What is Countertransference?

Introduction

Countertransference is defined as redirection of a psychotherapist‘s feelings toward a client – or, more generally, as a therapist’s emotional entanglement with a client.

Refer to Body-Centred Countertransference.

Early Formulations

The phenomenon of countertransference (German: Gegenübertragung) was first defined publicly by Sigmund Freud in 1910 (The Future Prospects of Psycho-Analytic Therapy) as being “a result of the patient’s influence on [the physician’s] unconscious feelings”; although Freud had been aware of it privately for some time, writing to Carl Jung for example in 1909 of the need “to dominate ‘counter-transference’, which is after all a permanent problem for us”. Freud stated that since an analyst is a human himself he can easily let his emotions into the client. Because Freud saw the countertransference as a purely personal problem for the analyst, he rarely referred to it publicly, and did so almost invariably in terms of a “warning against any countertransference lying in wait” for the analyst, who “must recognize this countertransference in himself and master it”. However, analysis of Freud’s letters shows that he was intrigued by countertransference and did not see it as purely a problem.

The potential danger of the analyst’s countertransference – “In such cases, the patient represents for the analyst an object of the past on to whom past feelings and wishes are projected” – became widely accepted in psychodynamic circles, both within and without the psychoanalytic mainstream. Thus, for example, Jung warned against “cases of counter-transference when the analyst really cannot let go of the patient…both fall into the same dark hole of unconsciousness”. Similarly Eric Berne stressed that “Countertransference means that not only does the analyst play a role in the patient’s script, but she plays a part in his…the result is the ‘chaotic situation’ which analysts speak of”. Lacan acknowledged of the analyst’s “countertransference…if he is re-animated the game will proceed without anyone knowing who is leading”.

In this sense, the term includes unconscious reactions to a patient that are determined by the psychoanalyst’s own life history and unconscious content; it was later expanded to include unconscious hostile and/or erotic feelings toward a patient that interfere with objectivity and limit the therapist’s effectiveness. For example, a therapist might have a strong desire for a client to get good grades in university because the client reminds her of her children at that stage in life, and the anxieties that the therapist experienced during that time. Even in its most benign form, such an attitude could lead at best to “a ‘countertransference cure’…achieved through compliance and a ‘false self’ suppression of the patient’s more difficult feelings”.

Another example would be a therapist who did not receive enough attention from her father perceiving her client as being too distant and resenting him for it. In essence, this describes the transference of the treater to the patient, which is referred to as the “narrow perspective”.

Middle Years

As the 20th century progressed, however, other, more positive views of countertransference began to emerge, approaching a definition of countertransference as the entire body of feelings that the therapist has toward the patient. Jung explored the importance of the therapist’s reaction to the patient through the image of the wounded physician: “it is his own hurt that gives the measure of his power to heal”. Heinrich Racker emphasised the threat that “the repression of countertransference…is prolonged in the mythology of the analytic situation”. Paula Heimann highlighted how the “analyst’s countertransference is not only part and parcel of the analytic relationship, but it is the patient’s creation, it is part of the patient’s personality”. As a result, “counter-transference was thus reversed from being an interference to becoming a potential source of vital confirmation”. The change of fortune “was highly controversial. Melanie Klein disapproved on the grounds that poorly analysed psycho-analysts could excuse their own emotional difficulties” thereby; but among her younger followers “the trend within the Kleinian group was to take seriously the new view of counter-transference” – Hanna Segal warning in typically pragmatic fashion however that “Countertransference can be the best of servants but is the most awful of masters”.

Late Twentieth-Century Paradigm

By the last third of the century, a growing consensus appeared on the importance of “a distinction between ‘personal countertransference’ (which has to do with the therapist) and ‘diagnostic response’ – that indicates something about the patient…diagnostic countertransference”. A new belief had come into being that “countertransference can be of such enormous clinical usefulness….You have to distinguish between what your reactions to the patient are telling you about his psychology and what they are merely expressing about your own”. A distinction between “neurotic countertransference” (or “illusory countertransference”) and “countertransference proper” had come (despite a wide range of terminological variation) to transcend individual schools. The main exception is that for “most psychoanalysts who follow Lacan’s teaching…counter-transference is not simply one form of resistance, it is the ultimate resistance of the analyst”.

The contemporary understanding of countertransference is thus generally to regard countertransference as a “jointly created” phenomenon between the treater and the patient. The patient pressures the treater through transference into playing a role congruent with the patient’s internal world. However, the specific dimensions of that role are coloured by treater’s own personality. Countertransference can be a therapeutic tool when examined by the treater to sort out who is doing what, and the meaning behind those interpersonal roles (The differentiation of the object’s interpersonal world between self and other). Nothing in the new understanding alters of course the need for continuing awareness of the dangers in the narrow perspective – of “serious risks of unresolved countertransference difficulties being acted out within what is meant to be a therapeutic relationship”; but “from that point on, transference and counter-transference were looked upon as an inseparable couple…’total situation'”.

Twenty-First-Century Developments

Further developments in the current century might be said to be the increased recognition that “Most countertransference reactions are a blend of the two aspects”, personal and diagnostic, which require careful disentanglement in their interaction; and the possibility that nowadays psychodynamic counsellors use countertransference much more than transference – “another interesting shift in perspective over the years”. One explanation of the latter point might be that because “in object relations therapy…the relationship is so central, ‘countertransference’ reactions are considered key in helping the therapist to understand the transference”, something appearing in “the post-Kleinian perspective…[as] Indivisible transferencecountertransference”.

Body-Centred Countertransference

Psychologists at NUI Galway and University College Dublin have recently begun to measure body-centred countertransference in female trauma therapists using their recently developed “Egan and Carr Body Centred Countertransference Scale”, a sixteen symptom measure. High levels of body-centred countertransference have since been found in both Irish female trauma therapists and clinical psychologists. This phenomenon is also known as “somatic countertransference” or “embodied countertransference” and links to mirror neurons and automatic somatic empathy for others due to the actions of these neurons have been hypothesised.

What is Ego Psychology?

Introduction

Ego psychology is a school of psychoanalysis rooted in Sigmund Freud’s structural id-ego-superego model of the mind.

An individual interacts with the external world as well as responds to internal forces. Many psychoanalysts use a theoretical construct called the ego to explain how that is done through various ego functions. Adherents of ego psychology focus on the ego’s normal and pathological development, its management of libidinal and aggressive impulses, and its adaptation to reality.

Brief History

Early Conceptions of the Ego

Sigmund Freud initially considered the ego to be a sense organ for perception of both external and internal stimuli. He thought of the ego as synonymous with consciousness and contrasted it with the repressed unconscious. In 1910, Freud emphasized the attention to detail when referencing psychoanalytical matters, while predicting his theory to become essential in regards to everyday tasks with the Swiss psychoanalyst, Oscar Pfister. By 1911, he referenced ego instincts for the first time in Formulations on the Two Principles of Mental Functioning and contrasted them with sexual instincts: ego instincts responded to the reality principle while sexual instincts obeyed the pleasure principle. He also introduced attention and memory as ego functions.

Freud’s Ego Psychology

Freud later argued that not all unconscious phenomena can be attributed to the id, and that the ego has unconscious aspects as well. This posed a significant problem for his topographic theory, which he resolved in The Ego and the Id (1923).

In what came to be called the structural theory, the ego was now a formal component of a three-way system that also included the id and superego. The ego was still organised around conscious perceptual capacities, yet it now had unconscious features responsible for repression and other defensive operations. Freud’s ego at this stage was relatively passive and weak; he described it as the helpless rider on the id’s horse, more or less obliged to go where the id wished to go.

In Inhibitions, Symptoms, and Anxiety (1926), Freud revised his theory of anxiety as well as delineated a more robust ego. Freud argued that instinctual drives (id), moral and value judgments (superego), and requirements of external reality all make demands upon an individual. The ego mediates among conflicting pressures and creates the best compromise. Instead of being passive and reactive to the id, the ego was now a formidable counterweight to it, responsible for regulating id impulses, as well as integrating an individual’s functioning into a coherent whole. The modifications made by Freud in Inhibitions, Symptoms, and Anxiety formed the basis of a psychoanalytic psychology interested in the nature and functions of the ego. This marked the transition of psychoanalysis from being primarily an id psychology, focused on the vicissitudes of the libidinal and aggressive drives as the determinants of both normal and psychopathological functioning, to a period in which the ego was accorded equal importance and was regarded as the prime shaper and modulator of behaviour.

Systematisation

Following Sigmund Freud, the psychoanalysts most responsible for the development of ego psychology, and its systematization as a formal school of psychoanalytic thought, were Anna Freud, Heinz Hartmann, and David Rapaport. Other important contributors included Ernst Kris, Rudolph Loewenstein, René Spitz, Margaret Mahler, Edith Jacobson, Paul Federn, and Erik Erikson.

Anna Freud

Anna Freud focused her attention on the ego’s unconscious, defensive operations and introduced many important theoretical and clinical considerations. In The Ego and the Mechanisms of Defense (1936), Anna Freud argued the ego was predisposed to supervise, regulate, and oppose the id through a variety of defences. She described the defences available to the ego, linked them to the stages of psychosexual development during which they originated, and identified various psychopathological compromise formations in which they were prominent. Clinically, Anna Freud emphasized that the psychoanalyst’s attention should always be on the defensive functions of the ego, which could be observed in the manifest presentation of the patient’s associations. The analyst needed to be attuned to the moment-by-moment process of what the patient talked about in order to identify, label, and explore defences as they appeared. For Anna Freud, direct interpretation of repressed content was less important than understanding the ego’s methods by which it kept things out of consciousness. Her work provided a bridge between Freud’s structural theory and ego psychology.

Heinz Hartmann

Heinz Hartmann (1939/1958) believed the ego included innate capacities that facilitated an individual’s ability to adapt to his or her environment. These included perception, attention, memory, concentration, motor coordination, and language. Under normal conditions, which Hartmann called “an average expectable environment,” these capacities developed into ego functions with autonomy from the libidinal and aggressive drives; that is, they were not products of frustration and conflict as Freud (1911) believed. Hartmann recognised, however, that conflicts were part of the human condition and that certain ego functions may become conflicted by aggressive and libidinal impulses, as witnessed by conversion disorders (e.g., glove paralysis), speech impediments, eating disorders, and attention-deficit disorder.

