Film Analysis Essay On Psychodynamic Theory

Psychoanalysis is a set of theories and therapeutic techniques[1] related to the study of the unconscious mind,[2] which together form a method of treatment for mental-health disorders. The discipline was established in the early 1890s by Austrian neurologist Sigmund Freud and stemmed partly from the clinical work of Josef Breuer and others.

Freud first used the term psychoanalysis (in French) in 1896. Die Traumdeutung (The Interpretation of Dreams), which Freud saw as his "most significant work", appeared in November 1899.[3] Psychoanalysis was later developed in different directions, mostly by students of Freud such as Alfred Adler and Carl Gustav Jung,[a] and by neo-Freudians such as Erich Fromm, Karen Horney and Harry Stack Sullivan.[4] Freud retained the term psychoanalysis for his own school of thought.[5] The basic tenets of psychoanalysis include:

  1. a person's development is determined by often forgotten events in early childhood, rather than by inherited traits alone;
  2. human behaviour and cognition are largely determined by irrational drives that are rooted in the unconscious;
  3. attempts to bring those drives into awareness triggers resistance in the form of defense mechanisms, particularly repression;
  4. conflicts between conscious and unconscious material can result in mental disturbances such as neurosis, neurotic traits, anxiety and depression;
  5. unconscious material can be found in dreams and unintentional acts, including mannerisms and slips of the tongue;
  6. liberation from the effects of the unconscious is achieved by bringing this material into the conscious mind through therapeutic intervention;
  7. the "centerpiece of the psychoanalytic process" is the transference, whereby patients relive their infantile conflicts by projecting onto the analyst feelings of love, dependence and anger.[6]

During psychoanalytic sessions, which typically last 50 minutes and ideally take place 4–5 times a week,[7] the patient (the "analysand") may lie on a couch, with the analyst often sitting just behind and out of sight. The patient expresses his or her thoughts, including free associations, fantasies and dreams, from which the analyst infers the unconscious conflicts causing the patient's symptoms and character problems. Through the analysis of these conflicts, which includes interpreting the transference and countertransference[8] (the analyst's feelings for the patient), the analyst confronts the patient's pathological defenses to help the patient gain insight.

Psychoanalysis is a controversial discipline and its validity as a science is contested. Nonetheless, it remains a strong influence within psychiatry, more so in some quarters than others.[b][c] Psychoanalytic concepts are also widely used outside the therapeutic arena, in areas such as psychoanalytic literary criticism, as well as in the analysis and deconstruction of film, fairy tales and other cultural phenomena.

History

1890s

The idea of psychoanalysis (German: Psychoanalyse) first started to receive serious attention under Sigmund Freud, who formulated his own theory of psychoanalysis in Vienna in the 1890s. Freud was a neurologist trying to find an effective treatment for patients with neurotic or hysterical symptoms. Freud realised that there were mental processes that were not conscious, whilst he was employed as a neurological consultant at the Children's Hospital, where he noticed that many aphasic children had no apparent organic cause for their symptoms. He then wrote a monograph about this subject.[11] In 1885, Freud obtained a grant to study with Jean-Martin Charcot, a famed neurologist, at the Salpêtrière in Paris, where Freud followed the clinical presentations of Charcot, particularly in the areas of hysteria, paralyses and the anaesthesias. Charcot had introduced hypnotism as an experimental research tool and developed the photographic representation of clinical symptoms.

Freud's first theory to explain hysterical symptoms was presented in Studies on Hysteria (1895), co-authored with his mentor the distinguished physician Josef Breuer, which was generally seen as the birth of psychoanalysis. The work was based on Breuer's treatment of Bertha Pappenheim, referred to in case studies by the pseudonym "Anna O.", treatment which Pappenheim herself had dubbed the "talking cure". Breuer wrote that many factors that could result in such symptoms, including various types of emotional trauma, and he also credited work by others such as Pierre Janet; while Freud contended that at the root of hysterical symptoms were repressed memories of distressing occurrences, almost always having direct or indirect sexual associations.[12]

Around the same time Freud attempted to develop a neuro-physiological theory of unconscious mental mechanisms, which he soon gave up. It remained unpublished in his lifetime.[13]

The first occurrence of the term "psychoanalysis" (written psychoanalyse) was in Freud's essay "L'hérédité et l’étiologie des névroses" which was written and published in French in 1896.[14][15]

In 1896 Freud also published his so-called seduction theory which proposed that the preconditions for hysterical symptoms are sexual excitations in infancy, and he claimed to have uncovered repressed memories of incidents of sexual abuse for all his current patients.[16] However, by 1898 he had privately acknowledged to his friend and colleague Wilhelm Fliess that he no longer believed in his theory, though he did not state this publicly until 1906.[17] Though in 1896 he had reported that his patients "had no feeling of remembering the [infantile sexual] scenes", and assured him "emphatically of their unbelief",[18] in later accounts he claimed that they had told him that they had been sexually abused in infancy. This became the received historical account until challenged by several Freud scholars in the latter part of the 20th century who argued that he had imposed his preconceived notions on his patients.[19][20][21] However, building on his claims that the patients reported infantile sexual abuse experiences, Freud subsequently contended that his clinical findings in the mid-1890s provided evidence of the occurrence of unconscious fantasies, supposedly to cover up memories of infantile masturbation.[22] Only much later did he claim the same findings as evidence for Oedipal desires.[23]

1900–1940s

By 1900, Freud had theorised that dreams had symbolic significance, and generally were specific to the dreamer. Freud formulated his second psychological theory— which hypothesises that the unconscious has or is a "primary process" consisting of symbolic and condensed thoughts, and a "secondary process" of logical, conscious thoughts. This theory was published in his 1900 book, The Interpretation of Dreams.[24] Chapter VII was a re-working of the earlier "Project" and Freud outlined his "Topographic Theory". In this theory, which was mostly later supplanted by the Structural Theory, unacceptable sexual wishes were repressed into the "System Unconscious", unconscious due to society's condemnation of premarital sexual activity, and this repression created anxiety.

