When the average person is asked to conjure up a picture of a famous psychologist, one image dominates: A bald man with a grey beard, smoking a cigar, and querying somebody about their mother. From the early 1900s through the 1960s, Freudian theory was enormously influential. He was an icon of his age and his name was tossed around with the likes of Darwin and Einstein, and his impact was dramatic; not only in psychology and psychiatry, but in the social sciences, humanities, and larger cultural zeitgeist as well.
At the same time, Freud was also seen by many as a little more than a charlatan, someone who generated fanciful, implausible, and inaccurate ideas, and whose influence was more a function of the way he created a cult-like following via his domineering personality than because his ideas had validity. Indeed, many have pronounced Freud’s ideas dead and gone, with good riddance. And yet, despite these frequent pronouncements, he remains a central figure and many continue to find his ideas attractive and powerful.
So what is the best way to think of Freud? Was he a brilliant trailblazer whose ideas were foundational to our understanding of psychology and psychopathology…or was he a charlatan who misled the field for fifty plus years? The answer is a little bit of both; as such, we need to understand how to separate the baby from the bathwater.
I characterize the baby in Freudian thought (i.e., good and valid) as “psychodynamic”, whereas I call the bathwater (i.e., bad and wrong) “psychoanalytic”. Although this difference in terminology usage has some correspondence in the literature, I should note that the rather sharp split between “psychodynamic” and "psychoanalytic" that I offer here is largely mine and the remainder of the blog details what I mean. Thus, be warned that some authors use psychodynamic and psychoanalytic fairly interchangeably, and might use (modern) psychoanalytic in a way that would be synonymous with how I use psychodynamic. With that caveat, let’s turn first to the psychodynamic baby.
Drew Westen wrote in an influential article on Freud’s legacy in which he described how contemporary psychodynamic theory focuses on a) how the human mind manages conflicting motivational and emotional states and b) how it filters certain information out of consciousness in order to maintain psychic equilibrium. It also emphasizes the importance of c) early developmental influences, especially one’s attachment to primary caretakers and d) one’s current relationships and the social environment in general to mental health. These are crucial aspects to understanding the human condition, and they are aspects that are sometimes not particularly well developed in practitioners trained primarily in cognitive and behavioral approaches to treatment.
Consider, for example, the following description of a woman entering psychotherapy.
Emily is a 29-year-old Caucasian female who entered psychotherapy because she was concerned about the direction her life was headed. Her mood over the past year has worsened, a mood she described as “sour” and “joyless”, and she reported to you in the first session that she finds herself wondering what the point of her job, her marriage, and even her life is. Her family of origin was intact and upper middle class. She has two younger sisters, aged 26 and 24, both of whom have children. She described her mother, a librarian at a University, as strict, protective, and loving. Her father is good natured, but distant. He is a pediatrician. She indicated that negative emotions were generally dismissed in her family. She stated her relationship with her family is the same as it has always been, but she did not elaborate although she did report that her mother seemed closer to her younger sisters than to her. She was raised Methodist, not currently attending church, but is religious, although she does not like “institutionalized” religion. She has always had a lot of friends, but few of them have been very intimate. She graduated from a good law school in the top 20% of her class, always achieved good marks in school.
Her most immediate concern is that her marriage of four years to Jacob (28) is experiencing difficulties. Both are lawyers in a local firm. They are doing well financially, but she reported they have lost the spark. Much of the difficulty according to her stems from her not wanting to have children. Although when they got married, she thought she wanted kids, she now doesn’t. In reporting this, she somewhat defensively asked the intake interviewer “Don’t I have the right to change my mind?” They have sexual relations approximately once a month and have “yelling” arguments at least weekly. She stated that she frequently feels irritated and annoyed by other people, and came across to the interviewer as guarded. She describes her job as “fine” but did not elaborate. She did mention that if she wants to make full partner, she needs to increase her billable hours.
