Psychoanalysis

Psychoanalysis is a means of understanding human thought and emotions, as well as potentially treating malfunctions, originating with the work of Sigmund Freud. A neurologist by training, he saw symptomatology that could not be explained by the neurobiology of the time. Part of the reason psychoanalysis is sometimes considered prescientific, or even pseudoscience, is the much greater modern understanding of neurosciences. Nevertheless, he did examine how what he termed conscious and unconscious thinking could affect a patient's world view.

A broader view today bases psychodynamic psychotherapy on principles derived from psychoanalysis.

Theory

Freud began a private practice in Vienna in 1886 through 1896, in which he abstracted concepts from his observations of his patients. trying to help patients as well as himself, developed a provocative and influential theory of psychoanalysis. Freud suggested that persons go through so-called psychosexual stages of development which he named oral (sucking and eating as a baby), anal (pleasure from bodily control over waste), phallic (sexual desire related to the opposite–sex parent), latency (an intermediate stage characterized by less interest in sex), and genital (for adolescents onwards where sexual urges are expressed in sexual relationships). Freud suggested that persons who get stuck at one stage (he used the term fixation) have trouble progressing to later stages and developing fully as persons, which prevented them from attaining an intelligent balance between his hypothetical three basic structures of the personality. These parts were: the id (basic powerful subconscious drives such as hunger and sex), the superego (a conscience and internalized parental guide emphasizing rules and order), and the ego, an adult reality–based mechanism to resolve conflicts between the id and superego. According to Freud, when conflicts are not handled properly, the mind can engage in a variety of so-called defense mechanisms (his terms: Denial, Displacement, Intellectualization, Projection, Repression, Rationalization, Reaction Formation, and Sublimation) to cope, but his therapy was based on teaching a person to understand these mechanisms and resolve conflicts as a mature and reasonable adult.

Psychoanalytic psychotherapy

Transference and countertransference

In psychoanalysis, as the analysand forms associations, he or she is believed to go through a process of transference, in which the analyst represents a significant childhood or other figure. While classic psychoanalysis does not use role-playing, once a state of transference exists, the patient may be able to verbalize previously unconscious conflicts with that figure.

Countertransference is the formation of attitudes about the analysand by the analyst, and can interfere with the process. Analysts often stay in training analysis, or discuss cases with a colleague, to resolve countertransferences and other problems with the analysis to which the analyst contributes.

Flight into health

A psychodynamic term of obscure origin is the "flight into health".

Although its origin remains a mystery, the term flight into health has been part of the psychotherapeutic lexicon for more than half a century. Historically, the term has been used as an interpretative label, suggesting that patients who responded “too quickly” to therapeutic intervention were actually engaging in escape tactics. According to this view, rapid responses to therapy were attempts to avoid the pain and anxiety of further exploration and self-disclosure.

Major students

Several of his close associates, including Alfred Adler, Carl Jung and Otto Rank eventually broke away to develop their own styles of psychotherapy.

Others, such as Karen Horney, stayed with a Freudian approach but developed it further. Frieda Fromm-Reichmann (1889–1957) was a psychiatrist and contemporary of Sigmund Freud who pioneered an intensive method of psychoanalysis which emphasized empathy, honesty, and directness, and she came to believe that experiences in early life were more important than psychosexual motivations in mental health.