This "topographic theory" is still popular in much of Europe, although it has fallen out of favour in much of North America.[25] In 1905, Freud published Three Essays on the Theory of Sexuality[26] in which he laid out his discovery of so-called psychosexual phases: oral (ages 0–2), anal (2–4), phallic-oedipal (today called 1st genital[by whom?]) (3–6), latency (6-puberty), and mature genital (puberty-onward). His early formulation included the idea that because of societal restrictions, sexual wishes were repressed into an unconscious state, and that the energy of these unconscious wishes could be turned into anxiety or physical symptoms. Therefore, the early treatment techniques, including hypnotism and abreaction, were designed to make the unconscious conscious in order to relieve the pressure and the apparently resulting symptoms. This method would later on be left aside by Freud, giving free association a bigger role.

In On Narcissism (1915)[27] Freud turned his attention to the subject of narcissism. Still using an energic system, Freud characterized the difference between energy directed at the self versus energy directed at others, called cathexis. By 1917, in "Mourning and Melancholia", he suggested that certain depressions were caused by turning guilt-ridden anger on the self.[28] In 1919 in "A Child is Being Beaten" he began to address the problems of self-destructive behavior (moral masochism) and frank sexual masochism.[29] Based on his experience with depressed and self-destructive patients, and pondering the carnage of World War I, Freud became dissatisfied with considering only oral and sexual motivations for behavior. By 1920, Freud addressed the power of identification (with the leader and with other members) in groups as a motivation for behavior (Group Psychology and the Analysis of the Ego).[30] In that same year (1920) Freud suggested his "dual drive" theory of sexuality and aggression in Beyond the Pleasure Principle, to try to begin to explain human destructiveness. Also, it was the first appearance of his "structural theory" consisting three new concepts id, ego, and superego.[31]

Three years later, he summarised the ideas of id, ego, and superego in The Ego and the Id.[32] In the book, he revised the whole theory of mental functioning, now considering that repression was only one of many defense mechanisms, and that it occurred to reduce anxiety. Hence, Freud characterised repression as both a cause and a result of anxiety. In 1926, in Inhibitions, Symptoms and Anxiety, Freud characterised how intrapsychic conflict among drive and superego (wishes and guilt) caused anxiety, and how that anxiety could lead to an inhibition of mental functions, such as intellect and speech.[33]Inhibitions, Symptoms and Anxiety was written in response to Otto Rank, who, in 1924, published Das Trauma der Geburt (translated into English in 1929 as The Trauma of Birth), analysing how art, myth, religion, philosophy and therapy were illuminated by separation anxiety in the "phase before the development of the Oedipus complex".[34] Freud's theories, however, characterized no such phase. According to Freud, the Oedipus complex, was at the centre of neurosis, and was the foundational source of all art, myth, religion, philosophy, therapy—indeed of all human culture and civilization. It was the first time that anyone in the inner circle had characterised something other than the Oedipus complex as contributing to intrapsychic development, a notion that was rejected by Freud and his followers at the time.

By 1936 the "Principle of Multiple Function" was clarified by Robert Waelder.[35] He widened the formulation that psychological symptoms were caused by and relieved conflict simultaneously. Moreover, symptoms (such as phobias and compulsions) each represented elements of some drive wish (sexual and/or aggressive), superego, anxiety, reality, and defenses. Also in 1936, Anna Freud, Sigmund's daughter, published her seminal book, The Ego and the Mechanisms of Defense, outlining numerous ways the mind could shut upsetting things out of consciousness.[36]

1940s–present

When Hitler's power grew, the Freud family and many of their colleagues fled to London. Within a year Sigmund Freud died.[37] In the United States, also following the death of Freud, a new group of psychoanalysts began to explore the function of the ego. Led by Heinz Hartmann, Kris, Rappaport and Lowenstein, the group built upon understandings of the synthetic function of the ego as a mediator in psychic functioning[jargon]. Hartmann in particular distinguished between autonomous ego functions (such as memory and intellect which could be secondarily affected by conflict) and synthetic functions which were a result of compromise formation[jargon]. These "Ego Psychologists" of the 1950s paved a way to focus analytic work by attending to the defenses (mediated by the ego) before exploring the deeper roots to the unconscious conflicts. In addition there was burgeoning interest in child psychoanalysis. Although criticized since its inception, psychoanalysis has been used as a research tool into childhood development,[38] and is still used to treat certain mental disturbances.[39] In the 1960s, Freud's early thoughts on the childhood development of female sexuality were challenged; this challenge led to the development of a variety of understandings of female sexual development[citation needed], many of which modified the timing and normality of several of Freud's theories (which had been gleaned from the treatment of women with mental disturbances). Several researchers[40] followed Karen Horney's studies of societal pressures that influence the development of women. The psychoanalyst Mark J. Blechner argued that dreams reveal how the mind works when it is not concerned with communicability.[41]

In the first decade of the 21st century, there were approximately 35 training institutes for psychoanalysis in the United States accredited by the American Psychoanalytic Association (APsaA), which is a component organization of the International Psychoanalytical Association (IPA), and there are over 3000 graduated psychoanalysts practicing in the United States. The IPA accredits psychoanalytic training centers through such "component organisations" throughout the rest of the world, including countries such as Serbia, France, Germany, Austria, Italy, Switzerland,[42] and many others, as well as about six institutes directly in the United States.

