Albert L. Peia
General Psychology
August 9, 2009
The Psychoanalytic Method
Introduction
I truly believe Freud to have been a mental
case in his own right, in need of some substantial psychoanalysis pursuant to
what has come to be described as the psychoanalytic method; but definitely not
by himself. I can totally understand and empathize with the outrage that must
have been felt by intelligent, capable women as, for example, Karen Horney, who
must have cringed at the preposterousness of Freud’s notion of penis envy
suffered by women everywhere which, after all, must have brought a good old
boys back-slappin’ chuckle by real men at the men’s clubs who, presumably endowed
with penises, were the envy of women everywhere without even trying, by virtue
thereof. While I could understand her outrage and frustration at being the
brunt of such a ridiculous position, having been born with a vagina and not
“graced” with a penis, I do think she would have been more intellectually
honest and ultimately taken more seriously by resisting the ‘tit-for-tat’ (also
preposterous) notion of ‘womb envy’ and
focused upon Freud’s unsupported theories as merely a projection of his own
neuroses. Specifically, she might have said that Freud, the apple of mommy’s
eye, upon being spurned by mommy as to his sexual advances, in protest and to
punish her developed a latent tendency to fixate on men’s penises which that
constant phallic cigar in his mouth represented. I realize it would less than
scientific for me to say that because I have never known any person, male or
female, who suffered from womb or penis envy respectively, or that because it
seems so outlandishly ridiculous, it is. However, I think they both with their
respective aforementioned preposterous notions shared that same position of
lack of empirical evidence/support. That said, there is no question but that
Freud’s psychoanalytic method, so obvious and simple as great ideas / approaches
are with hindsight, was groundbreaking brilliance at its best since I believe
all treatments for mental disorders/illnesses must incorporate some of that;
particularly because, in my own view, it is or should be the essence/focus of
treatment; hence, the reason for my topic herein.
Psychoanalysis
“Psychoanalysis is a body of
ideas developed by Austrian Physician Sigmund Freud and continued by others. It is
primarily devoted to the study of human psychological functioning and behavior,
although it also can be applied to societies.
Psychoanalysis has three applications:
Under the broad umbrella
of psychoanalysis there are at least twenty-two different theoretical
orientations regarding the underlying theory of understanding of human
mentation and human development. The various approaches in treatment called
"psychoanalytic" vary as much as the different theories do. In
addition, the term refers to a method of studying child development.
Freudian psychoanalysis refers to a specific type of treatment in which
the "analysand" (analytic patient) verbalizes thoughts, including free
associations, fantasies,
and dreams, from which the analyst formulates the unconscious conflicts causing the patient's
symptoms and character problems, and interprets them for the patient to create
insight for resolution of the problems.
The specifics of the analyst's interventions typically include
confronting and clarifying the patient's pathological defenses, wishes and guilt.
Through the analysis of conflicts, including those contributing to resistance
and those involving transference onto the
analyst of distorted reactions, psychoanalytic treatment can clarify how
patients unconsciously are their own worst enemies: how unconscious, symbolic
reactions that have been stimulated by experience are causing symptoms.” Wikipedia
I think it important to emphasize at this
juncture that the foregoing (psycho)analytic (method) procedure in no way
constricts the analyst to the narrow confines of an archaic and I believe
eccentric/neurotic and ultimately incorrect Freudian view/orientation/bias where such as “Oedipal and Electra”
dynamics, etc, are considered omnipresent; but rather in the course of
employing the method might among other conflicts be revealed. Indeed, I’d be
the last person to dismiss entirely the Oedipal aspect inasmuch as I had
occasion to lunch periodically with the son of a commercially successful man,
often discussing the very attractive girls he was able to bed at what was
essentially his father’s firm. (His mother and father were divorced). In fact,
he was also having sex with his mother’s friend to the exclusion of other
girlfriends as he was often available to her, helping with her kids (We
surmised her husband must have been having his own affair but there was no
evidence of same and maybe said consideration was more an effort to soothe a
troubled conscience?) . He blurted out that he wanted to “f**k his mother”
which caused me to exert tremendous effort not to look shocked (in my way of
thinking that’s pretty sordid and disgusting), and quickly rebounded to advise
him not to repeat that to anyone other than his doctor or psychologist (also to
gently let him know I thought it wrong without sounding too judgmental). I additionally felt compelled to suggest
that he get a younger girlfriend nearer his age since I felt he was somewhat
troubled by said liasons with his mother’s friend.
