Psychoanalytic Theory

Introduction

According to classical psychoanalytic theory, the key to determining psychopathology (whether it be anxiety or neurosis, depression, interpersonal relationship issues or substance use disorders) lies in the past. Therefore, psychoanalysis seeks not only to uncover these past traumas, conflicts and so on but to do so in such a way that the client develops insight. Insight can be viewed as a deep understanding of both the unconscious and conscious understanding of the origins of one’s disorders. This is often a very emotional (or cathartic) and often an anxiety-provoking process, which is why psychoanalysis is often considered an inappropriate treatment for substance use disorders, especially for those who are in early recovery. Yet, psychoanalytic theory provides counselors with an understanding of how trauma impacts on peoples lives, often for years after the traumatizing incident. Psychoanalytic theory also provides counselors with an understanding of defense mechanisms such as denial, rationalization and sublimation, which often fuel the addiction by distorting the painful reality of the impact that alcohol and/or drug use has on his or her life. There’s an old Alcoholics Anonymous (AA) saying that addresses these distortions, “alcoholism is a disease that tells you, you don’t have a disease” and it’s the defense mechanisms that account for these distortions. And yet, everyone employs defense mechanisms in their daily life, not just those with substance use disorders (SUDs).

Another reason that psychoanalysis and psychoanalytic theory are not viewed as acceptable or effective in substance use disorders is due, in part, to the fact that psychoanalytic theory is often viewed as antiquated or outdated. Also, traditional or classical analysis is done over the course of months and often years, with clients attending therapy sessions sometimes three or four times a week.This makes psychoanalysis not only time-consuming, but also very costly and, in many instances, not very practical. Addiction counseling, especially in the early phases of treatment, tends to be very practical and focuses more on the here-and-now (Washton & Zweben, 2006). As many of us who have worked with individuals with substance use disorders know, insight alone doesn’t necessarily translate into behavioral change when it comes to achieving sobriety.

Yet, psychoanalytic theory has made, often indirectly, many contributions to the addictions treatment field. For example, we will talk about Attachment Theory (a theory which grew out of psychoanalytic theory), which examines how disturbed relationships with significant others can often be a precursor to addictions later in life. In addition, Attachment Theory suggests that one’s ability to form healthy connections with others can often become the foundation of sobriety, whether those connections be in 12-Step programs or in counseling. For now, however, let’s go back to the beginnings of psychoanalytic theory with its founder, Sigmund Freud.

Sigmund Freud was born in Moravia on May 6, 1856, although he lived in worked in Vienna, Austria for nearly 80 years. Freud was interested in becoming a scientist, so he entered Medical School at the University ofVienna in 1873. Freud never intended to practice medicine, however, given the lack of rewards for scientific research and few faculty positions for Jewish scholars in Austria and Germany, he began a private practice specializing in neurology. It was as a result of his private practice work that Freud, developed the psychoanalytic approach to treating neuroses (i.e. a type of mental disorder), in the latter part of the 19th century. Freud was originally trained as a neurologist but the psychological origins of the symptoms of many of his patients piqued his interest in studying how emotional trauma would transform into complaints of various neurological ailments (Hall & Lindzey, 1970). Freud had treated many patients who manifested neurological symptoms such as paralysis, blindness and numbness for which he could find no medical/neurological explanations. (Freud later labeled these pseudo-neurological symptoms as “conversion disorders” because he concluded that psychological or emotionally painful experiences had “converted” into physical symptoms.) These types of symptoms initially led Freud into studying hypnosis, which he employed as a means of helping to uncover the psychological or emotional trauma that had caused these various conversion reactions in his patients. Freud later discovered that hypnosis was limited in allowing his patients to experience catharsis (or an outpouring of emotions), which is when he began to use free association, a therapeutic technique in which patients were encouraged to say whatever came to mind in the session. Free association, dream interpretation, and analysis of resistance and transference became the hallmarks of psychoanalysis and psychoanalytically oriented psychotherapy.

Learning Opportunity 2.1

Can you recall something that took place in your childhood (prior to age 8) that may have had an impact on the person you’ve become today? If you’re working on this in class, break into groups of three and share what you’ve written with the two other people in your triad.

Key Terms

abreaction: the process by which patients experience extreme emotional catharsis as they re-live a traumatic episode or event.

catharsis: similar to abreaction — the patient experiences an outpouring of emotions in response to a traumatic or stressful event or episode that is recollected in therapy.

ego: a part of one’s personality structure which is responsible for making executive daily decisions based upon current realities; the ego’s major role is to act as a mediator between the id and superego.

id: a part of one’s personality structure that is often part of one’s unconscious (or outside of one’s awareness). The id operates on the “pleasure principle,” (i.e. if it feels good, do it) without concern for reality. The id would contain sexual urges and impulses and any other behaviors that produce pleasure for the individual (including alcohol and moodaltering substances).

superego: a part of one’s personality structure from which one’s sense of conscience or morals are derived. The superego exists in opposition to the id.

defense mechanism: often referred to as ego, defense mechanisms are distortions which serve to protect the ego from harsh or traumatic realities. For example, repression protects the ego by pushing traumatic memories out of conscious awareness. Anna Freud had conceptualized most of the defense mechanism described in Table 2.1.

dream interpretation: a technique used in psychoanalysis and psychoanalytic-ally oriented therapy. Dreams are thought to hold valuable repressed or unconscious information.

free association: a psychoanalytic technique in which a client is asked to speak about whatever thoughts, feelings or images come into their mind without censoring.

unconscious: that part of the mind that is outside of one’s everyday awareness. Unconscious urges may include one’s sexual or aggressive impulses or urges that are considered to be unacceptable (especially to the superego). transference: refers to the relationship the patient has with his or her therapist.

Here the patient is thought to unconsciously transfer feelings, attitudes, attributes or motives towards a significant person in his or her life towards the therapist. One of the key roles of the therapist is to interpret this transference as part of the therapeutic relationship.

countertransference: just as the patient harbors unconscious feelings towards the therapist, so too does the therapist transfer feelings, attributes, motives towards the patient of someone significant in their life or from their past. resistance: Sigmund Freud warned that resistance is very much part of the therapeutic process and may be encountered during every aspect of therapy. Just as there’s a part of the patient who wants to get well and improve, there’s another part that wants to maintain the status quo or that part of the personality which opposes change.