Theories

The predominant psychoanalytic theories can be organised into several theoretical schools. Although these theoretical schools differ, most of them emphasize the influence of unconscious elements on the conscious. There has also been considerable work done on consolidating elements of conflicting theories (cf. the work of Theodore Dorpat, B. Killingmo, and S. Akhtar).[43] As in all fields of medicine,[not specific enough to verify] there are some persistent conflicts regarding specific causes of certain syndromes, and disputes regarding the ideal treatment techniques. In the 21st century, psychoanalytic ideas are embedded in Western culture,[vague] especially in fields such as childcare, education, literary criticism, cultural studies, mental health, and particularly psychotherapy. Though there is a mainstream of evolved analytic ideas, there are groups who follow the precepts of one or more of the later theoreticians. Psychoanalytic ideas also play roles in some types of literary analysis such as Archetypal literary criticism.

Topographic theory

Topographic theory was named and first described by Sigmund Freud in The Interpretation of Dreams (1900).[24][44] The theory hypothesizes that the mental apparatus can be divided into the systems Conscious, Preconscious, and Unconscious. These systems are not anatomical structures of the brain but, rather, mental processes. Although Freud retained this theory throughout his life he largely replaced it with the Structural theory.[45] The Topographic theory remains as one of the meta-psychological points of view for describing how the mind functions in classical psychoanalytic theory.

Structural theory

Structural theory divides the psyche into the id, the ego, and the super-ego. The id is present at birth as the repository of basic instincts, which Freud called "Triebe" ("drives"): unorganized and unconscious, it operates merely on the 'pleasure principle', without realism or foresight. The ego develops slowly and gradually, being concerned with mediating between the urging of the id and the realities of the external world; it thus operates on the 'reality principle'. The super-ego is held to be the part of the ego in which self-observation, self-criticism and other reflective and judgmental faculties develop. The ego and the super-ego are both partly conscious and partly unconscious.[45]

Ego psychology

Ego psychology was initially suggested by Freud in Inhibitions, Symptoms and Anxiety (1926). The theory was refined by Hartmann, Loewenstein, and Kris in a series of papers and books from 1939 through the late 1960s. Leo Bellak was a later contributor. This series of constructs, paralleling some of the later developments of cognitive theory, includes the notions of autonomous ego functions: mental functions not dependent, at least in origin, on intrapsychic conflict. Such functions include: sensory perception, motor control, symbolic thought, logical thought, speech, abstraction, integration (synthesis), orientation, concentration, judgment about danger, reality testing, adaptive ability, executive decision-making, hygiene, and self-preservation. Freud noted that inhibition is one method that the mind may utilize to interfere with any of these functions in order to avoid painful emotions. Hartmann (1950s) pointed out that there may be delays or deficits in such functions.

Frosch (1964) described differences in those people who demonstrated damage to their relationship to reality, but who seemed able to test it. Deficits in the capacity to organize thought are sometimes referred to[by whom?] as blocking or loose associations (Bleuler), and are characteristic of schizophrenia.[citation needed] Deficits in abstraction ability and self-preservation also suggest psychosis in adults.[citation needed] Deficits in orientation and sensorium are often indicative of a medical illness affecting the brain (and therefore, autonomous ego functions).[citation needed] Deficits in certain ego functions are routinely found in severely sexually or physically abused children, where powerful effects generated throughout childhood seem to have eroded some functional development.[citation needed]

According to ego psychology, ego strengths, later described by Otto F. Kernberg (1975), include the capacities to control oral, sexual, and destructive impulses; to tolerate painful affects without falling apart; and to prevent the eruption into consciousness of bizarre symbolic fantasy. Synthetic functions, in contrast to autonomous functions, arise from the development of the ego and serve the purpose of managing conflict processes. Defenses are synthetic functions that protect the conscious mind from awareness of forbidden impulses and thoughts. One purpose of ego psychology has been to emphasize that some mental functions can be considered to be basic, rather than derivatives of wishes, affects, or defenses. However, autonomous ego functions can be secondarily affected because of unconscious conflict. For example, a patient may have an hysterical amnesia (memory being an autonomous function) because of intrapsychic conflict (wishing not to remember because it is too painful).

Taken together, the above theories present a group of metapsychological assumptions. Therefore, the inclusive group of the different classical theories provides a cross-sectional view of human mentation. There are six "points of view", five described by Freud and a sixth added by Hartmann. Unconscious processes can therefore be evaluated from each of these six points of view. The "points of view" are: 1. Topographic 2. Dynamic (the theory of conflict) 3. Economic (the theory of energy flow) 4. Structural 5. Genetic (propositions concerning origin and development of psychological functions) and 6. Adaptational (psychological phenomena as it relates to the external world).[46]

Modern conflict theory

Modern conflict theory, a variation of ego psychology, is a revised version of structural theory, most notably different by altering concepts related to where repressed thoughts were stored(Freud, 1923, 1926). Modern conflict theory addresses emotional symptoms and character traits as complex solutions to mental conflict.[47] It dispenses with the concepts of a fixed id, ego and superego, and instead posits conscious and unconscious conflict among wishes (dependent, controlling, sexual, and aggressive), guilt and shame, emotions (especially anxiety and depressive affect), and defensive operations that shut off from consciousness some aspect of the others. Moreover, healthy functioning (adaptive) is also determined, to a great extent, by resolutions of conflict.

A major objective of modern conflict-theory psychoanalysis is to change the balance of conflict in a patient by making aspects of the less adaptive solutions (also called "compromise formations") conscious so that they can be rethought, and more adaptive solutions found. Current theoreticians following Brenner's many suggestions (see especially Brenner's 1982 book, The Mind in Conflict) include Sandor Abend, MD (Abend, Porder, & Willick, (1983), Borderline Patients: Clinical Perspectives), Jacob Arlow (Arlow and Brenner (1964), Psychoanalytic Concepts and the Structural Theory), and Jerome Blackman (2003), 101 Defenses: How the Mind Shields Itself.

