Psychoanalysis has had a long gestation, during the course of which it has experienced multiple rebirths, leading some current authors to complain that there has been such a proliferation of theories of psychoanalysis over the past 115 years that the field has become theoretically fragmented and is in disarray (Fonagy & Target, 2003; Rangell, 2006). In this paper, I survey the past and present landscapes of psychoanalytic theorizing and clinical practice to trace the evolution of Freud’s original insights and psychoanalytic techniques to current theory and practice. First, I sketch the evolutionary chronology of psychoanalytic theory; second, I discuss the key psychoanalytic techniques derived from clinical practice, with which psychoanalysis is most strongly identified; third, I interrogate whether Freud’s original theoretical conceptualizations and clinical practices are still recognizable in current psychoanalytic theory and practice, using four key exemplars – object relations theory, attachment-informed psychotherapy, existential/phenomenological and intensive short-term dynamic psychotherapy; and fourth, I discuss recent unhelpful, disintegrative developments in psychoanalytic scholarship. To this end, I critique the cul-de-sacs into which some psychoanalytic scholars have directed us, and conclude with the hope that the current state of affairs can be remedied.
Psychoanalysis is simultaneously a form treatment, a theory, and an “investigative tool” (Lothane, 2006, p. 711). Freud used each of these three facets of psychoanalysis iteratively to progress our understanding of human mental functioning. Among Freud‘s unique theoretical insights into the human condition was the historically new idea that humans are primarily animals driven by instincts (Freud, 1915a, 1920) who undergo growth via universal developmental (psychosexual) stages that are influenced by family and social life. This was in opposition to the prevailing view of his time that humanity was God’s highest creation. Freud (1908) challenged the cherished belief that humankind is rational and primarily governed by reason, replacing it with the disturbing notion that we are in fact driven by unacceptable and hence repressed aggressive and sexual impulses that are constantly at war with the “civilized” self.
Freud himself and Freud scholars (Jones, 1953; Strachey, 1955) consider that the Studies on Hysteria (Breuer & Freud, 1893) mark the beginning of psychoanalysis as a theory and a treatment. These early papers place the causes of the symptoms of hysteria firmly in the psychological, not the neurological domain (although such a distinction is no longer sustainable), thus moving thinking about the cause of hysterical and other psychological symptoms from the brain to the mind. This insight underpinned a paradigm shift in thinking about the mental functioning of human beings, for which there was a scant vocabulary and embryonic conceptualizations. The theory that organized early clinical observations gradually unfolded, many precepts of which have entered the psychological lexicon as givens, concepts that are now taken for granted. Three of these bedrock concepts are the existence of the Unconscious, the notion of hidden meaning and the idea of repression.
The Unconscious, hidden meaning, repression and the affect-trauma model
The central tenet of Freud’s psychoanalytic theory is the concept of the unconscious, from which he derived two corollary concepts: hidden meaning and repression . The concept of repression is essential, not only to an understanding of the Unconscious but to psychoanalysis itself. Freud described it as the “cornerstone” of psychoanalysis (Freud, 1914g, p. 16) and viewed repression as “the prototype of the Unconscious” (Freud, 1923a). In fact, Freud viewed repression as the mental process that creates the Unconscious.
The aim of Freud’s psychoanalysis was to support expression of the affect associated with a traumatic memory, a process later termed catharsis, and to bring the repressed trauma into conscious memory, a process called abreaction. The Unconscious refers to the existence of thoughts and feelings of which we are not aware that motivate our strivings and behaviour. It is the locus of dynamic psychic activity – the place where wishes, impulses and drives reside, a place not beholden to the realities of logic or time or the constraints of socially acceptable behaviour. The contents of the Unconscious are usually experienced as painful and/or forbidden and have therefore been repressed, that is, excluded from consciousness, in order to reduce the associated anxiety, guilt or conflict. Repression is a defence mechanism that keeps unconscious material out of conscious awareness. However, the excluded material continues to influence behaviour because it is so emotionally charged that it demands expression. Individuals express their repressed thoughts or feelings in subtle, symbolic or disguised ways, such as in dreams, slips of the tongue, jokes, and symptoms – manifestations that Freud called “the return of the repressed” (Freud, 1915b, p. 148), a process that today is called enactment (Cambray, 2001; Chused, 2003; Eagle, 1993; Friedman & Natterson, 1999; Ivey, 2008). The hidden meaning of symptoms must be uncovered and consciously re-experienced, together with their associated affect in order to effect a “cure.” This was the first of Freud’s models of the functioning of the mind that became known as the affect-trauma model, a model that resonates strongly with current psychoanalytic approaches that address early relational trauma through a holding therapeutic relationship that resembles the mother-infant dyad (Holmes, 2011).
Freud’s theorizing was greatly affected by his observations of the post-traumatic stress disorders in soldiers returning from World War 1. Prior to 1920, Freud believed that most neurotic symptoms were related to the repressed experiences of infantile sexuality. After this time, Freud gave primacy to the experience of trauma, a position that became a central tenet of subsequent psychoanalytical theorizing and speculation (Miliora, 1998; Mills, 2004; Muller, 2009; Naso, 2008; Oliner, 2000). The traumas of war and the constant imminent threat to survival must surely come closest to repeating the feeling of infant helplessness and its associated anxiety. The proximal trauma triggers the distal archaic infant anxieties, resulting in a traumatic neurosis. Freud understood the symptoms, including repeated nightmares and reliving of the war trauma as an attempt to master the trauma psychologically. Freud had identified the phenomenon of the “compulsion to repeat” (Freud, 1893b, p. 105) both in actual life and in the transference relationship with the analyst in his earliest cases (Freud, 1914g) and understood this as a form of remembering. In Remembering, Repeating and Working-Through, Freud (1914g) came to the conclusion that psychopathology (neuroses) is a “magnification of universal human phenomena” (Van Haute & Geyskens, 2007, p. 33). The helplessness and dependency that we all experience as infants are re-activated in subsequent experiences of threat, anxiety and loss.
