Psychoanalysis is an approach which aims for a patient to be provided with a secure space in which they feel enabled and motivated to to explore themselves. It is a method which provides a model for self exploration with the support of the analyst. The analyst will seek to guide the client through negativity as it arises during the process and to recognise the unconscious motivation of the consciousness they experience. Patients are helped to recognise past patterns which impact on the present in the form their of emotions, attachments, behaviours and thoughts. Emphasis is, therefore, placed on recognising the past in the present.
Freud and Breuer
Sigmund Freud (1856-1939) is widely regarded to have created psychoanalysis, however, the work of Joseph Breuer (1842-1925) greatly inspired him. Breuer became a mentor to him and could be said to have laid the foundations for what was to become known as the psychoanalytical approach.
Breuer was a physician who recognised the positive effects of talking with patients as a mental health treatment. His work with a patient called Anna O was key in his development of this approach. It was Anna O who first used the term ‘talking cure’ to describe the process and the benefits she experienced.
A key moment for Freud and his further exploration of his ideas of psychoanalysis, was the death of his father. This event left Freud deeply shaken. By analysing the experiences of his patients and himself he discovered common themes of childhood experience and trauma. In his book ‘The Interpretation of Dreams’ (1899) Freud introduced his ideas on inner conflict and the dynamic conscious. He had come to realise that as a child he had developed feelings of jealousy to his father due to be in love with his mother and that these emotions were suppressed in his unconscious. He theorised that this was the common experience of you boys. These ideas were to become his theory of the Oedipus complex. By further examining his idea of inner conflicts, he suggested we experience powerful wishes on an unconscious level all the time. These urges can be unacceptable as civilised behaviour and are kept from appearing at a conscious level by a barrier. These unsatisfied wishes would come to the fore in dreams and these in turn could be interpreted and analysed.
Exploring his theories further in his book ‘The Psychopathology of Everyday Life’ (1901) Freud decided that the subconscious did not only appear in dreams, but influenced conscious behaviour as well. Psychoanalysis could associate conscious disorders with the subconscious event and memory. The understanding could be passed to the patient who would benefit from this recognition. This became known as ‘interpretation’, the relating of current feelings to childhood experiences and relationships.
Melanie Klein (1182-1960) was the first to apply Freud’s theories in the observation of infant behaviour. She found evidence of very early development of Oedipus complex and the superego, the level of psyche that acts as a barrier to unacceptable unconscious urges. Her theory of ‘object relations’ stated the importance of the relationship between infant and mother. The effects of these relationships would be stored in the unconscious and affect a patients internal framework regarding relationships with others in later life.
Otto Kernberg (1928- ) developed further Klein’s theories of object relations. In his theory on narcissism, he suggested that the narcissism had it’s roots in early childhood and that the apparent high self esteem acted as a defence for low self esteem. Kernberg’s ‘transference’ approach to therapy sought to address the disjointed and illogical views of oneself and other people found in some personality disorders such as borderline personality disorder. These caused often contradictory representations of self and others that contribute to emotional irregularity, unstable self identity and relationships.
A path can be drawn to present day psychoanalytic approaches from Freud, through Klein to the recent work of Otto Kernberg. A second path can be seen to have developed alongside this. This path moves away from the traditional idea of a therapist as a ‘blank sheet’ onto which the patient can project their thoughts and emotions for the analyst to interpret. They believed that the relationship between therapist and patient was important and could be curative.
Sandor Ferenczi (1873-1933) originally was interested in spiritism and telepathy. H e became a close associate of Freud. His ‘Clinical Diary’ is regarded as his most important work although it wasn’t published until the 1980’s. This diary detailed his work with a patient known as ‘RN’ (Elizabeth Severn). She had a very traumatic childhood involving sexual abuse from her father and was very troubled. Not much progress was being made when Elizabeth revealed she thought this was the case because he hated her. Through a process of mutual analysis he realised that deep inside he did hate her. Once he had resolved these issues was able to help her. It became apparent to him that the relationship between himself and Severn had been key to her recovery. This started the path towards the interpersonal-relational theories of psychoanalysis.
Donald Winnicott (1896-1971) was a paediatrician who would analyse children by using play. He came to an important understanding of the power of non verbal communication in psychoanalysis. He stressed the importance of being prepared to change technique as opposed to expecting the patient to become moulded to the current form of treatment. He introduced spontaneous personal relating between therapist and patient and an approach that was humane and creative.
Heinz Kohut (1913-1981) considered ideas from many theories of psychoanalysis. He created self psychology which was the first approach to consider empathy as an essential part of the therapeutic process. With this empathetic approach, Kohut would help a patient explore how their current sense of self has been created by their childhood experiences. He proposed that a child who doesn’t connect with their parents will be unable to connect healthily with others as an adult. He suggested that Freud’s approaches could impose an analysts beliefs on a patient and better help could be given if the analyst tried to understand the problems from the patients point of view.
Stephen Mitchell (1946-2000) concepts were a move away from classical psychoanalysis as they were less focussed on the unconscious drives of Freud’s theories and gave more importance to relationships. He pulled together various of relationship models to create a framework for relational psychoanalysis. His suggested approach to the therapeutic process was that both patient and therapist can open up and relate to each other’s past and feelings. From the input of both participants, positive ideas to develop growth could be discovered.