One of the first people to develop psychological treatments for psychological disorders was
Sigmund Freud. Freud believed that such disorders were caused by prior experiences,
particularly early traumatic experiences. Along with Josef Breuer, he pioneered the method of
psychoanalysis.
In early forms of psychoanalysis, the client would lie on a couch while the therapist sat out of
view. This method was meant to reduce the client's inhibitions and allow freer access to
unconscious thought processes.
Treatment involved uncovering unconscious feelings and drives that Freud believed gave rise to
maladaptive thoughts and behavior s (FIGURE 15.1).
Techniques included free association and dream analysis. In free association, the client would
say whatever came to mind and the therapist would look for signs of unconscious conflicts,
especially where the client appeared resistant to discussing certain topics. In dream analysis,
the therapist would interpret the hidden meaning of the client's dreams.
The general goal of psychoanalysis is to increase clients' awareness of their own unconscious
psychological processes and how these processes affect their daily functioning. By gaining
insight of this kind, the clients are freed from these unconscious influences. According to
psychoanalysis, the clients' symptoms diminish as a result of reducing
unconscious conflicts. Traditional psychoanalytic therapy is expensive and time consuming,
sometimes continuing for many years. Minimal empirical evidence exists for much of Freudian
theorizing, however, and therefore it is not surprising that
treatments for psychological disorders based on those theories are largely ineffective.
Psychotherapists later reformulated some of Freud's ideas, and these adaptations are known
collectively as psychodynamic therapy. In using this approach, a therapist aims to help clients
examine their needs, defenses, and motives as a way of understanding why they are
distressed.
Most proponents of the psychodynamic perspective today continue to embrace Freud's "talking
therapy." They have replaced the couch with a chair, however, and the talking tends to be more
conversational.
Some features of contemporary psychodynamic therapy include exploring the client's avoidance
of distressing thoughts; looking for recurring themes and patterns in thoughts and feelings;
discussing early traumatic experiences; focusing on interpersonal relations and childhood
attachments; emphasizing the relationship with the therapist; and exploring fantasies, dreams,
and daydreams (Shedler, 2010). Some of these features, such as focusing on patterns in
thoughts and feelings and addressing interpersonal relationships, are common to most forms of
psychotherapy, and thus they do not distinguish psychodynamic therapy from other types of
treatment (Tryon & Tryon, 2011). During the past few decades, the use of traditional
psychoanalytic therapy has become increasingly controversial. A new approach to
psychodynamic therapy consists of offering fewer sessions and focusing more on current
relationships than on early-childhood experiences.
Therapists who use this approach do not necessarily accept all of Freud's ideas, but they do
believe that people have underlying conflicts that need to be resolved, such as their relations
with other people. Proponents argue that this short-term psychodynamic therapy has been
shown in research to be potentially useful for treating certain disorders, including depression,
eating disorders, and substance abuse (Leichsenring et al., 2004). Other brief forms of
psychodynamic therapy, such as those focusing on emotional conflicts that result from defense
mechanisms, have also been found to be more effective than no treatment at all (Lilliengren et
al., 2016). However, it is not clear whether the psychodynamic aspects are superior to other
brief forms of therapy, such as simply talking about personal problems to a caring therapist. The
opportunity to talk about one's problems to someone who will listen plays a role in all
therapeutic relationships.