September 23, 2011

Psychoanalysis is an intensive treatment method based on the observation that people are usually unaware of the factors responsible for their symptoms, difficulties at work, relationships, moods, irrational fears, and a general inability to enjoy life and live up to their potential. Psychoanalysis is also a basic psychological theory of normal as well as pathological human development and personality formation. Psychoanalysis emphasizes relationships, awareness of defensive processes, understanding of basic needs and wishes, and recognition of transference in all human relationships. Transference is the influence of past relationships and feelings on present relationships. Psychoanalytic understanding of how the mind functions is the basis of psychoanalytic treatment and psychodynamic “talking therapy.” It originated in Sigmund Freud’s discovery of the unconscious and how it reveals itself in dreams, slips of the tongue, and unintended actions.

Freud (1856-1939) learned that the most effective way to help patients is to urge them to say whatever comes to mind without censor (“free associating”—free from conscious control) while lying on a couch, not influenced by visual feedback from the doctor. In this way a patient could become aware of the impulses he or she is repressing from consciousness because they are in conflict with his or her moral standards or the requirements of reality and the society in which we live. This awareness, as well as learning how the past created some of the conflicts hidden in the unconscious, may relieve painful emotional symptoms and maladaptive behaviors interfering with relationships, work, and play. Insight is made possible by reliving the intense feelings of the past in the present relationship with the analyst in the confidential, respectful atmosphere established in this long-term exclusive treatment relationship. It allows a patient to correct the misfit of past experience and a child’s perception with the present experience and understanding of the adult.

Freud published his basic theory in 1900 in his book The Interpretation of Dreams. Freud’s theory evolved through several phases as he continued learning from listening to his patients. He first concentrated on making the unconscious conscious. The unconscious was considered to be mainly the repository of the biologically based sexual and aggressive drives. Freud focused on the sexual drives; he named the energy fuelling them “libido.” Freud described the following overlapping stages of psychosexual development: oral (age 0-2 years) where the infant’s life-preserving and sensual drives center in the mouth and its functions, anal (2-3 years) with its pleasure in retaining and expelling feces, phallic (age 3-5) with its focus on the intense penile and clitoral sensations, leading to the genital-oedipal phase (5-6 years) involving love and a wish for exclusive possession of the parent of the opposite sex and hostile competition with the parent of the same sex. Because of fear of retaliation from the perceived competitor, the child eventually displaces these desires to outside persons while identifying with the competitor, taking in real and imagined prohibitions as building blocks for his or her conscience. These various phases have the potential for conflicts if not managed well by the environment. Unmanageable conflict leads to anxiety, inhibitions, and symptoms. Freud next focused on the agencies regulating psychic forces: the Id—repository of the drives, the Ego—the mediating, executive function of the personality, and the Superego— repository of moral injunctions and ideals we want to live up to. Anxiety is a signal of unmanageable conflict between these agencies. The three greatest fears of childhood are the fear of loss of love, the fear of losing the object of one’s love, and ultimately the fear of loss of oneself. Any one of these can be symbolized by castration anxiety, the fear of injury to his genitals in the male’s case, and the fantasy of having been injured in the female’s case because of the absence of a penis, leading to “penis envy.”

Freud was the product of a patriarchal repressive society. He had a masculine-centric attitude, with a misogynist’s view of women. Freud confessed his inability to understand women, comparing them to a dark continent. In spite of this he encouraged and trained some brilliant women analysts whose contributions clarified female development and enriched psychoanalytic knowledge in general.

Psychoanalytic knowledge has evolved over the past 100 years beyond Freud’s original formulations. Anna Freud contributed to ego psychology with her description of the necessary and adaptive function of defenses. She also developed child analysis. She demonstrated the importance of mother-child attachment and the traumatic effects of early separations from mother. It was her work that influenced such innovations in hospital procedures as allowing parents to stay with their hospitalized children.

Helena Deutsch (1944) described the importance of a woman being in control of her childbirth experience. This influenced some of the changes in maternity ward procedures and support for natural childbirth. She also clarified that relationships are more important to women than to men, leading to inhibition of aggression and, at times, striving to be peacemakers at any price.

Greta Bibring studied the psychological processes during pregnancy showing the need of the pregnant woman for a supportive close relationship with another woman if her mother is not available. This developmental phase in a woman’s life is also a chance to rework the often intensely ambivalent, early motherdaughter tie.

Melanie Klein established the equivalence of a child’s play with free associations, thus enabling work with very young children, and made a major contribution to object relations theory. She elucidated the centrality of the early mother-child relationship and clarified the distortions created by the child’s projection of its own impulses and fantasies on to the mother/other and reaction to that distorted perception of the mother/ other as actuality. She also established the importance of aggression in a person’s life. Melanie Klein was a pioneer in alerting us to how helpful it is to be aware of the countertransference of the therapist as a clue to how the patient affects others in their way of relating, as well as to the underlying fantasies in their interactions.

Infant and child observations established the fact that genital identity is set by age 18-24 months dependent on the perception and labeling by the environment as well as the child’s identification with the adults in its life, independent of its genetic sex. The genital identity does not in itself influence the sexual object choice of the individual. The latter is probably multidetermined. Freud was aware of the bisexual tendencies in one’s mental life, in view of an individual’s attachment and potential for identification with both parents as well as possible innate, biological factors. Penis envy is now seen as also secondary to cultural discriminations, or defensive against a fear of injury in intercourse. It has its counterpart in the boy’s womb envy—the ability to have babies. Little girls are aware of their inner and outer genitals and experience pleasurable sensations from them; if inhibited in this, sexual as well as a general learning disability may result. Menarche is normally an organizing, positive experience, consolidating a girl’s identity. Menopause can thus be experienced as a loss on many levels. Women have other psychological issues besides sexuality, such as a need to be appreciated as individuals capable of intellectual achievements, feeling comfortable with self-assertion and competitive striving, and finding a way to integrate this with their sexual and maternal needs.

Current psychoanalytic research, based on observation of infant-mother interaction, formulated an attachment theory that has demonstrated an ability to predict personality development based on the quality of the infant’s attachment to mother. The importance of the earliest experience for attachment led to the “roomingin” of newborn and mother at the hospital; it was found that besides making for better child development it also protects the child from parental abuse. The importance of a secure attachment of mother and child in the first 3 years of life has also highlighted the current conflict women have between ambitious careers and motherhood, as well as the problem of day care for the working mother and her child.

Fathers are important, representing the outside world and its reality, thus helping in the eventual separation
from mother and autonomy of the child. A father’s appreciation of his daughter also helps in her valuing her femininity and being a person in her own right. A father’s encouragement facilitates a woman’s success in pursuing a career.

Psychoanalysis is an effective treatment for many people who have not been helped in briefer therapies. Low-cost treatment for psychoanalysis or psychotherapy is usually available through local psychoanalytic institutes.

SEE ALSO: Cognitive-behavioral therapy, Psychotherapy

Suggested Reading

  • Richards, A. D., & Tyson, P. (Eds.). (1996). The psychology of women: Psychoanalytic perspectives. Journal of the American Psychoanalytic Association, 44(Suppl.).


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