Psychoanalysis Today

As the author of the American Psychological Association’s Theories of Psychotherapy Series graduate-level introduction to psychoanalytically oriented theory and practice, I am often asked to speak about contemporary psychoanalysis and both similarities and differences between psychoanalytic therapy and other therapeutic orientations. I’m happy to do so because there are so many widespread misconceptions about this topic.

Psychoanalysis is a distinctive form of psychological treatment and a model of psychological functioning, human development and psychopathology. There is no one unified psychoanalytic theory of treatment, but rather a variety of different psychoanalytic theories and treatment models that have developed over more than a century through the writings of a host of different psychoanalytic theorists, practitioners and researchers in different countries.

Despite this lack of a single unified perspective, it is possible to speak in general terms about certain basic principles that tend to cut across different psychoanalytic perspectives. These include:

1. An assumption that all human beings are motivated in part by wishes, fantasies or tacit knowledge that is outside of awareness (this is referred to as unconscious motivation)
2. An interest in facilitating awareness of unconscious motivations, thereby increasing choice
3. An emphasis on exploring the ways in which we avoid painful or threatening feelings, fantasies and thoughts
4. An assumption that we are ambivalent about changing and an emphasis on the importance of exploring this ambivalence
5. An emphasis on using the therapeutic relationship as an arena for exploring clients’ self-defeating psychological processes and actions (both conscious and unconscious)
6. An emphasis on using the therapeutic relationship as an important vehicle of change
7. An emphasis on helping clients to understand the way in which their own construction of their past and present plays a role in perpetuating their self-defeating patterns.

Some people equate psychoanalysis with Sigmund Freud. While there is no doubt that Freud is widely acknowledged as the founder of psychoanalysis, it is a mistake to equate psychoanalysis with Freud or to assume that the validity of psychoanalytic theory or the value of psychoanalytic treatment is dependent on whether or not all of Freud’s ideas and methods have stood the test of time. Freud was one person writing in a particular historical era in a specific culture. Some of his ideas were more valid in their original historical and cultural context than they are in contemporary times, and some were flawed from the beginning.

There are some dramatic differences between the psychoanalysis of Freud’s time and contemporary psychoanalysis. For example, relative to Freud’s times, contemporary American psychoanalysis has a greater emphasis on the mutuality of the therapeutic relationship, an emphasis on the fundamentally human nature of the therapeutic relationship, more of an emphasis on flexibility, creativity and spontaneity in the therapeutic process, and a more optimistic perspective on life and human nature. Contrary to the common misconception, there is a substantial and growing evidence base for the effectiveness of psychoanalytically oriented treatments. The fact that popular media tends to perpetuate the myth that psychoanalytic treatments are “unscientific” or not “empirically supported” does the public a great disservice.

In the United States, psychoanalysis has evolved under the influence of a number of characteristic American attitudes including a tendency towards optimism, and the philosophy of American egalitarianism. Another important factor is that many of today’s leading analysts came of age during the cultural revolution in the 1960s — a time when traditional social norms and sources of authority were being challenged. Contemporary psychoanalysis has absorbed important features of the humanistic and existential approaches to treatment that first emerged in the 1950s and ’60s. These include an emphasis on human freedom, dignity and agency and an appreciation for the complexity of human nature.

In addition, a number of prominent feminist psychoanalytic thinkers have challenged many of the patriarchal assumptions implicit in traditional psychoanalytic theory, raised important questions about the dynamics of power in the therapeutic relationship, and reformulated psychoanalytic thinking about gender. Another influence has been a postmodern sensibility that challenges the assumption that we can ever come to know reality objectively, maintains a skeptical attitude towards universalizing truth claims, and emphasizes the importance of theoretical pluralism.

A final influence has been the massive influx of clinical psychologists into postgraduate psychoanalytic training institutes in the last few decades. This has led to significant and intellectually interesting changes in a discipline that was traditionally dominated by psychiatry. Unfortunately, many people in the broader mental health field and the general public are unaware of these changes within psychoanalysis, and are responding to a partial or caricatured understanding of the tradition based upon aspects of psychoanalytic theory, practice and attitude that are no longer prominent.