Clinical Psychology

BOX12-4:Clinical Psychologist Perspective:

Kenneth N. Levy, Ph.D.

Interpretation and Insight

Curative Factors

The Lack of Emphasis on Behavior

BOX12-5:Clinical Psychologist Perspective:

Ali Khadivi, Ph.D.

The Economics of Psychotherapy

BOX12-6:Graduate Student Perspective:

Joseph E. Beeney

CHAPTER SUMMARY

KEY TERMS

WEB SITES OF INTEREST

T

he psychodynamic approach to therapy focuses

on unconscious motives and conflicts in the

search for the roots of behavior (Shedler, 2010). It

likewise depends heavily on the analysis of past

experience. The roots of this perspective reside in

the original psychoanalytic theory and therapy of

Sigmund Freud (see Box 12-1).

Without question, psychoanalytic theory

represents one of the most sweeping contributions

to the field of personality. What began as a halting

flow of controversial ideas based on a few neurotic

Viennese patients was transformed into a torrent

that changed the face of personality theory and

clinical practice. Hardly an area of modern life

remains untouched by Freudian thought. It influ-

ences art, literature, and culture as well (Luborsky &

Barrett, 2006). Such words and phrases as ego,

unconscious, death wish,Oedipal, and Freudian slip

have become a part of our everyday language.

What is true in our culture at large is no less true

for therapeutic interventions. Although psychoanalytic

therapy is sometimes regarded as an anachronism, it is

still practiced by some clinical psychologists (Norcross,

Karpiak, & Santoro, 2005). In fact, almost every

formoftherapythatreliesonverbaltransactions

between therapist and patient owes some debt to

psychoanalysis—both as a theory and as a therapy.

Whether it is existential therapy, cognitive-behavioral

therapy, or family therapy,psychoanalytic influences

are clearly evident, even though they are not always

formally acknowledged.

Psychoanalysis: The Beginnings

In 1885, Freud was awarded a grant to study in

Paris with the famous Jean Charcot. Charcot was

noted for his work with hysterics. Hysteria then was

viewed as a“female”disorder most often marked

by paralysis, blindness, and deafness. These symp-

toms suggested a neurological basis, yet no organic

cause could be found. Earlier, Charcot had dis-

covered that, while under hypnosis, some patients

with hysteria would relinquish their symptoms and

sometimes recall the traumatic experiences that had

caused them. It is likely that such recall under hyp-

nosis helped stimulate Freud’s thinking about the

nature of the unconscious. In any event, Freud

was greatly impressed by Charcot’s work and,

upon his return to Vienna, explained it to his phy-

sician friends. Many were quite skeptical about the

benefits of hypnosis, but Freud nevertheless began

to use it in his neurological practice.

Anna O.

A few years earlier, Freud had been fascinated by

Josef Breuer’s work with a young patient with

“hysteria”called Anna O. She presented many clas-

sic hysterical symptoms, apparently precipitated by

the death of her father. Breuer had been treating

her using hypnosis, and during one trance, she

told him about the first appearance of one of her

symptoms. What was extraordinary, however, was

that when she came out of the trance, the symptom

had disappeared! Breuer quickly realized that he

had stumbled onto something very important, so

he repeated the same procedures over a period of

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