psychoanalytic theory experiment

Psychoanalysis: A History of Freud’s Psychoanalytic Theory

However, psychoanalysis is much more than a quirky approach to understanding the human mind. It’s a specific form of talking therapy, grounded in a complex theory of human development and psychological functioning.

In this article, we’ll introduce the history of psychoanalytic theory, the basic tenets of the psychoanalytic model of the mind, and the clinical approach called psychoanalysis. We’ll explain the differences between psychoanalysis and psychotherapy and consider some criticisms of psychoanalysis.

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This Article Contains

What is psychoanalysis a definition and history of psychoanalytic theory, the approach: psychoanalytic perspective, techniques of psychoanalytic therapy, psychodynamic vs. psychoanalytic theory, psychoanalysis vs. psychotherapy, psychoanalysis test: the freudian personality test, criticisms of psychoanalytic theory, a take-home message.

Psychoanalysis is a talking therapy that aims to treat a range of mental health issues by investigating the relationship between the unconscious and conscious elements of psychological experience using clinical techniques like free association and dream interpretation (Pick, 2015).

Contemporary psychoanalysis has evolved a great deal from its roots in the classical Freudian approach, which developed in Vienna during the late 19th century.

Today, there are several psychoanalytic schools that adhere to different models of the mind and clinical approaches. These include the object relations school associated with Klein and Winnicott, Jung’s analytic psychology, and Lacanian psychoanalysis (Gaztambide, 2021).

Many controversies abound between these different approaches today, although all can be classified as an approach to psychoanalysis.

A common thread between them is their focus on the transference and countertransference dynamics between the analyst and analysand as the vehicle of psychological transformation and healing (Pick, 2015). This is explained further below.

Freudian theory: Sigmund Freud & psychoanalysis

The founder of psychoanalysis, Sigmund Freud, was born in Austria and spent most of his childhood and adult life in Vienna (Gay, 2006). He entered medical school and trained as a neurologist, earning a medical degree in 1881.

Soon after his graduation, he set up in private practice and began treating patients with psychological disorders. His colleague Dr. Josef Breuer’s intriguing experience with a patient, “Anna O.,” who experienced a range of physical symptoms with no apparent physical cause (Breuer & Freud, 1895/2001) drew his attention.

Dr. Breuer found that her symptoms abated when he helped her recover memories of traumatic experiences that she had repressed from conscious awareness. This case sparked Freud’s interest in the unconscious mind and spurred the development of some of his most influential ideas.

You can read more about the clinical origins of psychoanalysis in the original text Studies on Hysteria (Breuer & Freud, 1895/2001).

Models of the mind: Ego, id, & superego

Perhaps Freud’s greatest impact on the world was his model of the human mind, which divides the mind into three layers, or regions.

• Conscious Housing our current thoughts, feelings, and perceptual focus
• Preconscious (sometimes called the subconscious) The home of everything we can recall or retrieve from our memory
• Unconscious At the deepest level of our minds resides a repository of the processes that drive our behavior, including biologically determined instinctual desires (Pick, 2015).

Later, Freud proposed a more structured model of the mind that better depicted his original ideas about conscious and unconscious processes (Gaztambide, 2021).

In this model, there are three components to the mind:

• Id The id operates at an unconscious level as the motor of our two main instinctual drives: Eros, or the survival instinct that drives us to engage in life-sustaining activities, and Thanatos, or the death instinct that drives destructive, aggressive, and violent behavior.
• Ego The ego acts as a filter for the id that works as both a conduit for and check on our unconscious drives. The ego ensures our needs are met in a socially appropriate way. It is oriented to navigating reality and begins to develop in infancy.
• Superego The superego is the term Freud gives to “conscience” where morality and higher principles reside, encouraging us to act in socially and morally acceptable ways (Pick, 2015).

The image offers a context of this “iceberg” model of the mind, which depicts the greatest psychological influence as the realm of the unconscious.

Defense mechanisms

Freud believed these three components of the mind are in constant conflict because each has a different goal. Sometimes, when psychological conflict threatens psychological functioning, the ego mobilizes an array of defense mechanisms to prevent psychological disintegration (Burgo, 2012).

These defense mechanisms include:

• Repression The ego prevents disturbing memories or threatening thoughts from entering consciousness altogether, pushing them into our unconscious.
• Denial The ego blocks upsetting or overwhelming experiences from awareness, leading us to refuse to acknowledge or believe what is happening.
• Projection The ego attempts to resolve discomfort by attributing our unacceptable thoughts, feelings, and motives to another person.
• Displacement The ego satisfies an unconscious impulse by acting on a substitute object or person in a socially unacceptable way (e.g., expressing the anger you feel toward your boss at work with your spouse at home instead).
• Regression Ego functioning returns to a former stage of psychological development to cope with stress (e.g., an angry adult having a tantrum like a young child).
• Sublimation Similar to displacement, the ego overcomes conflict by channeling surplus energy into a socially acceptable activity (e.g., channeling anxiety into exercise, work, or other creative pursuits).

It is built on the foundational idea that biologically determined unconscious forces drive human behavior, often rooted in early experiences of attempting to get our basic needs met. However, these remain out of conscious awareness (Pick, 2015).

Psychoanalysis engages in a process of inquiry into adult defenses against unacceptable unconscious desires rooted in these early experiences and emphasizes their importance as the bedrock of adult psychological functioning (Frosh, 2016).

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A modern psychoanalyst may use a range of different interventions, depending on their school of psychoanalytic thought (e.g., object-relational, Lacanian, Jungian, etc.; Gaztambide, 2021).

However, there are four component techniques specific to psychoanalysis that we explain below.

What are the four ideas of psychoanalysis?

Interpretation

Interpretation refers to the analyst’s hypothesizing of their client’s unconscious conflicts. These hypotheses are communicated verbally to the client.

Generally, the analyst will attempt to make their client more aware of their defense mechanisms and their relational context, including their unconscious conflicts and the client’s motivation for mobilizing a particular defense mechanism (Kernberg, 2016).

There are three stages of interpretation (Kernberg, 2016):

• Clarification Where the analyst tries to clarify what is going on in the patient’s conscious mind
• Confrontation Gently aims to bring nonverbal aspects of the client’s behavior into their awareness
• Interpretation When the analyst proposes their hypothesis of the unconscious meaning that relates each aspect of the client’s communication with the other

Transference analysis

Transference refers to the repetition of unconscious conflicts rooted in the client’s relational past in the relationship with the analyst. Transference analysis involves tracking elements of the client’s verbal and nonverbal communications that aim to influence the analyst’s behavior toward the client (Racker, 1982).

For example, a client with a history of childhood trauma may begin to relate to the analyst as a threatening or predatory authority figure by expressing suspicion of the analyst’s motives, missing sessions, or becoming angry with the analyst.

The analysis of a client’s transference is an essential component of psychoanalysis and is the main driver of change during treatment. It provides the raw material that informs an analyst’s interpretations (Racker, 1982).

Technical neutrality

Technical neutrality refers to the analyst’s commitment to remain neutral and avoid taking sides in the client’s internal conflicts. The analyst strives to remain neutral and nonjudgmental by maintaining a clinical distance from the client’s external reality .

Additionally, technical neutrality demands that analysts refrain from imposing their value systems on the client (Kernberg, 2016).

Technical neutrality can sometimes seem like indifference or disinterest in the client, but that is not the goal; rather, analysts aim to serve as a mirror for their clients, reflecting clients’ own characteristics, assumptions, and behaviors back at them to develop a client’s self-awareness .

Countertransference analysis

Countertransference refers to the analyst’s responses and reactions to the client and the material they present during sessions, most especially the client’s transference.

Countertransference analysis involves tracking elements of the analyst’s own dispositional transference to the client that is co-determined by the client (Racker, 1982).

Countertransference analysis enables the analyst to maintain clinical boundaries and avoid acting out in the relationship with the client.

Following on from the example given above, an analyst working with a client with a history of childhood trauma may respond to the client’s transference by feeling dismissive or contemptuous of a client that misses sessions or expresses suspicion.

However, countertransference analysis enables the analyst to understand that such feelings are a response to the client’s transference rooted in their past relational conflicts. The analyst’s feelings are then observed as material for interpretation rather than expressed (Racker, 1982).

Psychodynamic theory agrees that clinical problems in adult life often originate in a client’s early relationships. It also considers a client’s current social context and their interactions with the immediate environment.

Both theoretical approaches agree on the following:

• The existence of unconscious drives/instincts and defense mechanisms
• The impact of the unconscious on human personality and behavior
• The importance of our earliest experiences in shaping later relational patterns
• The impact of internal factors on behavior, meaning behavior is never under a client’s complete control (Berzoff et al., 2008)

It may be helpful to further distinguish between the two by providing some examples of the differences and similarities in clinical approach.

First, both the psychoanalyst and the psychodynamic therapist work with transference and countertransference. In fact, any therapeutic approach that acknowledges and works with transference and/or countertransference may be termed psychodynamic, in part (Shedler, 2010).

Therefore, a psychodynamic therapist attends to their client’s communications to detect how deep-rooted unconscious conflicts may contribute to problematic behaviors, thoughts, and feelings in the present.

However, they also attend to the here-and-now social context of a client’s life to understand how real-world situations such as poverty, grief, abuse, violence, racism, sexism, and so on contribute to a client’s suffering (Berzoff et al., 2008).

A psychoanalyst will see their client (termed a patient, usually) every weekday over an indeterminate period of years. Meanwhile, a psychodynamic therapist will see a client less frequently, perhaps once or twice a week for several months or a few years, depending on the client’s needs. Psychodynamic therapy is more client centered in this respect (Berzoff et al., 2008).

A psychodynamic therapist may include techniques that are not psychoanalytic to work with transference and countertransference. These may include communication skills, such as active listening , empathy , and expressive arts interventions. Psychodynamic therapists are not limited in their approach by the traditional pillars of psychoanalytic technique mentioned above (Shedler, 2010).

A psychoanalyst works with their client on a couch to encourage regression and access unconscious material (Pick, 2015), while a psychodynamic therapist works face to face with a client sitting upright.

Now that we’ve clarified the differences between psychodynamic and psychoanalytic therapy, let’s look at the difference between psychoanalysis and psychotherapy overall.

A psychoanalyst has a particular set of skills gained from their specific psychoanalytic training. Meanwhile, psychotherapists can train in a range of therapeutic modalities, including psychodynamic , cognitive-behavioral , humanistic , or integrative approaches (Wampold, 2018).

However, both professions focus on helping people via talk therapy. Both use their skills to help their clients gain insight into their inner worlds, address their psychological problems, and heal.

In fact, a psychoanalyst is a type of psychotherapist who specializes in psychoanalysis. Therefore, every psychoanalyst is also a psychotherapist, but not every psychotherapist is a psychoanalyst (Wampold, 2018).

Although you’ll need to consult a psychoanalyst for a more valid and reliable classification, this test can give you an idea of how psychoanalysts conceptualize personality .

The test is composed of 48 items rated on a five-point scale from Disagree to Agree. The results are in the form of scores ranging from 0% to 100% across eight personality types:

• Oral-receptive
• Oral-aggressive
• Anal-expulsive
• Anal-retentive
• Phallic-aggressive
• Phallic-compensative
• Classic hysteric
• Retentive hysteric

To understand more about Freud’s theory of psychosexual development and how it relates to personality, check out the video below.

Although psychoanalytic theory laid the foundations for much of modern psychology, it is not without flaws. Psychoanalysis is still practiced today, and psychoanalytic theory has since been updated because of our improved understanding of human behavior , neuroscience , and the brain (Frosh, 2016).

However, serious criticisms of the theory and its applications remain (Eagle, 2007).

The major criticisms include the following:

• Many of the hypotheses and assumptions of psychoanalytic theory cannot be tested empirically, making it almost impossible to falsify or validate.
• It emphasizes the deterministic roles of biology and the unconscious and neglects environmental influences on the conscious mind.
• Psychoanalytic theory was deeply rooted in Freud’s sexist ideas, and traces of this sexism still remain in the theory and practice today.
• It is deeply Eurocentric and unsupported cross-culturally and may only apply to clients from Western Judeo–Christian and secular cultures.
• Freud emphasized pathology and neglected to study optimal psychological functioning.
• The theory was not developed through the application of the scientific method, but from Freud’s subjective interpretations of a small group of patients from a specific cultural background and historical period (Eagle, 2007).

Given these valid criticisms of psychoanalytic theory, it is wise to approach Freud and his theories with skepticism.

Although his work formed the foundations of modern psychology, it did not develop from a scientifically validated evidence base and is not falsifiable. Therefore, Freud’s students and followers have borne the burden of attempting to provide evidence to support the scientific and clinical validity of psychoanalysis.

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While Freud’s classical psychoanalytic theory and traditional clinical technique have earned widespread criticism for their lack of a scientific evidence base or testability, the explanatory power of psychoanalytic theory has become part of popular culture in the West.

For example, we all know about the Freudian slip and generally accept that people often remain “unconscious” of certain aspects of themselves, their motives, behavior, and the impact they have on others.

Various defense mechanisms have become part of the everyday language of popular psychology, such as denial, repression, and projection.

There is also no denying that Freud’s interpretation of dreams has led to the widespread belief that our dreams actually mean something, rather than just being a series of random events that occur when we’re sleeping.

Meanwhile, the central therapeutic concepts of transference and countertransference have informed a widely accepted psychodynamic understanding of relationships, especially in health and social care settings. These ideas have also informed the development of safeguarding practices that uphold professional boundaries.

Some of Freud’s ideas may seem eccentric and of their time, but his legacy is far reaching and has influenced areas of thought far beyond the clinical practice of psychoanalysis.

We hope you enjoyed reading this article. For more information, don’t forget to download our three Positive CBT Exercises for free .

Ed: Updated April 2023

• Berzoff, J., Flanagan, L. M., & Hertz, P. (2008). Inside out and outside in: Psychodynamic clinical theory and psychopathology in contemporary multicultural contexts . Jason Aronson.
• Breuer, J., & Freud, S. (2001). Studies on hysteria. In J. Strachey (Trans., Ed.), Complete psychological works of Sigmund Freud, Vol. II (1893–95) . Vintage. (Original work published 1895)
• Burgo, J. (2012). Why do I do that? Psychological defense mechanisms and the hidden ways they shape our lives . New Rise Press.
• Eagle, M. N. (2007). Psychoanalysis and its critics. Psychoanalytic Psycholog y, 24 (1), 10–24.
• Frosh, S. (2016). For and against psychoanalysis . Routledge.
• Gay, P. (2006). Freud: A life for our time . W. W. Norton.
• Gaztambide, D. J. (2021). A people’s history of psychoanalysis: From Freud to liberation psychology . Lexington Books.
• Kernberg, O. (2016). The four basic components of psychoanalytic technique and derived psychoanalytic psychotherapies. World Psychiatry , 15 (3), 287–288.
• Racker, H. (1982). Transference and countertransference . Routledge.
• Pick, D. (2015). Psychoanalysis: A very short introduction . Oxford University Press.
• Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologis t, 65 (2), 98–109.
• Wampold, B. E. (2018). The basics of psychotherapy: An introduction to theory and practice . American Psychological Association.

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I am a third-year university student, hoping to obtain my honors in Clinical Psychology. I must say that I am quite impressed with your writings and have now obtained a much clearer understanding of both the Freudian theory of Psychoanalysis and the process by which a relationship between the therapist and the client is conceptualized in Psychoanalytic theory. Thank you for this simplified version. From Namibia

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Sigmund Freud

Sigismund Schlomo Freud was born on 6th May 1856 to Jewish parents, Amalia and Jakob Freud, in a part of the Austro-Hungarian Empire now in the Czech Republic. When Sigmund was three, the Freuds moved to Vienna. He excelled academically, developing a passion for literature, languages and the arts that would profoundly influence his thinking about the human mind. Freud became very interested in medical and scientific research, and went on to study medicine at the University of Vienna. While studying, Freud developed a particular fascination with neurology, and later trained in neuropathology at the Vienna General Hospital. In 1885, Freud travelled to Paris to study at the Salpêtrière Hospital with Jean-Martin Charcot, a famous neurologist studying hypnosis and hysteria. Freud was deeply affected by Charcot’s work, and upon returning to Vienna he started using hypnosis in his own clinical work with patients.

Out of these experiments in hypnosis, and in collaboration with his colleague Josef Breuer, Freud developed a new kind of psychological treatment based on the patient talking about whatever came to mind – memories, dreams, thoughts, emotions – and then analysing that information in order to relieve the patient’s symptoms. He would later call this process ‘free association’. Early forays into this new ‘talking cure’ by Breuer and Freud yielded promising results (notably in the famous case of ‘Anna O.’) A year before marrying his fiancée Martha Bernays, Freud published Studies on Hysteria (1895) with Breuer, the first ever ‘psychoanalytic’ work. In this book, Freud and Breuer described their theory that the symptoms of hysteria were symbolic representations of traumatic, and often sexual, memories. By 1896, Freud had abandoned hypnosis and started using the term ‘psychoanalysis’ to refer to this new clinical method and its underlying theories. The following year, Freud embarked upon a self-analysis, which he deemed necessary both as a means of expanding and testing his theory of the mind, and as an exercise in honesty and self-knowledge. This self-investigation led him to build upon his and Breuer’s original theory that neurosis was caused by early trauma, and to develop substantially his ideas about infantile sexuality and repression. In the coming years and decades, Freud’s clinical work with his patients – among them the famous ‘Dora’, ‘Rat Man’, and ‘Little Hans’ – would remain the basis and core of his work, and would provide the vital material for his continual advancement and refinement of his theory of the mind.

