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2
“Look at yourself honestly and unflinchingly to the very bottom of your mind.”
Calligraphy by Shihan Tsutomo Ohshima, Martial Arts Master
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Author’s Note
This work-in-progress provides a jargon-free introduction to contemporary
psychodynamic thought. It is intended for trainees and for practitioners trained in other
therapy approaches. I wrote it because existing books did not meet my students’ needs.
Many classic introductions to psychoanalytic therapy are dated. They describe the
psychoanalytic thinking of decades ago, not today. Others contain too much jargon to be
accessible, or assume prior knowledge that few contemporary readers possess. Still
others have a partisan agenda of promoting one psychoanalytic school of thought over
others, but students are ill-served by drawing them into internecine theoretical disputes.
Finally, some otherwise excellent books assume an interested and sympathetic reader, an
assumption that is often unwarranted. Many students have been exposed to
considerable disinformation about psychoanalytic thought and approach it with
inaccurate and pejorative preconceptions.
The title is a double entendre. “That was then, this is now” alludes to a central
aim of psychoanalytic therapy, which is to help free people from the bonds of past
experience in order to live more fully in the present. People tend to react to what was
rather than what is, and psychoanalytic therapy aims to help with this. The title also
alludes to sea changes in psychoanalytic thinking that have occurred over the past
decades. For too many, the term “psychoanalysis” conjures up century old stereotypes
that bear little resemblance to what contemporary practitioners think and do.
These chapters were intended as the beginning of a book. I may finish it one day
but the project is on the back burner. For now, this is it.
Jonathan Shedler
April, 2010
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Chapter 1:
Roots of Misunderstanding
Psychoanalytic psychotherapy may be the most misunderstood of all therapies. I
teach a course in psychoanalytic therapy for clinical psychology doctoral students, many
of whom would not be there if it were not required. I begin by asking the students to
write down their beliefs about psychoanalytic therapy. Most express highly inaccurate
preconceptions. The preconceptions come not from first-hand encounters with
psychoanalytic practitioners, but from media depictions, from undergraduate psychology
professors who refer to psychoanalytic concepts in their courses but understand little
about them, and from textbooks that present caricatures of psychoanalytic theories that
were out of date half a century ago.
Some of the more memorable misconceptions are: That psychoanalytic concepts
apply only to the privileged and wealthy; that psychoanalytic concepts and treatments
lack empirical support (for a comprehensive review of empirical evidence, see Shedler,
2010); that psychoanalysts “reduce everything” to sex and aggression; that they keep
patients in long term treatment merely for financial gain; that psychoanalytic theories
are sexist, racist, or classist (insert your preferred politically incorrect adjective); that
Sigmund Freud, the originator of psychoanalysis, was a cocaine addict who developed his
theories under the influence; that he was a child molester (a graduate of an Ivy League
university had somehow gotten this bizarre notion from one of her professors); and that
the terms “psychoanalytic” and “Freudian” are synonyms—as if psychoanalytic
knowledge has not advanced since the early 1900s.
Most psychoanalytic therapists have no idea how to respond to the question (all
too common at cocktail parties), “Are you a ‘Freudian?’” The question has no
meaningful answer, and I myself fear that any answer I give will lead to
5
misunderstanding. In a basic sense, all mental health professionals are “Freudian”
because so many of Freud’s concepts have simply been assimilated into the broader
culture of psychotherapy. Many Freudian ideas now seem so commonplace,
commonsense, and taken-for-granted that people do not recognize that they originated
with Freud and were radical at the time. For example, most people take it for granted
that trauma can cause emotional and physical symptoms, that our care in the early years
profoundly affects our adult lives, that people have complex and often contradictory
motives, that sexual abuse of children occurs and can have disastrous consequences, that
emotional difficulties can be treated by talking, that we sometimes find fault with others
for the very things we do not wish to see in ourselves, that it is exploitive and destructive
for therapists to have sexual relations with clients, and so on. These and many more
ideas that are commonplace in the culture of psychotherapy are “Freudian.” In this
sense, every contemporary psychotherapist is a (gasp) Freudian, like it or not. Even the
practice of meeting with clients for regularly scheduled appointments originated with
Freud.
