Automatic and repetitive behaviors associated with implicit memory are transformed into explicit knowledge. Consequently, patients gain the ability to control automatic behaviors. They found that affect labeling was associated with decreased activity in the amygdala and increased activity in the right ventrolateral prefrontal cortex. Further accomplishments are necessary for successful treatment. Freud a stated that after the elimination of repression the target for working-through should be resistance to abandoning the typical forms of instinctual satisfaction.
This type of resistance is related to repetition compulsion Freud, b which, as discussed, is expressed as an implicit memory Clyman, The power of positive transference is crucial for the patient's acceptance of the interpretations and constructions offered by the analyst Andrade, ; Rosenblatt, Transference also plays a fundamental role in the process of changing the patient's behavior. The option of abandoning old defenses and adopting a healthier pattern of behavior is strongly influenced by the encouragement received by the patient from the analyst Andrade, ; Rosenblatt, Because of transference, the desire to please the analyst is likely to be one of the patient's main motivations in analytic treatment.
The feeling of approval then motivates the patient to repeat the healthier behavior. Therefore, operant conditioning may increase the frequency of healthier behaviors Olds, A process of gradually weakening and extinguishing inappropriate defenses then occurs. Consequently, a reduction in anxiety occurs. Supported by the analyst's encouragement and approval, the patient then faces the feared situations in reality. According to the principles of operant conditioning, the new behavioral pattern will be reinforced not only by the reduction in anxiety, but also by the improvement in the patient's quality of life Rosenblatt, The analyst's behaviors in the therapy sessions resemble those of the mother in a secure attachment situation.
Changes in implicit memory systems require regular practice. After the conscious choice of a healthier behavioral pattern is yielded through interpretative work, continuous repetition of the new behavioral pattern is necessary for its incorporation into implicit memory systems; thus, it becomes enduring, automatic, and independent of consciousness Clyman, ; Rosenblatt, The patient-analyst relationship.
In psychoanalysis, the mechanism of therapeutic action has long been debated. Several analysts stress the relevance of interpretative work, whereas others believe that clinical improvement essentially depends on the patient-analyst relationship Cooper, ; Greenberg, Different psychoanalytic schools yield similar therapeutic results, although they present different interpretative models.
So, aspects beyond interpretation are fundamental for successful analytic treatment Andrade, ; Gedo, New emotional experiences with the analyst may directly change the patient's implicit memory.
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Because of transference, the patient's typical pattern of interpersonal relationships formed during early infancy tends to be repeated with the analyst. However, the analyst behaves differently from the parental figures, which leads to the development of a new pattern and weakens the previous one. A case report offers support for this view. It is a common assertion that "unconscious-to-unconscious communication" occurs between analyst and patient. Pally suggested that the unconscious processing of nonverbal expressions of emotion e.
The analyst literally feels what the patient feels and vice versa. Schore a proposed that the interaction between analyst and patient represents communication between the right hemispheres of the brain because the right cerebral hemisphere is dominant for emotions. This author speculated that the ability to empathize is related to this hemisphere. The discovery of mirror neurons and several functional neuroimaging studies on emotions indicated that a cerebral correlate for empathy exists Gallese, The observation of the actions of others activates premotor areas that are normally involved in the execution of the same actions.
Some authors Gallese, ; Iacoboni, believe that the discovery of mirror neurons contributed to our understanding of intersubjectivity and provided support for the intersubjective approach used in analytic therapy. Olds stated that these studies offer information about the biological mechanisms of imitation and the relationship between imitation and identification, which could contribute to a deeper psychoanalytic understanding of identification.
According to Kandel , analytic treatment is successful only if it leads to adequate brain remodeling. Indeed, through environmental stimulation, synapses can be modified at any time in life Diamond et al. In our opinion, absence of these features in other forms of psychotherapy may be a limiting factor. Anxiety disorders, especially phobic disorders, are hypothesized to be related to fear conditioning, which involves the amygdala and the structures with which it is connected LeDoux, LeDoux stated that all forms of psychotherapy would aid the cortex in acquiring control over the amygdala, thus inhibiting the expression of pathological emotional responses through an extinction process.