In 1899 Freud published The Interpretation of Dreams. In this, one of his most important works, he described dreams as a form of wish-fulfilment, and asserted that: “[T]he interpretation of dreams is the royal road to a knowledge of the unconscious activities of the mind.” In his formulation, dreams were the result of the unconscious trying to resolve conflicts or express desires that, in our conscious minds, are not allowed to be acknowledged. He saw the preconscious mind as a kind of censor or bodyguard, only allowing unthreatening thoughts into the conscious mind. According to Freud, in dreams this censorship becomes weaker, and forbidden wishes can become visible to our sleeping minds, albeit in some kind of symbolic disguise or code. Freud believed these dream symbols were far from simple to interpret, often embodying several meanings at once. It was also in The Interpretation of Dreams that Freud introduced perhaps his most famous concept of the Oedipus Complex, and it was here that he first mapped out his topographical model of the mind. Between 1901 and 1905 Freud continued to elaborate and expand his model of human psychology, and he wrote two more very important works. In 'The Psychopathology of Everyday Life', he introduced the idea of ‘Freudian’ slips and ‘verbal bridges’, and in 'Three Essays on the Theory of Sexuality,' he delineated his early thinking about psychosexual development and infantile sexuality.

By the beginning of the twentieth century Freud’s ideas were drawing interest from several colleagues in Vienna. In 1902 a group of physicians and psychiatrists formed the Wednesday Psychological Society, which met every week in Freud’s apartment at Berggasse, 19. The original group was made up of Freud, Wilhelm Stekel, Alfred Adler, Max Kahane, and Rudolph Reitler, all Viennese physicians. By 1906 the group had grown to a membership of sixteen, including Carl Jung and Otto Rank, both of whom would go on to be highly influential psychoanalytic thinkers. At this point the group decided to re-name and establish itself as the Vienna Psychoanalytic Society. Freud and Carl Jung quickly became close colleagues and friends, both fascinated and enthused by the possibilities of psychoanalysis. In 1909 they travelled, along with Hungarian analyst Sándor Ferenczi, to the USA, where Freud gave a series of psychoanalytic lectures. It was after these American lectures that Freud’s renown and influence began to grow far beyond the confines of the Viennese medical community. American psychologists and neurologists were galvanised by Freud’s new ideas, and within a few years both the New York Psychoanalytic Society and the American Psychoanalytic Association were founded.

A year after the outbreak of the First World War, at the age of sixty, Freud gave his ‘Introductory Lectures on Psychoanalysis’ at the University of Vienna. In them he outlined the key tenets of psychoanalytic theory, as he had developed them over the past two decades, including his ideas of repression, free association and libido. The lectures were published two years later, and went on to become his most popular publication. The year after the end of the war, in 1919, Freud examined soldiers traumatized by their experience of fighting. He did not write much explicitly about the psychological damage done by warfare, but it nevertheless influenced his thinking significantly, for example in his concepts of repetition compulsion and the death instinct.

In 1920 Freud suffered a personal tragedy when his daughter Sophie died from the influenza eviscerating an already war-damaged Europe. She was aged only twenty-seven when she died, pregnant, and a mother of two. Three years later Freud would also lose Sophie’s son Heinerle, his grandson, at the age of four. He wrote in a letter: “I have hardly ever loved a human being, certainly never a child, so much as him.” He said he had never felt such grief. The year of Sophie’s death, Freud published 'Beyond the Pleasure Principle', a paper introducing his concepts of repetition compulsion and the death instinct, and building upon his earlier description of the function and operation of dreams. It is in this work that he revised his theory that human behaviour is almost entirely driven by sexual instincts, instead portraying the psyche in a state of conflict between opposites: creative, life-seeking, sexual Eros; and destructive, death-bent Thanatos. In Freud’s formulation, the death instinct was an expression of a fundamental biological longing to return to an inanimate state. This new theory was not well received by most of his analytic colleagues in Vienna, though it would, in time, have a big impact on the thinking of several preeminent psychoanalytic thinkers, notably Jacques Lacan and Melanie Klein.

In 1923 Freud published his important paper, 'The Ego and the Id'. Here he further developed and elucidated his model of the human mind, introducing his ‘Superego-Ego-Id’ formulation to supersede the 'conscious-preconscious-unconscious' structure described in The Interpretation of Dreams. In this year Freud also discovered a pre-cancerous growth in his jaw, certainly caused by his regular and liberal consumption of cigars. He nonetheless found himself unable to give them up, and likened his addiction to them to his obsessional collecting of antiquities. The growth later turned into cancer and would ultimately cause his death sixteen years later.

At the invitation of the League of Nations and its International Institute of Intellectual Co-operation at Paris, in 1932 Albert Einstein initiated an exchange of letters (for subsequent publication) with Freud, concerning the subject of war and how it might be avoided. Einstein and Freud had met several years earlier in Berlin, and were very interested in one another’s work. Only a year after this epistolary exchange, 1933 Hitler was elected Chancellor of the German Reich. In 1930 Freud had been awarded the Goethe Prize for his contributions to psychology and German literary culture, but in January 1933, the newly empowered Nazis seized Freud’s books, among many other psychoanalytic and Jewish-authored works, and publicly burned them in Berlin. The Nazis described this destruction as acting, "[A]gainst the soul-destroying glorification of the instinctual life, for the nobility of the human soul!” Meanwhile Freud’s comment on these barbaric proceedings was rather more ironic: "What progress we are making. In the Middle Ages they would have burned me. Now, they are content with burning my books."

As the Nazis gained power and territory, and their policies grew ever more flagrantly discriminatory, Freud continued to write and practise in Vienna. As the 1930s wore on, friends and colleagues encouraged him to consider leaving Vienna but, even after the Anschluss in March 1938 and the ensuing displays of anti-Semitic brutality, he showed no desire to move. Ernest Jones was very worried about this determination to stay in what was becoming an increasingly dangerous place for Jews, and he flew into Vienna soon after the annexation, determined to get Freud to move to Britain. Freud at last agreed and, after much financial and political negotiating with the Gestapo on the part of Jones and others, he and his daughter Anna left for London in June 1938. They moved into 20 Maresfield Gardens, in Hampstead (now the Freud Museum ), where Freud continued to write and treat patients, despite the painful advancement of his jaw cancer. In London Freud worked on his final books, Moses and Monotheism, and the incomplete Outline of Psychoanalysis. He was visited by Salvador Dalí – a passionate devotee –, his fellow Viennese writer Stefan Zweig, Virginia and Leonard Woolf, and H.G. Wells.

By the autumn of 1939, the progression of Freud's cancer was causing him severe pain and had by this point been declared inoperable. He asked his doctor and friend, Max Schur, to euthanize him with a high dose of morphine, and he died on 23rd September 1939, not long after the outbreak of World War Two. His body was cremated at Golders Green Crematorium. Ernest Jones and Stefan Zweig spoke at his funeral.

Eleanor Sawbridge Burton 2015

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Sigmund Freud's Life, Theories, and Influence

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Cara Lustik is a fact-checker and copywriter.

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Psychoanalysis

• Major Works
• Perspectives
• Thinkers Influenced by Freud
• Contributions

Frequently Asked Questions

Psychology's most famous figure is also one of the most influential and controversial thinkers of the 20th century. Sigmund Freud, an Austrian neurologist born in 1856, is often referred to as the "father of modern psychology."

Freud revolutionized how we think about and treat mental health conditions. Freud founded psychoanalysis as a way of listening to patients and better understanding how their minds work. Psychoanalysis continues to have an enormous influence on modern psychology and psychiatry.

Sigmund Freud's theories and work helped shape current views of dreams, childhood, personality, memory, sexuality, and therapy. Freud's work also laid the foundation for many other theorists to formulate ideas, while others developed new theories in opposition to his ideas.

Sigmund Freud Biography

To understand Freud's legacy, it is important to begin with a look at his life. His experiences informed many of his theories, so learning more about his life and the times in which he lived can lead to a deeper understanding of where his theories came from.

Freud was born in 1856 in a town called Freiberg in Moravia—in what is now known as the Czech Republic. He was the oldest of eight children. His family moved to Vienna several years after he was born, and he lived most of his life there.

Freud earned a medical degree and began practicing as a doctor in Vienna. He was appointed Lecturer on Nervous Diseases at the University of Vienna in 1885.

After spending time in Paris and attending lectures given by the French neurologist Jean-Martin Charcot, Freud became more interested in theories explaining the human mind (which would later relate to his work in psychoanalysis).

Freud eventually withdrew from academia after the Viennese medical community rejected the types of ideas he brought back from Paris (specifically on what was then called hysteria ). Freud went on to publish influential works in neurology, including "On Aphasia: A Critical Study," in which he coined the term agnosia , meaning the inability to interpret sensations.

In later years, Freud and his colleague Josef Breuer published "Preliminary Report" and "Studies on Hysteria." When their friendship ended, Freud continued to publish his own works on psychoanalysis.

Freud and his family left Vienna due to discrimination against Jewish people. He moved to England in 1938 and died in 1939.

Sigmund Freud’s Theories

Freud's theories were enormously influential but subject to considerable criticism both now and during his life. However, his ideas have become interwoven into the fabric of our culture, with terms such as " Freudian slip ," "repression," and "denial" appearing regularly in everyday language.

Freud's theories include:

• Unconscious mind : This is one of his most enduring ideas, which is that the mind is a reservoir of thoughts, memories, and emotions that lie outside the awareness of the conscious mind.
• Personality : Freud proposed that personality was made up of three key elements: the id, the ego, and the superego . The ego is the conscious state, the id is the unconscious, and the superego is the moral or ethical framework that regulates how the ego operates.
• Life and death instincts : Freud claimed that two classes of instincts, life and death, dictated human behavior. Life instincts include sexual procreation, survival and pleasure; death instincts include aggression, self-harm, and destruction.
• Psychosexual development : Freud's theory of psychosexual development posits that there are five stages of growth in which people's personalities and sexual selves evolve. These phases are the oral stage, anal stage, phallic stage, latent stage, and genital stage.
• Mechanisms of defense : Freud suggested that people use defense mechanisms to avoid anxiety. These mechanisms include displacement, repression, sublimation, and regression.

Sigmund Freud and Psychoanalysis

Freud's ideas had such a strong impact on psychology that an entire school of thought emerged from his work: psychoanalysis. Psychoanalysis has had a lasting impact on both the study of psychology and the practice of psychotherapy.

Psychoanalysis sought to bring unconscious information into conscious awareness in order to induce catharsis . Catharsis is an emotional release that may bring about relief from psychological distress. 

Research has found that psychoanalysis can be an effective treatment for a number of mental health conditions. The self-examination that is involved in the therapy process can help people achieve long-term growth and improvement.

Sigmund Freud's Patients

Freud based his ideas on case studies of his own patients and those of his colleagues. These patients helped shape his theories and many have become well known. Some of these individuals included:

• Anna O. (aka Bertha Pappenheim)
• Little Hans (Herbert Graf)
• Dora (Ida Bauer)
• Rat Man (Ernst Lanzer)
• Wolf Man (Sergei Pankejeff)
• Sabina Spielrein

Anna O. was never actually a patient of Freud's. She was a patient of Freud's colleague Josef Breuer. The two men corresponded often about Anna O's symptoms, eventually publishing the book, "Studies on Hysteria" on her case. It was through their work and correspondence that the technique known as talk therapy emerged.  

Major Works by Freud

Freud's writings detail many of his major theories and ideas. His personal favorite was "The Interpretation of Dreams ." Of it, he wrote: "[It] contains...the most valuable of all the discoveries it has been my good fortune to make. Insight such as this falls to one's lot but once in a lifetime."

Some of Freud's major books include:

• " The Interpretation of Dreams "
• "The Psychopathology of Everyday Life"
• "Totem and Taboo"
• "Civilization and Its Discontents"
• "The Future of an Illusion"

Freud's Perspectives

Outside of the field of psychology, Freud wrote and theorized about a broad range of subjects. He also wrote about and developed theories related to topics including sex, dreams, religion, women, and culture.

Views on Women

Both during his life and after, Freud was criticized for his views of women , femininity, and female sexuality. One of his most famous critics was the psychologist Karen Horney , who rejected his view that women suffered from "penis envy."

Penis envy, according to Freud, was a phenomenon that women experienced upon witnessing a naked male body, because they felt they themselves must be "castrated boys" and wished for their own penis.

Horney instead argued that men experience "womb envy" and are left with feelings of inferiority because they are unable to bear children.

Views on Religion

Freud was born and raised Jewish but described himself as an atheist in adulthood. "The whole thing is so patently infantile, so foreign to reality, that to anyone with a friendly attitude to humanity it is painful to think that the great majority of mortals will never be able to rise above this view of life," he wrote of religion.

He continued to have a keen interest in the topics of religion and spirituality and wrote a number of books focused on the subject. 

Psychologists Influenced by Freud

In addition to his grand and far-reaching theories of human psychology, Freud also left his mark on a number of individuals who went on to become some of psychology's greatest thinkers. Some of the eminent psychologists who were influenced by Sigmund Freud include:

• Alfred Adler
• Erik Erikson
• Melanie Klein
• Ernst Jones

While Freud's work is often dismissed today as non-scientific, there is no question that he had a tremendous influence not only on psychology but on the larger culture as well.

Many of Freud's ideas have become so steeped in public awareness that we oftentimes forget that they have their origins in his psychoanalytic tradition.

Freud's Contributions to Psychology

Freud's theories are highly controversial today. For instance, he has been criticized for his lack of knowledge about women and for sexist notions in his theories about sexual development, hysteria, and penis envy.

People are skeptical about the legitimacy of Freud's theories because they lack the scientific evidence that psychological theories have today.

However, it remains true that Freud had a significant and lasting influence on the field of psychology. He provided a foundation for many concepts that psychologists used and continue to use to make new discoveries.

Perhaps Freud's most important contribution to the field of psychology was the development of talk therapy as an approach to treating mental health problems.

In addition to serving as the basis for psychoanalysis, talk therapy is now part of many psychotherapeutic interventions designed to help people overcome psychological distress and behavioral problems. 

The Unconscious

Prior to the works of Freud, many people believed that behavior was inexplicable. He developed the idea of the unconscious as being the hidden motivation behind what we do. For instance, his work on dream interpretation suggested that our real feelings and desires lie underneath the surface of conscious life.

Childhood Influence

Freud believed that childhood experiences impact adulthood—specifically, traumatic experiences that we have as children can manifest as mental health issues when we're adults.

While childhood experiences aren't the only contributing factors to mental health during adulthood, Freud laid the foundation for a person's childhood to be taken into consideration during therapy and when diagnosing.

Literary Theory

Literary scholars and students alike often analyze texts through a Freudian lens. Freud's theories created an opportunity to understand fictional characters and even their authors based on what's written or what a reader can interpret from the text on topics such as dreams, sexuality, and personality.

Sigmund Freud was an Austrian neurologist who founded psychoanalysis. Also known as the father of modern psychology, he was born in 1856 and died in 1939.

While Freud theorized that childhood experiences shaped personality, the neo-Freudians (including Carl Jung, Alfred Adler, and Karen Horney) believed that social and cultural influences played an important role. Freud believed that sex was a primary human motivator, whereas neo-Freudians did not.

Sigmund Freud founded psychoanalysis and published many influential works such as "The Interpretation of Dreams." His theories about personality and sexuality were and continue to be extremely influential in the fields of psychology and psychiatry.

Sigmund Freud was born in a town called Freiberg in Moravia, which is now the Czech Republic.

It's likely that Freud died by natural means. However, he did have oral cancer at the time of his death and was administered a dose of morphine that some believed was a method of physician-assisted suicide.

Freud used psychoanalysis, also known as talk therapy, in order to get his patients to uncover their own unconscious thoughts and bring them into consciousness. Freud believed this would help his patients change their maladaptive behaviors.

Freud was the founder of psychoanalysis and introduced influential theories such as: his ideas of the conscious and unconscious; the id, ego, and superego; dream interpretation; and psychosexual development.

A Word From Verywell

While Freud's theories have been the subject of considerable controversy and debate, his impact on psychology, therapy, and culture is undeniable. As W.H. Auden wrote in his 1939 poem, "In Memory of Sigmund Freud":

"...if often he was wrong and, at times, absurd, to us he is no more a person now but a whole climate of opinion."

Grzybowski A, Żołnierz J. Sigmund Freud (1856-1939) .  J Neurol . 2021;268(6):2299-2300. doi:10.1007/s00415-020-09972-4

Bargh JA. The modern unconscious .  World Psychiatry . 2019;18(2):225-226. doi:10.1002/wps.20625

Boag S. Ego, drives, and the dynamics of internal objects .  Front Psychol . 2014;5:666. doi:10.3389/fpsyg.2014.00666

Meissner WW.  The question of drive vs. motive in psychoanalysis: A modest proposal .  J Am Psychoanal Assoc . 2009;57(4):807-845. doi:10.1177/0003065109342572

APA Dictionary of Psychology. Psychosexual development . American Psychological Association.

Waqas A, Rehman A, Malik A, Muhammad U, Khan S, Mahmood N.  Association of ego defense mechanisms with academic performance, anxiety and depression in medical students: A mixed methods study .  Cureus . 2015;7(9):e337. doi:10.7759/cureus.337

Shedler J.  The efficacy of psychodynamic psychotherapy .  Am Psychol . 2010;65(2):98-109. doi:10.1037/a0018378

Bogousslavsky J, Dieguez S. Sigmund Freud and hysteria: The etiology of psychoanalysis . In: Bogousslavsky J, ed.  Frontiers of Neurology and Neuroscience . S Karger AG. 2014;35:109-125. doi:10.1159/000360244

Grubin D.  Young Dr. Freud . Public Broadcasting Service.

