malchiodi, 1998). Several other psychiatric art assessments were created in the 1940s, and have been used ever since (Malchiodi 1998).

Notwithstanding, many art therapists eschew diagnostic testing and indeed some writers (Hogan 1997) question the validity of therapists making interpretative assumptions. More recent literature, however, highlights the utility of standardised approaches to treatment planning and clinical decision-making, such as is evidenced through this source. Below are some examples of art therapy assessments:

  • Mandala Assessment Research Instrument:
    • In this assessment, a person is asked to select a card from a deck with different mandalas (designs enclosed in a geometric shape) and then must choose a colour from a set of coloured cards.
    • The person is then asked to draw the mandala from the card they choose with an oil pastel of the colour of their choice.
    • The artist is then asked to explain if there were any meanings, experiences, or related information related to the mandala they drew.
    • This test is based on the beliefs of Joan Kellogg, who sees a recurring correlation between the images, pattern and shapes in the mandalas that people draw and the personalities of the artists.
    • This test assesses and gives clues to a person’s psychological progressions and their current psychological condition (Malchiodi 1998).
    • The mandala originates in Buddhism; its connections with spirituality help us to see links with transpersonal art.
  • House-Tree-Person:
    • In the house-tree-person test, the client/service user is asked to first draw a house, then a tree, then a person, and is asked several questions about each.
    • As of 2014, this test had not been well-validated.

Outsider Art

The relation between the fields of art therapy and outsider art has been widely debated. The term ‘art brut’ was first coined by French artist Jean Dubuffet to describe art created outside the boundaries of official culture. Dubuffet used the term ‘art brut’ to focus on artistic practice by insane-asylum patients. The English translation “outsider art” was first used by art critic Roger Cardinal in 1972.

Both terms have been criticized because of their social and personal impact on both patients and artists. Art therapy professionals have been accused of not putting enough emphasis on the artistic value and meaning of the artist’s works, considering them only from a medical perspective. This led to the misconception of the whole outsider art practice, while addressing therapeutical issues within the field of aesthetical discussion. Outsider Art, on the contrary, has been negatively judged because of the labelling of the artists’ work, i.e. the equation artist = genius = insane. Moreover, the business-related issues on the term outsider art carry some misunderstandings. While the outsider artist is part of a specific art system, which can add a positive value to both the artist’s work as well as his personal development, it can also imprison him within the boundaries of the system itself.

What is Psychoanalysis?

Introduction

Psychoanalysis (from Greek: ψυχή, psykhḗ, ‘soul’ + ἀνάλυσις, análysis, ‘investigate’) is a set of theories and therapeutic techniques used to study the unconscious mind, which together form a method of treatment for mental disorders. The discipline was established in the early 1890s by Austrian neurologist Sigmund Freud, who retained the term psychoanalysis for his own school of thought. Freud’s work stems partly from the clinical work of Josef Breuer and others. Psychoanalysis was later developed in different directions, mostly by students of Freud, such as Alfred Adler and his collaborator, Carl Gustav Jung, as well as by neo-Freudian thinkers, such as Erich Fromm, Karen Horney, and Harry Stack Sullivan.

Psychoanalysis has been known to be a controversial discipline, and its validity as a science is very contested. Nonetheless, it retains a relatively salient influence within psychiatry, albeit more so in some quarters than others. Psychoanalytic concepts are also widely used outside the therapeutic arena, in areas such as psychoanalytic literary criticism, as well as in the analysis of film, fairy tales, philosophical perspectives as Freudo-Marxism 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 alone.
  • Human behaviour and cognition are largely determined by instinctual drives that are rooted in the unconscious.
  • Attempts to bring such drives into awareness triggers resistance in the form of defence mechanisms, particularly repression.
  • Conflicts between conscious and unconscious material can result in mental disturbances, such as neurosis, neurotic traits, anxiety, and depression.
  • Unconscious material can be found in dreams and unintentional acts, including mannerisms and slips of the tongue.
  • Liberation from the effects of the unconscious is achieved by bringing this material into the conscious mind through therapeutic intervention.
  • The “centrepiece of the psychoanalytic process” is the transference, 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, ideally 4-5 times a week, the patient (or analysand) may lie on a couch, with the analyst often sitting 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 (the analyst’s feelings for the patient), the analyst confronts the patient’s pathological defences to help the patient gain insight.

