Complete Psychoanalysis

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From the 1890s until his death in 1939, the German physician Sigmund Freud developed a method of psychotherapy known as Psychoanalysis. Freud's understanding of the mind was largely based on interpretive methods, introspection and clinical observations, and was focused in particular on resolving unconscious conflict, mental distress and psychopathology. Freud's theories became very well-known, largely because they tackled subjects such as sexuality, repression, and the unconscious mind as general aspects of psychological development. Clinically, he helped to pioneer the method of free association and a therapeutic interest in dreams.
Freud had a significant influence on Swiss psychiatrist Carl Jung, whose analytical psychology became an alternative form of depth psychology. Other well-known psychoanalytic thinkers of the mid-twentieth century included Sigmund Freud's daughter psychoanalyst Anna Freud, German-American psychologist Erik Erickson, Austrian-British psychoanalyst Melanie Klein, English psychoanalyst and physician D. W. Winnicott, German psychologist Karen Horney, German-born psychologist and philosopher Erich Fromm, and English psychiatrist John Bowlby. Throughout the 20th century, psychoanalysis evolved into diverse schools of thought, most of which may be known as Neo-Freudian.
Psychoanalytic theory and therapy were criticized by psychologists such as B. F. Skinner and Hans Eysenck, and by philosophers including Karl Popper. Skinner and other behaviorists believed that psychology should be more empirical and efficient than psychoanalysis, although they frequently agreed with Freud in ways that became overlooked as time passed. While scholars of the humanities maintained that Freud was not a "scientist at all, but ... an interpreter.

• Kinds Of Problems Can Be Helped By Psychoanalytic Treatment?

Psychoanalysis is not a magic bullet and it is not for everyone. Psychoanalytic treatment is best suited for people who are interested in understanding themselves and in taking a careful look at how their own thoughts and feelings, some of which may be unconscious, contribute to their difficulties. Psychoanalytic treatment can help with:

• Troubled relationships
• Poor self-esteem
  
• Sexual troubles
• Anxiety
• Depression
• Chronic irritability
• Post-traumatic stress disorders
• Unresolved grief
• Obsessions and compulsions
• Phobias
• Psychosomatic conditions
• Blocked creativity
• Work and academic inhibitions
• Self-defeating behavior
• Attachment disorders

1. Free Association Method

Freud adopted the method of free associations during 1892-1898, starting from several criteria. The method was to replace the use of hypnosis. It relied on Freud's belief in psychic determinism. According to that perspective, psychic activity is not subordinated to free choice. All our mind produces has an unconscious root we can reach by means of free associations.
The theory of psychic determinism is amply debated upon in Freud's work The Psychopathology of Everyday Life. It is in the same place that we find plenty of instances of free associations related to various faulty and symptomatic acts (Freudian slips and mistakes), proving that involuntary psychic acts too are determined by specific causes.

We can say that this method is the golden rule of the psychoanalytic therapy.

Let us see how it works.

Lying on a smooth chair (state of relaxation), the patient speaks freely of anything that may cross his/her mind, without searching for some specific subject or topic. The flow of his/her thoughts is free, and followed with no voluntary intervention. The important thing is that the critical mind does not intervene to censor spontaneous thoughts. We truly have the drive to censure the products of our thinking, starting from various criteria: moral, ethic, narcissistic, cultural, spiritual. The method of free associations demands us to temporarily give up intellectual censorship and freely speak about any thought.
What is the result of this involuntary talk? Later analysis of thoughts produced by means of the above-mentioned method reveals certain repetitive topics indicative of psychic complexes of emotional charge. These complexes are unconscious. They are autonomously activated by chance verbal associations, and influence conscious psychic life in a frequently dramatic manner. The task of psychoanalysis is to bring such complexes to the surface of conscious mind, and integrate them into the patient's life.

• Example of free associations

Lying on a couch, in dim light and in a peaceful room, the patient produces the following free associations:
I am thinking of the fluffy clouds I seem to see with my very eyes. They are white and pearly. The sky is full of clouds but a few azure patches can still be seen here and there...
Clouds keep changing their shapes. They are fluid because they are condensed water particles...
I am thinking I may have an obsession about this water. The doctor has told me I am dehydrated; there's not enough water in my body. He suggested I should drink 2-3 liters of water every day. Mineral water or tea!
I thought there is a connection between my need to add salt to my food and thirst. My body has found itself a pretext - salty food - to make me drink more water. I have a lot of thoughts about the manifestations of my body, which seem logical and aim at inner balance. Everybody has in fact got an inner physician in oneself. What need is there of an outside doctor then? If you allow yourself lie at the will of your free inclinations, with no assumptions whatsoever, you will have the intuition of making things that may surprise you, nevertheless useful to your body and securing your health and high spirits.
I read somewhere that one can be one's own doctor... Everybody can be one's own doctor.