However, extinction does not eliminate the implicit memories that underlie fear conditioning from the amygdala. Therefore, a spontaneous return of anxiety symptoms is possible LeDoux, Considering this information, we suggest that a cognitive approach to emotional dysfunction e. Therefore, a more subtle approach that directly affects the implicit memories stored in the amygdala without involving the conscious processes related to the cortex is necessary.
Presently, substance dualism i. Accordingly, most believe that psychological processes are in some way related to brain function for a didactic review on the philosophy of the mind for non-philosophers, see Kendler, Some materialist monism positions do not favor a dialogue between psychoanalysis and neurobiology. Eliminative materialism i. However, in our opinion, other philosophical positions such as psychophysical supervenience and emergentism are compatible with an interaction between psychoanalysis and neurobiology. According to psychophysical supervenience, psychological phenomena depend on physical and biological phenomena.
Nevertheless, this does not imply that mental properties are reductive to physical or biological properties Marras, Several philosophers view mental processes as emergent properties of brain function. At the level of psychology, new features emerge that cannot be predicted from biology Kendler, Consistent with supervenience theory and emergentism, we assume that although psychoanalytic processes cannot be fully explained through neurobiological knowledge, psychoanalytic theory should not contradict biological laws.
Despite the current lack of prestige of substance dualism within philosophy and science, we observe a clear antagonism between psychodynamic and biological psychiatrists. The traditional and outdated etiological subdivision of mental disorders into psychological vs. According to this view, psychotherapy is the best treatment option for psychological disorders, whereas psychopharmacotherapy is more appropriate for organic disorders Gabbard, Neurobiological data have seriously challenged the dualistic perspective of mental disorders.
Recent studies using functional neuroimaging techniques e. Furthermore, three case studies Saarinen et al. These studies followed up a patient with depression and borderline personality disorder Viinamaki et al. Such results indicate that psychopharmacotherapy and psychotherapy both yield important and similar changes in neural activity, although likely through different mechanisms Beutel et al.
Some psychoanalysts such as Fonagy a and Rosenblatt studied the role of memory in the mode of action of analytic therapy and the importance of the distinction between explicit and implicit memory mechanisms for psychoanalysis. Likewise, we believe that Freud , in Remembering, Repeating and Working-Through , formulated a similar distinction. In analytic therapy, we consider "remembering" and "repeating" as forms of expression of explicit and implicit memory, respectively. Indeed, linking psychoanalytical treatment to changes in memory systems and brain structures would reduce the distance between psychoanalysis and psychotherapy modalities that aim to incorporate neuroscientific knowledge into its theories, such as cognitive therapy.
Accordingly, Wallerstein proposed that the differences between psychoanalysis and other types of psychotherapy are more quantitative than qualitative and that psychoanalysis would be situated at an extreme of a continuum. To summarize, we believe that clinical improvement in analytic therapy ultimately depends on changes in the implicit memory system, which entails structural brain changes.
Implicit memory system changes may be related to changes in explicit memory systems yielded by interpretative work. As Rosenblatt stated, the patient must practice to improve. However, the patient must first know what and how to practice. We view psychoanalysis and neurobiology as complementary rather than competing disciplines. In our opinion, a purely objective approach to mind where the vast contribution of psychoanalysis in the study of the subjective aspects and meanings of human behavior is ignored is incomplete.
Likewise, neurobiological knowledge can provide psychoanalysts with a broader understanding of several important therapy issues. In this sense, both the cognitive and affective components of therapy are relevant, and their actions can be synergistic Andrade, ; Watt, Ainsworth, M. Patterns of attachment: A psychological study of the strange situation. Hillsdale: Lawrence Erlbaum.
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Alexander, F. Psychoanalytic therapy: Principles and application. New York: Ronald Press. Anderson, M. Gabrieli, J. Neural systems underlying the suppression of unwanted memories. Science , , Andrade, V. Affect and the therapeutic action of psychoanalysis. International Journal of Psychoanalysis , 86 , Anooshian, L.
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Implicit and explicit memory in childhood: A review of relevant theory and research. Child Study Journal , 28 , Armsden, G. Parent and peer attachment in early adolescent depression. Journal of Abnormal Child Psychol ogy, 18 , Balint, M. The basic fault: Therapeutic aspects of regression. London: Tavistock. Basch, M. The concept of affect: A re-examination. Journal of the American Psychoanalytic Association , 24 , Baxter, L. Phelps, M. Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder. Archives of General Psychiatry , 49 , Beutel, M.
