The Origins of Psychotherapy: Freud and Psychoanalysis

All modern psychotherapy derives ultimately from the work of Sigmund Freud.

What is Psychoanalytic Therapy? – A Personal View, Part 3

To all intents and purposes modern secular psychotherapy originates at the beginning of the 20th century in the work of the Viennese neurologist Sigmund Freud (1856-1939).

In the 1880s one of Freud’s mentors, Josef Breuer, treated a young woman with emotional problems called Bertha Pappenheim. Bertha was immortalised in the literature under the sobriquet of “Anna O.” She was in great distress, suffering from various problems including occasional paralyses of her limbs, distortions in her vision, and a phobia about drinking water. Breuer got her to recount the memories of the traumatic events that had coincided with the onset of each of her symptoms. In this way he traced them to particular memories of the time Bertha had been caring for her father in his last illness.

Freud adapted and developed this approach with his own patients and gave formal shape to what Bertha herself had been the first to call “the talking cure”. Freud gave his work the name of psychoanalysis, which etymologically means “analysis of the soul (psyche)”.

Psychoanalysis began the contemporary practice that we now see everywhere in modern culture of treating people suffering from emotional problems by talking with them about their personal history and their experiences and feelings, using no other form of medical or psychological intervention apart from conversation, and without recourse to any religious frame of reference.

As Freud remarks however, there is nothing especially new in using dialogue as a way of helping people in emotional distress. Quite the contrary, words are the oldest instrument for trying to influence the spirits and demons that were for so long believed to inhabit the unhappy soul. (See for instance Freud’s essays “Psychic Treatment”, Psychische Behandlung, 1890, ERG 35, and “On Psychotherapy”, Über Psychotherapie, 1904, ERG 110) As Freud says: “Words are the essential instrument of psychotherapy. … The words of our daily speech are nothing other than faded magic.” (“Psychic Treatment”, Psychische Behandlung, 1890, ERG 17) The task of psychotherapy is to rediscover the magical power that resides in words to change our minds.

At the same time this new version of the ancient talking cure reflects a modern idea of the place of the soul in nature. For Plato and for the Christians the soul was what took us out of nature, made us go to war against nature, and ultimately, so the expectation was, enabled us to move on to a realm beyond nature after our natural deaths. Unlike this, the soul in psychoanalysis and in modern psychotherapy is treated as rooted in the nature of the body, whose task it is to interact between the needs of the body and the demands the rest of the natural world places on it.

The development of this way of treating the unhappy soul amounted to a revolution. In the immediate term this was a revolution in the treatment of mental illness. It showed for the first time that the language of mental illness, the way it expresses itself in various symptomatic behaviour patterns, feelings and experiences, is not something incomprehensible and closed to our rational understanding. It is in fact only a dialect of the everyday language used by normal people in normal circumstances.

By doing this, Freud changed the place occupied by madness in our culture. It was no longer something alien and frightening to be locked away out of sight but something in which we all to some extent partake and which, with a little sensitivity, we can all understand.

But in the longer term it was a revolution in the entire culture of the West. This is because the kernel of Freud’s achievement was that he discovered how to translate the expressions of mental illness into the language of our everyday concerns. The consequence of doing this was to make plain that a clear line between mental illness and mental health does not exist. Before Freud, people could reassure themselves, usually a little uneasily, that they were perfectly sane. Since Freud, this is something none of us can claim without sounding naive. As a result of Freud’s work we see now that human life at every level is suffused with irrationality.

“Being sick,” wrote Freud, “is in essence a practical concept. When you look at it from a theoretical point of view … you could easily say that we are all sick, that is to say, neurotic, because the conditions for developing symptoms can also be demonstrated in the case of normal people.” (Introductory Lectures, I, 1916-17 [Vorlesungen 350])

Freud stressed a number of things about human psychology in particular, for example: the role of unconscious emotions in guiding us, the unconscious transference of emotions aroused at one point in time by one person onto someone different at a later point in time, the prevalence of sexuality in our motives generally, and the fact that the mind evolves and develops, and therefore the importance of considering childhood experiences and relations with parents and family for an understanding of our emotional make-up. All of these ideas are now accepted by virtually everyone in the field of psychotherapy and counselling; their validity and importance are taken as a matter of course.

One should be aware therefore that all contemporary psychotherapy and counselling that relies on a conversation between therapist and client derives ultimately from Freud’s work.

