Psychoanalysis for Anxiety Disorders

sigmund freud red couch
Source: Sigmund Freud Museum

Up until about the early 1960’s, phobias and anxiety were treated almost exclusively through psychoanalysis. Sigmund Freud, the founder of psychoanalysis, believed unconsciously rooted conflicts were the cause of anxiety, and that the subconscious mind consisted of a “seething cauldron of conflicting impulses, urges, and wishes”. Freud believed that anxiety is caused when you block or repress your unconscious impulses. According to the founder of psychoanalysis, anxiety and fear are the result of freely expressing previously punished or repressed impulses. For example if as a child you were punished whenever you wanted to talk in the presence of other people, if now you wanted to talk in the same setting, this would make you feel anxious.

The goal of psychoanalysis is to help patients gain insight into their deep-seated conflicts and find socially acceptable ways of expressing these wished and gratifying their needs. To this end you need to delve into all your childhood conflicts with the help of a psychoanalyst. Usually this is accomplished through lengthy and arduous therapy. Among some of the techniques of psychoanalysis are free association, dream analysis, and analysis of the relationship between the patient and the therapist.

Historically, psychoanalysis proved ineffective in treating phobias. People may eventually learn to identify the root causes of their anxiety or phobia. However, the phobia itself often remains unchanged. Even Freud himself recognized the limitations of psychoanalysis in treating phobias:

One can hardly ever master a phobia if one waits ’til the patient lets the analysis influence him to give it up…One succeeds only when one can induce them through the influence of the analysis to go about alone and to struggle with their anxiety while they make the attempt.

The psychology professor and philosopher, Von Glasersfeld, explained it neatly with the following analogy. He said when we have a lock, the important issue is not the lock per se (its nature and its intrinsic constitution), rather finding a key to open it.

Psychoanalysis is based on the belief that the individual has within himself a disorder. This excludes all the important social and inter-relational factors that influence each person. The real world and what is going on in it at the present time takes its meaning exclusively from the past.

There are different kinds of analysts. Some follow the tenants of Freud and Jung while others prefer Adler, Bion, Klein, Lacan, Reich, etc. But they all have one variable in common: the need to look into the deep causes of inner conflict in order to help someone overcome their fears and anxiety. Change, they believe, must first happen in the unconscious mind of the person before it can happen in their life.

According to James Hilmann, the late American psychoanalyst, psychopathology based on the idea that we are a product of our childhood conflicts with our parents, is a myth of psychoanalysis. According to Jay Haley, one of the founding figures of Brief Therapy, “interpretations of unconscious communications are absurdly reductionistic, like summarizing a Shakespearean play in a sentence.”

The Menninger Foundation Psychotherapy Research commissioned what is known as the most famous study undertaken on the effectiveness of psychoanalysis. The study revealed that the averages duration of therapy was 835 sessions. This meant one session per week during seven years! Results showed that 30% of the patients were unchanged and other 30% reported actually getting worse!

No wonder then that in the 1960’s, 80% of psychotherapists were analysts but now only 25% still apply these methods.