Unlike subsequent theorists like Donald Winnicott and John Bowlby who argued that infantile trauma could be avoided or mitigated by “good enough mothering”, Freud believed that the original infant trauma could not be avoided because the felt helplessness of the infant is helplessness in relation to its own instincts. Freud thus proposed that infantile traumas are universal and differ only in their intensity between individuals and that such traumas have an impact on all subsequent development. According to this model, the child “attaches” to its mother out of fear of this feeling of helplessness and the attendant fear that it will not survive without assistance from caring adults. Thus the desire for contact and attachment is born of fear and is thus a secondary instinct. This position was subsequently challenged by the attachment theorists (Bowlby, 1940, 1958).
In summary, the affect-trauma model proposed that the symptoms of hysterical patients had hidden psychological meaning related to major emotional traumata that the patient had repressed (Freud, 1893a, 1893b, 1893c, 1893d). The struggle for expression of this trauma resulted in the presenting symptoms, which constituted a symbolic expression of the “strangulated affect” related to the trauma. Freud believed that the processes of abreaction and catharsis related to this trauma would resolve the patient’s symptoms and cure them of their hysteria.
The topographical and structural models
In The Unconscious, Freud (1915) revisited and reworked his ideas. He proposed ‘psychical systems’ that he named Conscious, PreConscious and Unconscious; he referred to these as the ‘psychical topography.’ He coined the term ‘depth psychology’ to indicate that he had advanced the field beyond the ‘psychology of consciousness’ (p. 173). Freud subsequently renamed his depth psychology, metapsychology, in which all psychological phenomena were examined from three different perspectives: topographical, economic and dynamic. The topographical analysis identified the system in which the psychic action was occurring; the economic analysis assessed the quantity of psychic energy being expended and the dynamic analysis explored the conflict between the pressures from instinctual drives (wishes, strivings) and the ego defences that are deployed to prevent the release of the forbidden material from repression (Quinodoz, 2005).
According to Freud’s structural model, which he introduced in 1923, our personality is an organized energy system of forces and counter forces whose task is to regulate and discharge aggressive and sexual energy in socially acceptable ways (Gramzow et al., 2004). This model re-focused attention on the importance of the social environment and the role of relationships with primary caregivers (Mayer, 2001). Freud proposed three structures, which he termed id, ego, and superego. At birth, we are all “id” – a series of sexual and aggressive impulses that seek gratification (Freud, 1923a). The id, the home of unconscious drives and impulses, operates according to a primary process that is very different from conscious thought, or secondary process thinking. It has no allegiance to rationality, chronology or order, and is fantasy-driven via visual imagery.
As the child develops, so does the ego, the reality tester, the rational part of the personality. Freud actually used the German word Ich to denote this ‘structure’ in his structural model. ‘Ego’ was the English translation of this word, but its meaning denotes ‘I’ – that part of the self that a person recognizes as ‘me.’ It is the role of the ego to regulate the primitive impulses of the id, the relentless and punishing superego and the demands of external reality. The ego protects itself from the Unconscious by developing repressing forces (defences mechanisms) that keep repressed material from breaking through to consciousness (Freud, 1937). Gradually the child learns to delay immediate gratification, to compromise, accept limits and cope with inevitable disappointments. Freud defined the ego in two ways; firstly, as the structure needing protection from the Unconscious; secondly, as the repressing force that keeps disturbing material at bay. Since the process of repression is itself unconscious, there must be an unconscious part of the ego.
With this understanding came a change in the understanding of the role of anxiety. In his early theorizing, anxiety was understood to be related to the fear of discharge of unacceptable sexual or aggressive drives. Subsequently, Freud (1926) understood anxiety to be, simultaneously, an affective signal for danger and the motivation for psychologically defending against the (perceived) danger. Freud believed at first that repression caused anxiety; he subsequently came to the view that it was anxiety that motivated repression (Freud, 1926). Freud proposed four basic danger situations – the loss of a significant other; the loss of love; the loss of body integrity; and the loss of affirmation by one’s own conscience (moral anxiety). When an individual senses one of these danger-situations, motivation for defending against the anxiety is triggered.
Freud distinguished between traumatic (primary) anxiety, which he defined as a state of psychological helplessness in the face of overwhelmingly painful affect, such as fear of abandonment or attack, and signal (secondary) anxiety, which is a form of anticipatory anxiety that alerts us to the danger of re-experiencing the original traumatic state by repeating it in a weakened form such that measures to protect against re-traumatization can be taken. He also revised his view about what was repressed, concluding that it was not traumatic experiences or memories but conflicted impulses, wishes and desires with their attendant anxiety that motivate repression. Hence, Freud shifted his focus from external trauma to a focus on inner conflict as the core of psychoanalytic theory and psychoanalysis (Eagle, 2011). Contemporary psychoanalytic theory reversed this shift, re-focusing on external (mostly interpersonal) trauma as the locus of psychopathology.
According to Freud, the superego develops between the ages of four and six years. The superego is formed out of the internalized or introjected values of parents (or significant other caregivers) (Freud, 1923a) and society and becomes the person’s conscience from which an ego ideal, the standard by which one measures oneself, is formed (Kilborne, 2004). Subsequently, psychoanalytic scholars tried to integrate the topographical and structural models, but a discussion of this is beyond the scope of this paper – see Sandler and Sandler (1983) for a detailed exposition. The schematic representation (Figure 1) below captures the essential elements of the integrated topographical and structural aspects of this psychoanalytic meta-theory.