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Attachment and loss. New York: Basic Books. Brakel, L. From the brain, the cognitive laboratory, and the couch. Journal of the American Psychoanalytic Association , 46 , Breuer, J. Studies on hysteria. Strachey Ed. London: Hogarth Press. Brody, A. Regional brain metabolic changes in patients with major depression treated with either paroxetine or interpersonal therapy: preliminary findings.
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Dreams: integrating psychoanalytic and neuroscientific views. Revista de Psiquiatria do Rio Grande do Sul , 28 , Cimino, C. Projective identification and consciousness alteration: A bridge between psychoanalysis and neuroscience? Recognition and "me-ness". Jaffe Eds. New York: Columbia University Press. Clyman, R. The procedural organization of emotions: A contribution from cognitive science to the psychoanalytic theory of therapeutic action.
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Lehtonen, J. Changes in midbrain serotonin transporter availability in atypically depressed subjects after one year of psychotherapy. Progress in Neuro-Psychopharmacology and Biological Psychiatry , 32 , Levin, F. Integrating some mind and brain views of transference: The phenomena. Journal of the American Psychoanalytic Association 45 , And so the debate goes on. This is a crucially important issue since Freud saw himself first and foremost as a pioneering scientist, and repeatedly asserted that the significance of psychoanalysis is that it is a new science , incorporating a new scientific method of dealing with the mind and with mental illness.
There can, moreover, be no doubt but that this has been the chief attraction of the theory for most of its advocates since then—on the face of it, it has the appearance of being not just a scientific theory but an enormously strong one, with the capacity to accommodate, and explain, every possible form of human behavior. However, it is precisely this latter which, for many commentators, undermines its claim to scientific status. The Logic of Scientific Discovery. Thus the principle of the conservation of energy physical, not psychic , which influenced Freud so greatly, is a scientific one because it is falsifiable—the discovery of a physical system in which the total amount of physical energy was not constant would conclusively show it to be false.
If the question is asked: "What does this theory imply which, if false, would show the whole theory to be false? Hence it is concluded that the theory is not scientific, and while this does not, as some critics claim, rob it of all value, it certainly diminishes its intellectual status as projected by its strongest advocates, including Freud himself. A related but perhaps more serious point is that the coherence of the theory is, at the very least, questionable. What is attractive about the theory, even to the layman, is that it seems to offer us long sought-after and much needed causal explanations for conditions which have been a source of a great deal of human misery.
However, even this is questionable, and is a matter of much dispute. In general, when it is said that an event X causes another event Y to happen, both X and Y are, and must be, independently identifiable. At a less theoretical, but no less critical level, it has been alleged that Freud did make a genuine discovery which he was initially prepared to reveal to the world. However, the response he encountered was so ferociously hostile that he masked his findings and offered his theory of the unconscious in its place see Masson, J.
What he discovered, it has been suggested, was the extreme prevalence of child sexual abuse, particularly of young girls the vast majority of hysterics are women , even in respectable nineteenth century Vienna. He did in fact offer an early "seduction theory" of neuroses, which met with fierce animosity, and which he quickly withdrew and replaced with the theory of the unconscious.
Questions concerning the traumas suffered by his patients seemed to reveal [to Freud] that Viennese girls were extraordinarily often seduced in very early childhood by older male relatives. Doubt about the actual occurrence of these seductions was soon replaced by certainty that it was descriptions about childhood fantasy that were being offered.
By what standard is this being judged? The answer can only be: By the standard of what we generally believe—or would like to believe—to be the case. Freud, according to them, had stumbled upon and knowingly suppressed the fact that the level of child sexual abuse in society is much higher than is generally believed or acknowledged. If this contention is true—and it must at least be contemplated seriously—then this is undoubtedly the most serious criticism that Freud and his followers have to face.
Further, this particular point has taken on an added and even more controversial significance in recent years, with the willingness of some contemporary Freudians to combine the theory of repression with an acceptance of the wide-spread social prevalence of child sexual abuse. On this basis, parents have been accused and repudiated, and whole families have been divided or destroyed. Victims of Memory. In this way, the concept of repression, which Freud himself termed "the foundation stone upon which the structure of psychoanalysis rests," has come in for more widespread critical scrutiny than ever before.