However, it is easy for the layman to be unaware of this because as a culture we have not always been grateful to Freud for pointing out how extensive is the reach of the irrational in our lives. Many people are still upset with Freud for having done this. They find it hard to get a handle on the irrational in their own lives and feel threatened by acknowledging its extent. Even at this distance in time they continue to feel uncomfortable around Freud. A lot of the critical literature on him and his work is driven by this personal discomfort, rather than by a balanced concern to get at the truth. If you are not a specialist it can be difficult to distinguish serious scientific criticism of Freud’s work, which is essential to the continuing development of psychotherapy, from the often inaccurate accounts of what he said and did that are to be found side by side with it in the bookshops and on the websites. It is no criticism of the book industry that it relies on sales and income like every other, but the result of this is that sensational “revelations” about Freud, however fictional, will always get more publicity than careful scholarly studies of his life and work.

Freud stirs up our emotions. Therefore if you wish to think critically and fruitfully about his work it is important to try to think critically about your own feelings about him, so that you are thinking about him in a clear and objective way and not in an emotional way.

Tomorrow: (4) Psychoanalysis and Psychoanalytic Therapy

Psychotherapy and Counselling

There is unnecessary confusion between the terms psychotherapy and counselling.

What is Psychoanalytic Therapy? – A Personal View, Part 2

The first two apparently alternative titles that need to be sorted out are the basic ones of psychotherapy and counselling.

This is particularly necessary here in Ireland, where the government is currently planning to introduce a formal professional distinction between psychotherapists and counsellors.

In its original sense, the word counsellor means someone who listens in confidence and gives advice.

For instance, Shakespeare’s Pericles says to his advisor Helicanus:

Fit counsellor and servant for a prince,
Who by thy wisdom makes a prince thy servant,
What wouldst thou have me do?
Pericles, scene 2.

In this broad sense of the word, intelligent counselling is part of the work of every competent psychotherapist. Some traditions in psychotherapy frown on the idea of the therapist giving advice. This is notably true of the old classical schools of psychoanalysis which encourage the therapist to say as little as possible. But what is to be avoided in psychotherapy is the giving of bad or stupid advice, or the therapist trying to compensate for what he cannot change in his own life by trying to change things in the life of his client. All psychotherapy involves some advice and counsel, even if this is no more than the implicit advice to turn up on time for one’s appointment.

The term “counselling” was first popularised in the context of psychotherapy in the 1940s by the American psychotherapist Carl Rogers (1802-1987). He used it partly because at the time in the US the title of “psychotherapist” could only legally be used by those with a medical qualification and partly because he wanted to stress that what is valuable in psychotherapy are those things that are not specifically medical about it. (Freud had made the same point in 1926 in his The Question of Lay Analysis.)

Rogers however did not attach any particular theoretical significance to the term “counselling”. For instance he did not use it to distinguish his own brand of “humanist” or “person-centered” psychotherapy from other psychotherapy, as he might have done.

Rogers himself writes in the opening pages of his Counselling and Psychotherapy (1942): “There has been a tendency to use the term counselling for more casual and superficial interviews, and to reserve the term psychotherapy for more intensive and long-continued contacts directed towards deeper reorganisation of the personality. While there may be some reason for this distinction, it is also plain that the most intensive and successful counselling is indistinguishable from intensive and successful psychotherapy.” (Chapter 1, page 4, my emphasis)

Since Rogers’ time the term counselling has become more widely used but it has retained the connotation of emotional help that is undertaken for a shorter duration than traditional psychotherapy, or that is in some sense less deep than full-scale psychotherapy.

For instance, when the survivors of a traumatic event are offered emotional therapy they receive what is invariably referred to as counselling. They are not usually said to be offered psychotherapy, though that is in fact what it is, even if it lasts for a restricted period.

The popularity of the term counselling is undoubtedly due to one genuine advantage it has over that of psychotherapy. This is that it gets us away from the implicit assumption that emotional distress is an “illness” to be “cured”, rather than an inevitable part of the human condition that we all must deal with at some point or another.

As a result counselling is now the most popular general term for what specialists have traditionally called psychotherapy. Nowadays, most people who are in psychotherapy even for several years will say they are attending their counsellor, not their psychotherapist. In all modern contexts now it has in fact become impossible to make any consistent distinction between the terms psychotherapy and counselling.

For this reason, many practitioners, including myself, now regularly describe themselves as psychotherapist and counsellor. This is the clearest and most accurate way to describe to the general public what we are and what we do. In practice, the two words are merging into a single professional title.

These two terms now refer to the same thing, and they are offered by the same people. Throughout this essay I shall therefore treat the terms psychotherapy and counselling, when referring to the contemporary scene, as synonymous.

Tomorrow: What is Psychoanalytic Therapy? – (3) The Origins of Psychotherapy: Freud and Psychoanalysis

What is Psychoanalytic Therapy? – A Personal View

Over the next 11 days, ending on 24 January 2021, I shall be posting an extended essay on Psychoanalytic Therapy and its place in the contemporary psychotherapy world.

Part 1: A Confusion of Terms

The field of psychotherapy has become a confusing one for the general public on account of the large number of names and titles now being used in it.