History

Sigmund Freud first used the term ‘psychoanalysis’ (French: psychoanalyse) in 1896, ultimately retaining the term for his own school of thought. In November 1899, he wrote the Interpretation of Dreams (German: Die Traumdeutung), 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 and Carl Gustav Jung,] and by neo-Freudians such as Erich Fromm, Karen Horney and Harry Stack Sullivan.

1890s

The idea of psychoanalysis (German: psychoanalyse) first began to receive serious attention under Sigmund Freud, who formulated his own theory of psychoanalysis in Vienna in the 1890s. Freud was a neurologist trying to find an effective treatment for patients with neurotic or hysterical 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 children had no apparent organic cause for their symptoms. He then wrote a monograph about this subject. In 1885, Freud obtained a grant to study with 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 anaesthesia’s. 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 (1895; Studien über Hysterie), co-authored with his mentor the distinguished physician Josef Breuer, which was generally seen as the birth of psychoanalysis. The work was based on Breuer’s treatment of Bertha Pappenheim, referred to in case studies by the pseudonym “Anna O.”, treatment which Pappenheim herself had dubbed the “talking cure”. 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; while Freud contended that at the root of hysterical symptoms were repressed memories of distressing occurrences, almost always having direct or indirect sexual associations.

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’ (psychoanalyse) was first introduced by Freud in his essay titled “Heredity and aetiology of neuroses” (“L’hérédité et l’étiologie des névroses”), 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 hysterical symptoms are sexual excitations in infancy. However, by 1898 he had privately acknowledged to his friend and colleague Wilhelm Fliess that he no longer believed in his theory, though he did not state this publicly until 1906. Though in 1896 he had reported that his patients “had no feeling of remembering the [infantile sexual] scenes”, 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 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. 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 theory” is still popular in much of Europe, although it has fallen out of favour in much of North America.

1900 to 1940s

In 1905, Freud published Three Essays on the Theory of Sexuality 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 (1915), Freud turned his attention to the titular subject of narcissism. Still using an energic system, Freud characterised the difference between energy directed at the self versus energy directed at others, called cathexis. By 1917, in “Mourning and Melancholia,” he suggested that certain depressions were caused by turning guilt-ridden anger on the self. In 1919, through “A Child is Being Beaten,” he began to address the problems of self-destructive behaviour (moral masochism) and frank sexual masochism. Based on his experience with depressed and self-destructive patients, and pondering the carnage of World War I, Freud became dissatisfied with considering only oral and sexual motivations for behaviour. By 1920, Freud addressed the power of identification (with the leader and with other members) in groups as a motivation for behaviour (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.

Three years later, in 1923, he summarised the ideas of id, ego, and superego in “The Ego and the Id.” In the book, he revised the whole theory of mental functioning, now considering that repression was only one of many defence 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, and how that anxiety could lead to an inhibition of mental functions, such as intellect and speech. “Inhibitions, Symptoms and Anxiety” was written in response to Otto Rank, 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, characterised 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 civilisation. 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 phobias and compulsions) each represented elements of some drive wish (sexual and/or aggressive), superego, anxiety, reality, and defences. Also in 1936, Anna Freud, Sigmund’s daughter, published her seminal book, The Ego and the Mechanisms of Defence, outlining numerous ways the mind could shut upsetting things out of consciousness.

1940s to Present

When 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, 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 defences (mediated by the ego) before exploring the deeper roots to the unconscious conflicts.

In addition, there was burgeoning interest in child psychoanalysis. Although criticised since its inception, psychoanalysis has been used as a research tool into childhood development, and is still used to treat certain mental disturbances. In the 1960s, Freud’s early thoughts on the childhood development of female sexuality 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’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 (APsaA), which is a component organisation of the International Psychoanalytical Association (IPA), and there are over 3000 graduated psychoanalysts practicing in the United States. The IPA accredits psychoanalytic training centres 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.

The Development of Alternatives to Psychotherapy

In the 1950s, psychoanalysis was the main modality of psychotherapy. 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 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 process. Beck developed this into a talking therapy in the early 1970s called cognitive behavioural therapy.

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, 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, especially in fields such as childcare, education, literary criticism, cultural studies, mental health, and particularly psychotherapy. Though there is a mainstream of evolved analytic ideas, there are groups who follow the precepts of one or more of the later theoreticians. Psychoanalytic ideas also play roles in some types of literary analysis such as Archetypal literary criticism.

