To begin, it will be useful to define what psychoanalysis is and what it is not, by positioning this discipline within the context of alternative psychodynamic therapies, or therapies that assume psychical phenomena result from conflict between opposing forces in a dynamic, as opposed to a static unconscious (Laplanche & Pontalis, 1973). While I recognize that other, non-psychodynamic therapies, such as cognitive-behavioural therapy and drug therapy, may also create psychological change in children, these therapies are not the focus of this study, and will not be discussed. This study is motivated by my own learning experiences that began once I started my theoretical education at a psychoanalytic program in Toronto and began my first practical case at a children’s mental health centre. Thus, I will not comment on other therapies because I have no experience with them. What I can offer is the evidence from some research studies that psychoanalytic therapy is effective in the treatment of children, but not superior in its achievements to therapies that are not psychoanalytically oriented. Summarizing this research, Bergin (1978) notes that, “psychoanalytic/insight therapies, humanistic or client-centered psychotherapy, many behavioural therapy techniques and, to a lesser degree, cognitive therapies achieve results that are superior to no treatment and to various placebo treatment procedures. Generally the above schools of therapy have been found to be about equally effective with the broad spectrum of outpatients to whom they are typically applied” (p. 170). To my knowledge, more recent studies have reached similar conclusions.
This study is not the place to discuss these findings, as I am not committing a comparative study outside of psychoanalysis, nor am I interested in creating propaganda for the superiority of psychoanalysis. I can only speak of what I have experienced, and my experience is limited to the psychoanalytic treatment of children.
What is psychoanalysis? Psychoanalysis is a variety of psychotherapy, which is a generic term that includes all types of psychological therapy that treat psychic or somatic disorders using psychological means. Laplanche and Pontalis (1973) define psychoanalysis as that discipline founded by Sigmund Freud which consists essentially “ . . . in bringing out the unconscious meaning of the words, the actions and the products of the imagination (dreams, phantasies, delusions) of a particular subject. The method is founded mainly on the subject’s free associations, which serve as the measuring-rod of the validity of the (analyst’s) interpretation” (p. 367). Interpretation may include the analyst’s comments on the patient’s resistance to treatment, transference of past affects onto the analyst, and the patient’s wishes.
So far, psychoanalysis consists of free associations (freely speaking about whatever comes to mind), interpretation, and unconscious meaning. A more traditional definition is offered by Oremland (1991): psychoanalysis is the technique which, “employed by a neutral analyst, results in the development of a regressive transference neurosis and the ultimate resolution of this neurosis by techniques of interpretation alone” (p. 7).
In addition to free association, interpretation, and unconscious meaning, psychoanalysis also includes “neutrality,” a “ regressive transference neurosis,” (a transference of the patient’s neurotic conflicts onto the relationship with the analyst), and the sole use of interpretation.
I prefer the more modern definition that is offered by the analyst George Klein (in Saks, 1998). For Klein, “psychoanalysis is the class of theories that concern themselves with the ‘why’of behaviour, that try to state reasons rather than causes, that try to say that a behaviour has a certain meaning, derived from the history of this meaning in the person’s life, that try to speak of the psychical functions through which the meaning is expressed” (p. 26).
To summarize, psychoanalysis concerns itself with the following notions: free association, interpretation, unconscious and conscious meaning, neutrality, regression, transference neurosis, reasons, behaviour, history, and psychical functions. It is interesting to note that the words ‘play’ and ‘relationship’ (two of the three models of therapeutic action described in this work) do not appear in the definitions I have selected. The reason why ‘play’ is omitted is most likely because playing tends to be reserved for definitions of child psychoanalysis (in this section we are dealing only with a definition of psychoanalysis). The omission of ‘relationship’ is more glaring, especially in Laplanche and Pontalis’ dictionary of psychoanalytic terms, but this neglect of relational factors in defining psychoanalysis is indicative of the tendency (relational analysts would say the problematic tendency) of some “classical”or traditional analysts to overlook the relationship in their conceptualizations of psychoanalysis.
To look more deeply into this problem is to introduce the main issue of this work. If I was going to be practicing psychoanalysis, I would need to know what psychoanalysis “really” is. But this is precisely the problem: there is no consensus on what psychoanalysis is, only a variety of opinions. The two main views are represented by the interpretive and relational models, with the play model representing a definition of child analysis only (one exception is Winnicott, 1971). A deeper introduction to this issue may be broached by learning how Freud came to choose the name for his new discipline.
In elaborating on why he chose to name his method psychoanalysis, a word that implies breaking up or separating out, and in this way is analogical to the work of chemists on the substances they work on, Freud wrote the following: “The patient’s symptoms and pathological manifestations . . . are of a highly composite kind; the elements of this compound are at bottom motives, instinctual impulses. But the patient knows nothing of these elementary motives or not nearly enough. We teach him to understand the way in which these highly complicated mental formations are compounded; we trace the symptoms back to the instinctual impulses which motivate them; we point out to the patient these instinctual motives, which are present in his symptoms and of which he has hitherto been unaware – just as a chemist isolates the fundamental substance, the chemical ‘element’, out of the salt in which it had been combined with other elements and in which it had been unrecognisable” (Freud, 1919).