Object relations theory

Object relations theory attempts to explain the ups and downs of human relationships through a study of how internal representations of the self and others are organized. The clinical symptoms that suggest object relations problems (typically developmental delays throughout life) include disturbances in an individual's capacity to feel warmth, empathy, trust, sense of security, identity stability, consistent emotional closeness, and stability in relationships with significant others. (It is not suggested that one should trust everyone, for example.) Concepts regarding internal representations (also sometimes termed, "introspects", "self and object representations", or "internalization of self and other") although often attributed to Melanie Klein, were actually first mentioned by Sigmund Freud in his early concepts of drive theory (Three Essays on the Theory of Sexuality, 1905). Freud's 1917 paper "Mourning and Melancholia", for example, hypothesized that unresolved grief was caused by the survivor's internalized image of the deceased becoming fused with that of the survivor, and then the survivor shifting unacceptable anger toward the deceased onto the now complex self-image.[48]

Vamik Volkan, in "Linking Objects and Linking Phenomena", expanded on Freud's thoughts on this, describing the syndromes of "Established pathological mourning" vs. "reactive depression" based on similar dynamics. Melanie Klein's hypotheses regarding internalization during the first year of life, leading to paranoid and depressive positions, were later challenged by René Spitz (e.g., The First Year of Life, 1965), who divided the first year of life into a coenesthetic phase of the first six months, and then a diacritic phase for the second six months. Margaret Mahler (Mahler, Fine, and Bergman, The Psychological Birth of the Human Infant, 1975) and her group, first in New York, then in Philadelphia, described distinct phases and subphases of child development leading to "separation-individuation" during the first three years of life, stressing the importance of constancy of parental figures, in the face of the child's destructive aggression, to the child's internalizations, stability of affect management, and ability to develop healthy autonomy.

John Frosch, Otto Kernberg, Salman Akhtar and Sheldon Bach have developed the theory of self and object constancy as it affects adult psychiatric problems such as psychosis and borderline states. Peter Blos described (in a book called On Adolescence, 1960) how similar separation-individuation struggles occur during adolescence, of course with a different outcome from the first three years of life: the teen usually, eventually, leaves the parents' house (this varies with the culture). During adolescence, Erik Erikson (1950–1960s) described the "identity crisis", that involves identity-diffusion anxiety. In order for an adult to be able to experience "Warm-ETHICS" (warmth, empathy, trust, holding environment (Winnicott), identity, closeness, and stability) in relationships (see Blackman, 101 Defenses: How the Mind Shields Itself, 2001), the teenager must resolve the problems with identity and redevelop self and object constancy.

Self psychology

Self psychology emphasizes the development of a stable and integrated sense of self through empathic contacts with other humans, primary significant others conceived of as "selfobjects". Selfobjects meet the developing self's needs for mirroring, idealization, and twinship, and thereby strengthen the developing self. The process of treatment proceeds through "transmuting internalizations" in which the patient gradually internalizes the selfobject functions provided by the therapist. Self psychology was proposed originally by Heinz Kohut, and has been further developed by Arnold Goldberg, Frank Lachmann, Paul and Anna Ornstein, Marian Tolpin, and others.

Jacques Lacan and Lacanian psychoanalysis

Lacanian psychoanalysis, which integrates psychoanalysis with structural linguistics and Hegelian philosophy, is especially popular in France and parts of Latin America. Lacanian psychoanalysis is a departure from the traditional British and American psychoanalysis, which is predominantly Ego psychology. Jacques Lacan frequently used the phrase "retourner à Freud" ("return to Freud") in his seminars and writings, as he claimed that his theories were an extension of Freud's own, contrary to those of Anna Freud, the Ego Psychology, object relations and "self" theories and also claims the necessity of reading Freud's complete works, not only a part of them. Lacan's concepts concern the "mirror stage", the "Real", the "Imaginary", and the "Symbolic", and the claim that "the unconscious is structured as a language".[49]

Though a major influence on psychoanalysis in France and parts of Latin America, Lacan and his ideas have taken longer to be translated into English and he has thus had a lesser impact on psychoanalysis and psychotherapy in the English-speaking world. In the United Kingdom and the United States, his ideas are most widely used to analyze texts in literary theory.[50] Due to his increasingly critical stance towards the deviation from Freud's thought, often singling out particular texts and readings from his colleagues, Lacan was excluded from acting as a training analyst in the IPA, thus leading him to create his own school in order to maintain an institutional structure for the many candidates who desired to continue their analysis with him.[51]

Interpersonal psychoanalysis

Interpersonal psychoanalysis accents the nuances of interpersonal interactions, particularly how individuals protect themselves from anxiety by establishing collusive interactions with others, and the relevance of actual experiences with other persons developmentally (e.g. family and peers) as well as in the present. This is contrasted with the primacy of intrapsychic forces, as in classical psychoanalysis. Interpersonal theory was first introduced by Harry Stack Sullivan, MD, and developed further by Frieda Fromm-Reichmann, Clara Thompson, Erich Fromm, and others who contributed to the founding of the William Alanson White Institute and Interpersonal Psychoanalysis in general.

Culturalist psychoanalysis

Main article: Culturalist psychoanalysts

Some psychoanalysts have been labeled culturalist, because of the prominence they attributed culture in the genesis of behavior.[52] Among others, Erich Fromm, Karen Horney, Harry Stack Sullivan, have been called culturalist psychoanalysts.[52] They were famously in conflict with orthodox psychoanalysts.[53]

Feminist psychoanalysis

Feminist theories of psychoanalysis emerged towards the second half of the 20th century, in an effort to articulate the feminine, the maternal and sexual difference and development from the point of view of female subjects. For Freud, male is subject and female is object. For Freud, Winnicott and the object relations theories, the mother is structured as the object of the infant's rejection (Freud) and destruction (Winnicott). For Lacan, the "woman" can either accept the phallic symbolic as an object or incarnate a lack in the symbolic dimension that informs the structure of the human subject. Feminist psychoanalysis is mainly post-Freudian and post-Lacanian with theorists like Toril Moi, Joan Copjec, Juliet Mitchell,[54] Teresa Brennan[55] and Griselda Pollock that rethinks Art and Mythology[56] following French feminist psychoanalysis,[57] the gaze and sexual difference in, of and from the feminine.[58] French theorists like Luce Irigaray challenge phallogocentrism.[59][60]Bracha Ettinger offers a "matrixial" subject's dimension that brings into account the prenatal stage (matrixial connectivity)[61] and suggests a feminine-maternal Eros, matrixial gaze and Primal mother-phantasies.[62]Jessica Benjamin addresses the question of the feminine and love.[63] Feminist psychoanalysis informs and includes gender, queer and post-feminist theories.