Topographic Theory

Topographic theory was named and first described by Sigmund Freud in The Interpretation of Dreams (1899). The theory hypothesizes that the mental apparatus can be divided into the systems Conscious, Preconscious, and Unconscious. These systems are not 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. 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 is present at birth as the repository of basic instincts, which Freud called “Triebe” (“drives”): unorganised 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 was initially suggested by Freud in “Inhibitions, Symptoms and Anxiety” (1926), while major steps forward would be made through Anna Freud’s work on 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 utilise 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. Defences 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 defences. 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 mentation. 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, 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, 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, especially The Mind in Conflict (1982), include Sandor Abend, Jacob Arlow, and Jerome Blackman.

Object Relations Theory

Object relations theory attempts to explain the ups and downs of human relationships through a study of how internal representations of the self and others are organised. 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

Concepts regarding internal representation (aka ‘introspect,’ ‘self and object representation,’ or ‘internalization of self and other’), although often attributed to Melanie Klein, were actually first mentioned by Sigmund Freud in his early concepts of drive theory (Three Essays on the Theory of Sexuality, 1905). Freud’s 1917 paper “Mourning and Melancholia,” for example, hypothesized that unresolved grief was caused by the survivor’s internalised 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.

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 internalisation 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. Mahler, Fine, and Bergman (1975) describe distinct phases and sub-phases 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, internalisations, 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. 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, 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 sense of self through empathic contacts with other humans, primary significant others conceived of as ‘selfobjects.’ Selfobjects meet the developing self’s needs for mirroring, idealisation, and twinship, and thereby strengthen the developing self. The process of treatment proceeds through “transmuting internalisations” 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 and Anna Ornstein, Marian Tolpin, and others.

Lacanian Psychoanalysis

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 “Imaginary”, and 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 analyse 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 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 topographic model of the mind (conscious, preconscious, and unconscious) over the 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 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. 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 mentalisation 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 behaviour, are usually diagnosed as psychopaths, or, using DSM-IV-TR, antisocial personality disorder.

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.

The shorthand term, oedipal – later explicated by Joseph J. Sandler in “On the Concept Superego” (1960) and modified by Charles Brenner in The Mind in Conflict (1982) – refers to the powerful attachments that children make to their parents in the preschool years. These attachments involve fantasies of 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 channelling wishes into something their parents approve of (“sublimation”) and the development, during the school-age years (“latency”) of age-appropriate obsessive-compulsive defensive manoeuvres (rules, repetitive games).

Treatment

Using the various analytic and psychological techniques to 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: phobias, conversions, compulsions, obsessions, anxiety attacks, depressions, sexual dysfunctions, a wide variety of relationship problems (such as dating and marital strife), and a wide variety of character problems (for example, painful shyness, meanness, obnoxiousness, workaholism, hyperseductiveness, hyperemotionality, hyperfastidiousness). The fact that many of such patients also demonstrate deficits above makes diagnosis and treatment selection difficult.

Analytical organizations such as the 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. Strachey (1936) stressed that figuring out ways the patient distorted perceptions about the analyst led to understanding what may have been forgotten. 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).

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 reorganise thoughts after the development of insight – through the interpretive work of the analyst. Although fantasy life can be understood through the examination of dreams, masturbation fantasies 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 – and in any case, very early experiences (before age two) – cannot be remembered.

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 is 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 defence, 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. defence vs. affect);
  • Genetic interpretation: explaining how a past event is influencing the present;
  • Resistance interpretation: showing the patient how they are avoiding their problems;
  • Transference interpretation: showing the patient ways old conflicts arise in current relationships, including that with the analyst; or
  • Dream interpretation: obtaining the patient’s thoughts about their dreams and connecting this with their current problems.

Analysts can also use reconstruction to estimate what may have happened in the past that created some current issue. These techniques are primarily based on conflict theory (see above). As object relations theory evolved, supplemented by the work of John Bowlby and Mary Ainsworth, techniques with patients who had more severe problems with basic trust (Erikson, 1950) and a history of maternal deprivation (see the works of Augusta Alpert) led to new techniques with adults. These have sometimes been called interpersonal, intersubjective (cf. Stolorow), relational, or corrective object relations techniques. These techniques include expressing an empathic attunement to the patient or warmth; exposing a bit of the analyst’s personal life or attitudes to the patient; allowing the patient autonomy in the form of disagreement with the analyst (cf. I. H. Paul, Letters to Simon); and explaining the motivations of others which the patient misperceives.

