Is psychoanalysis still valid?

Freud is dead. His views are antiquated. His theories of women are sexist. His ideas about homosexuals are homophobic. He has nothing to say to us now. He lived in the Victorian era and we live now.

These are just a few of the things one hears about Freud and psychoanalysis these days. To many people psychoanalysis is no longer valid, either as a system of thought or a form of psychotherapy.

As a licensed psychoanalyst, I often find myself having to justify using psychoanalytic theory or therapy, and I gladly do so, for I think both are indeed still valid. I say, “Let’s not throw the baby out with the bath water.”

Freud made many monumental discoveries that continue to be important and valid. He discovered the unconscious mind and, by implication, nonverbal communication. He discovered the unconscious defense mechanism such as repression, projection, denial, and compensation, which are now part of our everyday speech. He discovered transference and resistance and he was a pioneer in the study of narcissism, both in individuals and groups.

Psychoanalysts today have made many modifications, especially in how we do therapy. We no longer see patients 6 days a week, as Freud did. I currently see many patients twice a week, once in individual therapy and once in group therapy. Nor do we use psychoanalysis for every patient. Each patient dictates his or her own interventions. Cognitive or behavioral therapy is more successful with some.

In Freud’s day, patients came for a year, six days a week, and then were pronounced cured. Today patients continue in treatment for years, and there is no finite end to the therapy. Patients terminate therapy not because they are “cured,” but because they decide, along with the therapist, that they have found enough balance and inner strength to function successfully in their personal and professional lives.

The most valid thing, and the thing that makes psychoanalytic therapy stand out from other therapies, is the therapy relationship. In psychoanalytic therapy, the therapy relationship is seen as the key to progress.

A patient can talk about what’s going on in his life, but that is second hand. When he talks about his thoughts and feelings about the therapist, he is being more direct. Often, the biggest turning points come when the patient develops a transference neurosis. For example, he unconscious sees his therapist as a demanding parent who is trying to control him. He starts threatening to quit the therapy, making up excuses about not having money. The therapist bides his time. One day the patient angrily says he is quitting. The therapist says that will be fine.

“So you’re not even going try to talk me out of it!”

The patient suddenly becomes incensed. “You’re just like my father. He didn’t care about me and you don’t either!” The therapist waits. Right then, at that moment, he finally becomes clear about something.

“The anger that I’ve been feeling toward you is really meant for my father,” the patient finally admits. And he is able to make an important distinction, in therapy, and then out of therapy.