Gersick S. Penis envy . In: Zeigler-Hill V, Shackelford T, eds. Encyclopedia of Personality and Individual Differences . Springer, Cham. 2017. doi:10.1007/978-3-319-28099-8_616-1

Bayne E. Womb envy: The cause of misogyny and even male achievement? . Womens Stud Int Forum. 2011;34(2):151-160. doi:10.1016/j.wsif.2011.01.007

Freud S. Civilization and Its Discontents . Norton.

Yeung AWK. Is the influence of Freud declining in psychology and psychiatry? A bibliometric analysis . Front Psychol. 2021;12. doi:10.3389/fpsyg.2021.631516

Giordano G. The contribution of Freud’s theories to the literary analysis of two Victorian novels: Wuthering Heights and Jane Eyre . Int J Engl Lit. 2020;11(2):29-34. doi:10.5897/IJEL2019.1312

APA Dictionary of Psychology. Neo-Freudian . American Psychological Association.

Hoffman L.  Un homme manque: Freud's engagement with Alfred Adler's masculine protest: Commentary on Balsam .  J Am Psychoanal Assoc . 2017;65(1):99-108. doi:10.1177/0003065117690351

Macleod ADS. Was Sigmund Freud's death hastened? . Intern Med J. 2017;47(8):966-969. doi:10.1111/imj.13504

Kernberg OF. The four basic components of psychoanalytic technique and derived psychoanalytic psychotherapies .  World Psychiatry . 2016;15(3):287-288. doi:10.1002/wps.20368

Yale University. In Memory of Sigmund Freud .

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

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3.1 Psychoanalysis: Freud's theories and their contemporary development

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Psychoanalysis is: 1 A personality theory, and, more generally, a theory of psychological functioning that focuses particularly on unconscious mental processes; 2 A method for the investigation of psychological functions based on the exploration of free associations within a special therapeutic setting; 3 A method for treatment of a broad spectrum of psychopathological conditions, including the symptomatic neuroses (anxiety states, characterological depression, obsessive–compulsive disorder, conversion hysteria, and dissociative hysterical pathology), sexual inhibitions and perversions (‘paraphilias’), and the personality disorders. Psychoanalysis has also been applied, mostly in modified versions, i.e. in psychoanalytic psychotherapies, to the treatment of severe personality disorders, psychosomatic conditions, and certain psychotic conditions, particularly a subgroup of patients with chronic schizophrenic illness. All three aspects of psychoanalysis were originally developed by Freud whose theories of the dynamic unconscious, personality development, personality structure, psychopathology, methodology of psychoanalytic investigation, and method of treatment still largely influence the field, both in the sense that many of his central ideas continue as the basis of contemporary psychoanalytic thinking, and in that corresponding divergencies, controversies, and radical innovations still can be better understood in the light of the overall frame of his contributions. Freud's concepts of dream analysis, mechanisms of defence, and transference have become central aspects of many contemporary psychotherapeutic procedures. Freud's ideas about personality development and psychopathology, the method of psychoanalytic investigation, and the analytic approach to treatment gradually changed in the course of his dramatically creative lifespan. Moreover, the theory of the structure of the mind that he assumed must underlie the events that he observed clinically changed in major respects, so that an overall summary of his views can hardly be undertaken without tracing the history of his thinking. The present overview will lead up to summaries of his final conclusions as to the structure of the mind and how this is reflected in personality development and psychopathology. Psychoanalysis will then be described as a method of treatment, as seen from the point of view of resolution of conflict between impulse and defence, and from that of object-relations theory. We shall explore significant changes that have occurred in all these domains, and conclude with an overview of contemporary psychoanalysis, with particular emphasis upon the presently converging tendencies of contemporary psychoanalytic approaches, and new developments that remain controversial.

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• Introduction

Subject Matter of Psychoanalysis

Depth-psychology, pleasure-pain principle, mental topography, sexual instincts, the oedipus complex, transference, the psychoanalytic movement, bibliography.

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Sigmund Freud on psychoanalysis

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• Table Of Contents

The term psychoanalysis was not indexed in the Encyclopædia Britannica until well into the 20th century. It occurs in the 12th edition (1922) in such articles as “Behaviorism” and “Psychotherapy.” The first treatment of psychoanalysis as a subject unto itself appeared in the 13th edition (1926), and for that article Britannica went to the best possible authority, Sigmund Freud . He described the subject as he understood it at that time but also as he wished it to be understood later. “The future will probably attribute far greater importance to psychoanalysis as the science of the unconscious,” Freud wrote, “than as a therapeutic procedure.” Freud also chafed at what he seemed to think was the too-small space allotted to his article. “It is enough to say,” Freud declared, “that psychoanalysis, in its character of the psychology of the deepest, unconscious mental acts, promises to become the link between Psychiatry and all of these other fields of study,” among them medicine, anthropology, and literary history. As a unique piece of anthology, this article provides a remarkably clear exposition of psychoanalytic theory interlaced with Freud’s reflections upon his own scientific legacy.

PSYCHOANALYSIS: FREUDIAN SCHOOL

In the years 1880–2 a Viennese physician, Dr. Josef Breuer (1842–1925), discovered a new procedure by means of which he relieved a girl, who was suffering from severe hysteria, of her various symptoms. The idea occurred to him that the symptoms were connected with impressions which she had received during a period of excitement while she was nursing her sick father. He therefore induced her, while she was in a state of hypnotic somnambulism, to search for these connections in her memory and to live through the “pathogenic” scenes once again without inhibiting the affects that arose in the process. He found that when she had done this the symptom in question disappeared for good.

This was at a date before the investigations of Charcot and Pierre Janet into the origin of hysterical symptoms, and Breuer’s discovery was thus entirely uninfluenced by them. But he did not pursue the matter any further at the time, and it was not until some 10 years later that he took it up again in collaboration with Sigmund Freud. In 1895 they published a book, Studien über Hysterie , in which Breuer’s discoveries were described and an attempt was made to explain them by the theory of Catharsis . According to that hypothesis, hysterical symptoms originate through the energy of a mental process being withheld from conscious influence and being diverted into bodily innervation (“ Conversion ”). A hysterical symptom would thus be a substitute for an omitted mental act and a reminiscence of the occasion which should have given rise to that act. And, on this view, recovery would be a result of the liberation of the affect that had gone astray and of its discharge along a normal path (“ Abreaction ”). Cathartic treatment gave excellent therapeutic results, but it was found that they were not permanent and that they were dependent on the personal relation between the patient and the physician. Freud, who later proceeded with these investigations by himself, made an alteration in their technique, by replacing hypnosis by the method of free association. He invented the term “ psychoanalysis ,” which in the course of time came to have two meanings: (1) a particular method of treating nervous disorders and (2) the science of unconscious mental processes, which has also been appropriately described as “depth-psychology.”

Psychoanalysis finds a constantly increasing amount of support as a therapeutic procedure, owing to the fact that it can do more for certain classes of patients than any other method of treatment. The principal field of its application is in the milder neuroses—hysteria, phobias and obsessional states, but in malformations of character and in sexual inhibitions or abnormalities it can also bring about marked improvements or even recoveries. Its influence upon dementia praecox and paranoia is doubtful; on the other hand, in favourable circumstances it can cope with depressive states, even if they are of a severe type.

In every instance the treatment makes heavy claims upon both the physician and the patient: the former requires a special training, and must devote a long period of time to exploring the mind of each patient, while the latter must make considerable sacrifices, both material and mental. Nevertheless, all the trouble involved is as a rule rewarded by the results. Psychoanalysis does not act as a convenient panacea (“cito, tute, jucunde”) upon all psychological disorders. On the contrary, its application has been instrumental in making clear for the first time the difficulties and limitations in the treatment of such affections.

The therapeutic results of psychoanalysis depend upon the replacement of unconscious mental acts by conscious ones and are operative in so far as that process has significance in relation to the disorder under treatment. The replacement is effected by overcoming internal resistances in the patient’s mind. The future will probably attribute far greater importance to psychoanalysis as the science of the unconscious than as a therapeutic procedure.

Psychoanalysis, in its character of depth-psychology, considers mental life from three points of view: the dynamic, the economic and the topographical.

From the first of these standpoints, the dynamic one, psychoanalysis derives all mental processes (apart from the reception of external stimuli) from the interplay of forces, which assist or inhibit one another, combine with one another, enter into compromises with one another, etc. All of these forces are originally in the nature of instincts ; that is to say, they have an organic origin. They are characterised by possessing an immense (somatic) persistence and reserve of power (“ repetition-compulsion ”); and they are represented mentally as images or ideas with an affective charge (“ cathexis ”). In psychoanalysis, no less than in other sciences, the theory of instincts is an obscure subject. An empirical analysis leads to the formation of two groups of instincts: the so-called “ego-instincts,” which are directed towards self-preservation and the “object-instincts,” which are concerned with relations to an external object. The social instincts are not regarded as elementary or irreducible. Theoretical speculation leads to the suspicion that there are two fundamental instincts which lie concealed behind the manifest ego-instincts and object-instincts: namely ( a ) Eros, the instinct which strives for ever closer union, and ( b ) the instinct of destruction, which leads toward the dissolution of what is living. In psychoanalysis the manifestation of the force of Eros is given the name “ libido .”

From the economic standpoint psychoanalysis supposes that the mental representations of the instincts have a cathexis of definite quantities of energy, and that it is the purpose of the mental apparatus to hinder any damming-up of these energies and to keep as low as possible the total amount of the excitations to which it is subject. The course of mental processes is automatically regulated by the “ pleasure-pain principle ”; and pain is thus in some way related to an increase of excitation and pleasure to a decrease. In the course of development the original pleasure principle undergoes a modification with reference to the external world, giving place to the “ reality-principle ,” whereby the mental apparatus learns to postpone the pleasure of satisfaction and to tolerate temporarily feelings of pain.

Topographically , psychoanalysis regards the mental apparatus as a composite instrument, and endeavours to determine at what points in it the various mental processes take place. According to the most recent psychoanalytic views, the mental apparatus is composed of an “ id ,” which is the reservoir of the instinctive impulses, of an “ ego ,” which is the most superficial portion of the id and one which is modified by the influence of the external world, and of a “ super-ego ,” which develops out of the id, dominates the ego and represents the inhibitions of instinct characteristic of man. Further, the property of consciousness has a topographical reference; for processes in the id are entirely unconscious, while consciousness is the function of the ego’s outermost layer, which is concerned with the perception of the external world.

At this point two observations may be in place. It must not be supposed that these very general ideas are presuppositions upon which the work of psychoanalysis depends. On the contrary, they are its latest conclusions and are in every respect open to revision. Psychoanalysis is founded securely upon the observation of the facts of mental life; and for that very reason its theoretical superstructure is still incomplete and subject to constant alteration. Secondly, there is no reason for astonishment that psychoanalysis, which was originally no more than an attempt at explaining pathological mental phenomena, should have developed into a psychology of normal mental life. The justification for this arose with the discovery that the dreams and mistakes (“ parapraxes ,” such as slips of the tongue, etc.) of normal men have the same mechanism as neurotic symptoms.

Theoretical Basis

The first task of psychoanalysis was the elucidation of nervous disorders. The analytical theory of the neuroses is based upon three ground-pillars: the recognition of (1) “ repression ,” of (2) the importance of the sexual instincts and of (3) “ transference .”

There is a force in the mind which exercises the functions of a censorship, and which excludes from consciousness and from any influence upon action all tendencies which displease it. Such tendencies are described as “repressed.” They remain unconscious; and if the physician attempts to bring them into the patient’s consciousness he provokes a “ resistance .” These repressed instinctual impulses, however, are not always made powerless by this process. In many cases they succeed in making their influence felt by circuitous paths, and the indirect or substitutive gratification of repressed impulses is what constitutes neurotic symptoms.

For cultural reasons the most intensive repression falls upon the sexual instincts; but it is precisely in connection with them that repression most easily miscarries, so that neurotic symptoms are found to be substitutive gratifications of repressed sexuality. The belief that in man sexual life begins only at puberty is incorrect. On the contrary, signs of it can be detected from the beginning of extra-uterine existence; it reaches a first culminating point at or before the fifth year (“early period”), after which it is inhibited or interrupted (“latency period”) until the age of puberty, which is the second climax of its development. This double onset of sexual development seems to be distinctive of the genus Homo. All experiences during the first period of childhood are of the greatest importance to the individual, and in combination with his inherited sexual constitution, form the dispositions for the subsequent development of character or disease. It is a mistaken belief that sexuality coincides with “genitality.” The sexual instincts pass through a complicated course of development, and it is only at the end of it that the “primacy of the genital zone” is attained. Before this there are a number of “pre-genital organisations” of the libido—points at which it may become “fixated” and to which, in the event of subsequent repression, it will return (“ regression ”). The infantile fixations of the libido are what determine the form of neurosis which sets in later. Thus the neuroses are to be regarded as inhibitions in the development of the libido.

There are no specific causes of nervous disorders; the question whether a conflict finds a healthy solution or leads to a neurotic inhibition of function depends upon quantitative considerations, that is, upon the relative strength of the forces concerned. The most important conflict with which a small child is faced is his relation to his parents, the “ Oedipus complex ”; it is in attempting to grapple with this problem that persons destined to suffer from a neurosis habitually fail. The reactions against the instinctual demands of the Oedipus complex are the source of the most precious and socially important achievements of the human mind; and this probably holds true not only in the life of individuals but also in the history of the human species as a whole. The super-ego, the moral factor which dominates the ego, also has its origin in the process of overcoming the Oedipus complex.

By “ transference ” is meant a striking peculiarity of neurotics. They develop toward their physician emotional relations, both of an affectionate and hostile character, which are not based upon the actual situation but are derived from their relations toward their parents (the Oedipus complex). Transference is a proof of the fact that adults have not overcome their former childish dependence; it coincides with the force which has been named “suggestion”; and it is only by learning to make use of it that the physician is enabled to induce the patient to overcome his internal resistances and do away with his repressions. Thus psychoanalytic treatment acts as a second education of the adult, as a corrective to his education as a child.

Within this narrow compass it has not been possible to mention many matters of the greatest interest, such as the “ sublimation ” of instincts, the part played by symbolism, the problem of “ ambivalence ,” etc. Nor has there been space to allude to the applications of psychoanalysis, which originated, as we have seen, in the sphere of medicine, to other departments of knowledge (such as Anthropology, the Study of Religion, Literary History and Education) where its influence is constantly increasing. It is enough to say that psychoanalysis, in its character of the psychology of the deepest, unconscious mental acts, promises to become the link between Psychiatry and all of these other fields of study.

The beginnings of psychoanalysis may be marked by two dates: 1895, which saw the publication of Breuer and Freud’s Studien über Hysterie , and 1900, which saw that of Freud’s Traumdeutung . At first the new discoveries aroused no interest either in the medical profession or among the general public. In 1907 the Swiss psychiatrists, under the leadership of E. Bleuler and C.G. Jung , began to concern themselves in the subject; and in 1908 there took place at Salzburg a first meeting of adherents from a number of different countries. In 1909 Freud and Jung were invited to America by G. Stanley Hall to deliver a series of lectures on psychoanalysis at Clark University, Worcester, Mass. From that time forward interest in Europe grew rapidly; it showed itself, however, in a forcible rejection of the new teachings, characterised by an emotional colouring which sometimes bordered upon the unscientific.

The reasons for this hostility are to be found, from the medical point of view, in the fact that psychoanalysis lays stress upon psychical factors, and from the philosophical point of view, in its assuming as an underlying postulate the concept of unconscious mental activity; but the strongest reason was undoubtedly the general disinclination of mankind to concede to the factor of sexuality such importance as is assigned to it by psychoanalysis. In spite of this widespread opposition, however, the movement in favour of psychoanalysis was not to be checked. Its adherents formed themselves into an International Association, which passed successfully through the ordeal of the World War, and at the present time comprises local groups in Vienna, Berlin, Budapest, London, Switzerland, Holland, Moscow and Calcutta, as well as two in the United States. There are three journals representing the views of these societies: the Internationale Zeitschrift für Psychoanalyse , Imago (which is concerned with the application of psychoanalysis to non-medical fields of knowledge), and the International Journal of Psycho-Analysis .

During the years 1911–3 two former adherents, Alfred Adler , of Vienna, and C.G. Jung, of Zürich, seceded from the psychoanalytic movement and founded schools of thought of their own. In 1921 Dr. M. Eitingon founded in Berlin the first public psychoanalytic clinic and training-school, and this was soon followed by a second in Vienna. For the moment these are the only institutions on the continent of Europe which make psychoanalytic treatment accessible to the wage-earning classes.

Breuer and Freud, Studien über Hysterie (1895); Freud, Traumdeutung (1900); Zur Psychopathologie des Alltagslebens (1904); Drei Abhandlungen zur Sexualtheorie (1905); Vorlesungen zur Einführung in die Psychoanalyse (1916). Freud’s complete works have been published in Spanish ( Obras completas ) (1924), and German ( Gesammelte Schriften ) (1925); the greater part of them has been translated into English and other languages. Short accounts of the subject-matter and history of psychoanalysis will be found in: Freud, Ueber Psychoanalyse (the lectures delivered at Worcester, U.S.A.) (1909); Zur Geschichte der psychoanalytischen Bewegung (1914); Selbstdarstellung (in Grote’s collection Die Medizin der Gegenwart ) (1925). Particularly accessible to English readers are: A.A. Brill, Psycho-Analysis (1922); Ernest Jones, Papers on Psycho-Analysis (1923).

Sigmund Freud

The Father of Psychoanalysis

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Childhood in Austria-Hungary

Attending university and finding love, freud the researcher, hysteria and hypnosis.

• Private Practice and "Anna O"

The Unconscious

• The Analyst's Couch

Self-Analysis and the Oedipus Complex

The interpretation of dreams, freud and jung, id, ego, and superego, later years.

