Sigmund Freud was the originator of psychoanalysis. He was a brilliant thinker and a clear writer and his ideas laid the foundation stones for psychoanalysis as it is today. Freud was working with those with ‘nervous disorders’ in Vienna in the 1880s. The treatments of the day included hydrotherapy (warm baths through which an electric current was passed), hypnotism, electrotherapy and drug therapy (including administering morphine).
Freud discovered that by listening to his patients and understanding and interpreting what their conscious minds had found unacceptable, their symptoms could be alleviated; his colleague and friend Breuer called this ‘the talking cure’.
The unconscious, the ego, the id and the superego
Freud’s innovations were many. He described the conscious mind and distinguished it from ‘the unconscious’, where unacceptable memories and experiences were repressed. He described the functions of the ego (the conscious seat of the personality), the superego (a form of conscience which played a key role in repression), and the id (the basic bodily drives and impulses).
In his landmark book, The Interpretation of Dreams, published in 1900, he described what dreams revealed of the functioning of the mind. Dreams were, he said, ‘the royal road to the unconscious’. Already, in this book, he laid out the outline of the theory that he carried on developing throughout his lifetime.
Freud went on to describe the patient’s transference to the analyst, whereby the patient treated the analyst not as the ordinary, human doctor which in reality they were, but as someone endowed with special importance and significance. In particular, he felt that the patient often ‘transferred’ experiences and forms of relationship from the past onto the current relationship with the psychoanalyst.
Freud pointed out that whilst this might appear difficult and problematic to all concerned (his colleague Breuer had been most alarmed when his patient had fallen in love with him), in fact it gave the analyst and patient direct insight into the patient’s way of relating. As a result of this the problematical pattern could be addressed in the here-and-now of the analysis, rather than the analyst having to speculate about long-past events that could not be easily verified.
Freud also saw the sexual drive as central to his theory of human motivation. He outlined the Oedipus complex where, for the boy, the child is attracted to his mother and has rivalrous/murderous impulses toward his father, which have to be repressed. These are just a few of Freud’s innovations.
In the 1950s and 60s the importance of relationship itself, as the primary motivator, was recognised. As the Scot, Ronald Fairbairn said, we don’t have relationships in order to have sexual relations, we have sexual relations in order to have relationships. The theory of object relationship i.e. the primary importance of relationship itself, was born.
These views were expanded upon by such theorists as Melanie Klein, Donald Winnicott, Wilfred Bion and others – each of whom made unique contributions to the field. Klein and Winnicott in particular brought in experience from working with children and challenged Freud’s notion that the child was unrelated to the mother at first but rather lived in a self-enclosed world interested primarily in satisfying him or herself. Klein emphasised how the infant was intensely related to the mother from the beginning of life. This view has been borne out by infant development studies since the 1980s. The role of the infant’s relationship with their parents has been studied in detail and been shown to lay down patterns of attachment, behaviour and relationship that influence an individual throughout their life.
These developments have also been mirrored in a change in the practice of psychoanalysis itself. The notion of the analyst as a 'blank screen' whose primary role is to make conscious what has been repressed has given way to a view which also appreciates the influence of the relationship to the analyst in itself. A contemporary psychoanalyst will likely be much more in tune to the way the patient is alert to what the analyst is feeling, the patient’s feelings and phantasies about that, and the analyst’s own counter-transference response to the patient. It is now understood that this can tell the analyst much about the patient’s ongoing pattern of relating and difficulties.