Adaptive paradigm of psychoanalysis and psychotherapy

Main article: Robert Langs

The "adaptive paradigm of psychotherapy" develops out of the work of Robert Langs. The adaptive paradigm interprets psychic conflict primarily in terms of conscious and unconscious adaptation to reality. Langs’ recent work in some measure returns to the earlier Freud, in that Langs prefers a modified version of the topographic model of the mind (conscious, preconscious, and unconscious) over the structural model (id, ego, and super-ego), including the former’s emphasis on trauma (though Langs looks to death-related traumas rather than sexual traumas).[45] At the same time, Langs’ model of the mind differs from Freud’s in that it understands the mind in terms of evolutionary biological principles.[64]

Relational psychoanalysis

Relational psychoanalysis combines interpersonal psychoanalysis with object-relations theory and with inter-subjective theory as critical for mental health. It was introduced by Stephen Mitchell.[65] Relational psychoanalysis stresses how the individual's personality is shaped by both real and imagined relationships with others, and how these relationship patterns are re-enacted in the interactions between analyst and patient. In New York, key proponents of relational psychoanalysis include Lew Aron, Jessica Benjamin, and Adrienne Harris. Fonagy and Target, in London, have propounded their view of the necessity of helping certain detached, isolated patients, develop the capacity for "mentalization" associated with thinking about relationships and themselves. Arietta Slade, Susan Coates, and Daniel Schechter in New York have additionally contributed to the application of relational psychoanalysis to treatment of the adult patient-as-parent, the clinical study of mentalization in parent-infant relationships, and the intergenerational transmission of attachment and trauma.

Interpersonal-relational psychoanalysis

The term interpersonal-relational psychoanalysis is often used as a professional identification. Psychoanalysts under this broader umbrella debate about what precisely are the differences between the two schools, without any current clear consensus.

Intersubjective psychoanalysis

The term "intersubjectivity" was introduced in psychoanalysis by George E. Atwood and Robert Stolorow (1984). Intersubjective approaches emphasize how both personality development and the therapeutic process are influenced by the interrelationship between the patient's subjective perspective and that of others. The authors of the interpersonal-relational and intersubjective approaches: Otto Rank, Heinz Kohut, Stephen A. Mitchell, Jessica Benjamin, Bernard Brandchaft, J. Fosshage, Donna M.Orange, Arnold "Arnie" Mindell, Thomas Ogden, Owen Renik, Irwin Z. Hoffman, Harold Searles, Colwyn Trevarthen, Edgar A. Levenson, Jay Greenberg, Edward R. Ritvo, Beatrice Beebe, Frank M. Lachmann, Herbert Rosenfeld and Daniel Stern.

Modern psychoanalysis

"Modern psychoanalysis" is a term coined by Hyman Spotnitz and his colleagues to describe a body of theoretical and clinical approaches that aim to extend Freud's theories so as to make them applicable to the full spectrum of emotional disorders and broaden the potential for treatment to pathologies thought to be untreatable by classical methods[vague]. Interventions based on this approach are primarily intended to provide an emotional-maturational communication to the patient, rather than to promote intellectual insight. These interventions, beyond insight directed aims, are used to resolve resistances that are presented in the clinical setting. This school of psychoanalysis has fostered training opportunities for students in the United States and from countries worldwide. Its journal Modern Psychoanalysis has been published since 1976.[66]

Psychopathology (mental disturbances)

Adult patients

The various psychoses involve deficits in the autonomous ego functions (see above) of integration (organization) of thought, in abstraction ability, in relationship to reality and in reality testing. In depressions with psychotic features, the self-preservation function may also be damaged (sometimes by overwhelming depressive affect). Because of the integrative deficits (often causing what general psychiatrists call "loose associations", "blocking", "flight of ideas", "verbigeration", and "thought withdrawal"), the development of self and object representations is also impaired. Clinically, therefore, psychotic individuals manifest limitations in warmth, empathy, trust, identity, closeness and/or stability in relationships (due to problems with self-object fusion anxiety) as well.

In patients whose autonomous ego functions are more intact, but who still show problems with object relations, the diagnosis often falls into the category known as "borderline". Borderline patients also show deficits, often in controlling impulses, affects, or fantasies – but their ability to test reality remains more or less intact. Adults who do not experience guilt and shame, and who indulge in criminal behavior, are usually diagnosed as psychopaths, or, using DSM-IV-TR, antisocial personality disorder.

Panic, phobias, conversions, obsessions, compulsions and depressions (analysts call these "neurotic symptoms") are not usually caused by deficits in functions. Instead, they are caused by intrapsychic conflicts. The conflicts are generally among sexual and hostile-aggressive wishes, guilt and shame, and reality factors. The conflicts may be conscious or unconscious, but create anxiety, depressive affect, and anger. Finally, the various elements are managed by defensive operations – essentially shut-off brain mechanisms that make people unaware of that element of conflict. "Repression" is the term given to the mechanism that shuts thoughts out of consciousness. "Isolation of affect" is the term used for the mechanism that shuts sensations out of consciousness. Neurotic symptoms may occur with or without deficits in ego functions, object relations, and ego strengths. Therefore, it is not uncommon to encounter obsessive-compulsive schizophrenics, panic patients who also suffer with borderline personality disorder, etc.

This section above is partial to ego psychoanalytic theory "autonomous ego functions". As the "autonomous ego functions" theory is only a theory, it may yet be proven incorrect.