• B.A., History, University of California at Davis

Sigmund Freud is best known as the creator of the therapeutic technique known as psychoanalysis. The Austrian-born psychiatrist greatly contributed to the understanding of human psychology in areas such as the unconscious mind, sexuality, and dream interpretation. Freud was also among the first to recognize the significance of emotional events that occur in childhood.

Although many of his theories have since fallen out of favor, Freud profoundly influenced psychiatric practice in the twentieth century.

Dates: May 6, 1856 -- September 23, 1939

Also Known As: Sigismund Schlomo Freud (born as); "Father of Psychoanalysis"

Famous Quote: "The ego is not master in its own house."

Sigismund Freud (later know as Sigmund) was born on May 6, 1856, in the town of Frieberg in the Austro-Hungarian Empire (present-day Czech Republic). He was the first child of Jacob and Amalia Freud and would be followed by two brothers and four sisters.

It was the second marriage for Jacob, who had two adult sons from a previous wife. Jacob set up business as a wool merchant but struggled to earn enough money to take care of his growing family. Jacob and Amalia raised their family as culturally Jewish, but were not especially religious in practice.

The family moved to Vienna in 1859, taking up residence in the only place they could afford -- the Leopoldstadt slum. Jacob and Amalia, however, had reason to hope for a better future for their children. Reforms enacted by Emperor Franz Joseph in 1849 had officially abolished discrimination against Jews, lifting restrictions previously placed upon them.

Although anti-Semitism still existed, Jews were, by law, free to enjoy the privileges of full citizenship, such as opening a business, entering a profession, and owning real estate. Unfortunately, Jacob was not a successful businessman and the Freuds were forced to live in a shabby, one-room apartment for several years.

Young Freud began school at the age of nine and quickly rose to the head of the class. He became a voracious reader and mastered several languages. Freud began to record his dreams in a notebook as an adolescent, displaying a fascination for what would later become a key element of his theories.

Following graduation from high school, Freud enrolled at the University of Vienna in 1873 to study zoology. Between his coursework and lab research, he would remain at the university for nine years.

As his mother's undisputed favorite, Freud enjoyed privileges that his siblings did not. He was given his own room at home (they now lived in a larger apartment), while the others shared bedrooms. The younger children had to maintain quiet in the house so that "Sigi" (as his mother called him) could concentrate on his studies. Freud changed his first name to Sigmund in 1878.

Early in his college years, Freud decided to pursue medicine, although he didn't envision himself caring for patients in a traditional sense. He was fascinated by bacteriology, the new branch of science whose focus was the study of organisms and the diseases they caused.

Freud became a lab assistant to one of his professors, performing research on the nervous systems of lower animals such as fish and eels.

After completing his medical degree in 1881, Freud began a three-year internship at a Vienna hospital, while continuing to work at the university on research projects. While Freud gained satisfaction from his painstaking work with the microscope, he realized that there was little money in research. He knew he must find a well-paying job and soon found himself more motivated than ever to do so.

In 1882, Freud met Martha Bernays, a friend of his sister. The two were immediately attracted to one another and became engaged within months of meeting. The engagement lasted four years, as Freud (still living in his parents' home) worked to make enough money to be able to marry and support Martha.

Intrigued by the theories on brain function that were emerging during the late 19th century, Freud opted to specialize in neurology. Many neurologists of that era sought to find an anatomical cause for mental illness within the brain. Freud also sought that proof in his research, which involved the dissection and study of brains. He became knowledgeable enough to give lectures on brain anatomy to other physicians.

Freud eventually found a position at a private children's hospital in Vienna. In addition to studying childhood diseases, he developed a special interest in patients with mental and emotional disorders.

Freud was disturbed by the current methods used to treat the mentally ill, such as long-term incarceration, hydrotherapy (spraying patients with a hose), and the dangerous (and poorly-understood) application of electric shock. He aspired to find a better, more humane method.

One of Freud's early experiments did little to help his professional reputation. In 1884, Freud published a paper detailing his experimentation with cocaine as a remedy for mental and physical ailments. He sang the praises of the drug, which he administered to himself as a cure for headaches and anxiety. Freud shelved the study after numerous cases of addiction were reported by those using the drug medicinally.

In 1885, Freud traveled to Paris, having received a grant to study with pioneering neurologist Jean-Martin Charcot. The French physician had recently resurrected the use of hypnosis, made popular a century earlier by Dr. Franz Mesmer.

Charcot specialized in the treatment of patients with "hysteria," the catch-all name for an ailment with various symptoms, ranging from depression to seizures and paralysis, which mainly affected women.

Charcot believed that most cases of hysteria originated in the patient's mind and should be treated as such. He held public demonstrations, during which he would hypnotize patients (placing them into a trance) and induce their symptoms, one at a time, then remove them by suggestion.

Although some observers (especially those in the medical community) viewed it with suspicion, hypnosis did seem to work on some patients.

Freud was greatly influenced by Charcot's method, which illustrated the powerful role that words could play in the treatment of mental illness. He also came to adopt the belief that some physical ailments might originate in the mind, rather than in the body alone.

Private Practice and "Anna O"

Returning to Vienna in February 1886, Freud opened a private practice as a specialist in the treatment of "nervous diseases."

As his practice grew, he finally earned enough money to marry Martha Bernays in September 1886. The couple moved into an apartment in a middle-class neighborhood in the heart of Vienna. Their first child, Mathilde, was born in 1887, followed by three sons and two daughters over the next eight years.

Freud began to receive referrals from other physicians to treat their most challenging patients -- "hysterics" who did not improve with treatment. Freud used hypnosis with these patients and encouraged them to talk about past events in their lives. He dutifully wrote down all that he learned from them -- traumatic memories, as well as their dreams and fantasies.

One of Freud's most important mentors during this time was Viennese physician Josef Breuer. Through Breuer, Freud learned about a patient whose case had an enormous influence upon Freud and the development of his theories.

"Anna O" (real name Bertha Pappenheim) was the pseudonym of one of Breuer's hysteria patients who had proved especially difficult to treat. She suffered from numerous physical complaints, including arm paralysis, dizziness, and temporary deafness.

Breuer treated Anna by using what the patient herself called "the talking cure." She and Breuer were able to trace a particular symptom back to an actual event in her life that might have triggered it.

In talking about the experience, Anna found that she felt a sense of relief, leading to a diminishment -- or even the disappearance of -- a symptom. Thus, Anna O became the first patient to have undergone "psychoanalysis," a term coined by Freud himself.

Inspired by the case of Anna O, Freud incorporated the talking cure into his own practice. Before long, he did away with the hypnosis aspect, focusing instead upon listening to his patients and asking them questions.

Later, he asked fewer questions, allowing his patients to talk about whatever came to mind, a method known as free association. As always, Freud kept meticulous notes on everything his patients said, referring to such documentation as a case study. He considered this his scientific data.

As Freud gained experience as a psychoanalyst, he developed a concept of the human mind as an iceberg, noting that a major portion of the mind -- the part that lacked awareness -- existed under the surface of the water. He referred to this as the “unconscious.”

Other early psychologists of the day held a similar belief, but Freud was the first to attempt to systematically study the unconscious in a scientific way.

Freud's theory -- that humans are not aware of all of their own thoughts, and might often act upon unconscious motives -- was considered a radical one in its time. His ideas were not well-received by other physicians because he could not unequivocally prove them.

In an effort to explain his theories, Freud co-authored Studies in Hysteria with Breuer in 1895. The book did not sell well, but Freud was undeterred. He was certain that he had uncovered a great secret about the human mind.

(Many people now commonly use the term " Freudian slip " to refer to a verbal mistake that potentially reveals an unconscious thought or belief.)

The Analyst's Couch

Freud conducted his hour-long psychoanalytic sessions in a separate apartment located in his family's apartment building at Berggasse 19 (now a museum). It was his office for nearly half a century. The cluttered room was filled with books, paintings, and small sculptures.

At its center was a horsehair sofa, upon which Freud's patients reclined while they talked to the doctor, who sat in a chair, out of view. (Freud believed that his patients would speak more freely if they were not looking directly at him.) He maintained a neutrality, never passing judgment or offering suggestions.

The main goal of therapy , Freud believed, was to bring the patient's repressed thoughts and memories to a conscious level, where they could be acknowledged and addressed. For many of his patients, the treatment was a success; thus inspiring them to refer their friends to Freud.

As his reputation grew by word of mouth, Freud was able to charge more for his sessions. He worked up to 16 hours a day as his list of clientele expanded.

After the 1896 death of his 80-year-old father, Freud felt compelled to learn more about his own psyche. He decided to psychoanalyze himself, setting aside a portion of each day to examine his own memories and dreams , beginning with his early childhood.

During these sessions, Freud developed his theory of the Oedipal complex (named for the Greek tragedy ), in which he proposed that all young boys are attracted to their mothers and view their fathers as rivals.

As a normal child matured, he would grow away from his mother. Freud described a similar scenario for fathers and daughters, calling it the Electra complex (also from Greek mythology).

Freud also came up with the controversial concept of "penis envy," in which he touted the male gender as the ideal. He believed that every girl harbored a deep wish to be a male. Only when a girl renounced her wish to be a male (and her attraction to her father) could she identify with the female gender. Many subsequent psychoanalysts rejected that notion.

Freud's fascination with dreams was also stimulated during his self-analysis. Convinced that dreams shed light upon unconscious feelings and desires,

Freud began an analysis of his own dreams and those of his family and patients. He determined that dreams were an expression of repressed wishes and thus could be analyzed in terms of their symbolism.

Freud published the groundbreaking study The Interpretation of Dreams in 1900. Although he received some favorable reviews, Freud was disappointed by sluggish sales and the overall tepid response to the book. However, as Freud became better known, several more editions had to be printed to keep up with popular demand.

Freud soon gained a small following of students of psychology, which included Carl Jung, among others who later became prominent. The group of men met weekly for discussions at Freud's apartment.

As they grew in number and influence, the men came to call themselves the Vienna Psychoanalytic Society. The Society held the first international psychoanalytic conference in 1908.

Over the years, Freud, who had a tendency to be unyielding and combative, eventually broke off communication with nearly all of the men.

Freud maintained a close relationship with Carl Jung , a Swiss psychologist who embraced many of Freud's theories. When Freud was invited to speak at Clark University in Massachusetts in 1909, he asked Jung to accompany him.

Unfortunately, their relationship suffered from the stresses of the trip. Freud did not acclimate well to being in an unfamiliar environment and became moody and difficult.

Nonetheless, Freud's speech at Clark was quite successful. He impressed several prominent American physicians, convincing them of the merits of psychoanalysis. Freud's thorough, well-written case studies, with compelling titles such as "The Rat Boy," also received praise.

Freud's fame grew exponentially following his trip to the United States. At 53, he felt that his work was finally receiving the attention it deserved. Freud's methods, once considered highly unconventional, were now deemed accepted practice.

Carl Jung, however, increasingly questioned Freud's ideas. Jung didn't agree that all mental illness originated in childhood trauma, nor did he believe that a mother was an object of her son's desire. Yet Freud resisted any suggestion that he might be wrong.

By 1913, Jung and Freud had severed all ties with one another. Jung developed his own theories and became a highly influential psychologist in his own right.

Following the assassination of Austrian archduke Franz Ferdinand in 1914, Austria-Hungary declared war on Serbia, thus drawing several other nations into the conflict which became World War I.

Although the war had effectively put an end to the further development of psychoanalytic theory, Freud managed to stay busy and productive. He revised his previous concept of the structure of the human mind.

Freud now proposed that the mind comprised three parts : the Id (the unconscious, impulsive portion that deals with urges and instinct), the Ego (the practical and rational decision-maker), and the Superego (an internal voice that determined right from wrong, a conscience of sorts). 

During the war, Freud actually used this three-part theory to examine entire countries.

At the end of World War I, Freud's psychoanalytic theory unexpectedly gained a wider following. Many veterans returned from battle with emotional problems. Initially termed "shell shock," the condition resulted from psychological trauma experienced on the battlefield.

Desperate to help these men, doctors employed Freud's talk therapy, encouraging the soldiers to describe their experiences. The therapy seemed to help in many instances, creating a renewed respect for Sigmund Freud.

By the 1920s, Freud had become internationally known as an influential scholar and practitioner. He was proud of his youngest daughter, Anna, his greatest disciple , who distinguished herself as the founder of child psychoanalysis.

In 1923, Freud was diagnosed with oral cancer, the consequence of decades of smoking cigars. He endured more than 30 surgeries, including the removal of part of his jaw. Although he suffered a great deal of pain, Freud refused to take painkillers, fearing that they might cloud his thinking.

He continued to write, focusing more on his own philosophies and musings rather than the topic of psychology.

As Adolf Hitler gained control throughout Europe in the mid-1930s, those Jews who were able to get out began to leave. Freud's friends tried to convince him to leave Vienna, but he resisted even when the Nazis occupied Austria.

When the Gestapo briefly took Anna into custody, Freud finally realized it was no longer safe to stay. He was able to obtain exit visas for himself and his immediate family, and they fled to London in 1938. Sadly, four of Freud's sisters died in Nazi concentration camps .

Freud lived only a year and a half after moving to London. As cancer advanced into his face, Freud could no longer tolerate the pain. With the help of a physician friend, Freud was given an intentional overdose of morphine and died on September 23, 1939 at the age of 83.

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FOCUSED REVIEW article

Clinical case studies in psychoanalytic and psychodynamic treatment.

This article mentions parts of:

Theoretical pluralism in psychoanalytic case studies

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• Centre for Psychoanalytic Studies, University of Essex, Colchester, UK

This manuscript provides a review of the clinical case study within the field of psychoanalytic and psychodynamic treatment. The method has been contested for methodological reasons and because it would contribute to theoretical pluralism in the field. We summarize how the case study method is being applied in different schools of psychoanalysis, and we clarify the unique strengths of this method and areas for improvement. Finally, based on the literature and on our own experience with case study research, we come to formulate nine guidelines for future case study authors: (1) basic information to include, (2) clarification of the motivation to select a particular patient, (3) information about informed consent and disguise, (4) patient background and context of referral or self-referral, (5) patient's narrative, therapist's observations and interpretations, (6) interpretative heuristics, (7) reflexivity and counter-transference, (8) leaving room for interpretation, and (9) answering the research question, and comparison with other cases.

Introduction

Psychoanalysis has always been, according to its inventor, both a research endeavor and a therapeutic endeavor. Furthermore it is clear from Freud's autobiography that he prioritized the research aspect; he did not become a doctor because he wished to cure people in ill health ( Freud, 2001 [1925] ). His invention of the psychoanalytic approach to therapy, involving the patient lying down and associating freely, served a research purpose as much as a therapeutic purpose. Through free association, he would be able to gain unique insight in the human mind. Next, he had to find a format to report on his findings, and this would be the case study. The case study method already existed in medicine ( Forrester, 2016 ), but Freud adjusted it considerably. Case studies in medical settings were more like case files, in which the patient was described or reduced to a number of medical categories: the patient became a case of some particular ailment ( Forrester, 2016 ). In Freud's hands, the case study developed into Kranken Geschichten in which the current pathology of the patient is related to the whole of his life, sometimes even over generations.

Although Freud's case studies have demonstrably provided data for generations of research by analysts ( Midgley, 2006a ) and various scholars ( Pletsch, 1982 ; Sealey, 2011 ; Damousi et al., 2015 ), the method of the case study has become very controversial. According to Midgley (2006b) , objections against the case study method can be grouped into three arguments. First there is the data problem: case studies provide no objective clinical data ( Widlöcher, 1994 ), they only report on what went right and disregard any confusion or mistakes ( Spence, 2001 ). Second, there is the data analysis problem: the way in which the observations of the case study are analyzed lack validity; case studies confirm what we already know ( Spence, 2001 ). Some go even so far to say that they are purely subjective: Michels calls case studies the “crystallization of the analyst's countertransference” ( Michels, 2000 , p. 373). Thirdly, there is the generalizability problem: it is not possible to gain generalizable insight from case studies. Reading, writing and presenting case studies has been described as being a group ritual to affirm analysts in their professional identity, rather than a research method ( Widlöcher, 1994 ).

These criticisms stand in contrast to the respect gained by the case study method in the last two decades. Since the 1990s there has been an increasing number of psychoanalytic and psychodynamic clinical case study and empirical case studies being published in scientific journals ( Desmet et al., 2013 ; Cornelis et al., in press ). It has also been signaled that the case study method is being revived more broadly in the social sciences. In the most recent, fifth edition of his seminal book on case study research, Yinn (2014) includes a figure showing the steady increase of the frequency with which the term “case study research” appears in published books in the period from 1980 to 2008.

KEY CONCEPT 1. Clinical case study A clinical case study is a narrative report by the therapist of what happened during a therapy together with the therapist's interpretations of what happened. It is possible that certain (semi)-structured assessment instruments, such as a questionnaire or a diagnostic interview are included in clinical case studies, yet it is still the therapist that uses these, interprets and discusses them.

KEY CONCEPT 2. Empirical case studies In an empirical case study data are gathered from different sources (e.g., self-report, observation,…) and there is a research team involved in the analyses of the data. This study can take place either in a naturalistic setting (systematic case study) or in a controlled experimental environment (single-case experiment).

In addition to the controversy about the case study method, psychoanalysis has developed into a fragmented discipline. The different psychoanalytic schools share Freud's idea of the unconscious mind, but they focus on different aspects in his theoretical work. Some of the schools still operate under the wings of the International Psychoanalytic Association, while others have established their own global association. Each school is linked to one or several key psychoanalysts who have developed their own version of psychoanalysis. Each psychoanalytic school has a different set of theories but there are also differences in the training of new psychoanalysts and in the therapeutic techniques that are applied by its proponents.