A focus on ego functions and how an individual adapts to his or her environment led Hartmann to create both a general psychology and a clinical instrument with which an analyst could evaluate an individual’s functioning and formulate appropriate therapeutic interventions. Hartmann’s propositions imply that the task of the ego psychologist was to neutralize conflicted impulses and expand the conflict-free spheres of ego functions. Through such effects, Hartmann believed, psychoanalysis facilitated an individual’s adaptation to his or her environment. He claimed, however, that his aim was to understand the mutual regulation of the ego and environment rather than to promote adjustment of the ego to the environment; additionally, he proposed that diminishing conflict in an individual’s ego would help him or her to respond actively to, and shape rather than passively react to, the environment. Mitchell and Black (p.35) stated:

“Hartmann powerfully affected the course of psychoanalysis, opening up a crucial investigation of the key processes and vicissitudes of normal development. Hartmann’s contributions broadened the scope of psychoanalytic concerns, from psychopathology to general human development, and from an isolated, self-contained treatment method to a sweeping intellectual discipline among other disciplines”

David Rapaport

David Rapaport played a prominent role in the development of ego psychology, and his work likely represented its apex. In the influential monograph The Structure of Psychoanalytic Theory (1960), Rappaport organized ego psychology into an integrated, systematic, and hierarchical theory capable of generating empirically testable hypotheses. He proposed that psychoanalytic theory – as expressed through the principles of ego psychology – was a biologically based general psychology that could explain the entire range of human behaviour. For Rapaport, this endeavour was fully consistent with Freud’s attempts to do the same (e.g. Freud’s studies of dreams, jokes, and the “psychopathology of everyday life”).

Other Contributors

While Hartmann was the principal architect of ego psychology, he collaborated closely with Ernst Kris and Rudolph Loewenstein.

Subsequent psychoanalysts interested in ego psychology emphasized the importance of early-childhood experiences and socio-cultural influences on ego development. René Spitz (1965), Margaret Mahler (1968), Edith Jacobson (1964), and Erik Erikson studied infant and child behaviour, and their observations were integrated into ego psychology. Their observational and empirical research described and explained early attachment issues, successful and faulty ego development, and psychological development through interpersonal interactions.

Spitz identified the importance of mother-infant nonverbal emotional reciprocity; Mahler refined the traditional psychosexual developmental phases by adding the separation-individuation process; and Jacobson emphasized how libidinal and aggressive impulses unfolded within the context of early relationships and environmental factors. Finally, Erik Erikson provided a bold reformulation of Freud’s biologic, epigenetic psychosexual theory through his explorations of socio-cultural influences on ego development. For Erikson, an individual was pushed by his or her own biological urges and pulled by socio-cultural forces.

Decline

In the United States, ego psychology was the predominant psychoanalytic approach from the 1940s through the 1960s. Initially, this was due to the influx of European psychoanalysts, including prominent ego psychologists like Hartmann, Kris, and Loewenstein, during and after World War II. These European analysts settled throughout the United States and trained the next generation of American psychoanalysts.

By the 1970s, several challenges to the philosophical, theoretical, and clinical tenets of ego psychology emerged. The most prominent of which were: a “rebellion” led by Rapaport’s protégés (George Klein, Robert Holt, Roy Schafer, and Merton Gill); object relations theory; and self psychology.

Contemporary

Modern Conflict Theory

Charles Brenner (1982) attempted to revive ego psychology with a concise and incisive articulation of the fundamental focus of psychoanalysis: intrapsychic conflict and the resulting compromise formations. Over time, Brenner (2002) tried to develop a more clinically based theory, what came to be called “modern conflict theory.” He distanced himself from the formal components of the structural theory and its metapsychological assumptions, and focused entirely on compromise formations.

Heinz Kohut developed self psychology, a theoretical and therapeutic model related to ego psychology, in the late 1960s. Self psychology focuses on the mental model of the self as important in pathologies.

Ego Functions

FunctionDescription
Reality Testing1. The ego’s capacity to distinguish what is occurring in one’s own mind from what is occurring in the external world.
2. It is perhaps the single most important ego function because negotiating with the outside world requires accurately perceiving and understanding stimuli.
3. Reality testing is often subject to temporary, mild distortion or deterioration under stressful conditions.
4. Such impairment can result in temporary delusions and hallucination and is generally selective, clustering along specific, psychodynamic lines.
5. Chronic deficiencies suggest either psychotic or organic interference.
Impulse Control1. The ability to manage aggressive and/or libidinal wishes without immediate discharge through behaviour or symptoms.
2. Problems with impulse control are common; for example: road rage; sexual promiscuity; excessive drug and alcohol use; and binge eating.
Affect Regulation1. The ability to modulate feelings without being overwhelmed.
Judgement1. The capacity to act responsibly.
2. This process includes identifying possible courses of action, anticipating and evaluating likely consequences, and making decisions as to what is appropriate in certain circumstances.
Object Relations1. The capacity for mutually satisfying relationship.
2. The individual can perceive himself and others as whole objects with three dimensional qualities.
Thought Processes1. The ability to have logical, coherent, and abstract thoughts.
2. In stressful situations, thought processes can become disorganised.
3. The presence of chronic or severe problems in conceptual thinking is frequently associated with schizophrenia and manic episodes.
Defensive Functioning1. A defence is an unconscious attempt to protect the individual from some powerful, identity-threatening feeling.
2. Initial defences develop in infancy and involve the boundary between the self and the outer world; they are considered primitive defences and include projection, denial, and splitting.
3. As the child grows up, more sophisticated defences that deal with internal boundaries such as those between ego and super ego or the id develop; these defences include repression, regression, displacement, and reaction formation.
4. All adults have, and use, primitive defences, but most people also have more mature ways of coping with reality and anxiety.
Synthesis1. The synthetic function is the ego’s capacity to organize and unify other functions within the personality.
2. It enables the individual to think, feel, and act in a coherent manner.
3. It includes the capacity to integrate potentially contradictory experiences, ideas, and feelings; for example, a child loves his or her mother yet also has angry feelings toward her at times.
4. The ability to synthesize these feelings is a pivotal developmental achievement.

Reality testing involves the individual’s capacity to understand and accept both physical and social reality as it is consensually defined within a given culture or cultural subgroup. In large measure, the function hinges on the individual’s capacity to distinguish between her own wishes or fears (internal reality) and events that occur in the real world (external reality). The ability to make distinctions that are consensually validated determines the ego’s capacity to distinguish and mediate between personal expectations, on the one hand, and social expectations or laws of nature on the other. Individuals vary considerably in how they manage this function. When the function is seriously compromised, individuals may withdraw from contact with reality for extended periods of time. This degree of withdrawal is most frequently seen in psychotic conditions. Most times, however, the function is mildly or moderately compromised for a limited period of time, with far less drastic consequences’ (Berzoff, 2011).

Judgment involves the capacity to reach “reasonable” conclusions about what is and what is not “appropriate” behaviour. Typically, arriving at a “reasonable” conclusion involves the following steps: (1) correlating wishes, feeling states, and memories about prior life experiences with current circumstances; (2) evaluating current circumstances in the context of social expectations and laws of nature (e.g. it is not possible to transport oneself instantly out of an embarrassing situation, no matter how much one wishes to do so); and (3) drawing realistic conclusions about the likely consequences of different possible courses of action. As the definition suggests, judgment is closely related to reality testing, and the two functions are usually evaluated in tandem (Berzoff, 2011).

Modulating and controlling impulses is based on the capacity to hold sexual and aggressive feelings in check with out acting on them until the ego has evaluated whether they meet the individual’s own moral standards and are acceptable in terms of social norms. Adequate functioning in this area depends on the individual’s capacity to tolerate frustration, to delay gratification, and to tolerate anxiety without immediately acting to ameliorate it. Impulse control also depends on the ability to exercise appropriate judgment in situations where the individual is strongly motivated to seek relief from psychological tension and/or to pursue some pleasurable activity (sex, power, fame, money, etc.). Problems in modulation may involve either too little or too much control over impulses (Berzoff, 2011).

Modulation of affect The ego performs this function by preventing painful or unacceptable emotional reactions from entering conscious awareness, or by managing the expression of such feelings in ways that do not disrupt either emotional equilibrium or social relationships. To adequately perform this function, the ego constantly monitors the source, intensity, and direction of feeling states, as well as the people toward whom feelings will be directed. Monitoring determines whether such states will be acknowledged or expressed and, if so, in what form. The basic principle to remember in evaluating how well the ego manages this function is that affect modulation may be problematic because of too much or too little expression. As an integral part of the monitoring process, the ego evaluates the type of expression that is most congruent with established social norms. For example, in white American culture it is assumed that individuals will contain themselves and maintain a high level of personal/vocational functioning except in extremely traumatic situations such as death of a family member, very serious illness or terrible accident. This standard is not necessarily the norm in other cultures (Berzhoff, Flanagan, & Hertz, 2011).

Object relations involves the ability to form and maintain coherent representations of others and of the self. The concept refers not only to the people one interacts with in the external world but also to significant others who are remembered and represented within the mind. Adequate functioning implies the ability to maintain a basically positive view of the other, even when one feels disappointed, frustrated, or angered by the other’s behaviour. Disturbances in object relations may manifest themselves through an inability to fall in love, emotional coldness, lack of interest in or withdrawal from interactions with others, intense dependency, and/or an excessive need to control relationships (Berzhoff, Flanagan, & Hertz, 2011).

Self-esteem regulation involves the capacity to maintain a steady and reasonable level of positive self-regard in the face of distressing or frustrating external events. Painful affective states, including anxiety, depression, shame, and guilt, as well as exhilarating emotions such as triumph, glee, and ecstasy may also undermine self-esteem. Generally speaking, in dominant American culture a measured expression of both pain and pleasure is expressed; excess in either direction is a cause for concern. White Western culture tends to assume that individuals will maintain a consistent and steadily level of self-esteem, regardless of external events or internally generated feeling states (Berzhoff, Flanagan, & Hertz, 2011).

Mastery when conceptualized as an ego function, mastery reflects the epigenetic view that individuals achieve more advanced levels of ego organization by mastering successive developmental challenges. Each stage of psychosexual development (oral, anal, phallic, genital) presents a particular challenge that must be adequately addressed before the individual can move on to the next higher stage. By mastering stage-specific challenges, the ego gains strength in relations to the other structures of the mind and thereby becomes more effective in organizing and synthesizing mental processes. Freud expressed this principle in his statement, “Where id was, shall ego be.” An undeveloped capacity for mastery can be seen, for example, in infants who have not been adequately nourished, stimulated, and protected during the first year of life, in the oral stage of development. When they enter the anal stage, such infants are not well prepared to learn socially acceptable behaviour or to control the pleasure they derive from defecating at will. As a result, some of them will experience delays in achieving bowel control and will have difficulty in controlling temper tantrums, while others will sink into a passive, joyless compliance with parental demands that compromises their ability to explore, learn, and become physically competent. Conversely, infants who have been well gratified and adequately stimulated during the oral stage enter the anal stage feeling relatively secure and confident. For the most part, they cooperate in curbing their anal desires, and are eager to win parental approval for doing so. In addition, they are physically active, free to learn and eager to explore. As they gain confidence in their increasingly autonomous physical and mental abilities, they also learn to follow the rules their parents establish and, in doing so, with parental approval. As they master the specific tasks related to the anal stage, they are well prepared to move on to the next stage of development and the next set of challenges. When adults have problems with mastery, they usually enact them in derivative or symbolic ways (Berzhoff, Flanagan, & Hertz, 2011).

