Is Psychoanalysis Really Effective?

Psychoanalysis had begun with the discovery that a person in complete physical health could experience an illness with physical symptoms that caused by things trapped in the subconscious known as hysteria. Charcot, a French neurologist tried to liberate the mind through hypnosis. A Viennese physician, Josef Breuer, carried this purging further with a process based on his patient, Anna O., revealing her thoughts and feelings to him. Sigmund Freud took Breuer's method and made generalizations that grew into conceptualizations and eventually into the theories of psychoanalysis. Freud would listen to his patients, and then use these thoughts to interpret what was happening in the unconscious part of their mind. This was explained as bringing the unconscious to consciousness so it could be dealt with through therapy. Breuer and Freud's successes with this method led to the foundational publication of Studies in Hysteria in 1895. Freud continued his practice of theory until it became the system of psychology known as psychoanalysis, a system that is the single most influential theory of psychotherapy in our time.

Freud began with his study of the three forces of the psyche: the id, the ego, and the superego. In summary, the id seeks pleasure, the ego tests reality and mediate, the superego constrains and strives for perfection. Not surprisingly, the three components of personality are in constant conflict: the ego postpones the gratification the id wants immediately and the superego battles with both because behaviour often falls short of the moral code it represents.

In order to deal with this conflict, the ego develops a series of defence mechanisms which allow it to protect itself from the pressures of the id, the real world and the superego. Examples are: 1.) Repression - burying a memory so thoroughly that it is not recalled at all - "it never happened". 2.) Projection - attributing own unwanted "bad" feelings or ideas to another person. 3.) Rationalisation - making up a reasonable excuse for unacceptable behaviour and really believing it. 4.) Suppression - forgetting a shocking event on purpose: (consciously in this case) putting it out of one's mind. 5.) Denial - refusing to acknowledge something because it is so distressing. 6.) Displacement - transferring feelings from one person or object to another. 7.) Identification - imitating someone who is admired and modelling oneself on them. 8.) Reaction-Formation - consciously substituting the opposite emotion for true feelings about someone/something.

Freud believed that conflict is inevitable and all behaviour is a compromise. Conflict is the primary cause of human anxiety and unhappiness. Defence mechanisms are one way we have of dealing with our inner conflict; neurotic symptoms and dreaming are the other major forms of compromise.

Through this particular study, Freud contends that one must go back to birth, which is the manifestation of an individual's sexuality. The oral phase is where life begins and that is why babies explore everything with their mouth, the centre of all sensations. The following phase is the anal or sadistic-anal phase where excretory functions are the centre of everything. Pleasures are experienced in the anus during bowel movements. Finally these erotically tinged pleasures are experienced when the sexual organ is manipulated. Thus psychosexual development progresses from the oral through the anal to the phallic (in psychoanalytic theory phallic refers to both male and female sexual organs) stage. During the height of the phallic phase, about the ages of three to six, these libidinous forces focus on the parent of the opposite sex and lend an erotic cast to the relationship between parent and child (son/mother or daughter/father). This focus is known as the Oedipus phase for boys and the Electra phase for girls. The phallic phase is followed by a period of latency where sexual drives lay dormant until puberty when they are reawakened and individuals become more aware of the sexual roles they will play as an adult. Freud felt that special problems at any stage could arrest (or fixate) development and have a lasting effect on the individual's personality. The libido would remain attached to the activities appropriate for that stage. Thus a person who was weaned very early and did not have enough sucking pleasure might become fixated at the oral stage. As an adult, this person may be excessively dependent on others and overly fond of such oral pleasures as eating, drinking and smoking. Such a person is called an "oral" personality. The person fixated at the anal stage of psychosexual development may be abnormally concerned with cleanliness, orderliness, and saving.

The aim of psychoanalytic therapy is to bring about a fundamental change in the patient's personality so that he is released from his neurotic disorders. Freud believed that neurosis was caused by the repression of disturbing feelings and emotions associated with conflicts established in early childhood. These conflicts result from the impulses of the id or the strictures of an over demanding superego. He assumed that the patient's ego was too weak to cope with such conflicts and defended itself by repressing them into the unconscious. However, conflicts do not go away; they find expression through the symptoms and neurotic behaviour of the patients. The aims of psychoanalysis are to remove the infantile conflict from the unconscious and help the patient deal with it at a conscious level.

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 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