Ego psychological concepts of deficit in functioning led to refinements in supportive therapy. These techniques are particularly applicable to psychotic and near-psychotic (cf., Eric Marcus, “Psychosis and Near-psychosis”) patients. These supportive therapy techniques include discussions of reality; encouragement to stay alive (including hospitalisation); 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, defences creating pathology, and fantasies. Silence is not a technique of psychoanalysis (see also the studies and opinion papers of Owen Renik). “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. Sullivan introduced the term 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 F. Schilder, Samuel R. Slavson, Harry Stack Sullivan, and Wolfe. Child-centred counselling 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, Anna Freud adapted psychoanalysis for children through play. This is still used today for children, especially those who are preadolescent. Using toys and games, children are able to symbolically demonstrate their fears, fantasies, and defences; 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 defences such as disobedience and withdrawal, that have been guarding against various unpleasant feelings and hostile wishes. In art therapy, the counsellor may have a child draw a portrait and then tell a story about the portrait. The counsellor 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 counsellor understands the client’s culture. For example, Tori and Blimes found that defence mechanisms were valid in a normative sample of 2,624 Thais. The use of certain defence mechanisms was related to cultural values. For example, Thais value calmness and collectiveness (because of Buddhist beliefs), so they were low on regressive emotionality. Psychoanalysis also applies because Freud used techniques that allowed him to get the subjective perceptions of his patients. He takes an objective approach by not facing his clients during his talk therapy sessions. He met with his patients 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.

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, 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 defence 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 behaviour 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 behaviours. 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.

In 2015, psychoanalyst Bradley Peterson, who is also a child psychiatrist and director of the Institute for the Developing Mind at Children’s Hospital Los Angeles, said: “I think most people would agree that psychoanalysis as a form of treatment is on its last legs.” However psychoanalytic approaches continue to be listed by the UK NHS 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 centres 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 organisations 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 vigour and development of psychoanalysis for the benefit of psychoanalytic patients. It works in partnership with its 70 constituent organisations in 33 countries to support 11,500 members. In the US, there are 77 psychoanalytical organisations, 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 organisations are: provide ongoing educational opportunities for its members, stimulate the development and research of psychoanalysis, provide training and organise 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 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 organisation. 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 organisation 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 organisation 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.

United Kingdom

The London Psychoanalytical Society was founded by Ernest Jones on 30 October 1913. After World War I with the expansion of psychoanalysis in the United Kingdom, the Society was reconstituted and named the British Psychoanalytical Society in 1919. Soon after, the Institute of Psychoanalysis was established to administer the Society’s activities. These include: the training of psychoanalysts, the development of the theory and practice of psychoanalysis, the provision of treatment through The London Clinic of Psychoanalysis, the publication of books in The 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, 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, John Bowlby, Ronald Fairbairn, Anna Freud, Harry Guntrip, Melanie Klein, Donald Meltzer, Joseph J. Sandler, Hanna Segal, J.D. Sutherland and Donald Winnicott.

The 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 mentalisation-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 analysed the efficacy of analysis in cases of neurosis and character or personality problems. Psychoanalysis modified by object relations techniques has been shown to be effective in many cases of ingrained problems of intimacy and relationship (cf. the many books of Otto Kernberg). 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 ostracised him for his findings that hysterical conversion symptoms were not limited to women. Challenges to analytic theory began with Otto Rank and Alfred Adler (turn of the 20th century), continued with behaviorists (e.g. Wolpe) into the 1940s and ’50s, and have persisted (e.g. 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 levelled 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. In the past 30 years or so, the criticisms have centred 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 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, Françoise Dolto, 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 traumatisation 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.

Research Results

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 therapy to be effective, with outcomes comparable or greater than other kinds of psychotherapy 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.

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 (Cohen’s d) ranging from .34 to .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 .78 to .91 for somatic disorders compared to no treatment and .69 for treating depression. A 2012 Harvard Review of Psychiatry meta-analysis of Intensive Short-Term Dynamic Psychotherapy (ISTDP) found effect sizes ranging from .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 .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 .44 to .68.

According to a 2004 French review conducted by 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, panic disorder, obsessive compulsive disorder, specific phobia, bulimia and anorexia.

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 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 therapy in cases of schizophrenia, arguing that more trials are necessary to verify its effectiveness.

Criticism

As a Field of Science

Both Freud and psychoanalysis have been criticised in extreme terms. Exchanges between critics and defenders of psychoanalysis have often been so heated that they have come to be characterised as the Freud Wars.

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. Some have accused Freud of fabrication, most famously in the case of Anna O. 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.

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 modern interpretations).

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 (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 methodology inherent to science. According to Bunge, most psychoanalytic theories are either untestable or unsupported by evidence. 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.… [T]hinking…is not just a [result] of emotion or behavior.… [E]motion is always generated by cognition, not the other way around.