We may now add to the previous list of definitional terms the following ideas: breaking up (or down), tracing back, symptom, instinctual impulse, and teaching. Freud suggests the psychoanalyst is a scientist who deconstructs symptoms as chemists break down salt. Perhaps above all, the analyst is an investigator of the elements of the patient’s mind, snooping for clues, deductively drawing links between the elemental parts, and ultimately teaching the nature of these links to the patient.
Carveth (1998) compares Freud’s vision of psychoanalysis to a rationalism that is “ . . . determined to subject the irrational to a rational inquiry that, through knowing it, would disarm and subject (or at the very least sublimate or redirect) it and bring it under an overall dictatorship of reason” (p. 558). The neurotic or psychotic individual was believed to be suffering from illusions, and therapy was conceived as dis-illusioning, or liberating the patient from his false, irrational, distorted beliefs.
Melanie Klein (one of the pioneers of child analysis), like Freud, was also a disillusionist; both were practitioners of Nietzsche’s art of mistrust. “Along with Marx, Sartre, and . . . Nietzsche himself, they belonged to the Western tradition of suspicion whose adherents sought emancipation from the idols of the age by unmasking the false consciousness and dominant ideologies that are the collective equivalent of the personal illusions and delusions, the wishful thinking, transferences and projections that distort the neurotic individual’s relation to reality” (p. 558).
For analysts working on this path, psychoanalysis is defined by the progressive disillusionment of the patient, often utilizing interpretation to expose raw truths and make links between mental entities repressed from consciousness. This is “truth therapy” (Langs, 1980) where what is real is considered the main agent capable of dissolving illusions. The “truth therapist” is not oriented toward therapy, but investigation. He does not promise relief, healing, cure, or salvation, but attempts to dismantle illusions by providing knowledge. He purports that it is better to see and know than to bury one’s head in the sand. The more one knows the better one feels.
Carveth and other “disillusionists” lament the fact that today, a different definition of psychoanalysis has become dominant. In this conceptualization, patients are not seen as suffering from present illusions that need to be exposed and conflicts that require understanding and resolution, but are considered to have psychological deficits and arrested developments that require the provision of the analyst’s parental functions that manifest in the analytic relationship, such as empathy, warmth, reliability, and the capacity to remain attuned and reflective to the patient’s modes of expressing himself. This may be considered the facilitation of cure through love, or reparative parenting, and is compared to the illusions a mother presents to her infant when she responds optimally and is able to help the infant feel safe and protected from the outside, real world.
The analyst working in the tradition of suspicion often agrees that the “illusioning” aspects of the therapeutic relationship are important in a definition of psychoanalysis and in one’s conceptualization of therapeutic action. From the classical point of view, the problem with the relational theory is that it mistakes the necessary conditions of analysis for analysis itself. The relationship between analyst and patient frequently must be strong in order to make interpretations (illusion must precede disillusionment), but therapy is not “psychoanalysis” if it forgoes the second half of this word. To call oneself a psychoanalyst, one must analyze (Carveth, 1998).
Some workers in the interpretive model suggest that psychoanalysis that de-emphasizes actual analysis should be called (what is known as) supportive psychotherapy. In supportive interventions the goal is the patient’s accumulation of experiential knowledge, while interpretation in psychoanalysis aims to enhance the patient’s explicit understanding of himself, often making the interaction between analyst and patient itself the object of interpretation. Supportive therapy (some analysts say that certain brands of relational psychoanalysis are supportive psychotherapies. Relational analysts disagree.) has been criticized by psychoanalysts, such as Sandor Ferenczi, as an education in blindness. Looking can hurt so it is better not to see. Supportive therapists avoid confronting the patient with unpleasant truths when they are not prepared for them, an intervention they perceive as cruel, instead offering palliation through endowing patients with attributes of the therapist that are internalized and integrated as the patient’s own qualities. Therefore, supportive therapy may be limited by the range and scope of the attributes of the therapist offered for internalization. Psychotherapy, however palliative, may only create within the patient versions of the psychotherapist (Oremland, 1991).
Some psychoanalysts fear that this internal version of the therapist is vulnerable to idealization, leading to a feeling of being enriched by an appreciation of and submission to a higher power, or that of having joined a movement with a new vision of how human kind can be. Classical Freudian and Kleinian analysis eschews these romantic notions, and attempts to transcend idealization and internalization by making the motivations for these processes the object of scrutiny (Oremland, 1991). Where traditional psychoanalysis involves the analysis of the positive and negative aspects of the interaction between analyst and patient, in particular those aspects that are being transferred from past relationships with one’s caregivers (the positive and negative transferences), interactions in more contemporary brands of psychoanalysis sometimes go unanalysed, and other strategies such as offering suggestions, support, and empathy are emphasized over the accumulation of conscious insight.
Quoting Freud, the analyst Marie Bonaparte expresses the difference between the therapies this way: “The ordinary psychotherapist resembles a workman who accumulates materials on the pavement, at the point where the water is welling up, in order to stop the flow of water, with varying degrees of success. On the contrary, the psychoanalyst resembles the workman who pulls up the paving stones, digs down, removing the earth until he has found the source of the underground leak in the pipe and repaired it, replacing the earth and paving stones once he has done so” (Bonaparte, 1930, p. 112). What Bonaparte and Freud suggest is that while psychotherapy provides a temporary solution to the immediate problem, only traditional psychoanalysis gets to the root and actually fixes this problem.