Conflict, Defence and Resistance Analysis

According to Freud’s structural theory, an individual’s libidinal and aggressive impulses are continuously in conflict with his or her own conscience as well as with the limits imposed by reality. In certain circumstances, these conflicts may lead to neurotic symptoms. Thus, the goal of psychoanalytic treatment is to establish a balance between bodily needs, psychological wants, one’s own conscience, and social constraints. Ego psychologists argue that the conflict is best addressed by the psychological agency that has the closest relationship to consciousness, unconsciousness, and reality: the ego.

The clinical technique most commonly associated with ego psychology is defence analysis. Through clarifying, confronting, and interpreting the typical defence mechanisms a patient uses, ego psychologists hope to help the patient gain control over these mechanisms.

Cultural Influences

  • The classical scholar E. R. Dodds used ego psychology as the framework for his influential study The Greeks and the Irrational (1951).
  • The Sterbas relied on Hartmann’s conflict-free sphere to help explain the contradictions they found in Beethoven’s character in Beethoven and His Nephew (1954).

Criticisms

A number of authors have criticised Hartmann’s conception of a conflict-free sphere of ego functioning as both incoherent and inconsistent with Freud’s vision of psychoanalysis as a science of mental conflict. Freud believed that the ego itself takes shape as a result of the conflict between the id and the external world. The ego, therefore, is inherently a conflicting formation in the mind. To state, as Hartmann did, that the ego contains a conflict-free sphere may not be consistent with key propositions of Freud’s structural theory.

Ego psychology, and ‘Anna-Freudianism’, were together seen by Kleinians as maintaining a conformist, adaptative version of psychoanalysis inconsistent with Freud’s own views. Hartmann claimed, however, that his aim was to understand the mutual regulation of the ego and environment rather than to promote adjustment of the ego to the environment. Furthermore, an individual with a less-conflicted ego would be better able to actively respond and shape, rather than passively react to, his or her environment.

Jacques Lacan was if anything still more opposed to ego psychology, using his concept of the Imaginary to stress the role of identifications in building up the ego in the first place. Lacan saw in the “non-conflictual sphere…a down-at-heel mirage that had already been rejected as untenable by the most academic psychology of introspection’.

References

Berzoff, J., Flanagan, L.M. & Hertz, P (2011). Inside out and outside in: Psychodynamic clinical theory and psychopathology in contemporary multicultural contexts. (3rd ed. Lanham, MD: Rowman & Littlefield Publishers.

Mitchell, S.A. & Black, M.J. (1995). Freud and beyond: A history of modern psychoanalytic thought. New York: Basic Books.

What was the Vienna Psychoanalytic Society?

Introduction

The Vienna Psychoanalytic Society (German: Wiener Psychoanalytische Vereinigung, WPV), formerly known as the Wednesday Psychological Society, is the oldest psychoanalysis society in the world.

In 1908, reflecting its growing institutional status as the international psychoanalytic authority of the time, the Wednesday group was reconstituted under its new name with Sigmund Freud as President, a position he relinquished in 1910 in favour of Alfred Adler.

During its 36-year history, between 1902 and 1938, the Society had a total of 150 members.

First Meetings

In November 1902, Sigmund Freud wrote to Alfred Adler, “A small circle of colleagues and supporters afford me the great pleasure of coming to my house in the evening (8:30 PM after dinner) to discuss interesting topics in psychology and neuropathology… Would you be so kind as to join us?” The group included Wilhelm Stekel, Max Kahane and Rudolf Reitler, soon joined by Adler. Stekel, a Viennese physician who had been in analysis with Freud, provided the initial impetus for the meetings. Freud made sure that each participant would contribute to the discussion by drawing names from an urn and asking each to address the chosen topic.

New members were invited only with the consent of the entire group, and only a few dropped out. By 1906, the group, then called the Wednesday Psychological Society, included 17 doctors, analysts and laymen. Otto Rank was hired that year to collect dues and keep written records of the increasingly complex discussions. Each meeting included the presentation of a paper or case history with discussion and a final summary by Freud. Some of the members presented detailed histories of their own psychological and sexual development.

Active Years

As the meetings grew to include more of the original contributors to psychoanalysis, analytic frankness sometimes became an excuse for personal attacks. In 1908 Max Graf, whose five-year-old son had been an early topic of discussion as Freud’s famous “Little Hans” case, deplored the disappearance of congeniality. There were still discussions from which important insights could be gleaned, but many became acrimonious. Many members wanted to abolish the tradition that new ideas discussed at the meetings were credited to the group as a whole, not the original contributor of the idea. Freud proposed that each member should have a choice, to have his comments regarded as his own intellectual property, or to put them in the public domain.

In an attempt to resolve some of the disputes, Freud officially dissolved the informal group and formed a new group under the name Vienna Psychoanalytic Society. On the suggestion of Alfred Adler, the election of new members was based on secret ballot rather than Freud’s invitation. Although the structure of the group became more democratic, the discussions lost some of their original eclectic character as the identity of the group developed. The psychosexual theories of Freud became the primary focus of the participants.

After the end of World War I, the membership became more homogeneous, and the proportion of members identifying as Jewish increased. Over the course of the 36 years of its existence (until 1938), the Society registered a total of 150 members. Most members were Jewish, and 50 were (like Freud himself) children of Jewish immigrants from other Habsburg states.

Prominent Members

  • Sigmund Freud.
  • Alfred Adler.
  • Wilhelm Reich.
  • Otto Rank.
  • Karl Abraham.
  • Carl Jung.
  • Sándor Ferenczi.
  • Guido Holzknecht.
  • Isidor Isaak Sadger.
  • Victor Tausk.
  • Hanns Sachs.
  • Ludwig Binswanger.
  • Carl Alfred Meier.
  • Sabina Spielrein.
  • Margarete Hilferding.
  • Herbert Silberer.
  • Paul Schilder.

What is Analytical Psychology?

Introduction

Analytical psychology (German: Analytische Psychologie, sometimes translated as analytic psychology and referred to as Jungian analysis) is a term coined by Carl Jung, a Swiss psychiatrist, to describe research into his new “empirical science” of the psyche.

It was designed to distinguish it from Freud’s psychoanalytic theories as their seven-year collaboration on psychoanalysis was drawing to an end between 1912 and 1913. The evolution of his science is contained in his monumental opus, the Collected Works, written over sixty years of his lifetime.

The history of analytical psychology is intimately linked with the biography of Jung. At the start, it was known as the “Zurich school”, whose chief figures were Eugen Bleuler, Franz Riklin, Alphonse Maeder and Jung, all centred in the Burghölzli hospital in Zurich. It was initially a theory concerning psychological complexes until Jung, upon breaking with Sigmund Freud, turned it into a generalised method of investigating archetypes and the unconscious, as well as into a specialised psychotherapy.

Analytical psychology, or “complex psychology”, from the German: Komplexe Psychologie, is the foundation of many developments in the study and practice of Psychology as of other disciplines. The followers of Jung are many, and some of them are members of national societies in diverse countries around the world. They collaborate professionally on an international level through the International Association of Analytical Psychologists (IAAP) and the International Association for Jungian Studies (IAJS). Jung’s propositions have given rise to a rich and multidisciplinary literature in numerous languages.

Among widely used concepts owed specifically to Analytical psychology are: anima and animus, archetypes, the collective unconscious, complexes, extraversion and introversion, individuation, the Self, the shadow and synchronicity. The Myers–Briggs Type Indicator (MBTI) is based on another of Jung’s theories on psychological types. A lesser known idea was Jung’s notion of the Psychoid to denote a hypothesised immanent plane beyond consciousness, distinct from the collective unconscious, and a potential locus of synchronicity.

The approximately “three schools” of post-Jungian analytical psychology that are current, the classical, archetypal and developmental, can be said to correspond to the developing yet overlapping aspects of Jung’s lifelong explorations, even if he expressly did not want to start a school of “Jungians”. Hence as Jung proceeded from a clinical practice which was mainly traditionally science-based and steeped in rationalist philosophy, anthropology and ethnography, his enquiring mind simultaneously took him into more esoteric spheres such as alchemy, astrology, gnosticism, metaphysics, myth and the paranormal, without ever abandoning his allegiance to science as his long-lasting collaboration with Wolfgang Pauli attests. His wide-ranging progression suggests to some commentators that, over time, his analytical psychotherapy, informed by his intuition and teleological investigations, became more of an “art”.

The findings of Jungian analysis and the application of analytical psychology to contemporary preoccupations such as social and family relationships, dreams and nightmares, work-life balance, architecture and urban planning, politics and economics, conflict and warfare, and climate change are illustrated in a growing number of publications and films.

Background

Jung began his career as a psychiatrist in Zürich, Switzerland. Already employed at the Burghölzli hospital in 1901, in his academic dissertation for the medical faculty of the University of Zurich he took the risk of using his experiments on somnambulism and the visions of his mediumistic cousin, Helly Preiswerk. The work was entitled, “On the Psychology and Pathology of So-Called Occult Phenomena”. It was accepted but caused great upset among his mother’s family. Under the direction of psychiatrist Eugen Bleuler, he also conducted research with his colleagues using a galvanometer to evaluate the emotional sensitivities of patients to lists of words during word association. Jung has left a description of his use of the device in treatment. His research earned him a worldwide reputation and numerous honours, including Honorary Doctorates from Clark and Fordham Universities in 1909 and 1910 respectively. Other honours followed later.

Although they began corresponding a year earlier, in 1907 Jung travelled to meet Sigmund Freud in Vienna, Austria. At that stage, Jung, aged thirty-two, had a much greater international renown than the forty-nine year old neurologist. For a further six years, the two scholars worked and travelled to the United States together. In 1911, they founded the International Psychoanalytical Association, of which Jung was the first president. However, early in the collaboration, Jung had already observed that Freud would not tolerate ideas that were different from his own.

Unlike most modern psychologists, Jung did not believe in restricting himself to the scientific method as a means to understanding the human psyche. He saw dreams, myths, coincidence and folklore as empirical evidence to further understanding and meaning. So although the unconscious cannot be studied by using direct methods, it acts as a useful working hypothesis, according to Jung. As he said, “The beauty about the unconscious is that it is really unconscious.” Hence, the unconscious is ‘untouchable’ by experimental researches, or indeed any possible kind of scientific or philosophical reach, precisely because it is unconscious.

