This summer marks the 100th anniversary of the American Psychoanalytic Association, founded in 1911 on Sigmund Freud's approach to psychotherapy. Perhaps this is as good a time as any to untangle some of the misconceptions we may hold about our options for addressing mental health issues, now that a century has passed since his theories began to be disseminated.
For many people, the word "psychotherapy" is synonymous with Freud, bringing to mind terms such as sexual repression, oedipus complex, transference, anal retention, and the unconscious. These concepts may invoke the ubiquitous image of a patient reclining on a couch while a psychiatrist with a goatee taps a pencil on his knee and frowns up at the ceiling. No doubt we owe the persistence of this stereotype to media representations, but many people fail to realize that Freud's specific approach to therapy, known as psychoanalysis, has steadily lost popularity since its heyday in the 1960s. Today, only a small percentage of psychotherapists use psychoanalysis in mental health treatment. Extremely time-consuming in many cases and expensive to complete in comparison to modern therapies, psychoanalysis has been forced to change significantly as modern research has failed to uphold many of Freud's original assumptions. One thing that hasn't changed however, is the fact that now, just as in the past, its admittedly few but faithful practitioners are most likely to be psychiatrists (who hold medical degrees) rather than psychologists or other mental health clinicians.
The thought of psychoanalysis certainly does not appeal to everyone, but it doesn't need to. There have always been alternative therapeutic approaches, such as those founded by Freud's contemporaries, Alfred Adler and Carl Jung, and new treatments have continuously evolved as advances in the field of neuroscience have reinforced certain aspects of therapeutic practice and weeded out others.
Considering that there are many different approaches to psychotherapy and that some therapists use combinations of them, choosing a therapist ls a very personal process and should not be taken lightly. Ideally, it would begin with recommendations from trusted family, friends, clergy, or health professionals. Whether to choose a therapist who works with individuals or one who works with couples, families, or issue-focused groups will naturally depend on the specific needs of the client or clients, but in any case it is important to be confident that the therapist will respect and be sensitive to the client's cultural identity, which includes areas such as ethnicity, gender, social class, and religion.
Modern approaches to psychotherapy, such as the cognitive behavioral therapy for obsessive-compulsive disorder (OCD) developed by UCLA's Jeffrey Schwartz, generally focus on changing the thoughts, emotions or behaviors that contribute to mental distress or dysfunction. Because of their focus on personal change, psychotherapies can be extremely useful, not only for helping people who suffer from mental disorders like OCD, but also for helping to resolve those relatively minor but maddeningly persistent and disruptive interpersonal issues that arise in family relationships. There is no doubt that learned behaviors and styles of relating to one another can be very difficult to change, even when we understand that change is necessary and are strongly motivated to achieve it. Psychotherapy is only one of many tools—albeit a very useful one—that can help us as we work to replace habitual unwanted thoughts and behaviors with those that are more constructive.
Three Guys From Vienna
Sigmund Freud, Alfred Adler, and Carl Jung were associates for a period of time in Vienna as each developed his own approach to psychotherapy. In this collection of articles, Vision examines how well these three approaches have withstood the test of time.