Linguist Noam Chomsky has criticized psychoanalysis for lacking a scientific basis. Steven Pinker considers Freudian theory unscientific for understanding the mind. Evolutionary biologist Stephen Jay Gould considered psychoanalysis influenced by pseudoscientific theories such as recapitulation theory. Psychologists Hans Eysenck (1985) and John F. Kihlstrom (2012/2000) have also criticised the field as pseudoscience.

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.

Richard Feynman wrote off psychoanalysts as mere “witch doctors:”

If you look at all of the complicated ideas that they have developed in an infinitesimal amount of time, if you compare to any other of the sciences how long it takes to get one idea after the other, if you consider all the structures and inventions and complicated things, the ids and the egos, the tensions and the forces, and the pushes and the pulls, I tell you they can’t all be there. It’s too much for one brain or a few brains to have cooked up in such a short time.

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 EST. Psychologist Alice Miller charged psychoanalysis with being similar to the poisonous pedagogies, which she described in her book For Your Own Good. She scrutinized and rejected the validity of Freud’s drive theory, including the Oedipus complex, which, according to her and Jeffrey Masson, blames the child for the abusive sexual behaviour 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.

Michel Foucault and Gilles Deleuze claimed that the institution of psychoanalysis has become a centre of power and that its confessional techniques resemble the Christian tradition. Jacques Lacan criticised 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-Œdipus, take the cases of Gérard Mendel, Bela Grunberger and Janine Chasseguet-Smirgel, prominent members of the most respected associations (IPA), to suggest that, traditionally, psychoanalysis enthusiastically embraces a police state.

The theoretical foundations of psychoanalysis lie in the same philosophical currents that lead to interpretive phenomenology rather than in those that lead to scientific positivism, making the theory largely incompatible with positivist approaches to the study of the mind.

Although 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, a French 2004 report from INSERM concluded that psychoanalytic therapy is less effective than other psychotherapies (including cognitive behavioural therapy) for certain diseases. This report used a meta-analysis of numerous other studies to find whether the treatment was “proven” or “presumed” to be effective on different diseases.

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 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, 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.

Many aspects of Freudian theory are indeed out of date, and they should be: Freud died in 1939, and he has been slow to undertake further revisions. His critics, however, are equally behind the times, attacking Freudian views of the 1920s as if they continue to have some currency in their original form. Psychodynamic theory and therapy have evolved considerably since 1939 when Freud’s bearded countenance was last sighted in earnest. Contemporary psychoanalysts and psychodynamic therapists no longer write much about ids and egos, nor do they conceive of treatment for psychological disorders as an archaeological expedition in search of lost memories. (Drew Westen, 1998).

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 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 (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.

On This Day … 25 December

People (Births)

  • 1875 – Francis Aveling, Canadian psychologist and priest (d. 1941).

People (Deaths)

  • 1925 – Karl Abraham, German psychoanalyst and author (b. 1877).

Francis Aveling

Francis Arthur Powell Aveling DD DSc PhD DLit MC ComC (25 December 1875 to 6 March 1941) was a Canadian psychologist and Catholic priest. He married Ethel Dancy of Steyning, Sussex in 1925.

Life

Francis Aveling was born at St. Catharines, Ontario 25 December 1875. He went to Bishop Ridley College in Ontario and McGill University before studying at Keble College at the Oxford University, England. Aveling was received into the Roman Catholic Church by Father Luke Rivington in 1896 and entered the Pontificio Collegio Canadese in Rome. There he earned his doctor of divinity degree. He was ordained to the priesthood in 1899, and served as a curate in Tottenham, before becoming first rector of Westminster Cathedral Choir School. He was also a chaplain at the Cathedral, and to St. Wilfrid’s Convent, Chelsea.

In 1910, Aveling obtained a doctor of philosophy degree at the age of 35 from the University of Louvain (his advisor was Albert Michotte), and in 1912 he was recipient of a doctor of science degree from the University of London, and received the Carpenter Medal following his work On the Consciousness of the Universal and the Individual: A Contribution to the Phenomenology of the Thought Process. Subsequently, Aveling received his doctor of letters degree from the University of London.

Career

Aveling taught at University College, London from 1912 as a Lecturer (Assistant Professor), under the leadership of Charles Spearman, until the First World War. During that war he served in France as a chaplain in the British Army, after which he returned to the University of London. In 1922, he transferred to King’s College, London where he was promoted to reader (associate professor), and later to professor of psychology. He was an extern examiner in philosophy at the National University of Ireland; and a lecturer in pedagogical methods for the London County Council.