The Break with Freud

It was the publication of a book by Jung which provoked the break with psychoanalysis and led to the founding of analytical psychology. In 1912 Jung met “Miss Miller”, brought to his notice by the work of Théodore Flournoy and whose case gave further substance to his theory of the collective unconscious. The study of her visions supplied the material which would go on to furnish his reasoning which he developed in Psychology of the Unconscious (Wandlungen und Symbole der Libido) (re-published as Symbols of Transformation in 1952) (C.W. Vol. 5). At this, Freud muttered about “heresy”. It was the second part of the work that brought the divergence to light. Freud mentioned to Ernest Jones that it was on page 174 of the original German edition, that Jung, according to him, had “lost his way”. It is the extract where Jung enlarged on his conception of the libido. The sanction was immediate: Jung was officially banned from the Vienna psychoanalytic circle from August 1912. From that date the psychoanalytic movement split into two obediences, with Freud’s partisans on one side, Karl Abraham being delegated to write a critical notice about Jung, and with Ernest Jones as defender of Freudian orthodoxy; while on the other side, were Jung’s partisans, including Leonhard Seif, Franz Riklin, Johan van Ophuijsen and Alphonse Maeder.

Jung’s innovative ideas with a new formulation of psychology and lack of contrition sealed the end of the Jung-Freud friendship in 1913. From then, the two scholars worked independently on personality development: Jung had already termed his approach analytical psychology (1912), while the approach Freud had founded is referred to as the Psychoanalytic School, (psychoanalytische Schule).

Jung’s postulated unconscious was quite different from the model proposed by Freud, despite the great influence that the founder of psychoanalysis had had on him. In particular, tensions manifested between him and Freud because of various disagreements, including those concerning the nature of the libido. Jung de-emphasized the importance of sexual development as an instinctual drive and focused on the collective unconscious: the part of the unconscious that contains memories and ideas which Jung believed were inherited from generations of ancestors. While he accepted that libido was an important source for personal growth, unlike Freud, Jung did not consider that libido alone was responsible for the formation of the core personality. Due to the particular hardships Jung had endured growing up, he believed his personal development and that of everyone was influenced by factors unrelated to sexuality.

The overarching aim in life, according to Jungian psychology, is the fullest possible actualisation of the “Self” through individuation. Jung defines the “self” as “not only the centre but also the whole circumference which embraces both conscious and unconscious; it is the centre of this totality, just as the ego is the centre of the conscious mind”. Central to this process of individuation is the individual’s continual encounter with the elements of the psyche by bringing them into consciousness. People experience the unconscious through symbols encountered in all aspects of life: in dreams, art, religion, and the symbolic dramas enacted in relationships and life pursuits. Essential to the process is the merging of the individual’s consciousness with the collective unconscious through a huge range of symbols. By bringing conscious awareness to bear on what is unconscious, such elements can be integrated with consciousness when they “surface”. To proceed with the individuation process, individuals need to be open to the parts of themselves beyond their own ego, which is the “organ” of consciousness. In a famous dictum, Jung said, “the Self, like the unconscious is an a priori existent out of which the ego evolves. It is … an unconscious prefiguration of the ego. It is not I who create myself, rather I happen to myself’.

It follows that the aim of (Jungian) psychotherapy is to assist the individual to establish a healthy relationship with the unconscious so that it is neither excessively out of balance in relation to it, as in neurosis, a state that can result in depression, anxiety, and personality disorders or so flooded by it that it risks psychosis resulting in mental breakdown. One method Jung applied to his patients between 1913 and 1916 was active imagination, a way of encouraging them to give themselves over to a form of meditation to release apparently random images from the mind in order to bridge unconscious contents into awareness.

“Neurosis” in Jung’s view results from the build up of psychological defences the individual unconsciously musters in an effort to cope with perceived attacks from the outside world, a process he called a “complex”, although complexes are not merely defensive in character. The psyche is a self-regulating adaptive system. People are energetic systems, and if the energy is blocked, the psyche becomes sick. If adaptation is thwarted, the psychic energy stops flowing and becomes rigid. This process manifests in neurosis and psychosis. Jung proposed that this occurs through maladaptation of one’s internal realities to external ones. The principles of adaptation, projection, and compensation are central processes in Jung’s view of psyche’s attempts to adapt.

Innovations of Jungian Analysis

Philosophical and Epistemological Foundations

Philosophy

Jung was an adept principally of the American philosopher William James, founder of pragmatism, whom he met during his trip to the United States in 1909. He also encountered other figures associated with James, such as John Dewey and the anthropologist, Franz Boas. Pragmatism was Jung’s favoured route to base his psychology on a sound scientific basis according to historian Sonu Shamdasani. His theories consist of observations of phenomena, and according to Jung it is phenomenology. In his view psychologism was suspect.

Displacement into the conceptual deprives experience of its substance and the possibility of being simply named.

Throughout his writings, Jung sees in empirical observation not only a precondition of an objective method but also respect for an ethical code which should guide the psychologist, as he stated in a letter to Joseph Goldbrunner:

I consider it a moral obligation not to make assertions about things one cannot see or whose existence cannot be proved, and I consider it an abuse of epistemological power to do so regardless. These rules apply to all experimental science. Other rules apply to metaphysics. I regard myself as answerable to the rules of experimental science. As a result nowhere in my work are there any metaphysical assertions nor – nota bene – any negations of a metaphysical nature.

According to the Italo-French psychoanalyst Luigi Aurigemma, Jung’s reasoning is also marked by Immanuel Kant, and more generally by German rationalist philosophy. His lectures are evidence of his assimilation of Kantian thought, especially the Critique of Pure Reason and Critique of Practical Reason. Aurigemma caracterises Jung’s thinking as “epistemological relativism” because it does not postulate any belief in the metaphysical. In fact, Jung uses Kant’s teleology to bridle his thinking and to guard himself from straying into any metaphysical excursions. On the other hand, for French historian of psychology, Françoise Parot, contrary to the alleged rationalist vein, Jung is “heir” to mystics, (Meister Eckhart, Hildegard of Bingen, or Augustine of Hippo) and to the romantics be they scientists, such as Carl Gustav Carus or Gotthilf Heinrich von Schubert in particular, or to philosophers and writers, along the lines of Nietzsche, Goethe, and Schopenhauer, in the way he conceptualised the unconscious in particular. Whereas his typology is profoundly dependent on Carl Spitteler.

Scientific Heritage

As a trained psychiatrist, Jung had a grounding in the state of science in his day. He regularly refers to the experimental psychology of Wilhelm Wundt. His Word Association Test designed with Franz Riklin is actually the direct application of Wundt’s theory. Notwithstanding the great debt of analytical psychology to Sigmund Freud, Jung borrowed concepts from other theories of his time. For instance, the expression “abaissement du niveau mental” comes directly from the French psychologist Pierre Janet whose courses Jung attended during his studies in France, during 1901. Jung had always acknowledged how much Janet had influenced his career.

Jung’s use of the concept of “participation mystique” is owed to the French ethnologist Lucien Lévy-Bruhl:

What Rousseau describes is nothing other than the primitive collective mentality which Lucien Lévy-Bruhl has brilliantly called “participation mystique”

which he uses to illustrate the surprising fact, to him, that some native peoples can experience relations that defy logic, as for instance in the case of the South American tribe, whom he met during his travels, where the men pretended they were scarlet aras birds. Finally, his use of the English expression, “pattern of behaviour”, which is synonymous with the term archetype, is drawn from British studies in ethology.

The principal contribution to analytical psychology, nevertheless, remains that of Freud’s psychoanalysis, from which Jung took a number of concepts, especially the method of inquiring into the unconscious through free association. Individual analysts’ thinking was also integrated into his project, among whom are Sándor Ferenczi (Jung refers to his notion of “affect”) or Ludwig Binswanger and his Daseinsanalyse [de], (Daseinsanalysis). Jung affirms also Freud’s contribution to our knowledge of the psyche as being, without doubt, of the highest importance. It reveals penetrating information about the dark corners of the soul and of the human personality, which is of the same order as Nietzsche’s On the Genealogy of Morality (1887). In this context, Freud was, according to Jung, one of the great cultural critics of the XIXth century.

Divergences from Psychoanalysis

Jungian Analysis, as is psychoanalysis, is a method to access, experience and integrate unconscious material into awareness. It is a search for the meaning of behaviours, feelings and events. Many are the channels to extend knowledge of the self: the analysis of dreams is one important avenue. Others may include expressing feelings about and through art, poetry or other expressions of creativity, the examination of conflicts and repeating patterns in a person’s life. A comprehensive description of the process of dream interpretation is complex, in that it is highly specific to the person who undertakes it. Most succinctly it relies on the associations which the particular dream symbols suggest to the dreamer, which at times may be deemed “archetypal” in so far as they are supposed common to many people throughout history. Examples could be a hero, an old man or woman, situations of pursuit, flying or falling.

Whereas (Freudian) psychoanalysis relies entirely on the development of the transference in the analysand (the person under treatment) to the analyst, Jung initially used the transference and later concentrated more on a dialectical and didactic approach to the symbolic and archetypal material presented by the patient. Moreover his attitude towards patients departed from what he had observed in Freud’s method. Anthony Stevens has explained it thus:

Though [Jung’s] initial formulations arose mainly out of his own creative illness, they were also a conscious reaction against the stereotype of the classical Freudian analyst, sitting silent and aloof behind the couch, occasionally emitting ex cathedra pronouncements and interpretations, while remaining totally uninvolved in the patient’s guilt, anguish, and need for reassurance and support. Instead, Jung offered the radical proposal that analysis is a dialectical procedure, a two-way exchange between two people, who are equally involved. Although it was a revolutionary idea when he first suggested it, it is a model which has influenced psychotherapists of most schools, though many seem not to realise that it originated with Jung.

In place of Freud’s “surgical detachment”, Jung demonstrated a more relaxed and warmer welcome in the consulting room. He remained aware nonetheless that exposure to a patient’s unconscious contents always posed a certain risk of contagion (he calls it “psychic infection”) to the analyst, as experienced in the countertransference. The process of contemporary Jungian analysis depends on the type of “school of analytical psychology” to which the therapist adheres, (see below). The “Zurich School” would reflect the approach Jung himself taught, while those influenced by Michael Fordham and associates in London, would be significantly closer to a Kleinian approach and therefore, concerned with analysis of the transference and countertransference as indicators of repressed material along with the attendant symbols and patterns.

