That Was Then, This Is Now: An Introduction to Contemporary Psychodynamic Psychotherapy (Part 1)
Part 1 of 7: Roots of misunderstanding.
Index
This work is in seven parts. Here are links to each section.
Part 1: Roots of misunderstanding ◀
Part 2: Unconscious mental life
Part 3: The mind in conflict
Part 4: The past lives on in the present
Part 5: Transference
Part 6: Defense
Part 7: Psychological causation
Author’s Note
This seven-part piece is a jargon-free introduction to contemporary psychodynamic thought. It is intended for trainees and for clinicians trained in other therapy approaches. I wrote it because existing books did not meet my students’ needs. Many classic introductions to psychoanalytic therapy are dated; they describe the psychoanalytic thinking of decades past, not today.
Others contain too much jargon to be accessible, or assume prior knowledge that few contemporary readers possess. Still others have a partisan agenda, promoting one psychoanalytic school over others—but trainees are ill-served by treating them as pawns in internecine theoretical disputes. Finally, some otherwise excellent books assume an interested and sympathetic reader. That assumption is now unwarranted. Students today are exposed to considerable disinformation about psychoanalytic thought and often approach it with inaccurate and pejorative preconceptions.
The title is a double entendre. “That was then, this is now” alludes to a central aim of psychoanalytic therapy: to help free people from the bonds of past experience in order to live more fully and freely in the present. People tend to react to what was rather than what is, and psychoanalytic therapy aims to help with this. The title also alludes to sea changes in psychoanalytic thinking that have occurred over the past decades. For too many, the term psychoanalysis conjures up century-old stereotypes that bear little resemblance to what contemporary practitioners think and do.
This piece was originally intended as the beginning of a book. I may finish it one day, but the project is on the back burner. For now, this is it.
Roots of misunderstanding
Psychoanalytic psychotherapy may be the most misunderstood of all therapies. I teach a course in psychoanalytic therapy for clinical psychology doctoral students, many of whom would not be there if it were not required. I begin by asking the students to write down their beliefs about psychoanalytic therapy. Most express highly inaccurate preconceptions.
The preconceptions come not from first-hand encounters with psychoanalytic practitioners but from media depictions, from undergraduate psychology professors who refer to psychoanalysis in their courses but understand little about it, and from textbooks that present caricatures of psychoanalytic theories that were out of date half a century ago.
Some of the more memorable misconceptions are that psychoanalytic concepts apply only to the privileged or wealthy; that psychoanalytic concepts and treatments lack scientific support (for reviews of empirical evidence, see, e.g., Shedler, 2010; Leichsenring, et al. 2023); that psychoanalytic therapists “reduce everything” to sex and aggression; that they keep patients in lengthy treatments merely for financial gain; that psychoanalytic theories are sexist, racist, classist, etc. (insert your preferred condemnation); that Sigmund Freud, the founding father of psychoanalysis, was a cocaine addict who developed his theories under the influence; and that the terms “psychoanalytic” and “Freudian” are synonyms—as if theory and practice have been frozen in time and have not evolved since the horse and buggy era.
Most psychoanalytic therapists have no idea how to respond to the question (all too common at social gatherings), “Are you a ‘Freudian?’” The question has no meaningful answer, and I fear that any answer I give could lead only to misunderstanding. In a basic sense, all mental health professionals are “Freudian,” because so many of Freud’s concepts have simply been assimilated into the broader culture of therapy. They now seem so commonplace, commonsense, and taken-for-granted that people do not recognize they originated with Freud and were radical at the time.
For example, most people believe that trauma causes emotional and physical symptoms; that our care in the early years shapes our development; that people have competing and often contradictory motives; that sexual abuse of children occurs and can have disastrous consequences; that emotional difficulties can be treated by talking; that we sometimes find fault with others for the very things we do not wish to see in ourselves; that it is exploitive and destructive for therapists to have sexual relations with patients; and so on. These and many more ideas that are commonplace in the culture of psychotherapy are “Freudian.” In this sense, every contemporary psychotherapist is a (gasp) Freudian, like it or not. Even the practice of meeting with patients for regularly scheduled appointment hours originated with Freud.
In another sense, the question “Are you a Freudian?” is unanswerable because no contemporary psychoanalytic therapist is a “Freudian.” What I mean is that psychoanalytic thinking has evolved radically since Freud’s day—not that you would know this from reading psychology textbooks. In the past decades, there have been sea changes in theory and practice. The field has grown in diverse directions, far from Freud’s historical writings. In this sense, no one is a “Freudian.” Psychoanalysis is continually evolving new models and paradigms. The development of psychoanalytic knowledge did not end with Freud any more than physics ended with Newton, astronomy with Copernicus, or the development of the behavioral tradition in psychology ended with John Watson.
There are multiple schools of thought within psychoanalysis with different and sometimes bitterly divisive views and the notion someone could tell you “the” psychoanalytic view of something is quaint and naïve. There may be greater diversity of viewpoints within psychoanalysis than within any other school of psychotherapy, if only because psychoanalysis is the oldest of the therapy traditions. Asking a psychoanalytic therapist for “the” psychoanalytic perspective may be as meaningful as asking a philosophy professor “the” philosophical answer to a question. I imagine the poor professor could only shake her head in bemusement and wonder where to begin. So it is with psychoanalysis. Psychoanalysis is not one theory but a diverse collection of theories, each of which represents an attempt to shed light on one or another facet of human functioning.
What it isn’t
It may be easier to say what psychoanalysis is not than what it is.
