According to a claim made several years ago in the New York Times, Freud’s theory is still taught in universities, but not in psychology classes. When asked to explain why, the article puts forward the assertion (backed by two prominent psychologists) that psychoanalysis doesn’t have a solid evidence-based grounding.
I recently heard a talk in which the speaker, a physicist, referred to the Times article as “proof” that there’s not a shred of validity to the Freudian perspective. It seems like a good time to set the record straight. Using the criteria established for evidence-based treatment, traditional psychoanalysis alone does not in fact pass muster as a method of therapy for the large majority of psychological disorders. However, to dismiss Freud’s contributions as irrelevant to psychology, as this article (and the speaker) implies, is an oversimplification.
Psychoanalysis is more than a method of treatment—it’s a theoretical approach to understanding human behavior. However, with few exceptions, psychologists today talk about the psychodynamic not the psychoanalytic perspective (Shedler, 2010). As such, this perspective refers to the dynamic forces within our personalities whose shifting movements underlie much of the basis for our observable behavior. Psychoanalysis is a much narrower term referring to the Freudian-based notion that to understand, and treat, abnormal behavior, our unconscious conflicts must be worked through. Part of the baggage that psychoanalysis carries with it includes a number of terms specific to this method of treatment—pardon the oversimplifications—such as “transference,” (transferring your feelings from your parents to your therapist), “resistance,” (refusing to comply with the therapist’s requests) and “working through” (bringing your unconscious conflicts into conscious awareness). Then there are other well-known terms such as “penis envy” (little girls wishing they had the anatomies of little boys) and “Oedipus complex” (little boys wanting to have sex with their mothers).
Freud’s theory is just one of many psychodynamic approaches being used—and taught—in today’s psychology departments. Some of the specific concepts from old-style psychoanalysis still make their way into the terminology of psychology, but when they do, it’s to describe the history of the field. Rarely does a student take a general psychology course that focuses exclusively on psychoanalysis, or even psychodynamics, but many courses in the undergraduate curriculum include concepts that are central to its perspective. It’s almost impossible, in fact, to find an introductory, developmental, personality, abnormal, or even social psychology textbook that doesn’t refer to one or more basic psychodynamic terms. If you took one of these courses, you most likely remember a chapter or more on Freudian theory.
Popular culture loves Freudian theory. It’s difficult not to tune in to any TV drama, sitcom, or even documentary without running into a Freudian term spoken by a character. Often the words are uttered by a TV therapist, but just as often, the terms or concepts are injected into an everyday conversation. The popular game show “Jeopardy!” features frequent questions, some quite obscure (e.g. “what is synchronicity?”), based on the psychodynamic perspective.
Freud is to the field of psychology, in many ways, as Newton is to physics. Courses in physics include Newton but don’t stop there. Similarly, in psychology, Freud’s ideas about the unconscious became the basis for later theories that built on his basic principles. For many years, though, it was almost impossible to put Freud’s theory to the test in the same way that researchers could test Newtonian physics. Another well-known psychology giant, Ivan Pavlov, was able to test his theory of classical conditioning in the lab, but even so, you won’t find a course called “Classical Conditioning” in any psychology department today. Science moves on, expanding and revising even the most well-tested theory as researchers gain more evidence through increasingly sophisticated techniques.
For example, one of the most popular theories in psychology today, attachment theory, originated from Freud’s focus on the importance of early emotional bonds in infancy. Attachment theory proposes that we develop our sense of self on the basis of our relationships with our earliest caregivers. Researchers have since discovered that the attachment framework accurately captures adult romantic relationships as well and it is now accepted throughout developmental, social, and personality psychology.
Defense mechanisms are another central concept is Freudian theory. The study of these key ideas in psychodynamic theory was hampered for years by the fact that researchers had to rely on people’s direct answers to questions about themselves. Self-report is virtually useless for testing people’s tendencies to defend against the experience of anxiety. People simply deny that they’re in denial. Instead, psychologists came up with the so-called “projective measures” such as the Rorschach inkblots which asked people to “project” their unconscious fantasies and urges onto ambiguous drawings. Although researchers eventually developed relatively sound ways to score projective test data, many psychologists today still feel that these scores are not sufficiently trustworthy to merit their use. As a result, research based on psychodynamic theory in general, and defense mechanisms in particular, languished.
