It’s a bold question, Is psychoanalysis dead or alive? And a complex one. As a practicing psychoanalyst and a true believer, I wish I could make an open-and-shut case that psychoanalysis is very much alive in 2014. I have witnessed firsthand the powerful ways in which psychoanalytic work can bring lasting relief of psychiatric symptoms and also heal the troubled soul. In my experience, not only is psychoanalysis alive, but it is life-giving. But that is not the whole story. Truth be told, here in the United States, psychoanalysis is engaged in a fight for its own life.
Fifty years ago in the United States, psychoanalysis was the treatment of choice for a whole range of people and their difficulties: from the worried well to the very ill. It was trendy; it was respected; and it was the gold standard treatment for what ailed us.
But times have changed—and, in some ways, to good account. Since the 1950’s, the scientific study of mental illness has yielded discoveries that have made monumental advances in the effective treatment of psychological disorders. Most notably, researchers discovered that certain forms of mental illness—from schizophrenia to depression to bipolar disorder to autism—are linked to brain chemistry. As a result of this discovery, medications were developed that were far more effective than the woeful treatments available before. We said a fond farewell to lobotomies, straightjackets, and ice baths. We welcomed psychotropic medications that offered relief for the most severe psychiatric symptoms and helped people find their way back to reality.
But with such advances, our whole mindset as a culture began to shift. The medical model got the upper hand, both in how we think about our psychological troubles and how we go about treating them. Biological explanations, psychopharmacological treatments, and evidence-based therapies became king. We grew suspicious of anything that could not be measured in a lab, on a 5-point Likert scale, or as a cost-benefit analysis. We became the Prozac generation and expected that ten sessions of cognitive behavioral therapy or behavior modification would do the trick.
Not only did we become a fast-food nation, we became a fast-therapy nation, too.
With this cultural shift, many people lost confidence in psychoanalytic therapies. They took too long, cost too much, and lacked the focus on immediate, measurable outcomes. Given the changing atmosphere, these criticisms were understandable and needed to be addressed. But for many years, psychoanalysts mostly kept quiet, ironically resistant to change. Some stuck their heads in the sand, too tied to their theories and their heroes. Others dug in, reluctant to submit to the microscope of research, claiming that the sacred analytic endeavor could not and should not be reduced to laboratory study. Most had difficulty waking up to the need to make their discipline user-friendly, relevant, and more practical. Fewer and fewer mental health professionals went into training to become psychoanalysts, and fewer and fewer patients sought their help.
But that wasn’t the end of the story. Some psychoanalysts began to wake up to the need for change. In an honest, straight-shooting article, Blue Skies or Dinosaurs: The Future of Psychoanalysis, Nigel Burch and Mary Pat Campbell of the British Psychoanalytic Council put it this way: “To the vast majority of society psychoanalysis is irrelevant… The current generation, it seems, wants help that provides a quick fix, not what they sometimes term ‘navel gazing’… If our profession is to survive, other than as an anachronistic rump, it has to be seen to be making a meaningful contribution to society. We have no ‘God given’ right to survive, and we will only survive if we can examine ourselves and make real changes.”
Quietly, behind the scenes, a makeover has been underway in psychoanalysis. Freud is taking less of center stage and is now viewed more as Newton is to physics: a pioneer but not a god. New strands of psychoanalysis have taken root. British object relations, attachment theory, intersubjectivity, and relational approaches are bringing the outdated modes of psychoanalysis into the 21st century. Freud’s unconscious still has its place, but now there is also consideration for the place of inborn temperament, early life experiences, and the impact of another’s psyche in the development of one’s own. Psychoanalysts understand now more than ever how we are shaped by the psychological reality we co-create with another person: first with mom and then dad, siblings, and others in our intimate circle, including our psychoanalyst if we have the courage to find one. They haven’t thrown Freud’s baby out with the bathwater, but they have gotten to know the psychological complexity of that baby much, much better.
And they opened the doors to research. Not wide open, mind you, but at least wide enough so that a few talented researchers have been able to get a foot in the door. Early results in psychotherapy outcome research are encouraging. They are showing that psychoanalytically based therapies are as effective as other mainstream therapies—with the added bonus of yielding changes that last. A growing body of neuroscience research is also demonstrating that positive functional and structural changes occur in the brain as a result of psychoanalytic treatment. Respected neuroscientists are identifying the unconscious and emotional factors that motivate our behavior and our thinking, making the case for the value of psychotherapy approaches that reach our psychological hearts and emotional guts as well as our rational minds.
As much as these advances have breathed new life into contemporary psychoanalysis, there is one more thing that needs to be done: psychoanalysts need to get the word out. They need to reach out beyond the privacy of their offices and professional circles. They need to get comfortable with the ways people connect with one another in 2014: Facebook, Twitter, TED talks, blogging, writing engaging books for a general audience, and finding ways to talk with people where they live their ordinary lives.
I hope that I am making some small contribution to this outreach effort by writing my blog for Psychology Today as well as through my forthcoming book (shameless plug), Wisdom from the Couch: Knowing and Growing Yourself from the Inside Out. I am heartened by outgoing President Charles Hanly who, at the big meeting of the International Psychoanalytic Association in Prague last summer, spurred his fellow psychoanalysts by saying: “One good outreach project is worth more than any new article in a journal.”
In essence, psychoanalysis is transforming itself from a mechanistic to a more human model, from a hierarchical to a more egalitarian process, from the purist pursuit of insight to a more clinically-focused model as an agent of change. It is emerging from its isolation and elitism to take its place as a legitimate treatment among other legitimate treatments. Hopefully, it is becoming more approachable and user-friendly, too.
To be sure, not all psychoanalysts have changed in these ways and not all psychoanalysts welcome such change. Nevertheless, there is a growing recognition that psychoanalysis needs to become more relevant in today’s world, both in order to survive and in its fundamental purpose to be helpful to the patients who entrust themselves to its care.
Copyright 2014 by Jennifer Kunst, Ph.D.
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To learn more about the ideas introduced in this short post, check out the more thorough, brilliant, and award-winning piece by journalist Wendy Dennis, Why Psychoanalysis Matters.
For previous posts in my series about the basics of psychoanalysis, check out, What Is Psychoanalysis.