Friday, April 28, 2006

Freud and Psychotherapy

A collection of Sigmund Freud's drawings is scheduled for exhibition at the New York Academy of Medicine, according to a story in the New York Times. The drawings reflect Freud's progression from a neuroanatomist to psychoanalyst. As is obligatory in articles about psychoanalysis, the comment is made, "Freud's methods have fallen from favor in recent decades, but science historians say that his investigation of the unconscious more than a century ago stands as a revolutionary achievement that still informs many therapists' understanding of memory, trauma and behavior."

When I was in graduate school, the conventional wisdom was that Freud's greatest contribution was his concept of transference. In traditional psychoanalytic thought, transference refers to a client's tendency to think of his or her analyst as a parent. The client's behavior toward the analyst was then used as evidence of early relationships and interpreted back to the client.

Today, the term, transference, is out of style. Nevertheless, a good clinician uses behavior in the office as the primary data for treatment. How a client responds to me tells me much about how the client behaves outside of therapy. For example, I usually teach angry clients relaxation exercises, so they can calm themselves when angry. If a client tells me that relaxation exercises seem silly to him, it tells me a lot about how he behaves outside of the session. He may behave judgmentally toward his bosses, coworkers, or family members. Then, I can show him how he angers himself, by saying, "This is silly. I shouldn't have to do this." From there, it's a simple step to restructuring the thoughts by substituting, "It can't hurt to try it and see if it helps."

I certainly don't think of myself as a psychoanalyst, although I respect Freud's genius in uncovering the healing nature of a relationship. Freud did something else, which therapists should never forget. He let his patients teach him about healing.


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