A modern psychodynamic lens would be crucial to understanding this woman’s presentation. By that I mean it would be crucial to explore in therapy how her identity was influenced by her role in her family system (her representations of herself in relation to them), it would be important to hypothesize that Emily likely had trouble processing certain negative feelings, and that she likely repressed certain aspects of her experience and rationalized others as a function of these conflicts. In short, she is confused and conflicted about who she is and does not know how to move forward in an adaptive way. The psychodynamic perspective allows for “insight” into key variables associated with herself, which in turn would open up avenues for adaptive change.
(If you are interested in learning more about modern psychodynamic theory, I recommend fellow PT blogger, Jonathan Shedler. In addition, some excellent modern psychodynamic authors include Paul Wachtel, Hanna Levenson, Diana Fosha, Leigh McCullough Valiant, and Nancy McWilliams. If Emily were my sister, I would recommend she see a therapist very familiar with these authors.)
Being the brilliant observer of human behavior that he was, I believe Freud was capable of seeing many of the processes that would attract the attention of a modern psychodynamic therapist. However, Freud believed he discovered another level of the mental, a deeper level that existed underneath the subconscious and relational conflicts that are apparent when you know how to look for them. Unfortunately, though, instead of locating fundamental truths about this deeper level, Freud made some fundamental blunders. I refer to the bathwater in Freudian thought as “psychoanalytic” because it is the core of formal psychoanalytic theory that is so problematic.
Here are five myths that were originally central to Freud’s psychoanalysis:
1. Psychoanalytic treatment, in which one lies on a couch and free associates several times a week for several years, as an analyst offers transference-based interpretations of the material via Freudian theory, is an effective treatment for neurotic conditions like depression and anxiety. The reality is that while this is an interesting approach for bored, rich people to kill time, it is not an effective way to address mental health concerns.
2. The fundamental drives that make up the “id” were sex and aggression. Although it was the primary conflict that caused the break between Freud and Jung, for a long time now the vast majority of even hard core backers of Freudian theory realized that relational forces (early attachments, social pressures, needs to be valued) were more central to understanding subconscious motivational conflicts than sex and aggression. (This shift is called “the relational turn” in psychoanalytic circles).
3. The unconscious mind “cathects” energy via symbolism. Freud’s original model of the mind was anchored to a hydraulic engine, in which energy from the id would be built up and would need release either via “acting out” or derivatives of the impulse experienced in imagery and feeling and attached to objects. This model was associated with another mythical Freudian principle, that of psychic determinism, which posits that all action, even that which is seemingly accidental or incidental, is a function of psychic energy being “released”. It was this model of the mind that led to some of the most ridiculous Freudian claims, such as the claim that morning sickness was a function of the pregnant woman’s aggression towards her offspring and her repressed desire to purge the fetus.
4. The Oedipal/Electra complexes are central developmental processes for most boys and girls. One of Freud’s most famous ideas was that opposite sex children have a secret wish to slay their same sex parent and possess their mother or father is both fascinating and largely incorrect in the general. The complex should have been called “The Freudian Complex”, because it did describe Freud’s feelings. But he was the exception not the rule. However, like many of Freud’s ideas, there is an important grain of truth. It is the case that children must navigate the complicated world of their own needs relative to the needs of their parents and the family system at large. The way they choose to either defy the system or defer to it is a central conflict for many.
5. Personality evolves via psychosexual stages and is largely fixed by age five. Freud believed that psychic energy was focused on certain erogenous zones (mouth, anus, genitals), and that the way a child managed the conflict between those urges and reality essentially fixed their personality. This is pretty far off the mark on many levels.
There are many other Freudian myths, including the idea of a death instinct, the idea that woman are fundamentally inferior or less developed, and that the primary function of dreams is to release psychic energy. The bottom line is that Freud was fundamentally more wrong about his defining ideas than some of science’s greatest thinkers, like Darwin and Einstein. But that he was wrong about much does not mean we should dismiss all that has emerged in his wake. Rather a healthy understanding of psychology requires that we separate and preserve the psychodynamic baby from the psychoanalytic bathwater.