Psychotherapy

Though not the first methodology in the practice of individual verbal psychotherapy,[154] Freud's
psychoanalytic system came to dominate the field from early in the twentieth century, forming the
basis for many later variants. While these systems have adopted different theories and techniques,
all have followed Freud by attempting to effect behavioral change through having patients talk about
their difficulties.[7] Psychoanalysis itself has, according to psychoanalyst Joel Kovel, declined as a
distinct therapeutic practice, despite its pervasive influence on psychotherapy.[155]
The neo-Freudians, a group including Alfred Adler, Otto Rank, Karen Horney, Harry Stack
Sullivan and Erich Fromm, rejected Freud's theory of instinctual drive, emphasized interpersonal
relations and self-assertiveness, and made modifications to therapeutic practice that reflected these
theoretical shifts. Adler originated the approach, although his influence was indirect due to his
inability to systematically formulate his ideas. In Kovel's view, neo-Freudian practice shares the
same assumption as most current therapeutic approaches in the United States: "If what is wrong
with people follows directly from bad experience, then therapy can be in its basics nothing but good
experience as a corrective." Neo-Freudian analysis therefore places more emphasis on the patient's
relationship with the analyst and less on exploration of the unconscious. [155]
Carl Jung believed that the collective unconscious, which reflects the cosmic order and the history of
the human species, is the most important part of the mind. It contains archetypes, which are
manifested in symbols that appear in dreams, disturbed states of mind, and various products of
culture. Jungians are less interested in infantile development and psychological conflict between
wishes and the forces that frustrate them than in integration between different parts of the person.
The object of Jungian therapy was to mend such splits. Jung focused in particular on problems of
middle and later life. His objective was to allow people to experience the split-off aspects of
themselves, such as the anima (a man's suppressed female self), the animus (a woman's
suppressed male self), or the shadow (an inferior self-image), and thereby attain wisdom.[155]
Jacques Lacan approached psychoanalysis through linguistics and literature. Lacan believed that
Freud's essential work had been done prior to 1905 and concerned the interpretation of dreams,
neurotic symptoms, and slips, which had been based on a revolutionary way of understanding
language and its relation to experience and subjectivity. Lacan believed that ego
psychology and object relations theory were based upon misreadings of Freud's work. For Lacan,
the determinative dimension of human experience is neither the self (as in ego psychology) nor
relations with others (as in object relations theory), but language. Lacan saw desire as more
important than need and considered it necessarily ungratifiable. [156]
Wilhelm Reich developed ideas that Freud had developed at the beginning of his psychoanalytic
investigation but then superseded but never finally discarded. These were the concept of the
Actualneurosis and a theory of anxiety based upon the idea of dammed-up libido. In Freud's original

view, what really happened to a person (the "actual") determined the resulting neurotic disposition.
Freud applied that idea both to infants and to adults. In the former case, seductions were sought as
the causes of later neuroses and in the latter incomplete sexual release. Unlike Freud, Reich
retained the idea that actual experience, especially sexual experience, was of key significance. By
the 1920s, Reich had "taken Freud's original ideas about sexual release to the point of specifying the
orgasm as the criteria of healthy function." Reich was also "developing his ideas about character into
a form that would later take shape, first as "muscular armour", and eventually as a transducer of
universal biological energy, the "orgone"."[155]
Fritz Perls, who helped to develop Gestalt therapy, was influenced by Reich, Jung and Freud. The
key idea of gestalt therapy is that Freud overlooked the structure of awareness, which, properly
understood, is "an active process that moves toward the construction of organized meaningful
wholes... between an organism and its environment." These wholes, called gestalts, are "patterns
involving all the layers of organismic function thought, feeling, and activity." Neurosis is seen as
splitting in the formation of gestalts, and anxiety as the organism sensing "the struggle towards its
creative unification." Gestalt therapy attempts to cure patients through placing them in contact with
"immediate organismic needs." Perls rejected the verbal approach of classical psychoanalysis;
talking in gestalt therapy serves the purpose of self-expression rather than gaining self-knowledge.
Gestalt therapy usually takes place in groups, and in concentrated "workshops" rather than being
spread out over a long period of time; it has been extended into new forms of communal living. [155]
Arthur Janov's primal therapy, which has been an influential post-Freudian psychotherapy,
resembles psychoanalytic therapy in its emphasis on early childhood experience, but nevertheless
has profound differences with it. While Janov's theory is akin to Freud's early idea of Actualneurosis,
he does not have a dynamic psychology but a nature psychology like that of Reich or Perls, in which
need is primary while wish is derivative and dispensable when need is met. Despite its surface
similarity to Freud's ideas, Janov's theory lacks a strictly psychological account of the unconscious
and belief in infantile sexuality. While for Freud there was a hierarchy of danger situations, for Janov
the key event in the child's life is awareness that the parents do not love it. [155] Janov writes that
primal therapy has in some ways returned to Freud's early ideas and techniques. [157]
Frederick Crews considers Freud the key influence upon "champions of survivorship" such as Ellen
Bass and Laura Davis, co-authors of The Courage to Heal (1988), although in his view they are
indebted not to classic psychoanalysis but to "the pre-psychoanalytic Freud, the one who
supposedly took pity on his hysterical patients, found that they were all harboring memories of early
abuse... and cured them by unknotting their repression." Crews sees Freud as having anticipated
the recovered memory movement's "puritanical alarmism" by emphasizing "mechanical cause-andeffect relations between symptomatology and the premature stimulation of one body zone or
another", and with pioneering its "technique of thematically matching a patient's symptom with a
sexually symmetrical 'memory.'" Crews believes that Freud's confidence in accurate recall of early

memories anticipates the theories of recovered memory therapists such as Lenore Terr, which in his
view have led to people being wrongfully imprisoned or involved in litigation. [158]
Ethan Watters and Richard Ofshe write that the psychodynamic conception of the mind may be at
the end of its usefulness, which could affect "thousands upon thousands and therapists and their
patients." They believe that due to "the massive investment the field of psychotherapy has made in
the psychodynamic approach, the dying convulsions of the paradigm will not be pretty", even though
uninformed or unsophisticated people may continue to accept the psychodynamic paradigm despite
its lack of validity.[159]