If you are looking for therapy for chronic physical aches and pains your task is relatively straightforward: you only have find a reliable professional who uses the title of physiotherapist.

But if you are looking for help with stress and strain of an emotional kind your task is a bit more complicated: you have to decide whether you need a professional who calls himself a counsellor – or a psychotherapist, or a psychoanalyst, or a psychoanalytic therapist, or a cognitive behavioural therapist, or an existential therapist, or a gestalt therapist, or a life coach, or … several other things besides.

[Note that throughout this essay I shall refer to any therapist, and any member of the general public, as “he”, “him” and “himself”. This is of course to be understood as a convenient stylistic shorthand for “he or she”, “him or her” and “himself or herself”. It makes no assumptions about the likely gender of either therapists or their clients.]

As a general statement, most of these labels mean less than they seem to mean, in the sense that for the most part there is more that the people who use them have in common than there is that sets them apart.

The fact that it can be difficult to distinguish between the different schools of therapy that use these professional titles helps explain the irritability that so often arises between them. A market square full of stall-holders who are selling similar goods to passers-by is unlikely to be the most tranquil and even-tempered part of town.

To try to offer a little clarity in this confusing picture I want to consider here the general meaning of what is one of the oldest and most widely accepted labels in the field: psychoanalytic therapy. This is also the one which I happen to use for my own work.

This term originates in the oldest tradition in psychotherapy, which is psychoanalysis. Psychoanalysis has a relation with every other professional title now used in the field, because every other title can largely be defined by how much or how little of traditional psychoanalysis is still endorsed by the people who use that title. Almost all modern psychotherapies rely heavily on the ideas that first emerged with psychoanalysis, though they don’t always acknowledge this. One important school, cognitive behavioural psychology, owes its origins to the work of psychologists who were often strongly motivated to prove psychoanalysis wrong. In spite of this, today most therapy that goes by the name of cognitive behavioural borrows a significant amount of theory and practice from psychoanalysis. Because the influence of psychoanalysis can be found in virtually all modern psychotherapy, by clarifying psychoanalytic therapy we should be able to go some way towards clarifying the field as a whole and showing where the meaningful alternatives are to be found within it.

At the same time it is important to stress that this account is a personal one and that it reflects my own views. This is inevitable. Strange as it may seem to those not involved in the world of psychotherapy, we don’t have objective definitions for any of the terms used in it, if by objective is meant enjoying universal agreement. In this respect, and not only in this respect, psychotherapy is more like a branch of literature or the arts than it is like a branch of the physical sciences. In psychotherapy, just as when we are learning to understand a work of literature or of art, we are engaged in debate about what things mean. And just as with literature and art, although one interpretation can be better informed and based on more experience and insight than another, there is, ultimately, no definitively right answer that everyone will agree on.

Psychoanalysis and psychotherapy have been pretty much the central interest of my life since I was a teenager in the 1970s. This was when I first read Freud’s Introductory Lectures which were published in easily available paperbacks at that time. These lectures gave a glimpse of what seemed to me a magical world in which it would be possible to discover the hidden meaning of our dreams and our little everyday habits and neurotic symptoms.

In later years, after many vicissitudes, I have been privileged to be able to make a small contribution to that world. And it has been as rewarding, and moving, as I expected it to be.

The years however have also taught me the sadder lesson that the profession of psychotherapy as a whole is in danger, as indeed it always has been, from professional insecurity, political in-fighting, unnecessary mystification, and general neuroticism. The work of exploring the unconscious mind is always fascinating. But the professional institutions that have grown up around that work are plagued by territoriality and by spurious claims to precedence and authority.

Contemporary psychotherapy reflects the dawning of the era in which the individual conscience begins to achieve primacy over the morality of the group and community. But because this deep cultural change frightens us more than we like to admit, the work of psychotherapy has stayed, for the greater part, within competing professional groups. Each of these communities of therapists represents, so to speak, a half-way house on the road to achieving the complete, ideal individual autonomy of the therapists who comprise it. The imperatives of therapy, because they are pushing all the time in the direction of this personal autonomy, are therefore themselves always at work corroding the structure of these groups. This is why they are all so prone not just to often bitter rivalries with each other but no less so to internal splitting and faction. At one level, each psychotherapeutic group is trying to break down into its constituent individuals. But the legitimate need of those individuals for learning, co-operation and mutual support, in addition to their conscious and unconscious personal anxieties, work always against this tendency. The outcome of this is that every institutional group in psychotherapy is a more or less uneasy alliance of the individuals who constitute it.

Each new generation of therapists has to do what it can to keep the threats that arise from this factionalism and over-politicisation at bay and try to ensure that psychotherapy remains as far as possible what it should be: a learned, rational and humane approach to overcoming our fears and to finding the courage to be honest with ourselves and to make the best and most fruitful lives that we can.