0.2 Sigmund freud  (Page 32/37)

…there is no point at all in advancing directly to the nucleus of the pathogenic organization. Even if it were possible for us to guess this, the patient would not know what to do with the elucidation given to him and would not be altered by it psychically. (pg. 293; Freud&Breuer, 1895/2004)

As suggested above, a different kind of obstacle arises when the relationship between the doctor and the patient has been damaged somehow. Freud considered this to be a likely occurrence in serious cases of analysis. Freud described three ways in which the doctor/patient relationship can suffer. The first case involves the patient feeling estranged, neglected, undervalued, insulted, or if they have heard negative things about the doctor. Freud considered this problem to be fairly easily handled through good communication, although he noted that good communication can be difficult with hysterical patients. The second situation involves patients who fear that they will become too dependent on the therapist and that they will lose their independence. This can lead to new resistances. As an example, Freud described patients who complained of headaches when he pressed on their forehead, but really they were just creating a new hysterical symptom to mask their aversion to the belief that they were being manipulated or controlled. The final problem that commonly disturbs the relationship between the therapist and the patient is known as transference (Freud&Breuer, 1895/2004). Transference occurs when the patient reacts as if the therapist were an important figure from the patient’s childhood or past, and transfers onto the therapist feelings and reactions appropriate to that person from the past. Although transference can interfere with the therapeutic process, it also offers advantages. The power conferred on the therapist by transference affords him an opportunity to re-educate the patient, correcting the mistakes of the parents, and it leads patients to reveal more about themselves than they might have if they had not developed such a connection to the therapist (Freud, 1938/1949).

Following transference, it is also possible for countertransference to occur. Countertransference refers first to an unconscious influence of the patient on the therapist, after which the therapist directs their own emotional states back onto the patient. In Freud’s circle of analysts their own psychoanalysis was conducted in large part to eliminate the influence of this distorting effect. Today, there are some therapists who view countertransference as a useful means to gain a deeper perception about what is going on in their patient’s mind (see Jarvis, 2004).

Is Psychoanalysis Effective?

The effectiveness of psychoanalysis as a treatment for psychological disorders has been a source of ongoing debate. In 2006, a select task force, established by the presidents of five major psychoanalytic organizations, published the Psychodynamic Diagnostic Manual (PDM Task Force, 2006). Included within the PDM is a section on research, including meta-analytic studies on the effectiveness of psychoanalysis on patient populations in the United States (Westen et al., 2006), the United Kingdom (Fonagy, 2006), and Germany (Leichsenring, 2006). Each of these chapters emphasize the difficulty in empirically evaluating the effectiveness of psychotherapy, and even more so comparing the effectiveness of different psychotherapeutic approaches. Nonetheless, for a variety of psychological disorders, there is evidence supporting the efficacy of psychoanalytic treatments. Both Fonagy (2006) and Leichsenring (2006) identify another area of research that needs to be continued: there is not just one type of psychoanalysis. Thus, continued research on the efficacy of psychoanalytic treatments should address the relative efficacy of different styles of psychoanalytically based therapies.