Psychoanalysis is a family of psychological approaches and methods that claim to elucidate connections among unconscious components of patients' mental processes, and to do so in a systematic way through a process of tracing out associations. The fundamental subject matter of psychoanalysis is the unconscious patterns of life as they become revealed through the analysand's (the patient's) free associations. The analyst's goal is to help liberate the analysand from unexamined or unconscious barriers of transference and resistance, that is, past patterns of relatedness that are no longer serviceable or that inhibit freedom.

History

Psychoanalysis was first devised in Vienna in the 1890s by Sigmund Freud, an M.D. interested in finding an effective treatment for patients with neurotic or hysterical symptoms. As a result of talking with these patients, Freud came to believe that their problems stemmed from culturally unacceptable, thus repressed and unconscious, desires and fantasies of a sexual nature, and as his theory developed, he included desires and fantasies of an aggressive nature, as well. Freud considered these aspects of life instinctive drives, libidinal energy/Eros and the death instinct/Thanatos. Freud's description of Eros/Libido included all creative, life-furthering instincts. The Death Instinct represented an instinctive drive to return to a state of calm, or non-existence. Since Freud's day, psychoanalysis has developed in many ways especially as a study of the personal, interpersonal and intersubjective sense of self.

Prominent current schools of psychoanalysis include ego psychology, which emphasizes defense mechanisms and unconscious fantasies, self psychology, which emphasizes the development of a stable sense of self through mutually empathic contacts with other humans, Lacanian psychoanalysis, which integrates psychoanalysis with semiotics and Hegelian philosophy, analytical psychology, which has a more spiritual approach, object relations theory, which stresses the dynamics of ones relationships with internal, fantasized, others, interpersonal psychoanalysis, which accents the nuances of interpersonal interactions, and relational psychoanalysis, which combines interpersonal psychoanalysis with object-relations theory. Although these schools have dramatically different theories, most of them continue to stress the strong influence of self-deception and the effects of past relationships on present relationships.

A few of the most influential psychoanalysts are Sigmund Freud, Sandor Ferenzci, Carl Jung, Melanie Klein, Heinz Hartmann, David Rapaport, Ernst Kris, Jacques Lacan, Donald Winnicott, Margaret Mahler, Theodor Reik, Harry Stack Sullivan, Heinz Kohut, Slavoj Zizek, Otto Kernberg, Charles Brenner, Roy Schafer, and Stephen A. Mitchell.

Techniques

The basic method of psychoanalysis is the transference and resistance analysis of free association. The patient, in a relaxed posture, is directed to say whatever comes to mind. Dreams, hopes, wishes, and fantasies are of interest, as are recollections of early family life. Generally the analyst simply listens, making comments only when, in his or her professional judgment, an opportunity for insight on the part of the patient arises. In listening, the analyst attempts to maintain an attitude of empathic neutrality, a nonjudgmental stance designed to create a safe environment. The analyst asks that the analysand speak with utter honesty about whatever comes to awareness while interpreting the patterns and inhibitions that appear in the patient's speech and other behavior.

A general rule of thumb in psychoanalytic treatment is that more insight-oriented techniques are to be used with healthier patients, whereas more supportive techniques are to be used with more disturbed patients. The most common example of an insight-oriented technique is an interpretation, in which the analyst delivers a comment to the patient that describes one or more cluster of unconscious wishes, anxieties, and defenses. An example of a supportive technique might be reassurance, in which the analyst tries to lower the patient's level of anxiety by assuring her that what she fears will not come to pass, or will be manageable. Analysts usually prefer to make more insight-oriented interventions when possible, as they feel that such interventions are generally the least judgmental, because when done correctly they simply describe what is going on in the patient's mind.

Although psychoanalytic techniques have sometimes been adapted to treatment of psychosis (with great effort and major sacrifice on the part of the analyst), psychoanalysis is generally thought by analysts to be useful as a method in cases of neurosis and with character or personality problems. Psychoanalysis is believed to be most useful in dealing with ingrained problems of intimacy and relationship and for those problems in which established patterns of life are problematic. As a therapeutic treatment, psychoanalysis generally takes three to five meetings a week and requires the amount of time for natural or normal maturational change (three to seven years).

Much recent psychoanalytic work has been devoted to exploring the use of psychoanalytic principles and techniques in shorter face-to-face psychodynamic psychotherapy, and integrating psychoanalysis with other psychotherapeutic techniques such as those of cognitive behavior therapy. Empirical research on the efficacy of psychoanalysis and psychoanalytic psychotherapy has also become prominent.

