Psychoanalysis is one of the oldest and most foundational approaches to psychological treatment. Over time, it has evolved into five major schools of thought: Freudian Psychoanalysis, Ego Psychology, Object Relations Theory, Self Psychology, and Contemporary Psychoanalysis. This article explores these approaches and compares them with evidence-based psychodynamic therapies.
Major Approaches in Psychoanalysis
1. Freudian Psychoanalysis
Founded by Sigmund Freud, Freudian Psychoanalysis emphasizes the role of the unconscious, childhood experiences, and inner conflicts (Freud, 1900). Techniques such as free association and dream analysis are used to uncover unconscious roots of psychological distress.
Research has shown that this approach can be effective in treating personality disorders and certain psychotic conditions. A meta-analysis by Leichsenring and Rabung (2008) demonstrated the efficacy of long-term psychodynamic psychotherapy in treating personality disorders.
2. Ego Psychology
The Ego Psychology approach, developed by Anna Freud and Heinz Hartmann, focuses on strengthening the ego and enhancing the individual’s capacity to adapt to reality (Hartmann, 1958). This model emphasizes defense mechanisms and ego functions, aiming to improve coping skills.
Research by Blanck and Blanck (1974) indicated that this approach can enhance coping abilities and reduce anxiety symptoms.
3. Object Relations Theory
Developed by Melanie Klein and others, Object Relations Theory centers on early relationships and their influence on personality development and psychological health (Klein, 1946). Psychological difficulties are seen as stemming from failures in forming healthy relationships.
A study by Levy et al. (2006) found this approach particularly effective in treating personality disorders, especially Borderline Personality Disorder.
4. Self Psychology
Proposed by Heinz Kohut, Self Psychology emphasizes the importance of empathy and validation in human development (Kohut, 1977). Failures in meeting these essential needs result in disorders of the self.
Research by Bachar et al. (1999) confirmed the effectiveness of this approach in treating eating disorders and depression.
5. Contemporary Psychoanalysis
Contemporary Psychoanalysis focuses more on interpersonal relationships and here-and-now interactions than on historical exploration. It is also more flexible than traditional models (Stern, 1995).
Empirical evidence suggests that contemporary psychoanalytic approaches are effective in treating anxiety and mood disorders (Stern et al., 2013).
Evidence-Based Psychodynamic Therapies
Evidence-Based Psychodynamic Therapies (EBPTs) build upon the principles of psychoanalysis but are structured and validated through empirical research. These include Short-Term Psychodynamic Therapy (STPP) and Transference-Focused Psychotherapy (TFP).
1. Theoretical Foundations and Empirical Basis
Whereas traditional psychoanalysis relies heavily on clinical observation and theoretical interpretation, EBPTs are supported by experimental and outcome-based research.
For example, a meta-analysis by Leichsenring et al. (2004) confirmed the efficacy of short-term psychodynamic psychotherapy in treating depression and anxiety.
2. Structure and Duration of Therapy
Unlike traditional psychoanalysis, which is often long-term and open-ended, EBPTs are time-limited and structured.
For instance, Short-Term Psychodynamic Therapy typically lasts between 12 and 40 sessions (Abbass et al., 2006).
3. Focus on Current Problems
These therapies place greater emphasis on current relational patterns and employ targeted interventions, such as correcting maladaptive transference patterns in present relationships.
For example, Transference-Focused Psychotherapy centers on identifying and modifying dysfunctional transference patterns (Kernberg et al., 2008).
4. Effectiveness
Numerous studies have confirmed the efficacy of EBPTs.
Meta-analyses indicate that evidence-based psychodynamic therapies are highly effective in reducing depressive and anxiety symptoms (Driessen et al., 2015).
Conclusion
Traditional psychoanalytic approaches and evidence-based psychodynamic therapies share common roots but differ in focus and structure. While traditional psychoanalysis emphasizes the exploration of the unconscious and the historical roots of psychological conflicts, evidence-based approaches concentrate on present issues, measurable outcomes, and structured interventions. The choice of approach ultimately depends on the patient’s needs and the therapeutic context.
References
Abbass, A., et al. (2006). Intensive Short-Term Dynamic Psychotherapy. Harvard Review of Psychiatry.
Bachar, E., Canetti, L., & Bonne, O. (1999). The effectiveness of self-psychology in treating eating disorders. International Journal of Psychoanalysis.
Blanck, G., & Blanck, R. (1974). Ego Psychology: Theory and Practice.
Driessen, E., et al. (2015). The efficacy of short-term psychodynamic psychotherapy. Clinical Psychology Review.
Freud, S. (1900). The Interpretation of Dreams.
Hartmann, H. (1958). Ego Psychology and the Problem of Adaptation.
Kernberg, O., et al. (2008). Transference-Focused Psychotherapy for Borderline Personality Disorder.
Klein, M. (1946). Notes on Some Schizoid Mechanisms. International Journal of Psychoanalysis.
Kohut, H. (1977). The Restoration of the Self.
Leichsenring, F., & Rabung, S. (2008). Effectiveness of long-term psychodynamic psychotherapy: A meta-analysis. JAMA Psychiatry.
Leichsenring, F., et al. (2004). The efficacy of short-term psychodynamic psychotherapy. JAMA Psychiatry.
Levy, K. N., Meehan, K. B., Kelly, K. M., et al. (2006). Psychodynamic therapies for borderline personality disorder. Clinical Psychology Review.
Stern, D. B. (1995). The Interpersonal World of the Infant: A View from Psychoanalysis and Developmental Psychology.
Stern, D. B., et al. (2013). Contemporary psychoanalysis and evidence-based practices. Psychoanalytic Dialogues.