Based on this heterogeneity of perspectives in psychoanalysis, a research group around the Single Case Archive investigated the current status of case study research in psychoanalysis ( Willemsen et al., 2015a ). They were particularly interested to know more about the output and methodology of case studies within the different psychoanalytic schools.

KEY CONCEPT 3. Single case archive The Single Case Archive is an online archive of published clinical and empirical case studies in the field of psychotherapy ( http://www.singlecasearchive.com ). The objective of this archive is to facilitate the study of case studies for research, clinical, and teaching purposes. The online search engine allows the identification of sets of cases in function of specific clinical or research questions.

Our Survey Among Case Study Authors About their Psychoanalytic School

In order to investigate and compare case studies from different psychoanalytic schools, we first had to find a way of identifying to which school the case studies belonged. This is very difficult to judge straightforwardly on the basis of the published case study: the fact that someone cites Winnicott or makes transference interpretations doesn't place him or her firmly within a particular psychoanalytic school. The best approach was to ask the authors themselves. Therefore, we contacted all case study authors included in the Single Case Archive (since the time of our original study in 2013, the archive has expanded). We sent emails and letters in different languages to 445 authors and received 200 replies (45% response rate). We asked them the following question: “ At the time you were working on this specific case, to which psychoanalytic school(s) did you feel most attached? ” Each author was given 10 options: (1) Self Psychology (1.a Theory of Heinz Kohut, 1.b Post-Kohutian Theories, 1.c Intersubjective psychoanalysis), (2) Relational psychoanalysis, (3) Interpersonal psychoanalysis, (4) Object relational psychoanalysis (4.a Theory of Melanie Klein, 4.b Theory of Donald W. Winnicott, 4.c Theory of Wilfred R. Bion, 4.d Theory of Otto F. Kernberg), (5) Ego psychology (or) “Classic psychoanalysis” (5.a Theories of Sigmund Freud, 5.b Ego psychology, 5.c Post-Ego psychology), (6) Lacanian psychoanalysis, (7) Jungian psychoanalysis, (8) National Psychological Association for Psychoanalysis (NPAP) related theory, (9) Modern psychoanalysis related to the Boston or New York Graduate School of Psychoanalysis (BGSP/NYGSP), (10) Other. Respondents could indicate one or more options.

Analysis of the responses indicated that the two oldest schools in psychoanalysis, Object-relations psychoanalysis and Ego psychology, dominate the field in relation to case studies that are published in scientific journals. More than three quarters of all case study authors (77%) reported these schools of thought to be the ones with which they considered themselves most affiliated. Three more recent schools were also well-represented among case studies: Self Psychology, Relational Psychoanalysis, and Interpersonal Psychoanalysis. Lacanian Psychoanalysis, Jungian Psychoanalysis, NPAP related Theory and Modern Psychoanalysis related to the BGSP/NYGSP were only rarely mentioned by case study authors as their school of thought. This does not mean that clinicians or researchers within these latter schools do not write any case studies. It only means that they publish few case studies in the scientific journals included in ISI-ranked journals indexed in Web of Science. But they might have their own journals in which they publish clinical material.

Our survey demonstrated that the majority of case study authors (59%) feel attached to more than one psychoanalytic school. This was in fact one of the surprising findings in our study. It seems that theoretical pluralism is more rule than exception among case study authors. There were some differences between the psychoanalytic schools though in terms of pluralism. Case study authors who feel attached to Self Psychology and Interpersonal Psychoanalysis are the most pluralistic: 92 and 86%, respectively also affiliate with one or more other psychoanalytic schools. Case study authors who feel attached to Object Relations Psychoanalysis are the “purest” group: only 69% of them affiliate with one or more other psychoanalytic schools.

KEY CONCEPT 4. Theoretical pluralism A situation in which several, potentially contradicting, theories coexist. It is sometimes interpreted as a sign of the immaturity of a science, under the assumption that a mature science should arrive at one single coherent truth. Others see theoretical pluralism as unavoidable for any applied discipline, as each theory can highlight only part of reality.

Psychoanalytic Pluralism and the Case Study Method

We were not really surprised to find that Object Relations psychoanalysis and Ego psychology were the most dominant schools in the field of psychoanalytic case studies, as they are very present in European, Latin-American and North-American psychoanalytic institutes. We were more surprised to find such a high degree of pluralism among these case study authors, given the fact that disputes between analysts from different schools can be quite ardent ( Green, 2005 ; Summers, 2008 ). Others have compared the situation of psychoanalytic schools with the Tower of Babel ( Steiner, 1994 ).

It has been argued that the case study method contributes to the degree of theoretical pluralism within psychoanalysis. The reason for this is situated in the reasoning style at the basis of case study research ( Chiesa, 2010 ; Fonagy, 2015 ). The author of a psychoanalytic case study makes a number of observations about the patient within the context of the treatment, and then moves to a conclusion about the patient's psychodynamics in general. The conclusion he or she arrives at inductively gains its “truth value” from the number and quality of observations it is based on. This style of reasoning in case study research is very similar to how clinicians reason in general. Clinicians look for patterns within patients and across patients. If they make similar observations in different patients, or if other psychoanalysts make similar observations in their patients, the weight of the conclusion becomes greater and greater. The problem with this reasoning style is that one can never arrive at definite conclusions: even if a conclusion is based on a large number of observations, it is always possible that the next observation disconfirms the conclusion. Therefore, it could be said, it is impossible to attain “true” knowledge.

The above argument is basically similar to objections against any kind of qualitative research. To this, we argue with Rustin (2003) that there is not one science and no hierarchy of research methods. Each method comes with strengths and weaknesses, and what one gains in terms of control and certainty in a conventional experimental setup is lost in terms of external validity and clinical applicability. Numerous researchers have pleaded for the case study approach as one method among a whole range of research methods in the field of psychoanalysis ( Rustin, 2003 ; Luyten et al., 2006 ; Midgley, 2006b ; Colombo and Michels, 2007 ; Vanheule, 2009 ; Hinshelwood, 2013 ). Leuzinger-Bohleber makes a distinction between clinical research and extra-clinical research ( Leuzinger-Bohleber, 2015 ). Clinical research is the idiographic type of research conducted by a psychoanalyst who is working with a patient. Unconscious phantasies and conflicts are symbolized and put into words at different levels of abstraction. This understanding then molds the perception of the analyst in subsequent clinical situations; even though the basic psychoanalytic attitude of “not knowing” is maintained. The clinical case study is clinical research par excellence . Extra-clinical research consists in the application of different methodologies developed in the natural and human sciences, to the study of the unconscious mind. Leuzinger-Bohleber refers to empirical psychotherapy research, experimental research, literature, cultural studies, etc. We believe that the clinical case study method should step up and claim its place in psychoanalytic research, although we agree that the method should be developed further. This paper and a number of others such as Midgley (2006b) should facilitate this methodological improvement. The clinical research method is very well-suited to address any research question related to the description of phenomena and sequences in psychotherapy (e.g., manifestation and evolution of symptoms and therapeutic relationship over time). It is not suitable for questions related to causality and outcome.

We also want to point out that there is a new evolution in the field of psychotherapy case study research, which consists in the development of methodologies for meta-studies of clinical case studies ( Iwakabe and Gazzola, 2009 ). The evolution builds on the broader tendency in the field of qualitative research to work toward integration or synthesis of qualitative findings ( Finfgeld, 2003 ; Zimmer, 2006 ). The first studies which use this methodology have been published recently: Widdowson (2016) developed a treatment manual for depression, Rabinovich (2016) studied the integration of behavioral and psychoanalytic treatment interventions, and Willemsen et al. (2015b) investigated patterns of transference in perversion. The rich variety of research aims demonstrates the potential of these meta-studies of case studies.

KEY CONCEPT 5. Meta-studies of clinical case studies A meta-study of clinical case studies is a research approach in which findings from cases are aggregated and more general patterns in psychotherapeutic processes are described. Several methodologies for meta-studies have been described, including cross-case analysis of raw data, meta-analysis, meta-synthesis, case comparisons, and review studies in general.

Lack of Basic Information in Psychoanalytic Case Studies

The second research question of our study ( Willemsen et al., 2015a ) concerned the methodological, patient, therapist, and treatment characteristics of published psychoanalytic case studies. All studies included in the Single Case Archive are screened by means of a coding sheet for basic information, the Inventory of Basic Information in Single Cases (IBISC). The IBISC was designed to assess the presence of basic information on patient (e.g., age, gender, reasons to consult), therapist (e.g., age, gender, level of experience), treatment (e.g., duration, frequency, outcome), and the methodology (e.g., therapy notes or audio recoding of sessions). The IBISC coding revealed that a lot of basic information is simply missing in psychoanalytic case studies ( Desmet et al., 2013 ). Patient information is fairly well-reported, but information about therapist, treatment and methodology are often totally absent. Training and years of experience are not mentioned in 84 and 94% of the cases, respectively. The setting of the treatment is not mentioned in 61% of the case studies. In 80% of the cases, it was not mentioned whether the writing of the case studies was on the basis of therapy notes, or audiotapes. In 91% of the cases, it was not mentioned whether informed consent was obtained.

Using variables on which we had more comprehensive information, we compared basic information of case studies from different psychoanalytic schools. This gave us a more detailed insight in the type of case studies that have been generated within each psychoanalytic school, and into the difference between these schools in terms of the kind of case study they generate. We found only minimal differences. Case studies in Relational Psychoanalysis stand out because they involve older patients and longer treatments. Case studies in Interpersonal Psychoanalysis tend to involve young, female patients and male therapists. Case study authors from both these schools tend to report on intensive psychoanalysis in terms of session frequency. But for the rest, it seems that the publication of case studies throughout the different psychoanalytic schools has intensified quite recently.

Guidelines for Writing Clinical Case Studies

One of the main problems in using psychoanalytic case studies for research purposes is the enormous variability in quality of reporting and inconsistency in the provision of basic information about the case. This prevents the reader from contextualizing the case study and it obstructs the comparison of one case study with another. There have been attempts to provide guidelines for the writing of case studies, especially in the context of analytic training within the American Psychoanalytic Association ( Klumpner and Frank, 1991 ; Bernstein, 2008 ). However, these guidelines were never enforced for case study authors by the editors from the main psychoanalytic journals. Therefore, the impact of these guidelines on the field of case study research has remained limited.

Here at the end of our focused review, we would like to provide guidelines for future case study authors. Our guidelines are based on the literature and on our experience with reading, writing, and doing research with clinical case studies. We will include fragments of existing case studies to clarify our guidelines. These guidelines do not provide a structure or framework for the case study; they set out basic principles about what should be included in a case study.

Basic Information

First of all, we think that a clinical case study needs to contain basic information about the patient, the therapist, the treatment, and the research method. In relation to the patient , it is relevant to report on gender, age (or an age range in which to situate the patient), and ethnicity or cultural background. The reader needs to know these characteristics in order to orientate themselves as to who the patient is and what brings them to therapy. In relation to the therapist , it is important to provide information about professional training, level of professional experience, and theoretical orientation. Tuckett (2008) emphasizes the importance for clinicians to be explicit about the theory they are using and about their way of practicing. It is not sufficient to state membership of a particular group or school, because most groups have a wide range of different ways of practicing. In relation to the treatment itself, it is important to be explicit about the kind of setting, the duration of treatment, the frequency of sessions, and details about separate sequences in the treatment (diagnostic phase, follow-up etc.). These are essential features to share, especially at a time when public sector mental health treatment is being subjected to tight time restrictions and particular ways of practising are favored over others. For example short-term psychotherapies are being implemented in public services for social and economic reasons. While case studies carried out in the public sector can give us information on those short-term therapies, private practice can offer details about the patient's progress on a long-term basis. Moreover, it is important to report whether the treatment is completed. To our astonishment, there are a considerable number of published case studies on therapies that were not finished ( Desmet et al., 2013 ). As Freud (2001 [1909] , p. 132) already advised, it is best to wait till completion of the treatment before one starts to work on a case study. Finally, in relation to the research method , it is crucial to mention which type of data were collected (therapy notes taken after each session, audio-recordings, questionnaires, etc.), whether informed consent was given, and in what way the treatment was supervised. Clinicians who would like to have help with checking whether they included all necessary basic information case use the Inventory for Basic Information in Single Cases (IBISC), which is freely available on http://www.singlecasearchive.com/resources .

Motivation to Select a Particular Patient

First of all, it is crucial to know what the motivation for writing about a particular case comes from. Some of the following questions should be kept in mind and made explicit from the beginning of the case presentation. Why is it interesting to look at this case? What is it about this case or the psychotherapist's work that can contribute to the already existing knowledge or technique?

“This treatment resulted in the amelioration of his [obsessive-compulsive] symptoms, which remained stable eight years after treatment ended. Because the standard of care in such cases has become largely behavioral and pharmacological, I will discuss some questions about our current understanding of obsessive-compulsive phenomena that are raised by this case, and some of the factors that likely contributed to the success of psychoanalytic treatment for this child ( McGehee, 2005 , p. 213–214).”

This quotation refers to a case that has been selected on the basis of its successful outcome. The author is then interested to find out what made this case successful.

Informed Consent and Disguise

As regulations on privacy and ethics are becoming tighter, psychotherapists find themselves with a real problem in deciding what is publishable and what is not. Winship (2007) points out that there is a potential negative effect of research overregulation as clinicians may be discouraged from reporting ordinary and everyday findings from their clinical practice. But he also offers very good guidelines for approaching the issue of informed consent. A good practice is asking for consent either at the start of the treatment or after completion of the treatment: preferably not during treatment. It is inadvisable to complete the case study before the treatment has ended. It is also advisable that the process of negotiating consent with the patient is reported in the case study.

“To be sure that Belle's anonymity was preserved, I contacted her while writing this book and told her it would not be published without her complete approval. To do this, I asked if she would review every word of every draft. She has ( Stoller, 1986 , p. 217).”

In relation to disguise, one has to strike a balance between thin and thick disguise. Gabbard (2000) suggests different useful approaches to disguising the identity of the patient.

Patient Background and Context of Referral or Self-Referral

It is important to include relevant facts about the patient's childhood, family history, siblings, any trauma or losses and relationship history (social and romantic) and the current context of the patient's life (family, working, financial). The context of referral is also key to understanding how and why the patient has come to therapy. Was the patient encouraged to come or had wanted to come? Has there been a recent crisis which prompted the intervention or an on-going problem which the patient had wanted to address for some time?

“Michael was one of the youngest children in his family of origin. He had older brothers and sisters who had been received into care before his birth. His parents separated before he was born. There had been some history of violence between them and Michael was received into care on a place of safety order when he was an infant because his mother had been unable to show consistent care toward him ( Lykins Trevatt, 1999 , p. 267).”

Patient's Narrative, Therapist's Observations, and Interpretations

A case study should contain detailed accounts of key moments or central topics, such as a literal transcription of an interaction between patient and therapist, the narration of a dream, a detailed account of associations, etc. This will increase the fidelity of the case studied, especially when both patient's and therapist's speech are reported as carefully as possible.

“Martha spoke in a high-pitched voice which sounded even more tense than usual. She explained that her best friend's mum had shouted at her for being so withdrawn; this made her angry and left her feeling that she wanted to leave their home for good. I told Martha that she often tried to undo her bad feelings by acting quickly on her instincts, as she did not feel able to hold her feelings in her mind and bring them to her therapy to think about with me. Martha nodded but it was not clear whether she could really think about what I just said to her. She then said that she was being held in the hospital until a new foster placement could be found. “In the meantime,” she said in a pleased tone, “I have to be under constant supervision” ( Della Rosa, 2015 , p. 168).”

In this example, observations of nonverbal behavior and tonality are also included, which helps to render a lively picture of the interaction.

Interpretative Heuristics

In which frame of reference is the writer operating? It is important to know what theories are guiding the therapist's thinking and what strategies he employs in order to deal with the clinical situation he is encountering. Tuckett (1993) writes about the importance of knowing what “explanatory model” is used by the therapist in order to make sense of the patient and to relate his own thinking to a wider public for the purpose of research. This idea is also supported by Colombo and Michels (2007) who believe that making theoretical orientations as explicit as possible would make the case studies intelligible and more easily employed by the research community. This can be done by the therapists explaining why they have interpreted a particular situation in the way they have. For example, Kegerreis in her paper on time and lateness (2013) stresses throughout how she is working within the object-relations framework and looking out for the patient's use of projective mechanisms.

“She was 10 minutes late. Smiling rather smugly to herself she told me that the wood supplied for her new floor had been wrongly cut. The suppliers were supposed to come and collect it and hadn't done so, so she had told them she was going to sell it to a friend, and they are now all anxious and in a hurry to get it.

I said she now feels as if she has become more powerful, able to get a response. She agrees, grinning more, telling me she does have friends who would want it, that it was not just a ploy.

She said she had found it easier to get up today but was still late. I wondered if she had a sense of what the lateness was about. She said it was trying to fit too much in. She had been held up by discussing the disposal of rubble with her neighbors.

I said I thought there was a link here with the story about the wood. In that she had turned the situation around. She had something that just didn't work, had a need for something, but it was turned around into something that was the suppliers' problem. They were made to feel the urgency and the need. Maybe when she is late here she is turning it around, so it is me who is to be uncertain and waiting, not her waiting for her time to come.

We maybe learn here something of her early object relationships, in which being in need is felt to be unbearable, might lead to an awful awareness of lack and therefore has to be exported into someone else. One could go further and surmise that in her early experience she felt teased and exploited by the person who has the power to withhold what you need ( Kegerreis, 2013 , p. 458).”

There can be no doubt reading this extract about the theoretical framework which is being used by the therapist.