Childhood origins

Freudian theories hold that adult problems can be traced to unresolved conflicts from certain phases of childhood and adolescence, caused by fantasy, stemming from their own drives. Freud, based on the data gathered from his patients early in his career, suspected that neurotic disturbances occurred when children were sexually abused in childhood (the so-called seduction theory). Later, Freud came to believe that, although child abuse occurs, neurotic symptoms were not associated with this. He believed that neurotic people often had unconscious conflicts that involved incestuous fantasies deriving from different stages of development. He found the stage from about three to six years of age (preschool years, today called the "first genital stage") to be filled with fantasies of having romantic relationships with both parents. Arguments were quickly generated in early 20th-century Vienna about whether adult seduction of children, i.e. child sexual abuse, was the basis of neurotic illness. There still is no complete agreement, although nowadays professionals recognize the negative effects of child sexual abuse on mental health.[67]

Many psychoanalysts who work with children have studied the actual effects of child abuse, which include ego and object relations deficits and severe neurotic conflicts. Much research has been done on these types of trauma in childhood, and the adult sequelae of those. In studying the childhood factors that start neurotic symptom development, Freud found a constellation of factors that, for literary reasons, he termed the Oedipus complex (based on the play by Sophocles, Oedipus Rex, where the protagonist unwittingly kills his father Laius and marries his mother Jocasta). The validity of the Oedipus complex is now widely disputed and rejected.[68][69] The shorthand term, "oedipal" — later explicated by Joseph J. Sandler in "On the Concept Superego" (1960) and modified by Charles Brenner in The Mind in Conflict (1982) — refers to the powerful attachments that children make to their parents in the preschool years. These attachments involve fantasies of sexual relationships with either (or both) parent, and, therefore, competitive fantasies toward either (or both) parents. Humberto Nagera (1975) has been particularly helpful in clarifying many of the complexities of the child through these years.

"Positive" and "negative" oedipal conflicts have been attached to the heterosexual and homosexual aspects, respectively. Both seem to occur in development of most children. Eventually, the developing child's concessions to reality (that they will neither marry one parent nor eliminate the other) lead to identifications with parental values. These identifications generally create a new set of mental operations regarding values and guilt, subsumed under the term "superego". Besides superego development, children "resolve" their preschool oedipal conflicts through channeling wishes into something their parents approve of ("sublimation") and the development, during the school-age years ("latency") of age-appropriate obsessive-compulsive defensive maneuvers (rules, repetitive games).

Treatment

Using the various analytic and psychological techniques to assess mental problems, some believe that there are particular constellations of problems that are especially suited for analytic treatment (see below) whereas other problems might respond better to medicines and other interpersonal interventions. To be treated with psychoanalysis, whatever the presenting problem, the person requesting help must demonstrate a desire to start an analysis. The person wishing to start an analysis must have some capacity for speech and communication. As well, they need to be able to have or develop trust and insight within the psychoanalytic session. Potential patients must undergo a preliminary stage of treatment to assess their amenability to psychoanalysis at that time, and also to enable the analyst to form a working psychological model, which the analyst will use to direct the treatment. Psychoanalysts mainly work with neurosis and hysteria in particular; however, adapted forms of psychoanalysis are used in working with schizophrenia and other forms of psychosis or mental disorder. Finally, if a prospective patient is severely suicidal a longer preliminary stage may be employed, sometimes with sessions which have a twenty-minute break in the middle. There are numerous modifications in technique under the heading of psychoanalysis due to the individualistic nature of personality in both analyst and patient.

The most common problems treatable with psychoanalysis include: phobias, conversions, compulsions, obsessions, anxiety attacks, depressions, sexual dysfunctions, a wide variety of relationship problems (such as dating and marital strife), and a wide variety of character problems (for example, painful shyness, meanness, obnoxiousness, workaholism, hyperseductiveness, hyperemotionality, hyperfastidiousness). The fact that many of such patients also demonstrate deficits above makes diagnosis and treatment selection difficult.

Analytical organizations such as the IPA, APsaA and the European Federation for Psychoanalytic Psychotherapy have established procedures and models for the indication and practice of psychoanalytical therapy for trainees in analysis. The match between the analyst and the patient can be viewed as another contributing factor for the indication and contraindication for psychoanalytic treatment. The analyst decides whether the patient is suitable for psychoanalysis. This decision made by the analyst, besides made on the usual indications and pathology, is also based to a certain degree by the "fit" between analyst and patient. A person's suitability for analysis at any particular time is based on their desire to know something about where their illness has come from. Someone who is not suitable for analysis expresses no desire to know more about the root causes of their illness.

An evaluation may include one or more other analysts' independent opinions and will include discussion of the patient's financial situation and insurances.

Techniques

The basic method of psychoanalysis is interpretation of the patient's unconscious conflicts that are interfering with current-day functioning – conflicts that are causing painful symptoms such as phobias, anxiety, depression, and compulsions. Strachey (1936) stressed that figuring out ways the patient distorted perceptions about the analyst led to understanding what may have been forgotten (also see Freud's paper "Repeating, Remembering, and Working Through"). In particular, unconscious hostile feelings toward the analyst could be found in symbolic, negative reactions to what Robert Langs later called the "frame" of the therapy[70] – the setup that included times of the sessions, payment of fees, and necessity of talking. In patients who made mistakes, forgot, or showed other peculiarities regarding time, fees, and talking, the analyst can usually find various unconscious "resistances" to the flow of thoughts (sometimes called free association).

When the patient reclines on a couch with the analyst out of view, the patient tends to remember more, experiences more resistance and transference, and is able to reorganize thoughts after the development of insight – through the interpretive work of the analyst. Although fantasy life can be understood through the examination of dreams, masturbation fantasies (cf. Marcus, I. and Francis, J. (1975), Masturbation from Infancy to Senescence) are also important. The analyst is interested in how the patient reacts to and avoids such fantasies (cf. Paul Gray (1994), The Ego and the Analysis of Defense).[71] Various memories of early life are generally distorted – Freud called them "screen memories" – and in any case, very early experiences (before age two) – cannot be remembered (See the child studies of Eleanor Galenson on "evocative memory").

