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Psychoanalysis

Psychoanalysis[i] is a set of theories and therapeutic techniques[ii] that deal in part with the unconscious mind,[iii] and which together form a method of treatment for mental disorders. The discipline was established in the early 1890s by Sigmund Freud,[1] whose work stemmed partly from the clinical work of Josef Breuer and others. Freud developed and refined the theory and practice of psychoanalysis until his death in 1939. In an encyclopedic article, he identified the cornerstones of psychoanalysis as "the assumption that there are unconscious mental processes, the recognition of the theory of repression and resistance, the appreciation of the importance of sexuality and of the Oedipus complex."[2] Freud's colleagues Alfred Adler and Carl Gustav Jung developed offshoots of psychoanalysis which they called individual psychology (Adler) and analytical psychology (Jung), although Freud himself wrote a number of criticisms of them and emphatically denied that they were forms of psychoanalysis.[3] Psychoanalysis was later developed in different directions by neo-Freudian thinkers, such as Erich Fromm, Karen Horney, and Harry Stack Sullivan.[4]

Freud distinguished between the conscious and the unconscious mind, arguing that the unconscious mind largely determines behaviour and cognition owing to unconscious drives. Freud observed that attempts to bring such drives into awareness triggers resistance in the form of defense mechanisms, particularly repression, and that conflicts between conscious and unconscious material can result in mental disturbances. He also postulated that unconscious material can be found in dreams and unintentional acts, including mannerisms and Freudian slips. Psychoanalytic therapy, or simply analytical therapy,[5] developed as a means to improve mental health by bringing unconscious material into consciousness. Psychoanalysts place a large emphasis on early childhood in an individual's development. During therapy, a psychoanalyst aims to induce transference, whereby patients relive their infantile conflicts by projecting onto the analyst feelings of love, dependence and anger.[6][7]


During psychoanalytic sessions a patient traditionally lies on a couch, and an analyst sits 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 defence mechanisms to help patients understand themselves better.[8]


Psychoanalysis is a controversial discipline, and its effectiveness as a treatment has been contested, although it retains influence within psychiatry.[iv][v] Psychoanalytic concepts are also widely used outside the therapeutic arena, in areas such as psychoanalytic literary criticism and film criticism, analysis of fairy tales, philosophical perspectives such as Freudo-Marxism, and other cultural phenomena.

History[edit]

1890s[edit]

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.[9] In 1885, Freud obtained a grant to study with Jean-Martin Charcot, a famed neurologist, at the Salpêtrière in Paris, where he followed the clinical presentations of Charcot, particularly in the areas of hysteria, paralyses and the anaesthesias. Charcot had introduced hypnotism as an experimental research tool and developed 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.[10] 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.[10]


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.[11] The term 'psychoanalysis' (psychoanalyse) was first introduced by Freud in his essay titled "Heredity and etiology of neuroses" ("L'hérédité et l'étiologie des névroses"), written and published in French in 1896.[12][13]


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.[14] 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",[14]: 204  in later accounts he claimed that they had told him that they had been sexually abused in infancy. 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.[15]


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.[15] Only much later did he claim the same findings as evidence for Oedipal desires.[16] In the latter part of the 20th century, several Freud scholars challenged Freud's perception of the patients who informed him of childhood sexual abuse, arguing that he had imposed his preconceived notions on his patients.[17][18][19]


By 1899, Freud had theorised that dreams had symbolic significance and generally were specific to the dreamer. Freud formulated his second psychological theory—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, which Freud thought of as his most significant work.[20][21] Freud outlined a new topographic theory, which theorised that unacceptable sexual wishes were repressed into the "System Unconscious". These wishes were made 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, where it has been largely supplanted by structural theory.[22] In addition, The Interpretation of Dreams contained Freud's first conceptualisation of the Oedipal complex, which asserted that young boys are sexually attracted to their mothers and envious of their fathers for being able to have sex with their mothers.


Psychologist Frank Sulloway in his book Freud, Biologist of the Mind: Beyond the Psychoanalytic Legend argues that Freud's biological theories like libido were rooted in the biological hypothesis that accompanied the work of Charles Darwin, citing theories of Krafft-Ebing, Molland, Havelock Ellis, Haeckel, Wilhelm Fliess as influencing Freud.[23]: 30 

1900–1940s[edit]

In 1905, Freud published Three Essays on the Theory of Sexuality in which he laid out his discovery of the psychosexual phases, which categorised early childhood development into five stages depending on what sexual affinity a child possessed at the stage:[24]

Psychopathology (mental disturbances)[edit]

Childhood origins[edit]

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.[69]


The theory on origins of pathologically dysfunctional relationships was further developed by the specialist in psychiatry Jürg Willi (* 16. März 1934 in Zürich; † 8. April 2019) into the Collusion (psychology) concept. The concept takes the observations of Sigmund Freud about the narcissistic, the oral, the anal and the phallic phases and translates them into a two-couples-relationship model, with respect to dysfunctions in the relationship resulting from childhood trauma.[70]

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.

Glossary of psychoanalysis

List of schools of psychoanalysis

Psychoanalytic sociology

Training analysis

– world's primary regulatory body for psychoanalysis, founded by Sigmund Freud (archived 18 January 1998)

International Psychoanalytical Association (IPA)

Psychoanalysis – Division 39 – American Psychological Association (APA)