Aveling authored several books. He was the doctoral advisor of Raymond Cattell From 1926 until 1929, Aveling was also a president of the British Psychological Society. Aveling was a member of the Council of the International Congresses, of the Aristotelian Society, of the council and advisory board of the National Institute of Industrial Psychology, of the council of the British Institute of Philosophical Studies and of the Child Guidance Council.

He was a contributor to the Dublin Review, The American Catholic Quarterly Review, Catholic World, The nineteenth Century, The Journal of Psychology, and the Catholic Encyclopaedia.

Karl Abraham

Karl Abraham 03 May 1877 to 25 December 1925) was an influential German psychoanalyst, and a collaborator of Sigmund Freud, who called him his ‘best pupil’.

Life

Abraham was born in Bremen, Germany. His parents were Nathan Abraham, a Jewish religion teacher (1842-1915) and his wife (and cousin) Ida (1847-1929). His studies in medicine enabled him to take a position at the Burghölzli Swiss Mental Hospital, where Eugen Bleuler practiced. The setting of this hospital initially introduced him to the psychoanalysis of Carl Gustav Jung.

Collaborations

In 1907, he had his first contact with Sigmund Freud, with whom he developed a lifetime relationship. Returning to Germany, he founded the Berliner Society of Psychoanalysis in 1910. He was the president of the International Psychoanalytical Association from 1914 to 1918 and again in 1925.

Karl Abraham collaborated with Freud on the understanding of manic-depressive illness, leading to Freud’s paper on ‘Mourning and Melancholia’ in 1917. He was the analyst of Melanie Klein during 1924–1925, and of a number of other British psychoanalysts, including Edward Glover, James Glover, and Alix Strachey. He was a mentor for an influential group of German analysts, including Karen Horney, Helene Deutsch, and Franz Alexander.

Karl Abraham studied the role of infant sexuality in character development and mental illness and, like Freud, suggested that if psychosexual development is fixated at some point, mental disorders will likely emerge. He described the personality traits and psychopathology that result from the oral and anal stages of development (1921). Abraham observed his only daughter Hilda Abraham reporting on her reaction to enemas and infantile masturbation by her brother. He asked that secrets be shared with him but he was careful to respect her privacy and some reports were not published until after Hilda.s death. Hilda was later to become a psychoanalyst.

In the oral stage of development, the first relationships children have with objects (caretakers) determine their subsequent relationship to reality. Oral satisfaction can result in self-assurance and optimism, whereas oral fixation can lead to pessimism and depression. Moreover, a person with an oral fixation will present a disinclination to take care of him/herself and will require others to look after him/her. This may be expressed through extreme passivity (corresponding to the oral benign suckling substage) or through a highly active oral-sadistic behaviour (corresponding to the later sadistic biting substage).

In the anal stage, when the training in cleanliness starts too early, conflicts may result between a conscious attitude of obedience and an unconscious desire for resistance. This can lead to traits such as frugality, orderliness and obstinacy, as well as to obsessional neurosis as a result of anal fixation (Abraham, 1921). In addition, Abraham based his understanding of manic-depressive illness on the study of the painter Segantini: an actual event of loss is not itself sufficient to bring the psychological disturbance involved in melancholic depression. This disturbance is linked with disappointing incidents of early childhood; in the case of men always with the mother (Abraham, 1911). This concept of the prooedipal “bad” mother was a new development in contrast to Freud’s oedipal mother and paved the way for the theories of Melanie Klein (May-Tolzmann, 1997).

Another important contribution is his work “A short study of the Development of the Libido”, where he elaborated on Freud’s “Mourning and Melancholia” (1917) and demonstrated the vicissitudes of normal and pathological object relations and reactions to object loss.

Moreover, Abraham investigated child sexual trauma and, like Freud, proposed that sexual abuse was common among psychotic and neurotic patients. Furthermore, he argued (1907) that dementia praecox is associated with child sexual trauma, based on the relationship between hysteria and child sexual trauma demonstrated by Freud.

Abraham (1920) also showed interest in cultural issues. He analysed various myths suggesting their relation to dreams (1909) and wrote an interpretation of the spiritual activities of the Egyptian monotheistic Pharaoh Amenhotep IV (1912).

Death

Abraham died prematurely on 25 December 1925 from complications of a lung infection and may have suffered from lung cancer.