Variations in technique

There is what is known among psychoanalysts as "classical technique", although Freud throughout his writings deviated from this considerably, depending on the problems of any given patient. Classical technique was summarized by Allan Compton, MD, as comprising instructions (telling the patient to try to say what's on their mind, including interferences); exploration (asking questions); and clarification (rephrasing and summarizing what the patient has been describing). As well, the analyst can also use confrontation to bringing an aspect of functioning, usually a defense, to the patient's attention. The analyst then uses a variety of interpretation methods, such as dynamic interpretation (explaining how being too nice guards against guilt, e.g. – defense vs. affect); genetic interpretation (explaining how a past event is influencing the present); resistance interpretation (showing the patient how they are avoiding their problems); transference interpretation (showing the patient ways old conflicts arise in current relationships, including that with the analyst); or dream interpretation (obtaining the patient's thoughts about their dreams and connecting this with their current problems). Analysts can also use reconstruction to estimate what may have happened in the past that created some current issue.

These techniques are primarily based on conflict theory (see above). As object relations theory evolved, supplemented by the work of John Bowlby and Mary Ainsworth, techniques with patients who had more severe problems with basic trust (Erikson, 1950) and a history of maternal deprivation (see the works of Augusta Alpert) led to new techniques with adults. These have sometimes been called interpersonal, intersubjective (cf. Stolorow), relational, or corrective object relations techniques. These techniques include expressing an empathic attunement to the patient or warmth; exposing a bit of the analyst's personal life or attitudes to the patient; allowing the patient autonomy in the form of disagreement with the analyst (cf. I.H. Paul, Letters to Simon); and explaining the motivations of others which the patient misperceives. Ego psychological concepts of deficit in functioning led to refinements in supportive therapy. These techniques are particularly applicable to psychotic and near-psychotic (cf., Eric Marcus, "Psychosis and Near-psychosis") patients. These supportive therapy techniques include discussions of reality; encouragement to stay alive (including hospitalization); psychotropic medicines to relieve overwhelming depressive affect or overwhelming fantasies (hallucinations and delusions); and advice about the meanings of things (to counter abstraction failures).

The notion of the "silent analyst" has been criticized. Actually, the analyst listens using Arlow's approach as set out in "The Genesis of Interpretation", using active intervention to interpret resistances, defenses creating pathology, and fantasies. Silence is not a technique of psychoanalysis (also see the studies and opinion papers of Owen Renik, MD). "Analytic neutrality" is a concept that does not mean the analyst is silent. It refers to the analyst's position of not taking sides in the internal struggles of the patient. For example, if a patient feels guilty, the analyst might explore what the patient has been doing or thinking that causes the guilt, but not reassure the patient not to feel guilty. The analyst might also explore the identifications with parents and others that led to the guilt.

Interpersonal–relational psychoanalysts emphasize the notion that it is impossible to be neutral. Sullivan introduced the term "participant-observer" to indicate the analyst inevitably interacts with the analysand, and suggested the detailed inquiry as an alternative to interpretation. The detailed inquiry involves noting where the analysand is leaving out important elements of an account and noting when the story is obfuscated, and asking careful questions to open up the dialogue.

Group therapy and play therapy

Although single-client sessions remain the norm, psychoanalytic theory has been used to develop other types of psychological treatment. Psychoanalytic group therapy was pioneered by Trigant Burrow, Joseph Pratt, Paul F. Schilder, Samuel R. Slavson, Harry Stack Sullivan, and Wolfe. Child-centered counseling for parents was instituted early in analytic history by Freud, and was later further developed by Irwin Marcus, Edith Schulhofer, and Gilbert Kliman. Psychoanalytically based couples therapy has been promulgated and explicated by Fred Sander, MD. Techniques and tools developed in the first decade of the 21st century have made psychoanalysis available to patients who were not treatable by earlier techniques. This meant that the analytic situation was modified so that it would be more suitable and more likely to be helpful for these patients. M.N. Eagle (2007) believes that psychoanalysis cannot be a self-contained discipline but instead must be open to influence from and integration with findings and theory from other disciplines.[72]

Psychoanalytic constructs have been adapted for use with children with treatments such as play therapy, art therapy, and storytelling. Throughout her career, from the 1920s through the 1970s, Anna Freud adapted psychoanalysis for children through play. This is still used today for children, especially those who are preadolescent (see Leon Hoffman, New York Psychoanalytic Institute Center for Children). Using toys and games, children are able to demonstrate, symbolically, their fears, fantasies, and defenses; although not identical, this technique, in children, is analogous to the aim of free association in adults. Psychoanalytic play therapy allows the child and analyst to understand children's conflicts, particularly defenses such as disobedience and withdrawal, that have been guarding against various unpleasant feelings and hostile wishes. In art therapy, the counselor may have a child draw a portrait and then tell a story about the portrait. The counselor watches for recurring themes—regardless of whether it is with art or toys.

Cultural variations

Psychoanalysis can be adapted to different cultures, as long as the therapist or counselor understands the client's culture. For example, Tori and Blimes found that defense mechanisms were valid in a normative sample of 2,624 Thais. The use of certain defense mechanisms was related to cultural values. For example, Thais value calmness and collectiveness (because of Buddhist beliefs), so they were low on regressive emotionality. Psychoanalysis also applies because Freud used techniques that allowed him to get the subjective perceptions of his patients. He takes an objective approach by not facing his clients during his talk therapy sessions. He met with his patients wherever they were, such as when he used free association — where clients would say whatever came to mind without self-censorship. His treatments had little to no structure for most cultures, especially Asian cultures. Therefore, it is more likely that Freudian constructs will be used in structured therapy (Thompson, et al., 2004). In addition, Corey postulates that it will be necessary for a therapist to help clients develop a cultural identity as well as an ego identity.