• Interpretation

We put a stop here to the flow of our patient's associations. We may notice these are indirectly related to the relationship with her therapist. Her associations related to the spontaneous medicine of her body lead to the idea that no physician is in fact necessary. The patient thinks the psychoanalyst has in fact no contribution to her well being, that she could very well do without one.
We must admit the series of free associations produced by the patient are somehow related to her present circumstances, including a recent reality: her psychoanalytic therapy. The novelty of the therapy, the relationship with the psychoanalyst, automatically induces thoughts, remarks, more or less recent memories. The fact that, during her therapy, the patient alludes to a doctor, who had in fact done nothing to help her, is no mere chance. This memory can be related to the present circumstance and it may be translated in the patient's skepticism concerning the utility of this analytic therapy.
Nevertheless, this skepticism has an even older history, bringing to the fore the patient's relationship to her mother, when still a child, and dependent on her parents support.

• Notes:

Freud had used the method of free associations in his self-analysis, in dream interpretation. In his Studies on Hysteria (1895), the emphasis increasingly lay on the patient's spontaneous expression. Freud remembers Emmy Von M., his patient who, on his urge to find the root of a certain symptom, had given the following answer: "he should not keep asking about the origin of this or the other, but allow her talk to him about anything that crosses her mind". Freud also remarked that: "Her accounts are not as unintentional as they seem; rather, they quite closely reproduce her memories, and new impressions, since our latest meeting and often, quite unexpectedly, spread from the pathogenic reminiscences she spontaneously discharges herself of through words

2. Dream Interpretation and Psychoanalysis

In the first pages of his work New Introductory Lectures On Psychoanalysis, dated December 6th 1932, Sigmund Freud clearly asserts that the theory of dreams "occupies a special place in the history of psychoanalysis and marks a turning-point; it was with it that analysis took the step from being a psycho-therapeutic procedure to being a depth-psychology" . The theory of dreams is the most characteristic and singular aspect of psychoanalytic science, "something to which there is no counterpart in the rest of our knowledge, a stretch of new country, which has been reclaimed from popular beliefs and mysticism."
Dream analysis, in psychoanalysis, provides the possibility to decipher the mystery of neurotic disorders, specifically hysteria, and secondly, it opens the road towards unconscious. Freud's phrase: "The interpretation of dreams is the royal road to a knowledge of the unconscious" has become famous. (1)
The first great dream interpreted by Freud that leads him to his great discoveries were materialized in 1895. It is the famous dream of Irma's injection, which Freud almost thoroughly analyzed and published in his grandiose work The Interpretation of Dreams (1900). Dream was approached in a manner, which was to become specific for the practitioners of psychoanalysis: by means of the dreamer's associations.
Dream analysis (details are provided in the quoted book) reveals Freud's feelings of guilt towards Irma, one of his young patients, whose treatment had not yielded the expected results. Freud defends himself from these negative feelings in his dream, blaming his very patient who, apparently, were not a submissive and compliant patient, or Dr. Otto, one of his colleagues, guilty of a careless medical intervention (an injection with an infected syringe).
After analyzing his dream, most coherent as it proved, Freud justly declared that dreams "are not meaningless, they are not absurd; they do not imply that one portion of our store of ideas is asleep while another portion is beginning to wake. On the contrary, they are psychical phenomena of complete validity - fulfillment's of wishes [our emphasis J.C.]…" Dreams therefore require integration into the range of intelligible waking mental acts; "they are constructed by a highly complicated activity of the mind".

(op. cit., chapter "A Dream is the Fulfillment of a Wish".)

This assertion in fact expresses a great opening towards the activity of abysmal psyche, and mostly the belief in psychic determinism, in the idea that all psychic deeds have their own meaning and connect to day activities, even in a somewhat less visible manner. Contrary to the general opinion of his time's scientific world, Freud thinks dreams are a coherent psychic activity, that can be analyzed in depth.
Nevertheless, the comprehensive definition of the dream includes other discoveries too, the true sign of Freudian approach original character: "a dream is a (disguised) fulfillment of a (suppressed or repressed) wish".

(op. cit., chapter Distortion in Dreams.)

This definition emphasizes two key aspects of the theory of dreams:

• Dreams are a disguised fulfillment of a wish, and
  
• This is repressed wish .
  