Here, the fact that, unlike some of his contemporary followers, Freud did not himself ever countenance the extension of the concept of repression to cover actual child sexual abuse, and the fact that we are not necessarily forced to choose between the views that all "recovered memories" are either veridical or falsidical are, perhaps understandably, frequently lost sight of in the extreme heat generated by this debate.
The theory upon which the use of leeches to bleed patients in eighteenth century medicine was based was quite spurious, but patients did sometimes actually benefit from the treatment! And of course even a true theory might be badly applied, leading to negative consequences. One of the problems here is that it is difficult to specify what counts as a cure for a neurotic illness as distinct, say, from a mere alleviation of the symptoms.
In general, however, the efficiency of a given method of treatment is usually clinically measured by means of a control group—the proportion of patients suffering from a given disorder who are cured by treatment X is measured by comparison with those cured by other treatments, or by no treatment at all. Such clinical tests as have been conducted indicate that the proportion of patients who have benefited from psychoanalytic treatment does not diverge significantly from the proportion who recover spontaneously or as a result of other forms of intervention in the control groups used.
So, the question of the therapeutic effectiveness of psychoanalysis remains an open and controversial one. Stephen P. Thornton Email: sfthornton eircom. Sigmund Freud — Sigmund Freud, the father of psychoanalysis, was a physiologist, medical doctor, psychologist and influential thinker of the early twentieth century.
Life Freud was born in Frieberg, Moravia in , but when he was four years old his family moved to Vienna where he was to live and work until the last years of his life. Backdrop to His Thought Although a highly original thinker, Freud was also deeply influenced by a number of diverse factors which overlapped and interconnected with each other to shape the development of his thought. Critical Evaluation of Freud It should be evident from the foregoing why psychoanalysis in general, and Freud in particular, have exerted such a strong influence upon the popular imagination in the Western World, and why both the theory and practice of psychoanalysis should remain the object of a great deal of controversy.
The Claim to Scientific Status This is a crucially important issue since Freud saw himself first and foremost as a pioneering scientist, and repeatedly asserted that the significance of psychoanalysis is that it is a new science , incorporating a new scientific method of dealing with the mind and with mental illness.
The Coherence of the Theory A related but perhaps more serious point is that the coherence of the theory is, at the very least, questionable. Freud's Discovery? In this way, it is suggested, the theory of the Oedipus complex was generated. References and Further Reading a.
Strachey with Anna Freud , 24 vols. London: New York: Free Press, Bettlelheim, B. Knopf, Cavell, M. Harvard University Press, Becoming a Subject: Reflections in Philosophy and Psychoanalysis. Chessick, R. Freud Teaches Psychotherapy. Hackett Publishing Company, Cioffi, F.
Freud: Modern Judgements. Macmillan, Deigh, J. Dilman, I. Freud and Human Nature. Blackwell, Dilman, I. Freud and the Mind. Blackwell, Edelson, M. Hypothesis and Evidence in Psychoanalysis. University of Chicago Press, Erwin, E. MIT Press, Fancher, R. Norton, Farrell, B. The Standing of Psychoanalysis. Oxford University Press, Fingarette, H. HarperCollins, Freeman, L.
The Story of Anna O. Paragon House, Frosh, S. Yale University Press, Gardner, S. Irrationality and the Philosophy of Psychoanalysis. Cambridge, Cambridge University Press, University of California Press, Gay, V. Freud on Sublimation: Reconsiderations. Hook, S. Psychoanalysis, Scientific Method, and Philosophy. New York University Press, Jones, E. Klein, G. Psychoanalytic Theory: An Exploration of Essentials. International Universities Press, Lear, J.
Cambridge, Harvard University Press, Lear, Jonathan. Happiness, Death, and the Remainder of Life. Routledge, Levine, M. The Analytic Freud: Philosophy and Psychoanalysis. London: Routledge, Levy, D. MacIntyre, A. The Unconscious: A Conceptual Analysis. Mahony, P.
Masson, J. Neu, J. The Cambridge Companion to Freud. Freud and the Passions. Pennsylvania State University Press, Popper, K. Hutchinson, Pendergast, M. Reiser, M. Basic Books, Ricoeur, P. Freud and Philosophy: An Essay in Interpretation trans. Robinson, P. Freud and His Critics. Berkeley, University of California Press, Rose, J. Princeton University Press,