Reflexivity and Counter-Transference

A good case study contains a high degree of reflexivity, whereby the therapist is able to show his feelings and reactions to the patient's communication in the session and an ability to think about it later with hindsight, by himself or in supervision. This reflexivity needs to show the pattern of the therapist's thinking and how this is related to his school of thought and to his counter-transferential experiences. How has the counter-transference been dealt with in a professional context? One can also consider whether the treatment has been influenced by supervision or discussion with colleagues.

“Recently for a period of a few days I found I was doing bad work. I made mistakes in respect of each one of my patients. The difficulty was in myself and it was partly personal but chiefly associated with a climax that I had reached in my relation to one particular psychotic (research) patient. The difficulty cleared up when I had what is sometimes called a ‘healing’ dream. […] Whatever other interpretations might be made in respect of this dream the result of my having dreamed it and remembered it was that I was able to take up this analysis again and even to heal the harm done to it by my irritability which had its origin in a reactive anxiety of a quality that was appropriate to my contact with a patient with no body ( Winnicott, 1949 , p. 70).”

Leaving Room for Interpretation

A case study is the therapist's perspective on what happened. A case study becomes richer if the author can acknowledge aspects of the story that remain unclear to him. This means that not every bit of reported clinical material should be interpreted and fitted within the framework of the research. There should be some loose ends. Britton and Steiner (1994) refer to the use of interpretations where there is no room for doubt as “soul murder.” A level of uncertainty and confusion make a case study scientifically fruitful ( Colombo and Michels, 2007 ). The writer can include with hindsight what he thinks he has not considered during the treatment and what he thinks could have changed the course for the treatment if he had been aware or included other aspects. This can be seen as an encouragement to continue to be curious and maintain an open research mind.

Answering the Research Question, and Comparison with Other Cases

As in any research report, the author has to answer the research question and relate the findings to the existing literature. Of particular interest is the comparison with other similar cases. Through comparing, aggregating, and contrasting case studies, one can discover to what degree and under what conditions, the findings are valid. In other words, the comparison of cases is the start of a process of generalization of knowledge.

“Although based on a single case study, the results of my research appear to concur with the few case studies already in the field. In reviewing the literature on adolescent bereavement, it was the case studies that had particular resonance with my own work, and offered some of the most illuminating accounts of adolescent bereavement. Of special significance was Laufer's (1966) case study that described the narcissistic identifications of ‘Michael’, a patient whose mother had died in adolescence. Both Laufer's research and my own were conducted using the clinical setting as a basis and so are reflective of day-to-day psychotherapy practice ( Keenan, 2014 , p. 33).”

As Yinn (2014) has argued for the social sciences, the case study method is the method of choice when one wants to study a phenomenon in context, especially when the boundaries between the phenomenon and the context are fussy. We are convinced that the same is true for case study methodology in the fields of psychoanalysis and psychotherapy. The current focused review has positioned the research method within these fields, and has given a number of guidelines for future case study researchers. The authors are fully aware that giving guidelines is a very tricky business, because while it can channel and stimulate research efforts it can as well-limit creativity and originality in research. Moreover, guidelines for good research change over time and have to be negotiated over and over again in the literature. A similar dilemma is often pondered when it comes to qualitative research ( Tracy, 2010 ). However, our first impetus for providing these guidelines is pedagogical. The three authors of this piece are experienced psychotherapists who also work in academia. A lot of our students are interested in doing case study research with their own patients, but they struggle with the methodology. Our second impetus is to improve the scientific credibility of the case study method. Our guidelines for what to include in the written account of a case study, should contribute to the improvement of the quality of the case study literature. The next step in the field of case study research is to increase the accessibility of case studies for researchers, students and practitioners, and to develop methods for comparing or synthesizing case studies. As we have described above, efforts in that direction are being undertaken within the context of the Single Case Archive.

Author Contributions

JW has written paragraphs 1–4; ER and JW have written paragraph 5 together; SK has contributed to paragraph 5 and revised the whole manuscript.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Author Biography

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Keywords: clinical case study, methodology, psychotherapy research, psychoanalysis, psychoanalytic schools, theoretical pluralism, review

Citation: Willemsen J, Della Rosa E and Kegerreis S (2017) Clinical Case Studies in Psychoanalytic and Psychodynamic Treatment. Front. Psychol . 8:108. doi: 10.3389/fpsyg.2017.00108

Received: 29 November 2016; Accepted: 16 January 2017; Published: 02 February 2017.

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Copyright © 2017 Willemsen, Della Rosa and Kegerreis. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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The Psychodynamic Approach

Who is the most famous psychologist of all time? 

The answer is subjective, but most would say Sigmund Freud. You’ve probably heard of him before. Or maybe you’ve heard the term “Freudian slip.” It’s the moment when you accidentally say something that you might have been meaning to say all along. This is one of the key concepts in psychoanalysis and psychodynamic theory.

What Is The Psychodynamic Approach?

Psychodynamic theory attempts to explain why we do the things we do and why we are the persons that we are. It has widely influenced the way that we treat mental conditions and look at development. But is it valid, or based on misinterpretations? Let’s explore. 

History of Psychodynamic Approach

People often use “psychodynamic” and “psychoanalytic” theory interchangeably. While psychodynamic theory certainly includes Freud’s theory on psychoanalytic, there is a lot more to the overall theory. Psychodynamic theory includes Freud’s work and the work of his followers. 

Basics of Psychoanalytic Theory 

Sigmund Freud was a therapist that gathered case studies and information from patients in the early 1900s. His work laid out the basic ideas of psychoanalytic theory, including the three elements of our personality, and the role of the unconscious mind. 

Psychodynamic Approach Experiments

Freud's method of collecting data and building his theories is controversial. Freud created most of his theories by working with individual patients, rather than conducting studies or experiments. This method is not regarded as the most accurate, or one that can speak to a universal theory for developing personality and decision-making. 

Personality: Ego, Id, and SuperEgo

Freud believed that all people were born with an id. The id contains two biological instincts (the sex and death instinct,) along with other components of a person’s personality determined by biology. 

But Freud believed that the id needed to be tamed by the ego. A person’s ego forms to make conscious decisions based on what is going on in the real world. The ego helps us function in society and is the part of the personality that we recognize and interact with. On top of the ego is the superego, influenced by society’s morals and values. 

The Unconscious Mind 

The superego and the id make up the unconscious mind. It’s the inner workings that we do not recognize. Freud believed that the unconscious mind was responsible for most of the decision-making process.  

Within the unconscious lies past events from our childhood that strongly influence the way that we view the world and make decisions. We may not remember these childhood events, but our unconscious has held onto them and is the driving force behind our decisions. 

In the debate between free will and determinism, psychoanalytical is largely deterministic. Our behaviors and decisions are largely influenced by the unconscious mind, one that we cannot control. 

Freudian Slip

One of the ways that the unconscious “comes to the surface” is through the Freudian slips I mentioned earlier. Let’s say you are in a conversation with a friend about dating preferences. You mean to say “I want to date a boy who likes fitness,” but you accidentally say, “I want to date a girl who…” At that point, you might stop yourself. Why did you say girl? You meant boy!

Freud would argue that your unconscious mind has some feelings about dating that you might not have consciously addressed yet. 

Stages of Psychosexual Development 

Freud also presented a theory of how we develop “flaws” in our personality, or “fixations.” His stages of psychosexual development lay out different erogenous zones that influence our personality at different ages. If we experience conflict or trauma during that stage, we may develop a fixation that associates with that erogenous zone. 

Other Theories Within Psychodynamic Approach 

If you’ve watched any of my videos on developmental psychology, you know that there are a few different theories that involve stages of development. Erikson’s Stages of Psychosocial Development , for example, outlines the many “crises” that people face from the time they are born to the moment they die. These crises, and whether or not they can be overcome, shape our personality. 

Erikson is just one psychologist who was influenced by Sigmund Freud. Together, the theories of Carl Jung, Melanie Klein, and Anna Freud make up the Psychodynamic Approach. 

All of the theories within the Psychodynamic Approach stem from the idea that the unconscious mind controls many of our conscious thoughts, decisions, and behaviors. But many psychologists disagreed with elements of psychoanalytics. 

Carl Jung , for example, didn’t agree with Freud’s heavy emphasis on sex. Jung developed the theory of the collective unconscious. 

Alfred Alder, while believing that our decisions were largely influenced by the unconscious, he didn’t see eye to eye with Freud’s idea of the id. Rather than instincts, Adler believed that we are influenced by an unknown creative force. 

Both object relation theory and attachment theory stemmed from psychoanalytic theory, but they place different emphasis on the importance of the parent-child relationship. 

Influence of Psychodynamic Approach 

Freud was a controversial character. His theories came to sexist conclusions and some of his theories have been disregarded completely. (His book on dream interpretation is a wild ride!) 

Reducing our personalities to three parts, and reducing our sexual development to five stages, is also quite controversial. 

Talk Therapy 

Nevertheless, the legacy of some of his ideas have lived on. Freud developed “The Talking Cure,” which influences the way that many therapists do their work today. He believed that by talking to patients about childhood events, he could peek into the unconscious. By revealing repressed feelings or memories, he could begin to treat the behaviors that resulted from that repression. 

Freud’s “Talking Cure” involved dream interpretations and word association. While you don’t see many therapists practicing this today, you will see the influence of Freud. Talk therapy is used today to help patients overcome phobias, process trauma, or manage symptoms of anxiety and depression. Many approaches, like the famous Imago Therapy, focus on the patient’s relationship to their parents and how it influences the patient’s relationship to their significant other. If you visit a therapist today, it’s likely that they’ll ask you about childhood experiences at some point during your next few sessions. 

Is Psychodynamic Theory Used Today?

Did Freud use the best methods for creating his theories? No. Did they all prove to be correct? No. But did these theories, and his influence, help us better understand the inner workings of the mind? Yes. Do therapies influenced by Freud help millions of people, including children, better manage their mental health? Yes. 

No theory in the world of psychology is perfect. We are still looking for many answers on how we make decisions and behave. But if you’re interested in diving deeper into the influence of the unconscious, the psychodynamic approach is a good place to start.

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Psychoanalysis today

Peter fonagy.

1 Psychoanalysis Unit, Sub-Department of Clinical Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK

The paper discusses the precarious position of psychoanalysis, a therapeutic approach which historically has defined itself by freedom from constraint and counted treatment length not in terms of number of sessions but in terms of years, in today's era of empirically validated treatments and brief structured interventions. The evidence that exists for the effectiveness of psychoanalysis as a treatment for psychological disorder is reviewed. The evidence base is significant and growing, but less than might meet criteria for an empirically based therapy. The author goes on to argue that the absence of evidence may be symptomatic of the epistemic difficulties that psychoanalysis faces in the context of 21st century psychiatry, and examines some of the philosophical problems faced by psychoanalysis as a model of the mind. Finally some changes necessary in order to ensure a future for psychoanalysis and psychoanalytic therapies within psychiatry are suggested.

Psychoanalysis today is an embattled discipline. What hope is there in the era of empirically validated treatments ( 1 ), which prizes brief structured interventions, for a therapeutic approach which defines itself by freedom from constraint and preconception ( 2 ), and counts treatment length not in terms of number of sessions but in terms of years? Can psychoanalysis ever demonstrate its effectiveness, let alone cost-effectiveness? After all, is psychoanalysis not a qualitatively different form of therapy which must surely require a qualitatively different kind of metric to reflect variations in its outcome? Symptom change as a sole indicator of therapeutic benefit must indeed be considered crude in relation to the complex interpersonal processes which evolve over the many hundreds of sessions of the average 3- 5 times weekly psychoanalytic treatment. Most psychoanalysts are sceptical about outcome investigations.

Surprisingly, given this unpropitious backdrop, there is, in fact, some suggestive evidence for the effectiveness of psychoanalysis as a treatment for psychological disorder. The evidence in relation to psychoanalytic outcomes was recently overviewed by Gabbard et al ( 3 ), and suggestions for enriching this literature with ongoing naturalistic follow- along investigations were offered. But the absence of evidence is only part of the problem. Indeed, it may be symptomatic of the scientific difficulties that psychoanalysis faces in the 21st century. I will review the evidence base of psychoanalytic treatments and go on to examine in more detail the problems faced by psychoanalysis as a body of ideas rather than as a mode of treatment.

DATA GATHERING AND PSYCHOANALYSIS

Psychoanalysts emulating the founder of the discipline take special pride in discovery. This has led to an abundance of psychoanalytic ideas. Yet this very overabundance of clinically rooted concepts is beginning to threaten the clinical enterprise ( 4 ). The plethora of clinical strategies and techniques that are not all mutually compatible creates almost insurmountable problems in the transmission of psychoanalytic knowledge and skills ( 5 ). Sadly, this also leads to resistance to the systematization of psychoanalytic knowledge, since those whose frame of reference depends on ambiguity and polymorphy can be threatened by the systematization of clinical reasoning. The source of the problem of theoretical diversity lies in psychoanalytic methods of data-gathering. As is well known, data is not the plural of anecdote. Psychoanalytic practice has profound limitations as a form of research. Psychoanalytic theory precludes the possibility that psychoanalysts can be adequate observers of their clinical work. The discovery of the pervasiveness of countertransference has totally discredited Freud's clinician- researcher model. In the absence of a genuine research tradition, academic disciplines will appropriately distance themselves from psychoanalytic study, in much the same way that they hold journalism at arm's length.

Progress in disciplines concerned with the mind has been remarkable. Excluding information from these disciplines is a high risk strategy at a time when interdisciplinary collaboration is perceived as the driving force of knowledge acquisition. Modern science is almost exclusively interdisciplinary. Many major universities have been restructured to facilitate interdisciplinary work. The impetus is for the abolition of discipline based departments and the re-configuring of medical faculties in terms of interdisciplinary research groupings (scientists working on similar problems regardless of their discipline of origin). It is likely that many basic questions that psychoanalysts have not been able adequately to answer, such as how psychological therapy cures, will only be illuminated by interdisciplinary (neuroscientific) research.

The last 30 years' advances in all the neurosciences have negated the reasons for the earlier psychoanalytic disregard of this field ( 6 ). Neuroscientists are no longer just concerned with cognitive disabilities or so-called organic disorders ( 7 , 8 ). Recent reviews of neuroscientific work confirm that many of Freud's original observations, not least the pervasive influence of non-conscious processes and the organizing function of emotions for thinking, have found confirmation in laboratory studies ( 9 , 10 ). If Freud were alive today, he would be keenly interested in new knowledge about brain functioning, such as how neural nets develop in relation to the quality of early relationships, the location of specific capacities with functional scans, the discoveries of molecular genetics and behavioral genomics ( 11 ) and he would surely not have abandoned his cherished Project for a Scientific Psychology ( 12 ), the abortive work in which he attempted to develop a neural model of behavior. Genetics has progressed particularly rapidly, and mechanisms that underpin and sustain a complex gene-environment interaction belie early assumptions about constitutional disabilities ( 13 ). In fact, for the past 15-20 years the field of neuroscience has been wide open for input from those with an adequate understanding of environmental determinants of development and adaptation.

It may be that the difficulty in pinpointing the curative factors in psychoanalytic treatment is directly related to the limitations of the uniquely clinical basis for psychoanalytic inquiry. The impact of psychoanalysis cannot be fully appreciated from clinical material alone. The repetition of patterns of emotional arousal in association with the interpretive process elaborates and strengthens structures of meaning and emotional response. This may have far-reaching effects, I would argue, even on the functioning of the brain and the expression of genetic potential. A range of studies have already suggested that the impact of psychotherapy can be seen in alterations in brain activity, using brain imaging techniques ( 14 - 16 ). These studies as a group provide a rationale for the hope that intensive psychoanalytic treatment might meaningfully affect biological as well as psychological vulnerability. This field is in its infancy but is progressing so fast that it seems highly likely that many future psychoanalytic discoveries about the mind will be made in conjunction and collaboration with biological science.

HOW PSYCHOANALYSIS WILL (COULD) BENEFIT FROM AN INTERDISCIPLINARY DIALOGUE

Whilst clinical psychoanalysis needs little help in getting to know an individual's subjectivity in the most detailed way possible, when we wish to generalize to a comprehensive model of the human mind, the discipline can no longer exist on its own. A general psychoanalytic model of mind, if it is to be credible, should be aligned with the wider knowledge of mind gained from a range of disciplines. This is already happening, albeit informally. Psychoanalysts cannot help incorporating advances about discoveries relevant to mental function because these are invariably contained in all our intuitive, common sense, folk psychologies or theories of the mind ( 17 , 18 ). Folk psychology develops alongside scientific discovery. The impact of psychoanalysis on psychiatric disorder over the course of the 20th century offers the best evidence for this. Our culture's acceptances of Freudian discoveries have made it more difficult for individuals to claim dramatic dysfunctions such as blindness, anesthesia, and paralysis. Medicine has advanced to a point where individuals must accept that the absence of a pathophysiological account for a bodily dysfunction implies emotional determinants - thus the disguise function of the physical symptom is lost and the point prevalence of conversion hysteria plummets. Just as common-sense knowledge of medicine and psychology impacts on our patients, so it must unconsciously influence the nature of psychoanalysts' theoretical musings. Thus, 'scientific advances' infiltrate psychoanalytic theory by the backdoor of the analyst's preconscious.