Dream Work

Jung’s preoccupation with dreams can be dated from 1902. It was only after the break with Freud that he published in 1916 his “Psychology of the Unconscious” where he elaborated his view of dreams, which contrasts sharply with Freud’s conceptualisation. While he agrees that dreams are a highway into the unconscious, he enlarges on their functions further than psychoanalysis did. One of the salient differences is the compensatory function they perform by reinstating psychic equilibrium in respect of judgements made during waking life: thus a man consumed by ambition and arrogance may, for example, dream about himself as small and vulnerable person.

According to Jung, this demonstrates that the man’s attitude is excessively self-assured and thereby refuses to integrate the inferior aspects of his personality, which are denied by his defensive arrogance. Jung calls this a compensation mechanism, necessary for the maintenance of a healthy mental balance. Shortly before his death in 1961, he wrote:

In order to secure mental and even physiological stability, it is necessary that the conscious and unconscious should be integrated one with the other. This is so that they evolve in parallel. (Pour sauvegarder la stabilité mentale, et même physiologique, il faut que la conscience et l’inconscient soient intégralement reliés, afin d’évoluer parallèlement).

Unconscious material is expressed in images through the deployment of symbolism which, in Jungian terms, means it has an affective role (in that it can sometimes give rise to a numinous feeling, when associated with an archetypal force) and an intellectual role. Some dreams are personal to the dreamer, others may be collective in origin or “transpersonal” in so far as they relate to existential events. They can be taken to express phases of the individuation process (see below) and may be inspired by literature, art, alchemy or mythology. Analytical psychology is recognised for its historical and geographical study of myths as a means to deconstruct, with the aid of symbols, the unconscious manifestations of the psyche. Myths are said to represent directly the elements and phenomena arising from the collective unconscious and though they may be subject to alteration in their detail through time, their significance remains similar. While Jung relies predominantly on christian or on Western pagan mythology (Ancient Greece and Rome), he holds that the unconscious is driven by mythologies derived from all cultures. He evinced an interest in Hinduism, in Zoroastrianism and Taoism, which all share fundamental images reflected in the psyche. Thus analytical psychology focusses on meaning, based on the hypothesis that human beings are potentially in constant touch with universal and symbolic aspects common to humankind. In the words of André Nataf:

Jung opens psychoanalysis to a dimension currently obscured by the prevailing scientism: spirituality. His contribution, though questionable in certain respects, remains unique. His explorations of the unconscious carried out both as a scientist and a poet, indicate that it is structured as a language but one which is in a mythical mode. (Jung ouvre la psychanalyse à une dimension cachée par le scientisme ambiant : la spiritualité. Son apport, quoique contestable sur certains points, reste unique. Explorant l’inconscient en scientifique et poète, il montre que celui-ci se structure non comme une langue mais sur le mode du mythe).

Principal Concepts

In analytical psychology two distinct types of psychological process may be identified: that deriving from the individual, characterised as “personal”, belonging to a subjective psyche, and that deriving from the collective, linked to the structure of an objective psyche, which may be termed “transpersonal”. These processes are both said to be archetypal. Some of these processes are regarded as specifically linked to consciousness, such as the animus or anima, the persona or the shadow. Others pertain more to the collective sphere. Jung tended to personify the anima and animus as they are, according to him, always attached to a person and represent an aspect of his or her psyche.

Anima and Animus

Jung identified the archetypal anima as being the unconscious feminine component of men and the archetypal animus as the unconscious masculine component in women. These are shaped by the contents of the collective unconscious, by others, and by the larger society. However, many modern-day Jungian practitioners do not ascribe to a literal definition, citing that the Jungian concept points to every person having both an anima and an animus. Jung considered, for instance, an “animus of the anima” in men, in his work Aion and in an interview in which he says:

“Yes, if a man realizes the animus of his anima, then the animus is a substitute for the old wise man. You see, his ego is in relation to the unconscious, and the unconscious is personified by a female figure, the anima. But in the unconscious is also a masculine figure, the wise old man. And that figure is in connection with the anima as her animus, because she is a woman. So, one could say the wise old man was in exactly the same position as the animus to a woman.”

Jung stated that the anima and animus act as guides to the unconscious unified Self, and that forming an awareness and a connection with the anima or animus is one of the most difficult and rewarding steps in psychological growth. Jung reported that he identified his anima as she spoke to him, as an inner voice, unexpectedly one day.

In cases where the anima or animus complexes are ignored, they vie for attention by projecting itself on others. This explains, according to Jung, why we are sometimes immediately attracted to certain strangers: we see our anima or animus in them. Love at first sight is an example of anima and animus projection. Moreover, people who strongly identify with their gender role (e.g. a man who acts aggressively and never cries) have not actively recognised or engaged their anima or animus.

Jung attributes human rational thought to be the male nature, while the irrational aspect is considered to be natural female (rational being defined as involving judgment, irrational being defined as involving perceptions). Consequently, irrational moods are the progenies of the male anima shadow and irrational opinions of the female animus shadow.

Archetypes

The use of archetypes in psychology was advanced by Jung in an essay entitled “Instinct and the Unconscious” in 1919. The first element in Greek ‘arche’ signifies ‘beginning, origin, cause, primal source principle’, by extension it can signify ‘position of a leader, supreme rule and government’. The second element ‘type’ means ‘blow or what is produced by a blow, the imprint of a coin …form, image, prototype, model, order, and norm’, …in the figurative, modern sense, ‘pattern underlying form, primordial form’. In his psychological framework, archetypes are innate, universal or personal prototypes for ideas and may be used to interpret observations. The method he favoured was hermeneutics which was central in his practice of psychology from the start. He made explicit references to hermeneutics in the Collected Works and during his theoretical development of the notion of archetypes. Although he lacks consistency in his formulations, his theoretical development of archetypes is rich in hermeneutic implications. As noted by Smythe and Baydala (2012):

his notion of the archetype as such can be understood hermeneutically as a form of non-conceptual background understanding.

A group of memories and attitudes associated with an archetype can become a complex, e.g. a mother complex may be associated with a particular mother archetype. Jung treated the archetypes as psychological organs, analogous to physical ones in that both are morphological givens which probably arose through evolution.

Archetypes have been regarded as collective as well as individual, and identifiable in a variety of creative ways. As an example, in his book Memories, Dreams, Reflections, Jung states that he began to see and talk to a manifestation of anima and that she taught him how to interpret dreams. As soon as he could interpret on his own, Jung said that she ceased talking to him because she was no longer needed. However, the essentialism inherent in archetypal theory in general and concerning the anima, in particular, has called for a re‐evaluation of Jung’s theory in terms of emergence theory. This would emphasise the role of symbols in the construction of affect in the midst of collective human action. In such a reconfiguration, the visceral energy of a numinous experience can be retained while the problematic theory of archetypes has outlived its usefulness.

Collective Unconscious

Jung’s concept of the collective unconscious has undergone re-interpretation over time. The term “collective unconscious” first appeared in Jung’s 1916 essay, “The Structure of the Unconscious”. This essay distinguishes between the “personal”, Freudian unconscious, filled with fantasies (e.g. sexual) and repressed images, and the “collective” unconscious encompassing the soul of humanity at large.

In “The Significance of Constitution and Heredity in Psychology” (November 1929), Jung wrote:

And the essential thing, psychologically, is that in dreams, fantasies, and other exceptional states of mind the most far-fetched mythological motifs and symbols can appear autochthonously at any time, often, apparently, as the result of particular influences, traditions, and excitations working on the individual, but more often without any sign of them. These “primordial images” or “archetypes,” as I have called them, belong to the basic stock of the unconscious psyche and cannot be explained as personal acquisitions. Together they make up that psychic stratum which has been called the collective unconscious. The existence of the collective unconscious means that individual consciousness is anything but a tabula rasa and is not immune to predetermining influences. On the contrary, it is in the highest degree influenced by inherited presuppositions, quite apart from the unavoidable influences exerted upon it by the environment. The collective unconscious comprises in itself the psychic life of our ancestors right back to the earliest beginnings. It is the matrix of all conscious psychic occurrences, and hence it exerts an influence that compromises the freedom of consciousness in the highest degree, since it is continually striving to lead all conscious processes back into the old paths.

Given that in his day he lacked the advances of complexity theory and especially complex adaptive systems (CAS), it has been argued that his vision of archetypes as a stratum in the collective unconscious, corresponds to nodal patterns in the collective unconscious which go on to shape the characteristic patterns of human imagination and experience and in that sense, “seems a remarkable, intuitive articulation of the CAS model”.

Individuation

Individuation is a complex process that involves going through different stages of growing awareness through the progressive confrontation and integration of personal unconscious elements. This is the central concept of analytical psychology first introduced in 1916. It is the objective of Jungian psychotherapy to the extent that it enables the realisation of the Self. As Jung stated:

The aim of individuation is nothing less than to divest the self of the false wrappings of the persona, on the one hand and the suggestive power of primordial images on the other.

Jung started experimenting with individuation after his split with Freud as he confronted what was described as eruptions from the collective unconscious driven by a contemporary malaise of spiritual alienation. According to Jung, individuation means becoming an individual and implies becoming one’s own self. Unlike individuality, which emphasizes some supposed peculiarity, Jung described individuation as a better and more complete fulfilment of the collective qualities of the human being. In his experience, Jung explained that individuation helped him, “from the therapeutic point of view, to find the particular images that lie behind emotions”.

Individuation is from the first what the analysand must undergo, in order to integrate the other elements of the psyche. This pursuit of wholeness aims to establish the Self, which include both the rational conscious mind of the ego and the irrational contents of the unconscious, as the new personality centre. Prior to individuation, the analysand is carefully assessed to determine if the ego is strong enough to take the intensity of this process. The elements to be integrated include the persona which acts as the representative of the person in her/his role in society, the shadow which contains all that is personally unknown and what the person considers morally reprehensible and, the anima or the animus, which respectively carry their feminine and masculine values. For Jung many unconscious conflicts at the root of neurosis are caused by the difficulty to accept that such a dynamic can unbalance the subject from his habitual position and confronts her/him with aspects of the self they were accustomed to ignore. Once individuation is completed the ego is no longer at the centre of the personality. The process, however, does not lead to a complete self-realisation and that individuation can never be a fixed state due to the unfathomable nature of the depths of the collective unconscious.

Shadow

The shadow is an unconscious complex defined as the repressed, suppressed or disowned qualities of the conscious self. According to Jung, the human being deals with the reality of the shadow in four ways: denial, projection, integration and/or transmutation. Jung himself asserted that “the result of the Freudian method of elucidation is a minute elaboration of man’s shadow-side unexampled in any previous age.” According to analytical psychology, a person’s shadow may have both constructive and destructive aspects. In its more destructive aspects, the shadow can represent those things people do not accept about themselves. For instance, the shadow of someone who identifies as being kind may be harsh or unkind. Conversely, the shadow of a person who perceives himself to be brutal may be gentle. In its more constructive aspects, a person’s shadow may represent hidden positive qualities. This has been referred to as the “gold in the shadow”. Jung emphasized the importance of being aware of shadow material and incorporating it into conscious awareness in order to avoid projecting shadow qualities on others.