In another sense, the question “Are you a Freudian?” is unanswerable because no
contemporary psychoanalytic therapist is a “Freudian.” What I mean is that
psychoanalytic thinking has evolved radically since Freud’s day—not that you would
know this from reading most textbooks. In the past decades, there have been sea
changes in theory and practice. The field has grown in diverse directions, far from
Freud’s historical writings. In this sense, no one is a Freudian. Psychoanalysis is
continually evolving new models and paradigms. The development of psychoanalytic
thought did not end with Freud any more than the development of physics ended with
Newton, or the development of the behavioral tradition in psychology ended with
Watson.
6
There are multiple schools of thought within psychoanalysis with different and
sometimes bitterly divisive views, and the notion that someone could tell you “the”
psychoanalytic view of something is quaint and naïve. There may be greater diversity of
viewpoints within psychoanalysis than within any other school of psychotherapy, if only
because psychoanalysis is the oldest of the therapy traditions. Asking a psychoanalyst
for “the” psychoanalytic perspective may be as meaningful as asking a philosophy
professor “the” philosophical answer to a question. I imagine the poor professor could
only shake her head in bemusement and wonder where to begin. So it is with
psychoanalysis. Psychoanalysis is not one theory but a diverse collection of theories,
each of which represents an attempt to shed light on one or another facet of human
functioning.
What it isn’t
It may be easier to explain what psychoanalysis is not than what it is. For
starters, contemporary psychoanalysis is not a theory about id, ego, and superego (terms,
incidentally, that Freud did not use; they were introduced by a translator). Nor is it a
theory about “fixations,” or sexual and aggressive instincts, or repressed memories, or
the Oedipus complex, or penis envy, or castration anxiety. One could dispense with
every one of these ideas and the essence of psychoanalytic thinking and therapy would
remain intact. (Surprised?) Some psychoanalysts may find some of these concepts
helpful, sometimes. Many psychoanalysts reject every one of them.
If you learned in college that psychoanalysis is a theory about id, ego, and
superego, your professors did you a disservice. I hope you will not shoot the messenger
for telling you that you may be less prepared to understand psychoanalytic thought than
if you had never taken a psychology course at all. Interest in that particular model of the
mind (known as the “structural theory”) has long since given way to other theories and
7
models (cf. Person, Cooper, & Gabbard, 2005). There is virtually no mention of it in
contemporary psychoanalytic writings other than in historical contexts. In the late 20th
century, the theory’s strongest proponent eventually went on to argue that it was no
longer relevant to psychoanalysis (Brenner, 1994). When psychology textbooks present
the structural theory of id, ego, and superego as if it were synonymous with
psychoanalysis, I don’t know whether to laugh or to cry.
It is fair to ask how so many textbooks could be so out of date and get it all so
wrong. Students have every reason to expect their textbooks to be accurate and
authoritative. The answer, in brief, is that psychoanalysis developed outside of the
academic world, mostly in freestanding institutes. For complex historical reasons, these
institutes tended to be rather insular, and for decades psychoanalysts did little to make
their ideas accessible to people outside their own closed circles. Some of the
psychoanalytic institutes were also arrogant and exclusive in the worst sense of the word
and did an admirable job of alienating other mental health professionals. This occurred
at a time when American psychoanalytic institutes were dominated by a hierarchical
medical establishment (for a historical perspective, see McWilliams, 2004). The
psychoanalytic institutes have changed but the hostility they engendered in other mental
health professions is likely to persist for years to come. It has been transmitted across
multiple generations of trainees, with each generation modeling the attitudes of its own
teachers.
Academic psychology also played a role in perpetuating widespread
misunderstanding of
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