We can therefore conclude that disguise is caused by repression. That is the reason why all dream researchers before Freud were not able to discover these facts: they only analyzed the manifest content of the dream, that is its outer shape at wakening time, its facade, not caring about latent thoughts giving rise to its becoming, thoughts we reach by means of the method of associations devised by Freud.
Freud goes even further to analyze the nature of distortion by the dream, partially the work of dream-censorship and partly of dream-work, a complex process by means of which latent thoughts are turned into dreams as such. Freud's analysis includes dream-work, and the end of his book also provides us his opinions concerning the psychology of the dream process: primary and secondary processes, repression, unconscious, etc.
That is why The Interpretation of Dreams represents the major work on dreams and unconscious life, not equaled so far! It remains an essential stage in the study of psychoanalysis!In spite of the importance of dream-analysis for the discovery of abysmal psyche functioning as well as for therapy as such, this crucial field of psychoanalysis has no more concerned psychoanalysts after Freud's research. The same work quoted at the beginning of the present article records Freud's own bitter remark: "In the earlier volumes [of Internationale Zeitschrift für (ärztliche) Psychoanalyse (2)] you will find a recurrent sectional heading 'On Dream-Interpretation', containing numerous contributions on various points in the theory of dreams. But the further you go the rarer do these contributions become, and finally the sectional heading disappears completely."
In spite of this constant lack of concern for dream theory, lack of regard nowadays materialized in schematic, abstract approach of dream in psychoanalytic therapy, the importance of this area of research is crucial. That is why we have to give it the place it deserves.

• Notes:

1. "…it is the securest foundation of psychoanalysis and the field in which every worker must acquire his convictions and seek his training. If I am asked how one can become a psychoanalyst, I reply: <>."

(New Introductory Lectures on Psychoanalysis.)

3. Analysis of Resistances

It became evident that the work of uncovering what had been photogenically forgotten had to struggle against a constant and very intense resistance. The critical objections which the patient raised in order to avoid communicating the ideas which occurred to him, and against which the fundamental rule of psycho-analysis was directed, had themselves already been manifestations of this resistance.
A consideration of the phenomena of resistance led to one of the corner-stones of the psycho-analytic theory of the neuroses - the theory of repression. It was plausible to suppose that the same forces which were now struggling against the pathogenic material being made conscious had at an earlier time made the same efforts with success.

(Sigmund Freud: An Outline of Psychoanalysis, 1940.)

• Five kinds of resistances

Further investigation of the subject shows that the analyst has to combat no less than five kinds of resistance, emanating from three directions - the ego, the id and the super-ego. The ego is the source of three of these, each differing in its dynamic nature.
The first of these three ego-resistances is the repression resistance, which we have already discussed above and about which there is least new to be added. Next there is the transference resistance, which is of the same nature but which has different and much clearer effects in analysis, since it succeeds in establishing a relation to the analytic situation or the analyst himself and thus re-animating a repression which should only have been recollected.
The third resistance, though also an ego-resistance, is of quite a different nature. It proceeds from the gain from illness and is based upon an assimilation of the symptom into the ego. It represents an unwillingness to renounce any satisfaction or relief that has been obtained. The fourth variety, arising from the id, is the resistance which, as we have just seen, necessitates "working-through". The fifth, coming from the super-ego and the last to be discovered, is also the most obscure though not always the least powerful one. It seems to originate from the sense of guilt or the need for punishment; and it opposes every move towards success, including, therefore, the patient's own recovery through analysis.

(Sigmund Freud: Inhibitions, Symptoms and Anxiety, 1926.)

4. Transference

The patient is not satisfied with regarding the analyst in the light of reality as a helper and adviser who, moreover, is remunerated for the trouble he takes and who would himself be content with some such role as that of a guide on a difficult mountain climb. On the contrary, the patient sees in him the return, the reincarnation, of some important figure out of his childhood or past, and consequently transfers on to him feelings and reactions which undoubtedly applied to this prototype. This fact of transference soon proves to be a factor of undreamt-of importance, on the one hand an instrument of irreplaceable value and on the other hand a source of serious dangers. This transference is ambivalent: it comprises positive (affectionate) as well as negative (hostile) attitudes towards the analyst, who as a rule is put in the place of one or other of the patient's parents, his father or mother.

(Sigmund Freud: An Outline of Psychoanalysis - 1940.)

• Universality of Transference

An analysis without transference is an impossibility. It must not be supposed, however, that transference is created by analysis and does not occur apart from it. Transference is merely uncovered and isolated by analysis. It is a universal phenomenon of the human mind, it decides the success of all medical influence, and in fact dominates the whole of each person's relations to his human environment. We can easily recognize it as the same dynamic factor which the hypnotists have named 'suggestibility', which is the agent of hypnotic rapport and whose incalculable behavior led to difficulties with the cathartic method as well.

(Sigmund Freud: An Autobiographical Study - 1925.)

• Absence of Transference

When there is no inclination to a transference of emotion such as this, or when it has become entirely negative, as happens in dementia praecox or paranoia, then there is also no possibility of influencing the patient by psychological means.

(Sigmund Freud: An Autobiographical Study - 1925.)