The shadow in dreams is often represented by dark figures of the same gender as the dreamer.

The shadow may also concern great figures in the history of human thought or even spiritual masters, who became great because of their shadows or because of their ability to live their shadows (namely, their unconscious faults) in full without repressing them.

Persona

Just like the anima and animus, the persona (derived from the Greek term for a mask, as would have been worn by actors) is another key concept in analytical psychology. It is the part of the personality which manages an individual’s relations with society in the outside world and works the same way for both sexes.

The persona … is the individual’s system of adaptation to, or the manner assumed in dealing with the world. Every calling or profession, for example, has its own characteristic persona […] Only the danger is that (people) become identical with their personas: thus the professor with his textbook, the tenor with his voice. One could say with little exaggeration, that the persona is that which in reality one is not, but which oneself as well as others think one is.

The persona, which is at the heart of the psyche, is contrary to the shadow which is actually the true personality but denied by the self. The conscious self identifies primarily with the persona during development in childhood as the individual develops a psychological framework for dealing with others. Identifications with diplomas, social roles, with honours and awards, with a career, all contribute to the apparent constitution of the persona and which do not lead to knowledge of the self. For Jung, the persona has nothing real about it. It can only be a compromise between the individual and society, yielding an illusion of individuality. Individuation consists, in the first instance, of discarding the individual’s mask, but not too quickly as often, it is all the patient has as a means of identification. The persona is implicated in a number symptoms such as compulsive disorders, phobias, shifting moods, and addictions, among others.

Psychological Types

Analytical psychology distinguishes several psychological types or temperaments.

  • Extravert.
  • Introvert.

According to Jung, the psyche is an apparatus for adaptation and orientation, and consists of a number of different psychic functions. Among these he distinguishes four basic functions:

  • Sensation: Perception by means of the sense organs.
  • Intuition: Perceiving in unconscious way or perception of unconscious contents.
  • Thinking: Function of intellectual cognition; the forming of logical conclusions.
  • Feeling: Function of subjective estimation.

Thinking and feeling functions are rational, while the sensation and intuition functions are irrational.

Note: There is ambiguity in the term ‘rational’ that Carl Jung ascribed to the thinking/feeling functions. Both thinking and feeling irrespective of orientation (i.e. introverted/extroverted) employ/utilise/are directed by in loose terminology an underlying ‘logical’ IF-THEN construct/process (as in IF X THEN Y) in order to form judgements. This underlying construct/process is not directly observable in normal states of consciousness especially when engaged in thoughts/feelings. It can be cognised merely as a concept/abstraction during thoughtful reflection. Sensation and intuition are ‘irrational’ functions simply because they do not employ the above-mentioned underlying logical construct/process.

Complexes

Early in Jung’s career he coined the term and described the concept of the “complex”. Jung claims to have discovered the concept during his free association and galvanic skin response experiments. Freud obviously took up this concept in his Oedipus complex amongst others. Jung seemed to see complexes as quite autonomous parts of psychological life. It is almost as if Jung were describing separate personalities within what is considered a single individual, but to equate Jung’s use of complexes with something along the lines of multiple personality disorder would be a step out of bounds.

Jung saw an archetype as always being the central organising structure of a complex. For instance, in a “negative mother complex,” the archetype of the “negative mother” would be seen to be central to the identity of that complex. This is to say, our psychological lives are patterned on common human experiences. Jung saw the Ego (which Freud wrote about in German literally as the “I”, one’s conscious experience of oneself) as a complex. If the “I” is a complex, what might be the archetype that structures it? Jung, and many Jungians, might say “the hero,” one who separates from the community to ultimately carry the community further.

Synchronicity

Carl Jung first officially used the term synchronicity during a conference held in memory of his sinologist friend, Richard Wilhelm in 1930. It was part of his explanation of the modus operandi of the I Ching. The second reference was made in 1935 in his Tavistock Lectures. For an overview of the origins of the concept, see Joseph Cambray: “Synchronicity as emergence”. It was used to denote the simultaneous occurrence of two events with no causal physical connection, but whose association evokes a meaning for the person experiencing or observing it. The often cited example of the phenomenon is Jung’s own account of a beetle (the common rose-chafer, Cetonia aurata) flying into his consulting room directly following on from his patient telling him a dream featuring a golden scarab. The concept only makes sense psychologically and cannot be reduced to a verified or scientific fact. For Jung it constitutes a working hypothesis which has subsequently given rise to many ambiguities.

I chose this term because the simultaneous occurrence of two meaningfully but not causally connected events seemed to me an essential criterion. I am therefore using the general concept of synchronicity in the special sense of a coincidence in time of two or more causally unrelated events which have the same or a similar meaning, in contrast to synchronism, which simply means the simultaneous occurrence of two events. Synchronicity therefore means the simultaneous occurrence of a certain psychic state with one or more external events which appear as meaningful parallels to the momentary subjective state -and, in certain cases, vice versa.

According to Jung, an archetype which has been constellated in the psyche can, under certain circumstances, transgress the boundary between substance and psyche.

Jung had studied such phenomena with the physicist and Nobel Prize winner, Wolfgang Pauli, who did not always agree with Jung, and with whom he carried on an extensive correspondence, enriched by the contributions of both specialists in their own fields. Pauli had given a series of lectures to the C.G. Jung Institute, Zürich whose member and patron he had been since 1947. It gave rise to a joint essay: Synchronicity, an a-causal principle (1952) The two men saw in the idea of synchronicity a potential way of explaining a particular relationship between “incontrovertible facts”, whose occurrence is tied to unconscious and archetypal manifestations:

The psyche and matter are ordered according to principles which are common, neutral, and incontrovertible.

Borrowing the notion from Arthur Schopenhauer, Jung calls it Unus mundus, a state where neither matter nor the psyche are distinguishable. whereas for Pauli it was a limiting concept, in two senses, in that it is at once scientific and symbolic. According to him, the phenomenon is dependent on the observer. Nevertheless, both men were in accord that there existed the possibility of a conjunction between physics and psychology. Jung wrote in a letter to Pauli:

These researches (Jung’s research into alchemy), have shown me that modern physics can symbolically represent psychological processes down to the minutest detail.

Marie-Louise von Franz also had a lengthy exchange of letters with Wolfgang Pauli. On Pauli’s death in 1958, his widow, Franca, deliberately destroyed all the letters von Franz had sent to her husband, and which he had kept locked inside his writing desk. However, the letters from Pauli to von Franz were all saved and were later made available to researchers and published.

Synchronicity has been is among the most developed ideas by Jung’s followers, notably by Michel Cazenave, James Hillman, Roderick Main, Carl Alfred Meier and by the British developmental clinician, George Bright. It has been explored also in a range of spiritual currents who have sought in it a scientific rigour.

Although Synchronicity as conceived by Jung within the bounds of the science available in his day, has been categorised as pseudoscience, recent developments in complex adaptive systems argue for a revision of such a view. Critics cite that Jung’s experiments that sought to provide statistical proof for this theory did not yield satisfactory result. His experiment was also faulted for not using a true random sampling method as well as for the use of dubious statistics and astrological material.

Post-Jungian Approaches

Andrew Samuels (1985) has distinguished three distinct traditions or approaches of “post-Jungian” psychology – classical, developmental and archetypal. Today there are more developments.

Classical

The classical approach tries to remain faithful to Jung’s proposed model, his teachings and the substance of his 20 volume Collected Works, together with recently published works, such as the Liber Novus, and the Black Books. Prominent advocates of this approach, according to Samuels (1985), include Emma Jung, Jung’s wife, an analyst in her own right, Marie-Louise von Franz, Joseph L. Henderson, Aniela Jaffé, Erich Neumann, Gerhard Adler and Jolande Jacobi. Jung credited Neumann, author of “Origins of Conscious” and “Origins of the Child”, as his principal student to advance his (Jung’s) theory into a mythology-based approach. He is associated with developing the symbolism and archetypal significance of several myths: the Child, Creation, the Hero, the Great Mother and Transcendence.

Archetypal

One archetypal approach, sometimes called “the imaginal school” by James Hillman, was written about by him in the late 1960s and early 1970s. Its adherents, according to Samuels (1985), include Gerhard Adler, Irene Claremont de Castillejo, Adolf Guggenbühl-Craig, Murray Stein, Rafael López-Pedraza and Wolfgang Giegerich. Thomas Moore also was influenced by some of Hillman’s work. Developed independently, other psychoanalysts have created strong approaches to archetypal psychology. Mythopoeticists and psychoanalysts such as Clarissa Pinkola Estés who believes that ethnic and aboriginal people are the originators of archetypal psychology and have long carried the maps for the journey of the soul in their songs, tales, dream-telling, art and rituals; Marion Woodman who proposes a feminist viewpoint regarding archetypal psychology. Some of the mythopoetic/archetypal psychology creators either imagine the Self not to be the main archetype of the collective unconscious as Jung thought, but rather assign each archetype equal value.[citation needed] Others, who are modern progenitors of archetypal psychology (such as Estés), think of the Self as the thing that contains and yet is suffused by all other archetypes, each giving life to the other.

Robert L. Moore has explored the archetypal level of the human psyche in a series of five books co-authored with Douglas Gillette, which have played an important role in the men’s movement in the United States. Moore studies computerese so he uses a computer’s hard wiring (its fixed physical components) as a metaphor for the archetypal level of the human psyche. Personal experiences influence the access to the archetypal level of the human psyche, but personalized ego consciousness can be likened to computer software.

Developmental

A major expansion of Jungian theory is credited to Michael Fordham and his wife, Frieda Fordham. It can be considered a bridge between traditional Jungian analysis and Melanie Klein’s object relations theory. Judith Hubback and William Goodheart MD are also included in this group. Andrew Samuels (1985) considers J.W.T. Redfearn, Richard Carvalho and himself as representatives of the developmental approach. Samuels notes how this approach differs from the classical by giving less emphasis to the Self and more emphasis to the development of personality; he also notes how, in terms of practice in therapy, it gives more attention to transference and counter-transference than either the classical or the archetypal approaches.

Sandplay Therapy

Sandplay is a non-directive, creative form of therapy using the imagination, originally used with children and adolescents, later also with adults. Jung had stressed the importance of finding the image behind the emotion. The use of sand in a suitable tray with figurines and other small toys, farm animals, trees, fences and cars enables a narrative to develop through a series of scenarios. This is said to express an ongoing dialogue between the conscious and the unconscious aspects of the psyche, which in turn activates a healing process whereby the patient and therapist can together view the evolving sense of self.