Training

Throughout the history of psychoanalysis, most psychoanalytic organizations have existed outside of the university setting, with a few notable exceptions.

Psychoanalytic training usually occurs at a psychoanalytic institute and may last approximately 4-10 years. Training includes coursework, supervised psychoanalytic treatment of patients, and personal psychoanalysis lasting 4 or more years.

Most psychoanalytic institutes require that applicants already possess a graduate degree. Applicants usually have degrees in clinical social work (MSW or DSW), clinical psychology (PhD or Psy.D), or medicine (MD). A small number of institutes also accept applicants who have graduate degrees in nonclinical disciplines, such as literature or philosophy.

Other definitions

Psychoanalysis is

1. A therapeutic technique for the treatment of neurosis.
2. A technique used to train psychoanalysts. A basic requirement of psychoanalytic training is to undergo a successful analysis.
3. A technique of critical observation. The successors and contemporaries of Freud—Carl Jung, Alfred Adler, Wilhelm Reich, Melanie Klein, Wilfred Bion, Jacques Lacan, and many others—have developed Freud's theories and advanced new theories using the basic method of quiet critical observation and study of individual patients and other events.
4. A body of knowledge so acquired.
5. A clinical theory. See, for example, "Ordinary Language Essentials of Clinical Psychoanalytic Theory" by Wynn Schwartz.
6. A movement, particularly as led by Freud, to secure and defend acceptance of the theories and techniques.

Psychoanalysis involves extended exploration of the self, a realization of the Delphian motto, "Know thyself". In this it resembles the extended meditative practices of Buddhist monastic schools such as Zen. If successful, it gives a person the capacity to be present in the moment, responding authentically to circumstances, being free of infantile responses inappropriate to the situation.

Today psychoanalytic ideas are imbedded in the culture, especially in childcare, education, literary criticism, and in psychiatry, particularly medical and non-medical psychotherapy. Though there is a mainstream of evolved analytic ideas, there are groups who more specifically follow the precepts of one or more of the later theoreticians.

Psychoanalyses in groups

Though the most commonly held image of a psychoanalytic session is one in which a single analyst works with a single client, 'group' sessions with two or more clients are not unknown. Carrying out psychoanalysis in groups can be motivated by economic factors (individual analysis is time-consuming and expensive) or by the belief that clients may benefit from witnessing the various client-client and analyst-client interactions. In most forms of group-based analysis, the group is initially an artefact created by the analyst selecting the various members; the assumption is that the common relationship to the analyst will lead to the formation of a genuine group situation. Group psychotherapy of 'natural' groups (e.g. of whole families) seems to be a relative rarity.

Cultural Adaptations

Psychoanalysis can be adapted to different cultures, as long as the therapist or counseling understands the client’s culture. For example, Tori and Blimes found that defense mechanisms were valid in a normative sample of 2,624 Thais. The use of certain defense 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’ where ever 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 (Thompson, et al., 2004). In addition, Corey postulates that it will be necessary for therapist to help clients develop a cultural identity as well as an ego identity. Since Freud has been criticized for not accounting for external/societal forces, it seems logical that therapist or counselors using his premises will work with the family more. Psychoanalytic constructs fit with constructs of other more structured therapies, and Firestone (2002) thinks psychotherapy should have more depth and involve both psychodynamic and cogitative-behavioral approaches. For example, Corey states, that Ellis, the founder of Rational Emotive Behavioral Therapy (REBT) would allow his clients to experience depression over a loss, such an emotion would be rational—often people will be irrational deny their feelings. Since Freudian constructs can fit with other psychotherapeutic and counseling approaches, it can also be adapted to a variety of cultures, but it can not be employed in its widest use as Freud and Firestone would advocate (Firestone, 2002; Tori and Blimes 2002,).