Mitchell ( 19 ), by contrast, claimed that 'no experiment or series of experiments will ever be able to serve as a final and conclusive arbiter of something as complex and elastic as the psychoanalytic theory'. Indeed, Mitchell writes that "ultimately it is the community of psychoanalytic practitioners who provide the crucial testing-ground in the crucible of daily clinical work". As we have seen, the community has been singularly unsuccessful in definitively eliminating theories, in part because of the loose definitions adopted to define underlying concepts. This is inevitable if the mechanisms or processes that underpin the surface function described are not well understood. The meaning of the construct has to be sensed or intuited. In psychoanalysis, communication, whether in writing or clinical discourse, occurs in terms of its impact upon the reader. As Phillips (20) puts it, paraphrasing Emerson, in psychoanalytic writing there is an attempt to "return the reader to his own thoughts whatever their majesty, to evoke by provocation. According to this way of doing it, thoroughness is not inciting. No amount of 'evidence' or research will convince the unamused that a joke is funny". In psychoanalysis we accept that something has been understood when the discourse about it is inciting. Elusiveness and ambiguity are not only permissible, they may be critical to accurately depict the complexity of human experience. It is here, in the specification of the mental mechanisms whose effects psychoanalytic writings describe and whose nature they allude to, that systematic research using psychoanalytic methods as well as methods from other disciplines will turn out to be so useful. Gill ( 21 ), in his discussion of the possible validation of psychoanalytic concepts, adopted a similar approach and suggested that Mitchell underestimated the potential contribution of systematic, not necessarily experimental, research on the psychoanalytic situation.

The above does not constitute an attempt to suggest that psychoanalytic concepts can be 'tested' or 'validated' by the methods of another science. Rather, systematic observations could be used to investigate the psychological processes underpinning clinical phenomena, which psychoanalysts currently use the metaphoric language of metapsychology to approximate. Inter-disciplinary research cannot test psychoanalytic theory, it cannot demonstrate that particular psychoanalytic ideas are true or false. What it can do is to elaborate the mental mechanisms that are at work in generating the phenomena that psychoanalytic writings describe. It is here, in the specification of the mental mechanisms whose effects psychoanalytic writings describe and whose nature they allude to, that systematic research using psychoanalytic methods as well as methods from other disciplines will be useful. This in turn will help to systematize the knowledge base of psychoanalysis so that integration with the new sciences of the mind becomes increasingly easier. Not only will psychoanalysts be able more readily to show that their treatment works, but they will have new possibilities of communicating with other scientists about their discoveries. It is to this set of opportunities that I would now like to turn. The integration of psychoanalytic ideas with modern science is unlikely to interest investigators from other disciplines unless psychoanalysis can actually contribute to directing or to informing data collection in these disciplines. For psychoanalysis to be taken seriously as a scientific study of the mind, it has to engage in systematic laboratory studies, epidemiological surveys or qualitative exploration in the social sciences.

Of course, methods for such systematic research are still in their infancy. The validation of theory poses a formidable challenge. Even apparently easily operationalisable constructs such as defense mechanisms have rarely been formulated with the kind of exactness required by research studies. Extra-clinical investigations, however, may help to constrain theorizing; for example our growing knowledge of infants' actual capacities may enable us to limit speculation concerning the impact of infancy on adult function. The projective processes of infancy are unlikely to work in the adultomorphic way described by Bion ( 22 - 24 ) and Klein ( 25 - 27 ), but this does not mean that these descriptions do not contain important truths about adult mental function, simply that 'infancy' is used metaphorically in these theorizations about mental process. For example, evidence from infant research provides strong evidence for Bion's containment concept. It uses the more readily operationalizable notion of 'marked mirroring' to denote the mother's capacity to reflect the infant's affect, while also communicating that the affect she is expressing is not hers but the infant's ( 28 - 30 ). Mothers who can 'mark' their emotional expression (add a special set of attributes, such as playfulness, to their expression of the child's affect that makes it clearly different from their own expression of that affect) appear to be able to soothe their baby considerably more rapidly. This may not be all that Bion meant by containment, but it seems to be linked to his hypotheses concerning the subsequent problems faced by individuals whose caregivers were unable to provide this mirroring encounter with emotion regulation. Restricting theory building to the clinical domain is foolhardy in the extreme.

To summarize, psychoanalysis could benefit from integrating its working theories with research findings from other fields by elaborating the psychoanalytic psychological models of the mechanisms involved in key mental processes. This in turn would help to systematize the psychoanalytic knowledge base, so that integration with the new sciences of the mind becomes increasingly easier. Not only will we be able more readily to show that our treatment works, but we will have new possibilities of communicating with other scientists about our discoveries. The integration of psychoanalytic ideas with modern science is unlikely to interest investigators from other disciplines unless psychoanalysis can actually contribute to directing or to informing data collection in these disciplines. Merely reviewing ideas in developmental science or neuroscience for their proximity to psychoanalytic hypotheses has scant relevance to them. For psychoanalysis to take its place at the high table of the scientific study of the mind, it has to show its mettle in the battlefield of systematic laboratory studies, epidemiological surveys or qualitative exploration in the social sciences.

THE EVIDENCE BASE OF PSYCHOANALYTIC TREATMENT

The evidence base for psychoanalytic therapy remains thin. There is little doubt that the absence of solid and persuasive evidence for the efficacy of psychoanalysis is the consequence of the self-imposed isolation of psychoanalysis from the empirical sciences. Few would dispute the assertion that psychoanalytic theory is in a perilous state. The psychoanalytic clinical situation might have yielded all that it can offer to advance our understanding of mind. Yet 'importing' extra-clinical data is often fiercely resisted and those psychoanalysts who have attempted to do so have commonly been subjected to subtle and not so subtle derision.

Psychoanalysts have been encouraged by the body of research that supports brief dynamic psychotherapy. A meta-analysis of 26 such studies has yielded effect sizes comparable to other approaches ( 31 ). It may even be slightly superior to some other therapies if long term follow-up is included in the design. One of the best designed randomized controlled trials (RCTs), the Sheffield Psychotherapy Project ( 32 ), found evidence for the effectiveness of a 16 session psychodynamic treatment based on Hobson's model ( 33 ) in the treatment of major depression. There is evidence for the effectiveness of psychodynamic therapy as an adjunct to drug dependence programs ( 34 ). There is ongoing work on a brief psychodynamic treatment for panic disorder ( 35 ). There is evidence for the use of brief psychodynamic approaches in work with older people ( 36 ).

There are psychotherapy process studies which offer qualified support for the psychoanalytic case. For example, psychoanalytic interpretations given to clients which are judged to be accurate are reported to be associated with relatively good outcome ( 37 , 38 ). There is even tentative evidence from the reanalysis of therapy tapes from the National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program that the more the process of a brief therapy (e.g. cognitive-behavioural therapy, CBT) resembles that of a psychodynamic approach, the more likely it is to be effective ( 39 ).

Evidence is available to support therapeutic interventions which are clear derivatives of psychoanalysis. However, most analysts would consider that the aims and methods of short-term once a week psychotherapy are not comparable to 'full analysis'. What do we know about the value of intensive and long-term psychodynamic treatment? Here the evidence base becomes somewhat patchy.

The Boston Psychotherapy Study ( 40 ) compared longterm psychoanalytic therapy (two or more times a week) with supportive therapy for clients with schizophrenia in a randomized controlled design. There were some treatment specific outcomes, but on the whole clients who received psychoanalytic therapy fared no better than those who received supportive treatment. In a more recent randomized controlled study ( 41 ), individuals with a diagnosis of borderline personality disorder were assigned to a psychoanalytically oriented day-hospital treatment or treatment as usual. The psychoanalytic arm of the treatment included therapy groups three times a week as well as individual therapy once or twice a week over an 18 month period. There were considerable gains in this group relative to the controls and these differences were not only maintained in the 18 months following discharge, but increased, even though the day hospital group received less treatment than the control group ( 42 ). The cost-effectiveness of these treatments is surprisingly impressive, with the cost of psychoanalytic partial hospital treatment comparable to treatment as usual for these patients, and the costs of the treatment mostly recovered in terms of savings in service use within 18 months of the end of treatment ( 43 - 46 ). Trials with similar patient groups using comparisons of outpatient psychoanalytic therapy treatments with extended baselines have yielded relatively good outcomes ( 47 ) as did comparisons with treatment as usual ( 48 ). Several prospective follow-along studies using a pre-post design have suggested substantial improvements in patients given psychoanalytic therapies for personality disorders ( 49 - 51 ). Uncontrolled studies, however, particularly those with relatively small sample sizes and clinical populations whose condition is known to fluctuate wildly, cannot yield data of consequence concerning what type of treatment is likely to be effective for whom.

A further controlled trial of intensive psychoanalytic treatment of children with chronically poorly controlled diabetes reported significant gains in diabetic control in the treated group which was maintained at one year follow-up ( 52 ). Experimental single case studies carried out with the same population supported the causal relationship between interpretive work and improvement in diabetic control and physical growth ( 53 ). The work of Heinicke also suggests that four or five times weekly sessions may generate more marked improvements in children with specific learning difficulties than a less intensive psychoanalytic intervention ( 54 ).

One of the most interesting studies to emerge recently was the Stockholm Outcome of Psychotherapy and Psychoanalysis Project ( 55 ). The study followed 756 persons who received national insurance funded treatment for up to three years in psychoanalysis or in psychoanalytic psychotherapy. The groups were matched on many clinical variables. Four or five times weekly analysis had similar outcomes at termination when compared with one to two sessions per week psychotherapy. However, in measurements of symptomatic outcome using the Short Check List-90 (SCL-90), improvement on three year follow-up was substantially greater for individuals who received psychoanalysis than those in psychoanalytic psychotherapy. In fact, during the follow-up period, psychotherapy patients did not change, but those who had had psychoanalysis continued to improve, almost to a point where their scores were indistinguishable from those obtained from a non-clinical Swedish sample.

A large scale follow-up study of a representatively selected group of psychoanalytically and psychotherapeutically treated individuals was recently reported from the German Psychoanalytic Association's collaborative investigation ( 56 ). A selection of patients whose treatments had taken place in a designated time period were interviewed by independent assessors and outcomes assessed by both standardized and interviewer coded instruments. While the group had been quite impaired at the time of referral according to retrospective assessments, on follow-up over 80% showed good outcomes. Follow-up data was favorable in relation to both anxiety and depression and savings were also demonstrated in relation to the use of hospital and outpatient medical treatment of physical symptoms replicating earlier German investigations ( 57 ). This carefully conducted study also provided important qualitative data in relation to the experience of psychoanalytic treatment and the relatively common disjunction of psychological changes at the level of self-understanding, and interpersonal-relational and work-related domains.

Another large pre-post study of psychoanalytic treatments has examined the clinical records of 763 children who were evaluated and treated at the Anna Freud Centre, under the close supervision of Freud's daughter ( 58 - 61 ). Children with certain disorders (e.g. depression, autism, conduct disorder) appeared to benefit only marginally from psychoanalysis or psychoanalytic psychotherapy. Interestingly, children with severe emotional disorders (three or more Axis I diagnoses) did surprisingly well in psychoanalysis, although they did poorly in once or twice a week psychoanalytic psychotherapy. Younger children derived greatest benefit from intensive treatment. Adolescents appeared not to benefit from the increased frequency of sessions. The importance of the study is perhaps less in demonstrating that psychoanalysis is effective, although some of the effects on very severely disturbed children were quite remarkable, but more in identifying groups for whom the additional effort involved in intensive treatment appeared not to be warranted.

The Research Committee of the International Psychoanalytic Association has recently prepared a comprehensive review of North American and European outcome studies of psychoanalytic treatment ( 62 ). The Committee concluded that existing studies failed to unequivocally demonstrate that psychoanalysis is efficacious relative to either an alternative treatment or an active placebo, and identified a range of methodological and design problems in the fifty or so studies described in the report. Nevertheless, the report is encouraging to psychoanalysts. A number of studies testing psychoanalysis with 'state of the art' methodology are ongoing and are likely to produce more compelling evidence over the next years. Despite the limitations of the completed studies, evidence across a significant number of pre-post investigations suggested that psychoanalysis appears to be consistently helpful to patients with milder (neurotic) disorders and somewhat less consistently so for other, more severe groups. Across a range of uncontrolled or poorly controlled cohort studies, mostly carried out in Europe, longer intensive treatments tended to have better outcomes than shorter, non-intensive treatments. The impact of psychoanalysis was apparent beyond symptomatology, in measures of work functioning and reductions in health care costs.

THE LIMITATIONS OF THE EVIDENCE BASED APPROACH

There are limitations concerning the nature of the evidence base for all psychotherapies. These limitations are well-known and their implications go well beyond the evaluation of the current status of psychoanalysis. The outcomes literature concerns RCTs administered over relatively brief periods (three to six months) with short follow-ups and a failure to control for inter-current treatments over these periods. Most evidence-based treatment reviews have been uniquely based on RCTs. RCTs in psychosocial treatments are often regarded as inadequate because of their low external validity or generalizability ( 63 ). In brief, they are not relevant to clinical practice - a hotly debated issue in the field of psychotherapy ( 64 ) and psychiatric research ( 65 ). There are a number of well publicized reasons: a) the unrepresentativeness of healthcare professionals participating; b) the unrepresentativeness of participants screened for inclusion to maximize homogeneity; c) the possible use of atypical treatments designed for a single disorder; d) limiting the measurement of outcome to the symptom that is the focus of the study and is easily measurable ( 66 ).

Belief in the supremacy of RCTs opens the door to treatments which, even if effective, one may not wish to entertain. A recent report in the British Medical Journal on the effects of remote, retro-active intercessory prayer on the outcome of patients with bloodstream infection is salutary. Leonard Leibovici ( 67 ) from the Rabin Medical Centre in Israel randomized 3,393 adult patients whose bloodstream infection was detected in the hospital between 1990 and 1996. A list of the first names of the patients in the intervention group was given to a person who said a short prayer for the wellbeing and recovery of the group as a whole. It was argued that as God is unlikely to be limited by linear time, an intervention carried out 4-10 years after the patients' infection and hospitalization was as likely to be effective as one carried out during the infection. Staggeringly, there were significant results on two of the three outcome measures. Length of hospital stay and duration of fever were both shorter in the intervention group. Mortality was also lower in the intervention group but the difference was not statistically significant. As two other independent studies also support intercessory prayer ( 68 , 69 ) by the American Psychological Association's criteria for empirically based treatments, this intervention should be accepted except for the heterogeneity of the medical conditions for which the treatment was used. This finding highlights the risk associated with an atheoretical stance to evidence based practice that reifies and idealises a research design. RCTs unquestionably have the potential to yield clinically relevant data in the absence of an adequate understanding of the underlying process. When James Lind in 1753 determined that lemons and limes cured scurvy, he knew nothing about ascorbic acid, nor did he understand the concept of a nutrient. Yet Leibovici's study demonstrates the absurdity which can be created by bringing the world of rigorous measurement into a domain that is totally unsuited to it.

Most importantly from the standpoint of psychoanalysis, the current categorization in evidence-based psychotherapies conflates two radically different groups of treatments: those that have been adequately tested and found ineffective for a client group, and those that have not been tested at all. It is important to make this distinction, since the reason that a treatment has not been subjected to empirical scrutiny may have little to do with its likely effectiveness. It may have far more to do with the intellectual culture within which researchers operate, the availability of treatment manuals, and peer perceptions of the value of the treatment (which can be critical for both funding and publication). The British psychodynamically oriented psychiatrist Jeremy Holmes ( 70 ) has eloquently argued in the British Medical Journal that the absence of evidence for psychoanalytic treatment should not be confused with evidence of ineffectiveness. In particular, his concern was that cognitive therapy would be adopted by default because of its research and marketing strategy rather than its intrinsic superiority. He argued that: a) the foundations of cognitive therapy were less secure than often believed; b) the impact of CBT on long-term course of psychiatric illness was not well demonstrated; c) in one 'real life trial' at least the CBT arm had to be discontinued because of poor compliance from a problematic group of patients who nevertheless accepted and benefited from couples therapy ( 71 ); d) the effect size of CBT is exaggerated by comparisons with waiting list controls; e) the emergence of a post-CBT approach (e.g. 72 , 73 ) that leans increasingly on psychodynamic ideas.

Whilst the present author is entirely in sympathy with Holmes' perspective, even if his work with Roth ( 74 ) was one of the targets of his criticism, it is only fair to expose the shortcomings of his communication. Tarrier ( 75 ), in a commentary on Holmes' piece, writes with passion: "Holmes relies on the specious old adage that absence of evidence is not evidence of absence [of effectiveness]. [...] I would have more enthusiasm for this argument if traditional psychotherapy were new. It has been around for 100 years or so. The argument, therefore, becomes a little less compelling when psychotherapy's late arrival at the table of science has been triggered by a threat to pull the plug on public funding because of the absence of evidence". Sensky and Scott ( 76 ) were similarly outraged both by Holmes' selective review of evidence and his allegations that some cognitive therapists are starting to question aspects of their discipline. The message from the CBT camp is this: if psychoanalytic clinicians are going to address the issue of evidence based practice, they will have to do more than gripe and join in the general endeavour to acquire data.

Of course, psychodynamic clinicians are at a disadvantage and not simply because they are late starters (after all, many new treatments find a place at the table of evidence based practice). There are profound incompatibilities between psychoanalysis and modern natural science. Whittle ( 77 ) has drawn attention to the fundamental incompatibility of an approach that aims to fill in gaps in self-narrative with cognitive psychology's commitment to minimal elaboration of observations, a kind of Wittgensteinian cognitive asceticism. In the former context, success is measured as eloquence (or meaningfulness) which is not reducible to either symptom or suffering. Moreover, psychoanalytic explanations invoke personal history, but behaviour genetics has brought environmental accounts into disrepute. While CBT also has environmentalist social learning theory at its foundations, it has been more effective in moving away from a naïve environmentalist position. To make matters worse, within psychoanalysis there has been a tradition of regarding the uninitiated with contempt, scaring off most open-minded researchers.

Psychoanalysts are not yet fully committed to systematically collecting data with the potential to challenge and contradict as well as to confirm cherished ideas. The danger that must be avoided at all costs is that research is embraced selectively only when it confirms previously held views. This may be a worse outcome than the wholesale rejection of the entire enterprise of seeking evidence, since it immunizes against being affected by findings at the same time as creating an illusion of participation in the virtuous cycle of exploring, testing, modifying and re-exploring ideas.

