Contemporary Psychoanalytic Therapy Isn’t Weird

Imagine all of psychoanalysis, a field with over 100 years of history, as a very big tree with Freud as the very bottom of the trunk and recent books and papers as the outermost branches. Jung's work, for example, branches out so early and grows so far away that we can think of Jungian psychoanalysis as being a separate tree. The center of this psychoanalytic tree has a few big solid branches with many many smaller branches stemming out and intertwining. Those central branches are the work of psychoanalysts such as Melanie Klein, Donald Winnicott, Wilfred Bion, Anna Freud, Salvador Ferenczi, and many more. Their ideas are what is taught at present, more often than Freud's, at psychoanalytic institutes, often in a pluralistic way, focused on pragmatic ways to use psychoanalytic theory to improve clinical practice. These ideas are the core of what I call "Contemporary Clinical Psychoanalysis."

Psychoanalysis has garnered an unfair reputation for being too weird to be true, perhaps even incoherent, and unscientific. Now, it is true that some of the branches on our psychoanalytic tree are strange theories stated in hard to understand language with little empirical grounding and less clinical use. But most of those branches involve ideas that are more popular with academics in the humanities than clinicians in contemporary practice. Those ideas that don’t help everyday clinicians understand patients, that are too abstract and not pragmatic, get ignored by practicing psychoanalytic clinicians who need ideas that help their clinical work. The result of this weeding out of the impractical has been the creation, over generations, of what I am calling Contemporary Clinical Psychoanalytic Psychotherapy, which is distinct from more abstruse, strange, perhaps occasionally unintelligible psychoanalytic ideas one might find in the academic humanities.

Is Contemporary Clinical Psychoanalytic Psychotherapy Too Weird to Be Believed?

The theories that make up Contemporary Clinical Psychoanalytic Psychotherapy have been created by generations of clinicians who hear patients talk about themselves in sessions and reveal themselves in the deepest and most intimate ways not normally accessible to even their closest friends, never mind a researcher with a survey. The clinician then takes this rich information about patients and tries to formulate, often via a metaphor, a way of seeing what might be happening, with at least some of these patients, that could be clinically useful to other therapists in at least in some cases.

Think, for example, of the very old Freudian idea of a defense mechanism. It’s a metaphor, a lens, or way of seeing things. There isn’t really a machine, nor a set of real battles in which “defenses” need to be deployed. But we can see ourselves as having defense mechanisms in that we don’t consciously attend to something because it would be distressing. It seems as if some automatic machinery exists inside of us to protect us from certain kinds of distress, and we can better understand how that metaphorical machinery works and what it might be protecting us from.

This way of seeing ourselves as having defense mechanisms is not a “weird” idea; it doesn’t violate common sense. Belief in defense mechanisms goes beyond common sense, I suppose, because you could live your life as a person with common sense, not understanding or ever thinking about defense mechanisms. But the idea doesn’t conflict with common sense either. Once you understand yourself as having defense mechanisms, you can enrich your self-understanding beyond common sense by exploring what your defense mechanisms might be and what activates them.

Of course, some small percentage of psychoanalytic theory is pure gobbledygook or of little clinical value. Psychoanalysis is a big tent with theorists writing for over 100 years, so there will be bad writing and bad ideas. Even so, that doesn’t mean it should all be cast as weird or absurd. By analogy, compare psychoanalysis with the last 100 years of philosophy. Yes, some philosophy is pure nonsense or word salad. But if you ignored all of the philosophy written over the last 100 years, you would know nothing about feminism, existentialism, many debates about different conceptions of justice, ideas about the limits of science and how to formulate the scientific method, and far more.

Is Contemporary Clinical Psychoanalytic Psychotherapy Scientific?

Since its inception, psychoanalysis has always striven to be a blend of science and the art of taking the meaning of each human’s experience seriously. Undeniably, some of Freud’s very old theories have now been shown to be false.

Freud plaque

Source: "Freud Plaque" by Megalit / CC BY-SA 4.0

What might surprise casual readers and critics is that contemporary psychoanalysis rejects a good deal of what Freud said; contemporary psychoanalysis continues and revises itself even as some ideas are shown to be false or unsupported. Indeed, much of contemporary psychoanalytic theory and practice is grounded in sound scientific practice. Take, for example, the work of Jonathan Shedler. Contemporary neuroscience also helps ground much of contemporary psychoanalytic practice in science, too, as Mark Solms explains here.

Psychoanalysis is not a stagnant field that only believes what Freud said 100 years ago. In fact, in years of taking psychoanalytic classes at a well respected psychoanalytic institute, I think I have almost never been assigned anything by Freud. His ideas are mentioned, but psychoanalysis is no more Freudian than physics is Newtonian.

Who Are The Contemporary Clinical Psychoanalytic Psychotherapists?

If you still don’t believe that contemporary psychoanalysis is empirically grounded, pragmatic, and conceptually clear, then read any of the following living, leading lights of our field: Nancy McWilliams, Glen Gabbard, Mark Solms, Karen Maroda, Teri Quatman, Adam Phillips, Jonathan Shedler, Antonino Ferro, Thomas Ogden, Alessandra Lemma, or Jonathan Lear. There are far more of course, but read any of these authors and you will not think psychoanalysis is anything but conceptually coherent, clear, intellectually respectable, scientifically grounded, and clinically useful.