It was with great excitement that I recently read Freud’s paper “On Psychotherapy.” The paper is taken from a 1904 lecture that Freud gave to a group of fellow doctors. This is Freud at the beginning of his career and at the inception of psychoanalysis (and subsequently psychotherapy). There are, of course, a lot of changes that have occurred in the field since that time. But it is very interesting to see the foundations of psychotherapy as articulated by Freud over a hundred years ago.
One of those foundations, at least as Freud saw it and how I see it, is the belief in the unconscious. People come into psychotherapy seeking answers for their disturbing behaviors and thoughts. They want to know why they do some behaviors that are not in their best interest or sabotage them in some ways. They want to know why they repeat patterns, particularly harmful ones. The answers to why a person puts off doing things interminably (as in procrastination) or repeats patterns in relationships that lead to them failing are often not to be found in the realm of logic. To investigate these situations, which is what we do in psychotherapy, is to delve into the realm of the unconscious.
In 1904, Freud spoke of the unconscious. In doing so, he seems quite modern in his insistence on the mind-body connection. He says “hysterical symptoms” (hysteria was the condition he tended to treat) are the result of “an excitation transposed from the sphere of the mental to the physical.” In other words, what is manifest physically as a symptom – for example, a tremor or twitch, or some erratic mood – is the product of some mental phenomenon. Here he is speaking of the mind’s ability to affect the body: that some sort of mental disturbance manifests itself in the physical world.
The aim of the technique that he created is to investigate the unconscious. “This therapy, then, is based on the recognition that unconscious ideas – or better, the unconsciousness of certain mental processes – are the direct cause of the morbid symptoms.” Freud is saying that symptoms – for example anxiety, depression, mania – stem from unconscious ideas and processes. The object of psychotherapy is to make conscious these ideas and mental processes. For example, a man might discover, perhaps based on early formative experiences in his family, that he takes himself to be unlovable, always destined to be alone, unworthy of love. That belief then colors the way he sees himself and his life. It may, for example, lead to isolative behaviors, avoiding intimate relationships and causing loneliness. Or if he does get into intimate relationships, because of the strong belief that he will not be loved, he may sabotage the relationship and cause his partner to flee.
Freud believed that once these unconscious ideas and process were discovered and brought to consciousness that symptoms would alleviate. He wrote “the transformation of this unconscious material in the mind of the patient into conscious material must have the result of correcting his deviation from normality and of lifting the compulsion to which his mind has been subjected.” This is one area where modern understanding of psychotherapeutic process has changed: while there is much to be gained by becoming aware of the unconscious material, we have seen that that awareness is not quite enough to promote change. Understanding is not enough; but it is an essential component in the change process.
The type of psychotherapy that Freud pioneered is called analytic therapy. He writes that it “concerns itself with the genesis of the morbid symptoms and the psychical context of the pathogenic idea.” This is why a focus on the past is often an essential part of analytically oriented psychotherapy (the type that I practice). The aim is to understand not only the “genesis” of the symptoms, but also of the beliefs (the “pathogenic ideas”) and mental processes that are negatively affecting the client. Of course, there is also a focus on the present (how these ideas influence the person in the here-and-now) and on what it takes to make substantial changes in one’s life.
While not all psychotherapy practices are concerned with the unconscious or even believe in it, the emphasis on understanding and getting some glimpse of the unconscious is central to the way I work. While working with addictions, obsessive and compulsive behaviors, depressed or anxious moods, the focus remains to attempt to understand the unseen and mysterious forces that are influencing the person and causing these symptoms.
Freud, S. (1905). On psychotherapy. Standard Edition, Vol. VII, 257-268.