Evaluation

A positive point for starters.  Freud’s theory was the first to consider psychological illness as having psychological causes.  Prior to Freud mental illness was considered to be the result of possession by the devil or earlier still due to witchcraft. 

However, there are a number of problems with Freud’s theory, method and treatments.

1.        The model is subjective and lacks any sort of scientific rigour.  Freud’s theory was developed from his own interpretations of his patients thoughts and cannot be verified using objective or scientific methods. 

2.       The methods used by the psychodynamic are especially questionable.  Most ideas are based on case studies which as we’ve already seen provide lots of detailed information about a case but are notoriously difficult to generalise.

3.       It is impossible to prove or disprove.  In interpreting dreams, if the patient agreed with Freud’s interpretation this would be seen as supporting evidence.  If the patient did not agree then Freud saw this as the patient’s denial or inability to come to terms with the nature of their repressed thoughts!  Similarly if a patient behaves as expected this would be seen as support, if they behaved differently this would be proof of the existence of defence mechanisms.

4.       Freud places too great an emphasis on childhood experiences whilst ignoring more recent adult events and similarly, according to later psychodynamic theorists places too great an emphasis on sex.  Erik Erikson (1963) describes psychosocial stages of development rather than psychosexual and believes that emotional conflict can arise from adult events just as much as childhood events.

5.       The components of personality, the stages, libido Eros and Thanatos etc are all hypothetical constructs, impossible to define or to study objectively.  They only manifest themselves through a subjective analysis of a patient. 

Ethical implications of the psychodynamic approach

Like the medical model it is deterministic.  It sees the abnormal behaviour as being out of control of the individual who Freud sees as a prisoner of their past and of their unconscious forces.  As a result people should not be blamed for their psychological illness.  However, since childhood experience is crucial in determining psychological well being later in life then surely parents, according to this approach, are partly to blame for disorders.  This can cause problems for the patient undergoing therapy. 

As mentioned in memory, there is also the issue of false memory syndrome were repressed material has been uncovered using psychoanalytic techniques and led to accusations of child abuse etc. that cannot be independently verified.

Bertha Pappenheim (Anna O)

Treatments based on the psychodynamic model

The basis of all treatments is giving the patient an insight into their unconscious mind.  Once a person had gained access they would be able to integrate or come to terms with whatever was at the root of their problem and cope with life better. 

Hypnosis and dream therapy

Initially Freud used hypnosis as a way of tapping into the patient’s unconscious mind but later went on to use dream therapy.  In 1901 Freud published his classic book ‘The Interpretation of Dreams,’ in which he outlined how the mind disguises unconscious desires behind symbols while we sleep.  Freud called dreams ‘the Royal road to the unconscious.’ 

Free association

The patient is encouraged to talk openly and at length without interruption.  Freud believed that this showed associations between thoughts that are caused by unconscious forces.  The job of the analyst is to unravel and interpret these connections and bring unconscious thoughts into the conscious mind.  Freud believed that pauses and embarrassed laughs gave clues to areas that were causing problems. 

The case of Anna O (real name Bertha Pappenheim)

Freud collaborated with Josef Breuer, another physician and physiologist. Breuer had a patient, known as Anna O who was suffering from paralysis of the extremities on her right hand side, hallucinations and disturbances of speech and vision.   Freud was convinced that she was suffering from hysteria caused by the death of her father.  During her treatment, Freud and Breuer discovered that recalling traumatic experiences with the help of free association cured her paralysis.  In 1895, Freud and Breuer published Studies in Hysteria, which documented "the cathartic method", also known as the "talking cure".

The case of Anna O is widely considered as the beginning of psychoanalysis.  Breuer initially attempted treatment via hypnosis but Anna herself found simply talking to be more effective and Free Association was born.  NB: Borch-Jacobsen 1996 have alleged that the case of Anna O was a fabrication.

Evaluation of psychodynamic treatments

There is evidence that treatment is effective.  Bergin (1971) in a huge study of 10,000 patients found that 80% of patients found the treatment beneficial.  Recently Tschuschke et al (2007) reported that the longer treatment lasts the more effective it will be,

Others support the idea of early experiences effecting later psychological health: kindler et al (1996) found that twins separated from a parent in early life were more prone to depression and to alcoholism later in life.  Comer (2001) reported a link between childhood trauma and adult psychological disorders but to nothing like the extent that Freud would have predicted.

However

Others, most notably Hans Eysenck (father of Michael) have argued that Freudian therapy is not more effective than placebo effect in the treatment of psychological disorders.

False memory syndrome

There have been many cases in recent years in which patients undergoing therapy have supposedly recalled long lost traumatic memories from childhood.  Many of these have involved abuse by a parent, relative or friend.  Psychoanalysis assumes that childhood memories can be recalled in this way and actively encourages this in order to access the unconscious mind.  In fact there is little evidence to suggest that childhood memories can be accessed in this way leading some to suggest that memories have been inadvertently implanted by the therapy. 

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