With the advent of computerized testing, brain imaging, and determined ingenuity, researchers now are approaching the study of unconscious motives from an entirely new perspective. Through computerized testing, for example, people’s reaction times can be measured to the precise millisecond while they view stimuli that are potentially anxiety-provoking. The Implicit Association Test measures your tendency to hold unconscious views that you consciously would find unacceptable, such as biases toward people of various race or ethnicities, age, or gender. Brain imaging methods allow researchers to spy on parts of your nervous system that react “unconsciously” with fear, anxiety, rage, or lust while you view stimuli or complete a cognitive task. A blog with the humorous title “Blame the Amygdala” reviews the state of the art on this tiny, but powerful, structure in the limbic system which plays an important role in our emotional state. Our more highly evolved prefrontal lobes of the brain try to keep the amygdala in check to prevent us from allowing our primitive emotions to leak out into our behavior. When you put the situation in those terms, how different is this scenario from Freud’s proposal that the superego (conscience) tries its best to inhibit the id (our lustful desires)? Brokering the whole deal is the ego, which neuropsychologists reframe as our “executive function” and locate partly in the prefrontal lobes as well.
Next, let’s tackle Freud’s approach to therapy. Frustrated by his inability to perform hypnosis, Freud eventually landed on the idea of the “talking cure” in which his clients talked without restraint using what he called free association. Based on his own self-analysis, Freud incorporated dream analysis into the free association method. The hallmark of psychoanalysis, though, is its emphasis on the relationship between the therapist and the client. By reliving long-ago conflicts in the moment, or should I say the 50-minute moment, the client ultimately can rework them more successfully and eventually gain psychological health.
It’s perhaps hardest to find evidence that Freud isn’t dead in the area of psychotherapy. Traditional psychoanalysis is still taught and practiced, and there are studies showing it to be an effective intervention (e.g. Knekt et al., 2008). For the most part, though, research-based evaluations of psychotherapy’s effectiveness increasingly attest to the value of interventions based on either behavioral theory, cognitive theory, or a combination of the two.
Given the centrality of treatment to the psychodynamic perspective, the findings on evidence-based treatment would seem to deal Freud's legacy a crushing blow. If Freud is dead in the area of psychotherapy, all the brain scans in the world won’t be able to revive him. However, if we shift our focus from traditional psychodynamic therapy to elements of the perspective’s approach to treatment, there’s plenty of evidence that he lives on, just in a different form.
Research on psychotherapy is showing that Freudian ideas are central to the therapeutic alliance, a key element of treatment (e.g. Constantino et al., 2010; Hentschel et al., 2005). In graduate professional psychology programs around the world, students do take courses or practica in which they learn and carry out the psychodynamic method. They take courses in other perspectives as well, including client-centered counseling, behavioral therapy, and cognitive therapy. Eventually, the large majority of clinical and counseling psychology students use psychodynamic principles to inform their relationships with their clients. Many of them blend at least some elements of psychodynamic therapy into their own integrative or eclectic approach that they develop over the course of their careers.
Peeking into the nooks and crannies of psychotherapy allows us to see that Freud’s influence lives on, even if it may be hard to recognize at times. Psychoanalysis circa 1910 was as much a cultural revolution as a scientific enterprise. Nevertheless, it is clearly a vital and evolving approach even in our highly empirical field today. Freud is dead, long live the king!
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Copyright Susan Krauss Whitbourne 2012
Constantino, M. J., Schwaiger, E. M., Smith, J. Z., DeGeorge, J., McBride, C., Ravitz, P., & Zuroff, D. C. (2010). Patient interpersonal impacts and the early therapeutic alliance in interpersonal therapy for depression. Psychotherapy: Theory, Research, Practice, Training, 47(3), 418-424. doi:10.1037/a0021169
Hentschel, U. (2005). Therapeutic alliance: The best synthesizer of social influences on the therapeutic situation? On links to other constructs, determinants of its effectiveness, and its role for research in psychotherapy in general.Psychotherapy Research, 15(1-2), 9-23. doi:10.1080/10503300512331327001
Knekt, P. P., Lindfors, O. O., Härkänen, T. T., Välikoski, M. M., Virtala, E. E., Laaksonen, M. A., & ... Renlund, C. C. (2008). Randomized trial on the effectiveness of long- and short-term psychodynamic psychotherapy and solution-focused therapy on psychiatric symptoms during a 3-year follow-up. Psychological Medicine: A Journal Of Research In Psychiatry And The Allied Sciences, 38(5), 689-703. doi:10.1017/S003329170700164X
Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98-109. doi:10.1037/a0018378