Cost and length of treatment

The cost to the patient of psychoanalytic treatment ranges widely from place to place and between practitioners. Low-fee analysis is often available in a psychoanalytic training clinic and graduate schools. Otherwise, the fee set by each analyst varies with the analyst's training and experience. Since, in most locations in the United States, unlike in Ontario and Germany, classical analysis (which usually requires sessions three to five times per week) is not covered by health insurance, many analysts may negotiate their fees with patients whom they feel they can help, but who have financial difficulties. The modifications of analysis, which include psychodynamic therapy, brief therapies, and certain types of group therapy (cf. Slavson, S. R., A Textbook in Analytic Group Therapy), are carried out on a less frequent basis – usually once, twice, or three times a week – and usually the patient sits facing the therapist. As a result of the defense mechanisms and the lack of access to the unfathomable elements of the unconscious, psychoanalysis can be an expansive process that involves 2 to 5 sessions per week for several years. This type of therapy relies on the belief that reducing the symptoms will not actually help with the root causes or irrational drives. The analyst typically is a 'blank screen', disclosing very little about themselves in order that the client can use the space in the relationship to work on their unconscious without interference from outside.

The psychoanalyst uses various methods to help the patient to become more self-aware and to develop insights into their behavior and into the meanings of symptoms. First and foremost, the psychoanalyst attempts to develop a confidential atmosphere in which the patient can feel safe reporting his feelings, thoughts and fantasies. Analysands (as people in analysis are called) are asked to report whatever comes to mind without fear of reprisal. Freud called this the "fundamental rule". Analysands are asked to talk about their lives, including their early life, current life and hopes and aspirations for the future. They are encouraged to report their fantasies, "flash thoughts" and dreams. In fact, Freud believed that dreams were, "the royal road to the unconscious"; he devoted an entire volume to the interpretation of dreams. Also, psychoanalysts encourage their patients to recline on a couch. Typically, the psychoanalyst sits, out of sight, behind the patient.

International Psychoanalytic Congress. Photograph, 1911. Freud and Jung in the center

Certain texts in the history of psychoanalytic theory form the primary body of reference material for psychoanalytic film theory. This changes from the first wave of traditional psychoanalytic film theory to the second wave, but an understanding of these texts is crucial for comprehending the theoretical project of each wave. Traditional psychoanalytic film theory relied heavily on Freud 1961, Lacan 2006, Miller 1977–1978, and Althusser 1971 for its blend of psychoanalytic and political theorizing. Later theorists turned to Freud 1953 and Lacan 1978.

  • Althusser, Louis. “Ideology and Ideological State Apparatuses.” Translated by Ben Brewster. In Lenin and Philosophy and Other Essays. By Louis Althusser, 127–188. New York: Monthly Review Press, 1971.

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    Originally published in French, Althusser’s essay theorized the fundamental operation of ideology as the formation of the subject. Though Althusser was not a psychoanalyst or a psychoanalytic theorist, traditional psychoanalytic film theorists took up this idea as foundational for their approach to the cinema and began to see the cinema itself as a place where the spectator was constituted ideologically as a subject. Available online.

  • Freud, Sigmund. The Interpretation of Dreams. Translated by James Strachey. In The Standard Edition of the Complete Psychological Works of Sigmund Freud. Vols. 4–5. By Sigmund Freud. Edited by James Strachey. London: Hogarth Press, 1953.

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    Though Freud never discusses the cinema or the analogy between dreams and films, this work provided much inspiration for psychoanalytic film theorists. Freud interprets the dream as the “disguised fulfillment of a wish” or as a fantasy, and this leads to the analysis of the cinema as a fantasy space.

  • Freud, Sigmund. “Fetishism.” Translated by James Strachey. In The Standard Edition of the Complete Psychological Works of Sigmund Freud. Vol. 21. By Sigmund Freud. Edited by James Strachey, 152–159. London: Hogarth Press, 1961.

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    Fetishism functions as the exemplary perversion for Freud. It allows the subject to disavow its castration while obtaining sexual pleasure at the same time. For many psychoanalytic film theorists (especially from the first wave), the same process occurs for the cinematic spectator.

  • Lacan, Jacques. The Four Fundamental Concepts of Psychoanalysis. Translated by Alan Sheridan. Edited by Jacques-Alain Miller. New York: Norton, 1978.

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    This was Lacan’s eleventh seminar and the first presented to the general public, rather than to a specialized group of psychoanalytic practitioners. Jacques-Alain Miller transformed the oral seminar into a French book, which subsequently greatly influenced psychoanalytic film theory because Lacan introduces the concept of the gaze as a form of what he calls the objet petit, or object-cause of desire.

  • Lacan, Jacques. “The Mirror Stage as Formative of the I Function as Revealed in Psychoanalytic Experience.” In Écrits: The First Complete Edition in English. By Jacques Lacan. Translated by Bruce Fink, 75–81. New York: Norton, 2006.

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    Written in French, Lacan’s essay on the mirror stage was the defining theoretical starting point for traditional psychoanalytic film theorists. Lacan theorizes that the mirror stage allows the infant to see its fragmentary self as an imaginary whole, and film theorists would see the cinema functioning as a mirror for spectators in precisely the same way.

  • Miller, Jacques-Alain. “Suture (Elements of the Logic of the Signifier).” Translated by Jacqueline Rose. Screen 18.4 (Winter 1977–1978): 23–34.

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    Engaging Jacques Lacan and Gottlob Frege, Miller links the formation of the subject in psychoanalysis to the act of suture. The subject, as Miller sees it, occupies the point of the zero in Frege’s mathematics. Originally published in a French psychoanalytic journal, Miller’s account of suture would become central for traditional psychoanalytic film theory.

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