Dr. Lothane, a
fervent admirer/defender of Freud and clinical associate professor of
psychiatry
at Mount Sinai School of Medicine, CUNY succinctly states in
pertinent part:
“…Healing
human suffering through the spoken word has its roots in such a common
experience as the soothing words of the mother to a child that is hurting,
whether physically or psychologically. Later in life such solicitude is
sublimated as care and empathy, the sympathy for another person's suffering, an
essential ingredient of every therapy. Anna O. made history when she called the
conversations with her doctor, Josef Breuer (1895d), the future mentor of
Freud, the "talking cure," at a time when cure still meant treatment.
Here is another interesting connection between words and what they stand for.
Today treatment means physical therapy of physical illness, but etymologically
treatment is related to tractatus and treatise, i.e., discourse. Similarly,
doctor, one who treats the body, derives from the Latin verb docere, to teach,
as in doctrine, or teaching. Today psychotherapy is practiced formally by
professionals-psychiatrists, psychologists, social workers and
psychoanalysts-and informally, by others, in ways folksy or fancy, in all walks
of life. It is also practiced in dealings with doctors, dentists, lawyers,
clergy and in the mass media. Prominent in the history of psychotherapy and its
entry into medical science were pioneers Franz Anton Mesmer and his followers
and Sigmund Freud, the founder of psychoanalysis.The Method Freud coined
the term psychoanalysis as a synonym for psychotherapy and developed a method,
or technique, for understanding and interpreting the verbal productions of
persons in health and disease. He enriched the method of psychotherapy he
learned from Breuer by adding the technique of free association and the concept
of transference. This enabled Freud to discover depth psychology, an analytical
method for understanding the meaningful connection between manifest content of
symptoms, thoughts, dreams and acts and their latent content, and hence the
motivational dynamics of consciously deliberate versus covertly-driven
behavior. The
discovery that symptoms had this dual structure, conscious and unconscious, that
they were not just brain events but mind events, enabled Freud to elucidate the
role of fantasy, the emotions, psychological trauma and the role of sex and
love in human relations. But experiences are told in words, meanings are shaped
into memories, metaphors, and myths, i.e., stories. In time, the above-defined
aspects of Freud's method became the generic foundation for all the other
schools of dynamic verbal therapy, whatever their theories (Lothane 1981, 1983,
1984, 1994a)… In summary, psychotherapy is an empirical method, or technique,
based on procedures and processes employed in the therapeutic situation, and in
keeping with ethical principles… The Theories The method of psychoanalysis is most often confused with
the various theories or doctrines or schools of psychoanalysis, a confusion
that began with Freud himself. One of the reasons for the confusion is a
tendency to overgeneralize empirical data of observation, converting them into
universal theories of causation... ”
Though he seems to defend Freud without
reservation, Dr. Lothane does in his article separate Freud and the psychoanalytic method in discussing
them in such a way as to mask the preposterousness of some of Freud’s views
rightfully criticized. He seems to inextricably link the two so as to lend
greater weight to Freud’s quirky personal views since it is the method that is
key and truly Freud’s great (and only, in my view) contribution.
In their instructive work, Psychoanalytic Method in Modern Dress (Bucci
and Maskit 2007) Bucci and Maskit dismiss Freud’s casual treatment of the need
for empirical evidence in favor of mere inference, even just plausible
inference. They in turn fault such by pointing to the less than scientific
nature of such an approach where the case report will contain data of a single
observer, himself an active participant with a perspective based on personal
experience and approach who selects both the case and what to report (Bucci and
Maskit 2007).
Reduced to essentials, the basic method of
psychoanalysis is interpretating the patient's unconscious conflicts that are
interfering with current-day functioning – conflicts that are causing painful,
potentially life altering 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 (also see Freud's paper "Repeating, Remembering,
and Working Through"). In particular, unconscious hostile feelings toward
the analyst could be found in symbolic, negative reactions to what Robert Langs
later called the "frame" of the therapy – the setup that included
times of the sessions, payment of fees, and necessity of talking. In patients
who made mistakes, forgot, or showed other peculiarities regarding time, fees,
and talking, the analyst can usually find various unconscious
"resistances" to the flow of thoughts (sometimes called free association).
When the patient
reclines on a couch with the analyst out of view, the patient tends to remember
more, experience more resistance and transference, and be able to reorganize
thoughts after the development of insight – through the interpretive work of
the analyst. Although fantasy life can be understood through the examination of
dreams, masturbation fantasies (cf. Marcus, I.
and Francis, J. (1975), Masturbation from Infancy to Senescence) are
also important. The analyst is interested in how the patient reacts to and
avoids such fantasies (cf. Paul Gray (1994), The Ego and the Analysis of
Defense).[30] Various memories of early life are
generally distorted – Freud called them "screen memories" – and in
any case, very early experiences (before age two) – can not be remembered (See
the child studies of Eleanor Galenson on "evocative memory")”
Wikipedia.(see also conflict theory
).