Jungian Sandplay started as a therapeutic method in the 1950s. Although its origin has been credited to a Swiss Jungian analyst, Dora Kalff it was in fact, her mentor and trainer, Dr. Margaret Lowenfeld, a British paediatrician, who had developed the Lowenfeld World Technique inspired by the writer H.G. Wells in her work with children, using a sand tray and figurines in the 1930s. Jung had witnessed a demonstration of the technique while on a visit to the UK in 1937. Kalff saw in it potential as a further application of analytical psychology. Encouraged by Jung, Kalff developed the new application over a number of years and called it Sandplay. From 1962 she began to train Jungian Analysts in the method including in the United States, Europe and Japan. Both Kalff and Jung believed an image can offer greater therapeutic engagement and insight than words alone. Through the sensory experience of working with sand and objects, and their symbolic resonance new areas of awareness can be brought into consciousness, as in dreams, which through their frames and storyline can bring material into consciousness as part of an integrating and healing process. The historian of psychology, Sonu Shamdasani has commented:

Historical reflection suggests the spirit of Jung’s practice of the image, his engagement with his own figures, is indeed more alive in Sandplay than in other Jungian conclaves.

One of Dora Kalff’s trainees was the American concert pianist, Joel Ryce-Menuhin, whose music career was ended by illness and who retrained as a Jungian analyst and exponent of sandplay.

Process-Oriented Psychology

Process-oriented psychology (also called Process work) is associated with the Zurich-trained Jungian analyst Arnold Mindell. Process work developed in the late 1970s and early 1980s and was originally identified as a “daughter of Jungian psychology”. Process work stresses awareness of the “unconscious” as an ongoing flow of experience. This approach expands Jung’s work beyond verbal individual therapy to include body experience, altered and comatose states as well as multicultural group work.

The Analytic Attitude

Formally Jungian analysis differs little from psychoanalysis. However, variants of each school have developed overlaps and specific divergences through the century, or more, of their existence. They share a “frame” consisting of regular spatio-temporal meetings, one or more times a week, focusing on patient material, using dialogue which may consist of elaboration, amplification and abreaction and which may last on average three years (sometimes more briefly or far longer). The spatial arrangement between analyst and analysand may differ: seated face to face or the patient may use the couch with the analyst seated behind.

In some approaches alternative elements of expression can take place, such as active imagination, sandplay, drawing or painting, even music. The session may at times become semi-directed (in contrast to psychoanalytic treatment which is essentially a non-directive encounter). The patient is at the heart of the therapy, as Marie Louise von Franz has it in her work, “Psychotherapy: the practitioner’s experience”, where she recounts Jung’s thinking on that point. The transference is sought out (contrary to psychoanalytic treatment which distinguishes positive and negative transferences) and, the interpretation of dreams is one of the central pillars of Jungian psychotherapy. In all other respects, the rules correspond to those of classical psychoanalysis: the analyst examines free associations and tries to be objective and ethical, meaning respectful of the patient’s pace and rhythm of unfolding progress. In fact, the task of Jungian analysis is not merely to explore the patient’s past, but to connect conscious awareness with the unconscious such that a better adaptation to their emotional and social life may ensue.

Neurosis is not a symptom of the re-emergence of a repressed past, but is regarded as the functional, sometimes somatic, incapacity to face certain aspects of lived reality. In Jungian analysis the unconscious is the motivator whose task it is to bring into awareness the patient’s shadow, in alliance with the analyst, the more so since unconscious processes enacted in the transference provoke a dependent relationship by the analysand on the analyst, leading to a falling away of the usual defences and references. This requires that the analyst guarantee the safety of the transference. The responsibilities and accountability of individual analysts and their membership organisations, matters of clinical confidentiality and codes of ethics and professional relations with the public sphere are explored in a volume edited by Solomon and Twyman, with contributions from Jungian analysts and psychoanalysts. Solomon has characterised the nature of the patient – analyst relationship as one where the analytic attitude is an ethical attitude since:

The ethical attitude presupposes special responsibilities that we choose to adopt in relation to another. Thus, a parallel situation pertains between caregiver and child and between analyst and patient: they are not equal partners, but nevertheless are in a situation of mutuality, shared subjectivity, and reciprocal influence.

Jungian Social, Literary and Art Criticism

Analytical psychology has inspired a number of contemporary academic researchers to revisit some of Jung’s own preoccupations with the role of women in society, with philosophy and with literary and art criticism. Leading figures to explore these fields include the British-American, Susan Rowland, who produced the first feminist revision of Jung and the fundamental contributions made to his work by the creative women who surrounded him. She has continued to mine his work by evaluating his influence on modern literary criticism and as a writer. Leslie Gardner has devoted a series of volumes to analytical psychology in 21st century life, one of which concentrates on the “Feminine Self”. Paul Bishop, a British German scholar, has placed analytical psychology in the context of precursors such as, Goethe, Schiller and Nietzsche.

The Franco-Swiss art historian and analytical psychologist, Christian Gaillard, has examined Jung’s place as an artist and art critic in his series of Fay lectures at the Texas A&M University. These scholars draw from Jung’s works that apply analytical psychology to literature such as the lecture “On the Relation of Analytical Psychology to Poetry”. In this presentation, which was delivered in 1922, Jung stated that the psychologist cannot replace the art critic. He rejected the Freudian art criticism for reducing complex works of art to Oedipal fantasies of their creators, stressing the danger of simplifying literature to causes found outside of the actual work.

Criticism

Since its inception, analytical psychology has been the object of criticism, emanating from the psychoanalytic sphere. Freud himself characterised Jung as a “mystic and a snob”. In his introduction to the 2011 edition of Jung’s “Lectures on the Theory of Psychoanalysis”, given in New York in 1912, Sonu Shamdasani contends that Freud orchestrated a round of critical reviews of Jung’s writings from Karl Abraham, Jung’s former colleague at the Burghölzli hospital, and from the early Welsh Freudian, Ernest Jones. Such criticisms multiplied during the 20th century, focusing primarily on the “mysticism” in Jung’s writings. Other psychoanalysts, including Jungian analysts, objected to the cult of personality around the Swiss psychiatrist. It reached a crescendo with Jung’s perceived collusion with Nazism in the build up and during World War II and is still a recurrent theme. Thomas Kirsch writes: “Successive generations of Jungian analysts and analysands have wrestled with the question of Jung’s complex relations to Germany.” Other considered evaluations come from Andrew Samuels and from Robert Withers.

The French philosopher, Yvon Brès, considers that the concept of the collective unconscious, “shows also how easily one can slip from the psychological unconscious into perspectives from a universe of thought, quite alien from traditional philosophy and science, where this idea arose.” (“Le concept jungien d’inconscient collectif “témoigne également de la facilité avec laquelle on peut glisser du concept d’inconscient psychologique vers des perspectives relevant d’un univers de pensée étranger à la tradition philosophique et scientifique dans laquelle ce concept est né'”).

In his Le Livre Rouge de la psychanalyse (“Red Book of psychoanalysis”), the French psychoanalyst, Alain Amselek, criticises Jung’s tendency to be fascinated by the image and to reduce the human to an archetype. He contends that Jung dwells in a world of ideas and abstractions, in a world of books and old secrets lost in ancient books of spells (fr: grimoires). While claiming to be an empiricist, Amselek finds Jung to be an idealist, a pure thinker who has unquestionably demonstrated his intellectual talent for speculation and the invention of ideas. While he considers his epistemology to be in advance of that of Freud, Jung remains stuck in his intellectualism and in his narrow provincial outlook.[clarification needed] In fact, his hypotheses are determined by the concept of his postulated pre-existing world and he has constantly sought to find confirmations of it in the old traditions of Western Medieval Europe.

More problematic has been, at times, the ad hominem criticism of academics outside the field of analytical psychology. One, a Catholic historian of psychiatry, Richard Noll, wrote three volumes but was able to publish only the first two in 1994 and 1997. Nolls argued that analytical psychology is based on a neo-pagan Hellenistic cult. These attacks on Jung and his work prompted the French psychoanalyst, Élisabeth Roudinesco, to state in a review: “Even if Noll’s theses are based on a solid familiarity with the Jungian corpus […], they deserve to be re-examined, such is the detestation of the author for the object of his study that it diminishes the credibility of the arguments.” (“Même si les thèses de Noll sont étayées par une solide connaissance du corpus jungien […], elles méritent être réexaminées, tant la détestation de l’auteur vis-à-vis de son objet d’étude diminue la crédibilité de l’argumentation.”). Another, a French ethnographer and anthropologist, Jean-Loïc Le Quellec, criticised Jung over his alleged misuse of the term archetype and his “suspect motives” in dealings with some of his colleagues.

On This Day … 06 May

Events

  • 1757 – English poet Christopher Smart is admitted into St Luke’s Hospital for Lunatics in London, beginning his six-year confinement to mental asylums.

People (Births)

  • 1856 – Sigmund Freud, Austrian neurologist and psychoanalyst (d. 1939).
  • 1922 – Camille Laurin, Canadian psychiatrist and politician, 7th Deputy Premier of Quebec (d. 1999).

People (Deaths)

2012 – Jean Laplanche, French psychoanalyst and author (b. 1924).

Christopher Smart

The English poet Christopher Smart (1722-1771) was confined to mental asylums from May 1757 until January 1763. Smart was admitted into St Luke’s Hospital for Lunatics, Upper Moorfields, London, on 06 May 1757. He was taken there by his father-in-law, John Newbery, although he may have been confined in a private madhouse before then. While in St Luke’s he wrote Jubilate Agno and A Song to David, the poems considered to be his greatest works. Although many of his contemporaries agreed that Smart was “mad”, accounts of his condition and its ramifications varied, and some felt that he had been committed unfairly.

Smart was diagnosed as “incurable” while at St Luke’s, and when they ran out of funds for his care he was moved to Mr. Potter’s asylum, Bethnal Green. All that is known of his years of confinement is that he wrote poetry. Smart’s isolation led him to abandon the poetic genres of the 18th century that had marked his earlier work and to write religious poetry such as Jubilate Agno (“Rejoice in the Lamb”). His asylum poetry reveals a desire for “unmediated revelation”, and it is possible that the self-evaluation found in his poetry represents an expression of evangelical Christianity.

Late 18th-century critics felt that Smart’s madness justified them in ignoring his A Song to David, but during the following century Robert Browning and his contemporaries considered his condition to be the source of his genius. It was not until the 20th century, with the rediscovery of Jubilate Agno (not published until 1939), that critics reconsidered Smart’s case and began to see him as a revolutionary poet, the possible target of a plot by his father-in-law, a publisher, to silence him.

Sigmund Freud

Sigmund Freud (born Sigismund Schlomo Freud; 06 May 1856 to 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for treating psychopathology through dialogue between a patient and a psychoanalyst.

