In conclusion, we cannot discount the contribution psychodynamic theories have
made regarding development and understanding, the ideas of Sigmund Freud and
development of theories since. Although limited, evidence may suggest long-term
psychoanalysis has or may be perceived by the patient to be an effective
treatment for abnormalities. To gain further insight into the mind and to
enable treatment it is vital to implement interdisciplinary measures in science
and psychology to assist the movement of psychoanalysis towards science, such
as the work of neuro-psychoanalysis; which positions mind and brain on an equal
footing (Panksepp, 2012). Psychoanalysis as a treatment relies heavily on the
interpretation of analysis and recall of patients Yet many theories lack
empirical evidence, are unobservable and have many methodological flaws.
Furthermore, discounting medical or genetic underlying factors for possible
abnormalities may hinder a patient’s recovery. With all this in mind, if a
patient deems they are indeed benefiting from treatment; then, in turn, their
mental health and wellbeing may improve. Equally, this may apply to any method
of treatment, such as CBT. Freud concluded “Analysis does not set out to make
pathological reactions impossible, but to give the patient’s ego freedom to
decide one way or another” (1923, p. 50). It is vital to take in to account all
types of therapies and theories. While not all psychologists will accept the
principles of psychodynamic theorists, most will agree that behaviours along
with thoughts, motives and responses do not arise at random, but stem from
combinations of identifiable psychological and biological process (Elliot, 2002).
Therefore, we must take a holistic approach to treatments, enabling sufficient
support and understanding.
Erick Kandel (1998) advocated for
empirically orientated psychodynamic practise in neuroscience; leading to the
development of neuro-psychoanalysis, enhancing researchers understanding of
both human behaviour and mental functioning (Solms et al, 2011). With this,
contemporary models of dream formation now incorporate principles from both
fields (Levin, 2007). Successfully implementing interdisciplinary practice can,
thereby, lead to further development of neuro-psychoanalysis.
Psychoanalytical techniques such as free association and dream analysis allow
speculation to contribute to the diagnosis. Patients may become susceptible or
influenced by suggestion. Elizabeth Loftus’s studies support the ideas that few
people can recall memories accurately (1993; 1995). Methods can be argued as
deterministic, deeming behaviour as pre-determined thereby removing a person’s
free will – attributing childhood experiences as acceptable reasons for adolescent
traumas. In contrast to cognitive or behavioural methods, which are designed to
address issues directly through logical and behavioural interventions.
The evidence above suggests the benefits that long-term psychoanalysis may
prove useful when dealing with specific mental health ailments. However, NICE
(2009) clinical guidelines advise “psychoanalysis is used as a second line
treatment for patients with mild to moderate depression when a patient has
rejected CBT or IPT”. Nevertheless, Shinohara (2013) concluded that surveys
consistently demonstrate patients’ preference for psychological therapies over
treatment via pharmaceuticals measures (Churchill, 2000; Riedel-Heller, 2005).
Studies conducted in Helsinki showed
long-term psychoanalysis as a treatment for depression to be inferior to
short-term treatment initially, but superior after a three year follow up
(Knekt, 2010). Equally a study on self-rated measures of depression showed
psychoanalysis treatment significantly superior at three years follow up, but
no difference at year one or two (Huber, D et al. 2013). With the longevity of
therapy needed regarding results basis, this could argue the cost-effectiveness
of psychoanalysis over other treatments such as cognitive behavioural therapy
(CBT), which are completed over a shorter period. CBT encourages patients to
deal with current issues rather than reflecting on matters of the past, with
the aim of improving state of mind daily (NHS, 2017).
Albeit there are many critics of analysis, recent reviews of neuroscientific
work in laboratory studies confirm Freud’s theories of the unconscious mind and
organisation of emotions and thinking (Western, D et al. 2002). However, the
use of psychodynamic therapies remains controversial (Leichsenring, 2004; 2007)
due to inconsistent findings. Svartbert (1991) suggests this may be in part
down to differences in population or culture.