Psychoanalysts referred to the
notion of "classical
technique," although Freud was more “patient-problem-centric” which
required deviating from this considerably. Classical technique was summarized
by Allan Compton, MD, as
“comprising instructions (telling the patient to try to
say what's on their mind, including interferences); exploration (asking
questions); and clarification (rephrasing and summarizing what the patient has
been describing). As well, the analyst can also use confrontation to bringing
an aspect of functioning, usually a defense, to the patient's attention. The
analyst then uses a variety of interpretation methods, such as dynamic
interpretation (explaining how being too nice guards against guilt, e.g. -
defense vs. affect); genetic interpretation (explaining how a past event is
influencing the present); resistance interpretation (showing the patient how
they are avoiding their problems); transference interpretation (showing the
patient ways old conflicts arise in current relationships, including that with
the analyst); or dream interpretation (obtaining the patient's thoughts about
their dreams and connecting this with their current problems). Analysts can
also use reconstruction to estimate what may have happened in the past that
created some current issue.” Wikipedia
The underpinning of most psychoanalytic
techniques as discussed above seems to be conflict theory although there are
other theories, all of which seem to be evolving over time.* I believe that the most important
interactions in the process for successful treatment require empathy,
conveyance of trust and knowledgeable competence, and a neutral posture that
conveys objectivity and genuineness.
Summary Conclusion
The importance of the psychoanalytic
method in the context of therapeutic treatment of the vast array of
psychological disorders/problems cannot be overstated. Indeed, the generic form
thereof as alluded to above is in my
estimation the essence of what a psychology professional / analyst can offer a
troubled person in terms of conflict / problem resolution. One must consider
the fact that many such conflicts are indeed repressed for their sheer
unpleasantness to be thought of / discussed / or understood which affords the subject
the ability to power on, however disfunctionally. While I hate to refer to
movies when discussing real-life issues, I justify same here owing to the
paucity of documented applications of the process owing to well-founded
physician / analyst - patient confidentiality (to engender trust and candor)
and invite attention to the movie Equus (the superlatively great actor
Richard Burton’s presence of itself warrants a look). The patient is in a
position of not being able to discuss some horrific events from his perspective
with anyone (mother extremely religious, father narrow of understanding and
rather intolerant of views beyond his ken) until Burton, his psychiatrist is
able ferret them out through a very generic application of the psychoanalytic
method. He is able to do this with knowledgeable competence, objectivity, and
most importantly, through the trust he has engendered with the patient
(Burton’s personal crises in the film were great drama but I believe
superfluous and a bit “over the top”). In sum, it is this ‘no one size’ fits
all approach by way of application of the psychoanalytic method, employing all
of the knowledge / theories at the analyst’s disposal to resolve conflicts /
problems, that is and should be the essence and thrust of psychotherapy.
Dated:
8-9-09 Signed: Albert L. Peia
-------------
*
”As object relations theory evolved, grass supplemented by the work of Bowlby, Ainsorth, and Beebe, 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 hospitalization); psychotropic medicines to relieve overwhelming
depressive affect or overwhelming fantasies (hallucinations and delusions); and
advice about the meanings of things (to counter abstraction failures).The
notion of the "silent analyst" has been criticized. Actually, the
analyst listens using Arlow's approach as set out in "The Genesis of
Interpretation"), using active intervention to interpret resistances,
defenses creating pathology, and fantasies. Silence and non-responsiveness was
a technique promulgated by Carl Rogers, in his
development of so-called "Client Centered Therapy" – and is not a
technique of psychoanalysis (also see the studies and opinion papers of Owen
Renik, MD). "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.” Wikipedia
December 1, 1996
Psychiatric Times. Vol. 13 No. 12
Psychoanalytic Method and the Mischief of Freud-Bashers Zvi
Lothane, M.D.
Dr. Lothane is clinical associate professor of psychiatry at Mount Sinai School
of Medicine, CUNY. http://www.psychiatrictimes.com/display/article/10168/50631
J Am
Psychoanal Assoc 2007; 55; 1355
Wilma Bucci
and Bernard Maskit
Beneath the Surface of the Therapeutic
Interaction: the Psychoanalytic Method in Modern Dress
http://apa.sagepub.com/cgi/content/abstract/55/4/1355