Freud was born to Galician Jewish parents in the Moravian town of Freiberg, in the Austrian Empire. He qualified as a doctor of medicine in 1881 at the University of Vienna. Upon completing his habilitation in 1885, he was appointed a docent in neuropathology and became an affiliated professor in 1902. Freud lived and worked in Vienna, having set up his clinical practice there in 1886. In 1938, Freud left Austria to escape Nazi persecution. He died in exile in the United Kingdom in 1939.

In founding psychoanalysis, Freud developed therapeutic techniques such as the use of free association and discovered transference, establishing its central role in the analytic process. Freud’s redefinition of sexuality to include its infantile forms led him to formulate the Oedipus complex as the central tenet of psychoanalytical theory. His analysis of dreams as wish-fulfilments provided him with models for the clinical analysis of symptom formation and the underlying mechanisms of repression. On this basis Freud elaborated his theory of the unconscious and went on to develop a model of psychic structure comprising id, ego and super-ego. Freud postulated the existence of libido, a sexualised energy with which mental processes and structures are invested and which generates erotic attachments, and a death drive, the source of compulsive repetition, hate, aggression and neurotic guilt. In his later works, Freud developed a wide-ranging interpretation and critique of religion and culture.

Though in overall decline as a diagnostic and clinical practice, psychoanalysis remains influential within psychology, psychiatry, and psychotherapy, and across the humanities. It thus continues to generate extensive and highly contested debate with regard to its therapeutic efficacy, its scientific status, and whether it advances or hinders the feminist cause. Nonetheless, Freud’s work has suffused contemporary Western thought and popular culture. W.H. Auden’s 1940 poetic tribute to Freud describes him as having created “a whole climate of opinion / under whom we conduct our different lives.”

Camille Laurin

Camille Laurin (06 May 1922 to 11 March 1999) was a psychiatrist and Parti Québécois (PQ) politician in the province of Quebec, Canada. MNA member for the riding of Bourget, he is considered the father of Quebec’s language law known informally as “Bill 101”.

Born in Charlemagne, Quebec, Laurin obtained a degree in psychiatry from the Université de Montréal where he came under the influence of the Roman Catholic priest, Lionel Groulx. After earning his degree, Laurin went to Boston, Massachusetts, where he worked at the Boston State Hospital. Following a stint in Paris, France, in 1957, he returned to practice in Quebec. In 1961, he authored the preface of the book Les fous crient au secours, which described the conditions of psychiatric hospitals of the time.

He was one of the early founders of the Quebec sovereignty movement. As a senior cabinet minister in the first PQ government elected in the 1976 Quebec election, he was the guiding force behind Bill 101, the legislation that placed restrictions on the use of English on public signs and in the workplace of large companies, and strengthened the position of French as the only official language in Quebec.

Laurin resigned from his cabinet position on 26 November 1984 because of a disagreement with Lévesque on the future of the sovereignty movement. He resigned from his seat in the National Assembly on 25 January 1985. He was elected once again to the Assembly on 12 September 1994 but did not run in the 1998 election for health reasons.

He died after a long battle with cancer.

Jean Laplanche

Jean Laplanche (21 June 1924 to 06 May 2012) was a French author, psychoanalyst and winemaker. Laplanche is best known for his work on psychosexual development and Sigmund Freud’s seduction theory, and wrote more than a dozen books on psychoanalytic theory. The journal Radical Philosophy described him as “the most original and philosophically informed psychoanalytic theorist of his day.”

From 1988 to his death, Laplanche was the scientific director of the German to French translation of Freud’s complete works (Oeuvres Complètes de Freud/Psychanalyse – OCF.P) in the Presses Universitaires de France, in association with André Bourguignon, Pierre Cotet and François Robert.

What is Free Association (Psychology)?

Introduction

Free association is the expression (as by speaking or writing) of the content of consciousness without censorship as an aid in gaining access to unconscious processes.

The technique is used in psychoanalysis (and also in psychodynamic theory) which was originally devised by Sigmund Freud out of the hypnotic method of his mentor and colleague, Josef Breuer.

Freud described it as such: “The importance of free association is that the patients spoke for themselves, rather than repeating the ideas of the analyst; they work through their own material, rather than parroting another’s suggestions”.

Background

Freud developed the technique as an alternative to hypnosis, because he perceived the latter as subjected to more fallibility, and because patients could recover and comprehend crucial memories while fully conscious. However, Freud felt that despite a subject’s effort to remember, a certain resistance kept him or her from the most painful and important memories. He eventually came to the view that certain items were completely repressed, cordoned off and relegated only to the unconscious realm of the mind. The new technique was also encouraged by his experiences with “Miss Elisabeth”, one of his early clients who protested against interruptions of her flow of thought, that was described by his official biographer Ernest Jones as “one of the countless examples of a patient’s furthering the physician’s work”.

“There can be no exact date for the discovery of the ‘free association’ method… it developed very gradually between 1892 and 1895, becoming steadily refined and purified from the adjutants – hypnosis, suggestion, pressing, and questioning – that accompanied it at its inception”.

Subsequently, in The Interpretation of Dreams, Freud cites as a precursor of free association a letter from Schiller, the letter maintaining that, “where there is a creative mind, Reason – so it seems to me – relaxes its watch upon the gates, and the ideas rush in pell-mell”. Freud would later also mention as a possible influence an essay by Ludwig Börne, suggesting that to foster creativity you “write down, without any falsification or hypocrisy, everything that comes into your head”.

Other potential influences in the development of this technique include Husserl’s version of epoche and the work of Sir Francis Galton. It has been argued that Galton is the progenitor of free association, and that Freud adopted the technique from Galton’s reports published in the journal Brain, of which Freud was a subscriber. Free association also shares some features with the idea of stream of consciousness, employed by writers such as Virginia Woolf and Marcel Proust: “all stream-of-consciousness fiction is greatly dependent on the principles of free association”.

Freud called free association “this fundamental technical rule of analysis… We instruct the patient to put himself into a state of quiet, unreflecting self-observation, and to report to us whatever internal observations he is able to make” – taking care not to “exclude any of them, whether on the ground that it is too disagreeable or too indiscreet to say, or that it is too unimportant or irrelevant, or that it is nonsensical and need not be said”.

The psychoanalyst James Strachey (1887-1967) considered free association as ‘the first instrument for the scientific examination of the human mind’.

Characteristics

In free association, psychoanalytic patients are invited to relate whatever comes into their minds during the analytic session, and not to censor their thoughts. This technique is intended to help the patient learn more about what he or she thinks and feels, in an atmosphere of non-judgemental curiosity and acceptance. Psychoanalysis assumes that people are often conflicted between their need to learn about themselves, and their (conscious or unconscious) fears of and defences against change and self-exposure. The method of free association has no linear or pre-planned agenda, but works by intuitive leaps and linkages which may lead to new personal insights and meanings: ‘the logic of association is a form of unconscious thinking’.

When used in this spirit, free association is a technique in which neither therapist nor patient knows in advance exactly where the conversation will lead, but it tends to lead to material that matters very much to the patient. ‘In spite of the seeming confusion and lack of connection…meanings and connections begin to appear out of the disordered skein of thoughts…some central themes’.

The goal of free association is not to unearth specific answers or memories, but to instigate a journey of co-discovery which can enhance the patient’s integration of thought, feeling, agency, and selfhood.

Free association is contrasted with Freud’s “Fundamental Rule” of psychoanalysis. Whereas free association is one of many techniques (along with dream interpretation and analysis of parapraxis), the fundamental rule is a pledge undertaken by the client. Freud used the following analogy to describe free association to his clients: “Act as though, for instance, you were a traveller sitting next to the window of a railway carriage and describing to someone inside the carriage the changing views which you see outside.” The fundamental rule is something the client agrees to at the beginning of analysis, and it is an underlying oath that is intended to continue throughout analysis: the client must promise to be honest in every respect. The pledge to the fundamental rule was articulated by Freud: “Finally, never forget that you have promised to be absolutely honest, and never leave anything out because, for some reason or other, it is unpleasant to tell it.”

Freudian Approach

Freud’s eventual practice of psychoanalysis focused not so much on the recall of these memories as on the internal mental conflicts which kept them buried deep within the mind. However, the technique of free association still plays a role today in therapeutic practice and in the study of the mind.

The use of free association was intended to help discover notions that a patient had developed, initially, at an unconscious level, including:

  • Transference: Unwittingly transferring feelings about one person to become applied to another person.
  • Projection: Projecting internal feelings or motives, instead ascribing them to other things or people.
  • Resistance: Holding a mental block against remembering or accepting some events or ideas.

The mental conflicts were analysed from the viewpoint that the patients, initially, did not understand how such feelings were occurring at a subconscious level, hidden inside their minds. ‘It is free association within language that is the key to representing the prohibited and forbidden desire…to access unconscious affective memory’.

Further Developments

Jung

Jung and his Zurich colleagues ‘devised some ingenious association tests which confirmed Freud’s conclusions about the way in which emotional factors may interfere with recollection’: they were published in 1906. As Freud himself put it, ‘in this manner Bleuler and Jung built the first bridge from experimental psychology to psychoanalysis’.

Ferenczi

Freud, at least initially, saw free association as a relatively accessible method for patients. Ferenczi disagreed, with the famous aphorism: ‘The patient is not cured by free-associating, he is cured when he can free-associate’.

Lacan

Lacan took up the point. ‘Free association is really a labour – so much so that some have gone so far as to say that it requires an apprenticeship, even to the point of seeing in such an apprenticeship its true formative value’.

20th Century

By the late twentieth century, ‘analysts today don’t expect the free-association process to take hold until well into the analysis; in fact, some regard the appearance of true free association as a signal to terminate the analysis’.

As time went on, other psychologists created tests that exemplified Freud’s idea of free association including Rorschach’s Inkblot Test and The Thematic Apperception Test (TAT) by Christina Morgan and Henry of Harvard University. Although Rorschach’s test has been met with significant criticism over the years, the TAT is still used today, especially with children.

Criticism

As object relations theory came to place more emphasis on the patient/analyst relationship, and less on the reconstruction of the past, so too did the criticism emerge that Freud never quite freed himself from some use of pressure. For example, ‘he still advocated the “fundamental rule” of free association…[which] could have the effect of bullying the patient, as if to say: “If you do not associate freely – we have ways of making you”‘.

A further problem may be that, ‘through overproduction, the freedom it offers sometimes becomes a form of resistance to any form of interpretation’.

Coda

Adam Phillips suggests that ‘the radical nature of Freud’s project is clear if one imagines what it would be like to live in a world in which everyone was able – had the capacity – to free-associate, to say whatever came into their mind at any given moment…like a collage’.

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.