As a therapy, psychoanalysis is based
on the concept that individuals are unaware of many factors that cause their
behaviour and emotions (American Psychoanalytic Association, 1998). Freud was the first psychoanalyst in
recognising the Importance of the unconscious mind and its workings. However,
lack of scientific evidence around psychoanalysis as a proven treatment for
abnormality may in turn regard psychoanalysis as an interpretation rather than
a treatment. The fundamental principles being to remove neuroses and thereby
cure patients by returning their damage ego to its normal state (Freud, 1949,
p.51). This analysis involves processes including free association,
transference and dream interpretation.
To address psychoanalysis as a
treatment for abnormality, we must first consider what ‘abnormality’ is.
Abnormality is defined in three ways; deviation from social norms, failure to
function adequately and deviation from ideal mental health. Still; these
definitions cannot be appropriately applied to all individuals, and it may
become problematic to identify each aspect. Social norms, behaviours and
personality can differ not only across different cultures but also as
normalities change over time, providing limitations in diagnosis and treatment.
The methodology of psychoanalysis has
many limitations. Generalisability of much-published research on this issue is
problematic; most of the evidence collated for theories are taken from case
studies. Sulloway (1991) comments on a re-examination of Freud’s clinical work
it is suggested that he had somewhat distorted patient’s cases to ‘fit’ with
On completion of twin studies, Eliot Slater (1961) concluded that hysteria as a
disease was too diverse as a concept. Evidence of the psychological cause to
which a mental illness or behavioural disturbance may be attributed was found
half as often in patients who later proved to have underlying medical
conditions or disease as in those who did not (1965). Arguing the theory that
hysteria was the result of traumatic experience; without consideration of
biological or genetic factors that contribute to abnormalities.
However, it is speculated Freud
confided in Jung (1926) that Anna O remained uncured. Additionally, Anna O
displayed many organic ailments including suggestions that she suffered from
strabismus and diplopia (Hurst, 1982). We must consider the argument there was
a more complex relationship between organic and emotional factors. Thus, the
cause of hysteria cannot be undeniably regarded as psychological and not
One of the studies which greatly
influenced the psychodynamic approach and associated with Freud is the case of
Anna O (Bertha Pappenheim, 1985), in which Freud worked closely with the
Austrian physician Josef Breuer. Anna O is a prevalent case in the history of
psychoanalysis and the development of the cathartic method, known as the
talking cure; the aim was to enable the hypnotised patient to recollect the
traumatic event at the origin of a symptom by accessing their unconscious mind.
Upon treatment for hysteria, Freud claimed ‘She was … free from the
innumerable disturbances which she had previously exhibited” (1895, p41) and argued
the case was a ‘great therapeutic success’ (1923).
In contrast to the psychodynamic approach, the behaviourist theories (Pavlov,
193; Skinner, 1974) argue that all human behaviour is mechanical, that
personality is the product of both stimuli and response. Focusing on behaviours
that can both be reliably measured and observed with methodology such as
classical and operant conditioning. Something that when addressing the
unconscious mind and psychodynamic case studies, we cannot.
Based on Marx definition, Eysenck
(1953a) concluded that psychoanalytic theory could not be called scientific
based on lack of evidence and validity; and that theories provided an
One of the main flaws of the psychodynamic theory is that it does not follow
scientific measures. Marx (1963) definition of science argues there are three
fundamental areas of scientific theory; including observations, constructs and
hypotheses. Data compiled by psychoanalytical theorists consists of many free
associations; regardless of how comprehensible or relevant, these thoughts may
be. Data was not accurately recorded at the time of patient/therapist
interaction but recalled as and when required – or written down at a later
stage. However, limited reliability of methodology may lead to subjectivity
(Kline, 1981). Many of the concepts of the psychodynamic theories are vague,
and it can become challenging to demonstrate the concepts themselves – leading
to difficulty in expressing or defining key ideas. Kline also comments on how
if the concepts of a theory are unclear; the hypothesis in which they have
formed a part must be difficult to refute or impossible to test.
Freud’s theories challenged the
biomedical view that mental disorders and abnormalities had physical origins.