But the absence of psychoanalytic research raises a related problem that particularly concerns me. A recent study from Luborsky's research team ( 78 ) demonstrates that the allegiance of the researcher predicts almost 70% of the variance in outcome across studies, with a remarkable multiple r of .85 if three different ways of measuring allegiance are simultaneously introduced. This means that 92% of the time we can predict which of two treatments compared will be most successful based on investigator allegiance alone. This becomes a pernicious self-fulfilling prophecy, as investigators who favour less focused more long-term treatment approaches are gradually excluded from the possibility of receiving funding and, if their treatments are subjected to systematic inquiry at all, these studies are performed by those with least interest in such treatments.

CONCLUSIONS

Our aim should be to assist the movement of psychoanalysis toward science. In order to ensure a future for psychoanalysis and psychoanalytic therapies within psychiatry, psychoanalytic practitioners must change their attitude in the direction of a more systematic outlook. This attitude shift would be characterized by several components: a) The evidence base of psychoanalysis should be strengthened by adopting additional data-gathering methods that are now widely available in biological and social science. New evidence may assist psychoanalysts in resolving theoretical differences, a feat which the current database of predominantly anecdotal clinical accounts have not been capable of achieving. b) The logic of psychoanalytic discourse would need to change from its overdependence on rhetoric and global constructs to using specific constructs that allow for cumulative data-gathering. c) Flaws in psychoanalytic scientific reasoning, such as failures to consider alternative accounts for observations (beyond that favored by the author), should be overcome and in particular, the issue of genetic and social influence should be approached with increased sophistication. d) The isolation of psychoanalysis should be replaced by active collaboration with other mental health disciplines. Instead of fearing that fields adjacent to psychoanalysis might destroy the unique insights offered by clinical work, we need to embrace the rapidly evolving 'knowledge chain' focused at different levels of the study of brain-behavior relationship, which, as Kandel ( 7 , 79 ) points out, may be the only route to the preservation of the hard won insights of psychoanalysis.

Psychodynamic Approach In Psychology

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

Learn about our Editorial Process

Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

On This Page:

The psychodynamic approach in psychology emphasizes unconscious processes and unresolved past conflicts as influences on behavior. Rooted in Freud’s theories, it explores the interplay of drives, desires, and defense mechanisms in shaping personality and behavior.

Key Takeaways

• The psychodynamic theory is a psychological theory Sigmund Freud (1856-1939) and his followers applied to explain the origins of human behavior.
• The psychodynamic approach includes all the theories in psychology that see human functioning based upon the interaction of drives and forces within the person, particularly the unconscious, and between the different structures of the personality.
• The words psychodynamic and psychoanalytic are often confused. Remember that Freud’s theories were psychoanalytic, whereas the term ‘psychodynamic’ refers to his theories and those of his followers.
• Sigmund Freud’s psychoanalysis was the original psychodynamic theory. Psychoanalysis is also the name given to the therapy derived from the theory of Sigmund Freud.
• The psychodynamic approach includes all theories that were based on Freud and his followers, including Carl Jung (1912), Melanie Klein (1921), Alfred Adler (1927), Anna Freud (1936), and Erik Erikson (1950).

Sigmund Freud (writing between the 1890s and the 1930s) developed a collection of theories which have formed the basis of the psychodynamic approach to psychology.

His theories are clinically derived – i.e., based on what his patients told him during therapy. The psychodynamic therapist would usually be treating the patient for depression or anxiety-related disorders.

Summary Table

Theoretical Assumptions

Theoretical assumptions in psychology are basic statements or beliefs that provide a framework for understanding human behavior. They also help researchers to develop new theories and to test existing theories.

Importance of the unconscious mind

The unconscious mind comprises mental processes inaccessible to consciousness that influence judgment, feelings, or behavior (Wilson, 2002).

According to the psychodynamic approach, the unconscious is the part of the mind that contains things we are unaware of, such as feelings, thoughts, urges, and memories.

According to Freud (1915), the unconscious mind is the primary source of human behavior. Like an iceberg, the most important part of the mind is the part you cannot see. Our feelings, motives, and decisions are powerfully influenced by past experiences and stored in the unconscious.

Most of the content of the unconscious is unacceptable or unpleasant and could cause feelings of pain, anxiety, or conflict if it becomes conscious.

For example, hysteria is an example of a physical symptom that has no physical cause though the ailment is just as real as if it had, but rather is caused by some underlying unconscious problem.

The unconscious is seen as a vital part of the individual. It is irrational, emotional, and has no concept of reality which is why its attempts to leak out must be inhibited.

The role of the unconscious mind is to protect the ego from this content. However, according to Freud, the content of the unconscious motivates our feelings, motives, and decisions.

Importance of early experience

Our behavior and feelings as adults (including psychological problems) are rooted in our childhood experiences.

The psychodynamic theory states that events in our childhood have a significant influence on our adult lives, shaping our personality. 

Personality is shaped as the drives are modified by different conflicts at different times in childhood (during psychosexual development).

Freud’s theory of psychosexual stages of development predicated that childhood experiences create the adult personality. Events that occur in childhood can remain in the unconscious and cause problems as adults, such as mental illness.

Psychic determinism

Psychodynamic theory is strongly determinist as it views our behavior as entirely caused by unconscious emotional drives over which we have no control.

Unconscious thoughts and feelings can transfer to the conscious mind through parapraxes, popularly known as Freudian slips or slips of the tongue. We reveal what is really on our minds by saying something we didn’t mean to.

Freud believed that slips of the tongue provided an insight into the unconscious mind and that there were no accidents, every behavior (including slips of the tongue) was significant (i.e., all behavior is determined).

Behavior can be explained in terms of the inner conflicts of the mind

Personality comprises three parts (i.e., tripartite): the id, ego, and super-ego . Parts of the unconscious mind (the id and superego) are in constant conflict with the conscious part of the mind (the ego). 

• The id is the primitive and instinctive component of personality. It consists of all the inherited (i.e., biological) components of personality present at birth, including the sex (life) instinct – Eros (which contains the libido), and the aggressive (death) instinct – Thanatos.
• The ego develops to mediate between the unrealistic id and the external real world. It is the decision-making component of personality.
• The superego incorporates society’s values and morals, which are learned from one’s parents and others. It has two components: the ego ideal, which sets the standards, and the conscience, which produces guilt. 

When unconscious conflicts between the id and the superego cannot be resolved by the ego, they create anxiety. To reduce this anxiety, we use defense mechanisms such as repression.

To be mentally healthy, the ego has to be able to balance the demands of the ego and the superego. If the superego is dominant, the individual might develop a neurosis e.g., depression. If the id is dominant, the individual might develop a psychosis e.g., schizophrenia.

According to the psychodynamic approach, the therapist would resolve the problem by assisting the client to delve back into their childhood and identify when the problem arose.

Having identified the problem, this can be brought into the conscious, where the imbalance can be resolved, returning equanimity between the id, ego, and superego.

Consequently, the defense mechanisms will only operate at the maintenance level, and the mental illness will be cured.

Key Figures

• Sigmund Freud : Freud is the founder of psychoanalysis and the psychodynamic approach. He developed many key concepts of psychodynamic theory, such as the unconscious mind, psychosexual development, and defense mechanisms.

Freudians and neo-Freudians both subscribe to the psychodynamic approach to psychology, which emphasizes the role of unconscious mental processes in human behavior and emotions.

Neo-Freudians expanded on or challenged Freud’s original theories. They were all influenced by Freud’s work, but they also developed their own unique theories about human behavior and personality. 

• Carl Jung :  Jung was a Swiss psychiatrist and one of Freud’s closest collaborators. However, he later broke away from Freud to develop his theory of personality, known as Jungian analysis. Jung’s theory emphasized the importance of the collective unconscious, a shared reservoir of knowledge and experience inherited from our ancestors.
• Alfred Adler : Adler was another Austrian psychiatrist who was a student of Freud’s. However, he later broke away from Freud to develop his theory of personality, known as individual psychology. Adler’s theory emphasized the importance of striving for superiority and belonging.
• Melanie Klein : Klein was a British psychoanalyst who contributed significantly to understanding early childhood development and child psychopathology.
• Karen Horney : Horney was a German-American psychoanalyst who was one of the first female psychoanalysts to be taken seriously. Her work focused on the impact of social and cultural factors on personality development. Horney believed that anxiety was the root cause of all psychopathology.
• Erik Erikson : Erikson was a German-American psychoanalyst who developed the theory of psychosocial development. Erikson’s theory describes the eight stages of development that people go through from birth to death.

Psychodynamic vs Psychoanalytic

Both psychodynamic and psychoanalytic theories originate from the ideas of Sigmund Freud, but they have different applications and emphases.

Psychoanalytic theory is the original theory of the unconscious mind, developed by Sigmund Freud. Freud believed the unconscious mind is a powerful force influencing our thoughts, feelings, and behaviors. He also believed that childhood experiences are critical in shaping personality and behavior.

Psychodynamic theory is a broader term that encompasses a variety of theories that are based on Freudian principles.

Psychodynamic theorists generally agree that the unconscious mind is important, but they may have different views on its role in human behavior and how it develops.

Some psychodynamic theorists also emphasize social and cultural factors more than Freud did. Some of the most notable Neo-Freudians include Carl Jung, Alfred Adler, Karen Horney, and Erich Fromm.

Historical Timeline

• Anna O, a patient of Dr. Joseph Breuer (Freud’s mentor and friend) from 1800 to 1882 suffered from hysteria.
• In 1895 Breuer and his assistant, Sigmund Freud, wrote a book, Studies on Hysteria . In it, they explained their theory: Every hysteria is the result of a traumatic experience, one that cannot be integrated into the person’s understanding of the world. The publication establishes Freud as “the father of psychoanalysis.
• By 1896, Freud had found the key to his own system, naming it psychoanalysis . In it, he had replaced hypnosis with “free association.”
• In 1900, Freud published his first major work, The Interpretation of Dreams , which established the importance of psychoanalytical movement.
• In 1902, Freud founded the Psychological Wednesday Society , later transformed into the Vienna Psychoanalytic Society .
• As the organization grew, Freud established an inner circle of devoted followers, the so-called “Committee” (including Sàndor Ferenczi, and Hanns Sachs (standing) Otto Rank, Karl Abraham, Max Eitingon, and Ernest Jones).

• Freud and his colleagues came to Massachusetts in 1909 to lecture on their new methods of understanding mental illness. Those in attendance included some of the country’s most important intellectual figures, such as William James , Franz Boas, and Adolf Meyer.
• In the years following the visit to the United States, the International Psychoanalytic Association was founded. Freud designated Carl Jung as his successor to lead the Association, and chapters were created in major cities in Europe and elsewhere. .
• Regular meetings or congresses were held to discuss the theory, therapy, and cultural applications of the new discipline.
• Carl Jung’s study on schizophrenia, The Psychology of Dementia Praecox, led him to collaborate with Sigmund Freud.
• Jung’s close collaboration with Freud lasted until 1913. Jung had become increasingly critical of Freud’s exclusively sexual definition of libido and incest. The publication of Jung’s Wandlungen und Symbole der Libido (known in English as The Psychology of the Unconscious) led to a final break.
• Following his emergence from this period of crisis, Jung developed his own theories systematically under the name of Analytical Psychology. Jung’s concepts of the collective unconscious and the archetypes led him to explore religion in the East and West, myths, alchemy, and later flying saucers.
• Melanie Klein took psychoanalytic thinking in a new direction by recognizing the importance of our earliest childhood experiences in the formation of our adult emotional world. .After becoming a full member of the Berlin Psychoanalytic Society in 1923, Klein embarks upon her first analysis of a child. 
• Extending and developing Sigmund Freud’s ideas, Klein drew on her analysis of children’s play to formulate new concepts such as the paranoid-schizoid position and the depressive position.
• Alfred Adler (1927) thought that the basic psychological element of neurosis was a sense of inferiority and that individuals suffering with the symptoms of this phenomenon spent their lives trying to overcome the feelings without ever being in touch with reality
• Wilhelm Reich (1933) was a psychoanalyst who developed a number of radical psychoanalytical and physical theories. An apprentice of Freud, he believed that neuroses, as well as physical illnesses such as cancer, derived from a lack of “orgone energy” in the body.
• Anna Freud (Freud’s daughter) became a major force in British psychology, specializing in the application of psychoanalysis to children.  Among her best known works are The Ego and the Mechanism of defense (1936).
• Erich Fromm , born in Frankfurt, was educated in Heidelberg and Munich before establishing a private psychotherapy practice in 1925. Fromm began as a disciple of Sigmund Freud, combining his psychological theories with Karl Marx’s social principle.

Issues and Debates

Free will vs determinism.

It is strongly determinist as it views our behavior as caused entirely by unconscious factors over which we have no control.

Nature vs. Nurture

Sigmund Freud believed both nature (innate drives) and nurture (early life experiences) played crucial roles in human development. For Freud, the interplay of nature and nurture was central to understanding human psychology.

He posited that individuals have inborn instincts and drives, like the id’s desires. Simultaneously, he emphasized the profound impact of early childhood experiences, especially within the family dynamic, on personality and behavior.

The psychodynamic approach argues that we are driven by innate biological instincts, represented by the Id (nature), but the ways these instincts are expressed are shaped by our social and cultural environment, such as early childhood experiences (nurture).

Holism vs. Reductionism

The psychodynamic approach is determinist as it rejects the idea of free will. A person’s behavior is determined by their unconscious motives which are shaped by their biological drives and their early experiences.

Idiographic vs. Nomothetic

Freud argued that human behavior is governed by universal processes that apply to everyone e.g. the tripartite structure of the mind (nomothetic).

However, he also proposed that the ways in which these processes manifest themselves in the individual is unique (idiographic).

Are the research methods used scientific?

The concepts proposed by Freud cannot be tested empirically . The theory is not falsifiable. If people behave in the way predicted by the theory, it is viewed as a support; if they don’t, it is argued that they are using defense mechanisms.

Critical Evaluation

The psychodynamic approach has given rise to one of the first “talking cure”, psychoanalysis, on which many psychological therapies are now based. Psychoanalysis is rarely used now in its original form, but it is still used in a shorter version in some cases.

Psychoanalytic therapy has been seen as appropriate mainly for the neurotic disorders (e.g. anxiety and eating disorders) rather than for the psychotic disorders such as schizophrenia. It is also used for depression although its effectiveness in this area is more questionable because of the apathetic nature of the depressive patients.

Bachrach et al., (1991) suggests that psychoanalysis may not be appropriate for patients suffering from obsessive-compulsive disorder in that it may inadvertently increase their tendency to over-interpret events in their life.

One of the very influential concept put forward by Freud is the lasting importance of childhood on later life and development. This has influenced Bowlby’s theory of attachment . John Bowlby (1952) was a psychoanalyst (like Freud) and believed that mental health and behavioral problems could be attributed to early childhood.

The greatest criticism of the psychodynamic approach is that it is unscientific in its analysis of human behavior.  Many of the concepts central to Freud’s theories are subjective and as such, difficult to test scientifically.

For example, how can scientifically study concepts like the unconscious mind or the tripartite personality?  In this respect, it could be argued that the psychodynamic perspective is unfalsifiable as its theories cannot be empirically investigated.

However, cognitive psychology has identified unconscious processes, such as procedural memory (Tulving, 1972), automatic processing (Bargh & Chartrand, 1999; Stroop, 1935), and social psychology have shown the importance of implicit processing (Greenwald & Banaji, 1995). Such empirical findings have demonstrated the role of unconscious processes in human behavior.

The concepts of id, ego and superego are very abstract and difficult to test experimentally, so evidence is obtained from case studies ( Little Hans , and Anna O ). However, the sample used in these case studies is mainly Austrian, so lacks population validity.

Kline (1989) argues that psychodynamic theory comprises a series of hypotheses, some more easily tested than others and some with more supporting evidence than others. Also, while the theories of the psychodynamic approach may not be easily tested, this does not mean that it does not have strong explanatory power.

The main problem here is that the case studies are based on studying one person in detail, and concerning Freud, the individuals in question are most often middle-aged women from Vienna (i.e., his patients). This makes generalizations to the wider population (e.g., the whole world) difficult.

Another problem with the case study method is that it is susceptible to researcher bias. Reexamination of Freud’s own clinical work suggests that he sometimes distorted his patients” case histories to “fit” with his theory (Sulloway, 1991).

The humanistic approach criticizes that the psychodynamic perspective is too deterministic. Freud suggests that all thoughts, behaviors, and emotions are determined by our childhood experiences and unconscious mental processes. This is a weakness because it suggests we have no conscious free will over our behavior, leaving little room for the idea of personal agency (i.e., free will).

The individual is not seen as responsible for their disorders however as the conflicts which lead to the disorder are unconscious there is nothing they can do about it without an analyst, they are disempowered.

The psychodynamic approach can be criticized for being sexist against women. For example, Freud believed that females” penis envy made them inferior to males. He also thought that females tended to develop weaker superegos and were more prone to anxiety than males.

Finally, it cannot explain the biological symptoms observed in some disorders, such as enlarged ventricles in schizophrenics.

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Is there a difference between psychodynamic and psychoanalytic?

The words psychodynamic and psychoanalytic are often confused. Remember that Freud’s theories were psychoanalytic, whereas the term ‘psychodynamic’ refers to both his theories and those of his followers.

What is psychodynamic in simple terms?

Sigmund Freud highlights the role of the unconscious mind, the structure of personality, and the influence that childhood experiences have on later life.

Freud believed that the unconscious mind determines most of our behavior and that we are motivated by unconscious emotional drives.

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