Adaptations for age and managed care

Play Therapy for different ages

Psychoanalytic constructs can be adapted and modified to both age and managed care through the use of play therapy such as art therapy, creative writing, storytelling, bibliotherapy, and psychodrama. In the 1920's, Anna Freud (Sigmund Freud's daughter) adapted psychoanalysis for children through play. Using toys and games, she was able to enhance relationship with the child - Freud has been criticized for his, objective and disengaged, approach. When children play, they often engage in a make believe world where they can express their fears and fantasies, and they do so without censorship, so it resembles very much the technique of free association. Psychoanalytic play therapy allows the child and the counselor to access material in the unconscious, material that was avoided and forgotten. This material is re-integrated into the conscience, and the counselor is able to work with the child and the family to address the trauma or issue that was forgotten. With adults, the term art therapy is used, instead of play, however they are synonymous. The counselor simply adapts art therapy to the age of the client. With children, a counselor may have a child draw a portrait of his self, and then tell a story about the portrait. The counselor watches for re-occurring themes - regardless of whether it is with art or toys. With adults, the counselor may work one on one or in a group and have clients do various art activities like painting or clay to express themselves - toys here would not probably not be age appropriate, and children stop pretend play as they transition into adolescence. Since play is considered appropriate in Occidental (Western) culture, it allows people to deal with personal/social issues that they would normally avoid - it allows them to drop their defenses without anxiety and fear.

Other play therapy techniques

Bibliocounseling involves selecting stories from books that children can identify with (similar issues). Through this story, a child will be more likely to not feel defensive and will work to find alternative solutions to problems. Storytelling is similar, the counselor may tell a story but not use a name, and instead he may address the child with each new sentence using his name. For example, He may say, "next, Eric, the little boy had dream about a mouse that was not like the other mice..."

Play therapy for managed care

Unlike traditional psychoanalysis, play therapy takes much shorter time span; which allow insurance companies to cover it for their clients. Even more, it provides more structure to the process allowing for specific measurable goals. Psychoanalytic theory will be applied in more preventative ways, such as educating parents on how to best meet the needs of the child and enhance the child's development and growth. Lastly, more advocates may use homework assignments such as journal writing to save time (Thompson et al., 2004).

Expressive writing for managed care

According to a book, review by Berman (2003) the writing cure provides an analysis of research that supports expressive writing as a way to integrate cognitions and work through trauma. People who write about traumatic events experience more self control. The Writing Cure offers new, cost-effective ways to treat clients; clients can even use expressive writing to work through their own personal/social issues.

Criticisms

Psychonalysis has been criticized on a variety of grounds by Karl Popper, Adolf Grünbaum, Peter Medawar, Ernest Gellner, Frank Cioffi, Frederick Crews, and others. Popper argues that it is not scientific because it is not falsifiable. Grünbaum argues that it is falsifiable, and in fact turns out to be false. Exchanges between critics and defenders of psychoanalysis have often been so heated that they have come to be characterized as the Freud Wars.

Some defenders of psychoanalysis suggest that its logics and formulations are more akin to those found in the humanities than those proper to the physical and biological sciences, though Freud himself tried to base his clinical formulations on a hypothetical neurophysiology of energy transformations. By the 1970's, psychoanalytic writers like Roy Schafer and George Klein treated psychoanalysis as two separate theories, one, a theory of energy transformations that lacked empirical validation and the other, an "experience-near" theory of human intentionality that was philosophically independent of the reductionism and determinism of 19th century science as seen in the works of Helmholz and Hobbes. Reductionism and determinism were recognized as contrary to the clinical methods and goals of psychological liberation. Psychoanalysis as a collection of clinical theories was recast as a theory of interpretation and development with a focus on understanding how the varieties of nonconscious dispositions and actions influence a person's life in the form of transference and resistance.

A related early criticism of psychoanalysis was that its theories were based on little quantitative and experimental research, and instead relied almost exclusively on the clinical case study method. This criticism has been addressed by an increasing amount of psychoanalytic research from academic psychologists and psychiatrists who have worked to quantify and measure psychoanalytic concepts. Some of the most well-known current psychoanalytic researchers include Wilma Bucci, Peter Fonagy, Robert Holt, Mary Main, Joseph Masling, Mark Solms, and Daniel Stern.

Psychoanalysts have often complained about the significant lack of theoretical agreement among analysts of different schools. Many authors have attempted to integrate the various theories, with limited success. In this regard, psychoanalysis is similar to the related discipline of psychology.

An important consequence of the wide variety of psychoanalytic theories is that psychoanalysis is difficult to criticize as a whole. Many critics have attempted to offer criticisms of psychoanalysis that were in fact only criticisms of specific ideas present only in one or more theories, rather than in all of psychoanalysis.

Although the popularity of psychoanalysis was in decline during the 1980's and early 1990's, prominent psychoanalytic institutes have experienced an increase in the number of applicants in recent years. link to article.