great deal in terms of their complexity and incisive-
ness. Sometimes they are designed to cut right to
the heart of a patient’s unconscious conflicts. But in
other cases, they may be little more than comments
or questions designed to move the patient ever so
slightly in the direction of insight. Perhaps they
should be labeled as verbal interventions rather
than interpretations. But all have the potential for
altering how a patient thinks or feels. These verbal
interventions might be considered as a dimension in
terms of how directly they seek to lead the patient
to a fresh way of viewing things.
Psychoanalytic Alternatives
Psychoanalytic theory underwent considerable
modification by the neo-Freudians, Alfred Adler,
Carl Jung, Otto Rank, the ego analysts, and others.
The seminal contributions of Freud remained, but
the emphases often changed. Jung made much
more of dreams and symbolic processes. Rank ele-
vated the birth trauma to a preeminent position.
Adler and the neo-Freudians stressed the impor-
tance of culture, learning, and social relationships
instead of instinctual forces.
Such variations would be expected to influence
the methods of therapy. However, these changes
often did little to alter the critical roles of free associ-
ation, dream analysis, interpretation, transference,
and resistance. The supreme role of insight was little
changed. Insight came about through traditional psy-
choanalytic methods, but now it was the insight of
Horney or Fromm or Sullivan. The neurotic symp-
tom was seen as rooted not only in repressed sexual
or aggressive urges; it now became the outgrowth of
a fear of being alone or of the insecurity that goes
along with the adult role. In most of these early
variants of psychoanalysis, interpretation remained
the essential therapeutic ingredient. What distin-
guished these variants was often the content of the
interpretation—the different ways in which uncon-
scious material was construed by the analyst.
For many years, the therapy room was like an
inner sanctum. The therapist talked with the patient
and no one else. Now, family members or a spouse
are often consulted, or sometimes therapy is con-
ducted with the family as a unit. There tends to be
much less emphasis on the past (childhood) and a
more active confrontation with the present. Even
the nature of the clientele has changed a bit. Clinics
or institutes now provide some therapeutic services
to aging clients, minority group clients, and others
who have not traditionally received psychoanalytic
treatment. They have tried to open up therapy to
nontraditional populations. Again, none of this is
meant to be a denial of Freudian principles; rather,
it is a demonstration that traditional Freudian treat-
ment procedures are not the only therapeutic
techniques that can be deduced from Freudian psy-
choanalytic theory.Ego Analysis
Theego analysismovement, originating from within
the framework of traditional psychoanalysis rather
than as a splinter group, held that classical psycho-
analysis overemphasized unconscious and instinc-
tual determinants at the expense of ego processes.
This group of theorists accepted the role of the ego
in mediating the conflict between the id and the
real world but believed that the ego also performed
other extremely important functions. They empha-
sized the adaptive,“conflict-free”functions of the
ego, including memory, learning, and perception.
These theorists include Hartmann (1939), Anna
Freud (1946a), Kris (1950), Erikson (1956), and
Rapaport (1953).
Ego-analytic psychotherapy has not departed
from the usual therapy methods except in degree.
In a sense, the ego analysts seem to prefer re-
educative goals rather than the reconstructive goals
of orthodox psychoanalysis. The exploration of
infantile experience and the induction of a trans-
ference neurosis seem to be less common in ego-
analytic therapy than in classical psychoanalysis.
Ego-analytic therapy focuses more on contemporary
problems in living than on a massive examination
and reinstatement of the past. Also, the therapist
must understand not only the neurotic aspects of
the patient’s personality but also the effective parts
and how they interact with those neurotic trends.356 CHAPTER 12