In Studies in Hysteria (1895) Freud proposed that physical symptoms are often
the surface manifestations of repressed conflicts and concluded no one is free
from conflicts caused by our unconscious and repressed memories; therefore,
abnormality is both “inevitable and beyond conscious control”.
In contrast to Freud’s views of
psychosexual development, Carl Jung, another influential theorist in
psychodynamics had ideological differences and deviations from Freud’s
framework. One of these the rejection of the Oedipus and Electra complex; Jung rejected
Freud’s emphasis on sexuality and believed the energy of the libido may have
different outputs. Likewise, many of Freud’s original ideas have since been built
upon by subsequent theorists known as post Freudians.
Additionally, a significant aspect of
Freud’s hypothesises is how internal conflict is marked in childhood due to the
ego not being fully developed. Freud suggests that personalities develop
throughout childhood in stages – and it is one’s libido that drives them
through these stages, known as psychosexual development stages. Each stage
associated with a particular conflict that must be resolved before the
individual can successfully advance to the next (McLeod, S 2008). These stages being oral, anal, phallic,
latency and genital. A person may become fixated at a stage, leading to a
preference for a certain gratification, influencing adult personality and
behaviour. It is also suggested a person may regress to a specific psychosexual
stage in later life. A criticism of this theory is the overreliance on the male
perspective being problematic, as it marginalises female sexuality. During the
phallic stage, women experience ‘penis envy’, known as the Electra complex.
Freud believed this conflict could never fully be resolved, deeming all women
to have an underdeveloped superego.
Freud hypothesised the human psyche is
structured into three; the id, ego and superego (Freud’s topographical model
represents his outline of the mind). All three parts of the mind must collectively
work together; in doing so produce all behaviours. The ID functions in the irrational and
emotional part of the brain – the pleasure principle, the ego functions with
the rational part of the mind – the reality principle. The superego, which is
the last part of the mind to develop, develops through socialisation and is
often referred to as the moral part of the mind balancing right and wrong – the
mortality principle. Freud stated “The poor ego has a still harder time of it;
it has to do its best to reconcile the claims and demands of all three… The
three tyrants are the external world, the superego, and the ID” (1960, p.128)
At the time a respectable way of providing a rationale for how people act in
specific ways, claiming imbalance between the ego and ID lead to internal
conflict at unconscious levels.
There are several fundamental concepts
of the psychodynamic theory; theorists believed that the mind had three levels;
the conscious, the preconscious and the unconscious. The conscious part of the
mind consisting of what someone is aware of at any given point in time, if a
person is aware of a thought, feeling, it is in one’s conscious mind; the
preconscious contains information just below the surface of awareness, the
interplay between our conscious and unconscious. The unconscious includes the
processes that take place outside of conscious awareness. Freud believed the
activities of the psyche are presumed to be mostly unconscious and saw the
unconscious mind as the primary source of behaviours. Thereby, the unconscious
mind encompasses mental processes that are inaccessible to consciousness, but influence
judgements, feelings, or behaviour (Wilson 2002).
The psychodynamic approach includes
all theories that see human functioning based on the interaction of drives and
forces within the person, mainly unconscious forces in determining rational
thought, behaviour and feelings. Equally between the different structures of
personality and the psychological factors that play a role in determining a
person’s behaviour thereby shaping personality. Sigmund Freud’s (1856-1939)
psychoanalytical theories and therapy were the basis of the psychodynamic
approach; however, the psychodynamic approach includes all theories based on
his ideas, including Carl Jung (1964), Alfred Adler (1927) and Erikson (1950).
Freud’s theories and treatments remain controversial and widely debated.
“The brain is wider than the sky”
(Dickinson 1830); the workings of the conscious and unconscious mind have intrigued
many for centuries and continue to do so. The purpose of this essay is to firstly
provide background to the psychodynamic approach in psychology and exploration
of the mind; for clarity, the discussion is primarily based on early work and
theories of Sigmund Freud. Additionally, the potential flaws and empirical
scepticism. Moving on to psychoanalysis as a method for treating abnormalities;
acknowledging areas of influence such as testability, methodology as well as
social and societal impacts. In doing this, it will be possible to assess and
evaluate psychoanalysis as a treatment method.