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■ Abstract Over the past century, the ideas set out in psychoanalytic theory have
permeated the field of psychology as well as literature, art, and culture. Despite this
popularity, analytic theory has only recently received empirical support. In this chapter,
we seek to highlight several fundamental concepts of analytic theory (the unconscious,
drives, defenses, object relations, Oedipus complex) and psychodynamic treatments
(transference, countertransference, interpretations, resistance). The first section of the
chapter offers a comprehensive definition and historical background for each concept.
This foundation is followed by a review of the empirical evidence supporting the
reliability and validity of these concepts, their impact on treatment, and their broader
influence on the future of psychology.
CONTENTS
INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
PSYCHOANALYTIC CONCEPTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Unconscious . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Drives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Parent-Infant and Parent-Child Relationships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Oedipus Complex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Defenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
PSYCHOANALYTIC CONCEPTS IN THERAPY . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Transference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Countertransference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Resistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Interpretation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Accuracy of Interpretation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
EVIDENCE FOR THE EXISTENCE OF PSYCHOANALYTIC CONCEPTS . . . . . 8
Evidence for the Unconscious . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Evidence for Drives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Evidence for Parent-Infant and Parent-Child Relationships . . . . . . . . . . . . . . . . . . 9
Evidence for the Oedipus Complex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Evidence for Defenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Evidence for Transference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
1548-5943/06/0427-0001$20.00 1
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2 LUBORSKY BARRETT
INTRODUCTION
Psychoanalytic concepts are prevalent throughout the field of psychology as well
as in literature, art, and popular culture. For example, the Oedipus complex is a
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primary theme in Shakespeare’s Hamlet and in later plays such as Eugene O’Neill’s
Morning Becomes Electra. Many of these concepts, however, originate in the
theoretical writings of Freud and the developments of psychoanalysis. In this
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PSYCHOANALYTIC CONCEPTS
Psychoanalysis and psychoanalytic theory have evolved considerably since the
1930s. For instance, rather than focusing on a distinct tripartite personality struc-
ture (i.e., id, ego, superego), theorists have shifted their attention to the role of
affect and motivation as determinants of personality (Westen 1998). Despite this
evolution, criticism continues to be leveled against many of the original con-
cepts, particularly about the issue of falsifiability (Macmillan 2001; see also
Wallerstein 1986, Weinberger & Westen 2001). Although certain aspects of Freud’s
concepts are not strictly speaking falsifiable (e.g., id, ego, Oedipus complex), a
number of them are accessible to empirical investigation. The psychoanalytic con-
cepts described in this chapter are especially well known, they form the basis
of modern psychoanalytic theory and dynamic therapy, and their importance in
our understanding of personality development has been demonstrated. However,
due to practical limitations, we have chosen to omit some concepts that, although
key to original psychoanalytic thinking, have been extensively discussed and re-
searched (e.g., id, ego, superego).1 The concepts highlighted in this chapter include
1
See Filsinger & Stilwell (1979), Stephenson (1982), and Tangney (1994) for empirical
discussions of the validity of these concepts.
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Unconscious
One of the main underpinnings of analytic theory is that painful or unacceptable
feelings are pushed out of the realm of awareness (by defenses). In order to avoid
pain or discomfort (according to the pleasure principle), a person will fight to
keep these feelings out of awareness or out of consciousness. However, life ex-
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Drives
A second concept central to analytic theory is the role of instinctual drives in de-
termining human development. Historically, a drive or instinctual urge has been
defined as an internal force or tension that propels an individual to act in ways that
reduce tension. This tension is influenced not only by internal strivings (motiva-
tion) but also by environmental or experiential factors acting upon the individual.
The original drive concepts included hunger, sex, aggression, and control, but
more recent models (see Compton 1983, Kernberg 2001) center on the general
notion of a need for pleasure (sex and hunger) and the instinctual response that
occurs when that need is blocked (aggression and control). From a developmental
perspective, the manner in which an infant’s need for comfort is met by a signif-
icant other (object) influences the way in which future relationships are defined
2
Several books highlight quite nicely the concept of the unconscious and the characteristic
ways in which it is evident (see Davanloo 1990; Fisher & Greenberg 1985, 1996). Fisher
and Greenberg (1996) also offer an excellent summary of psychoanalytic studies and their
usefulness in validating key analytic concepts.
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4 LUBORSKY BARRETT
Oedipus Complex
Freud’s original Oedipus concept developed from his observations of interactions
between parent and child (see example above). He concluded that any child (boy
or girl) had a twofold attitude toward the parents; that is, (a) a wish to eliminate
the father and take his place in a sexual relationship with the mother and (b) a wish
to eliminate the mother and take her place with the father (Brenner 1955). Most
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Defenses
As discussed in the section on the unconscious, an assumption of analytic theory
is that anxiety results from an internal perception of danger or threat to the self.
The self (or ego) will utilize whatever is available to defend against this anxiety
and decrease the perceived threat (i.e., a move to make it unconscious). Defenses,
therefore, represent the mechanisms by which we keep anxiety, fear, or discomfort
out of conscious awareness. The frequency and types of defenses are determined
by the strength of the ego (self), and they occur in response to and are the effect
of distress brought about by an internal unconscious psychological event. Once
unique to psychoanalytic theory, the concept of defenses has now been examined
in other areas (Caspar 1995), and we review a few of the more long-standing
defenses for which there is empirical support (Perry 1993).
1. Repression, one of the earliest defenses described by Freud, is a defensive
strategy that keeps from consciousness unpleasant or unacceptable memo-
ries, emotions, desires, or wishes. The concept involves the act of pushing
down memories and restricting their access to awareness. A repressed mem-
ory is one that is forgotten from the subjective perspective of the person in
whom the repression occurs.
2. Denial, a somewhat similar yet better-known defense, involves the act of
keeping from conscious awareness an unacceptable behavior or idea.
3. Projection, also among Freud’s earliest list of defenses, occurs when one
sees into another person but what one sees really comes from the self.
In other words, in an effort to avoid discomfort or anxiety as a result of
personal wishes or impulses, an individual will unconsciously see in an-
other that which she is unable to see in herself. By projecting her unaccept-
able wishes or impulses onto another, the individual is able to criticize that
which is discomforting about her without experiencing the associated pain.
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6 LUBORSKY BARRETT
For example, after a particularly stressful discussion, one person may re-
spond to another, “I am not angry, you are!”
4. Fantasy is a state of mind, much like a waking dream, in which conscious
memories and wishes, about personally important people, are reexamined in a
less threatening way. Such memories and wishes become less threatening due
to a decreasing need for being exact. The resulting fantasy is a “makeover”
of personally important people in terms of the individual’s conscious or
unconscious wish. Although having its historical basis in dream analysis,
fantasy was first discussed as a defense mechanism in the work of A. Freud
and M. Klein (Drapeau et al. 2003).
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identification has been viewed as a turning against the self because the ob-
ject of the identification is often seen as the aggressor. The only way in which
the conscious mind can deal with the unacceptable feelings toward another
person is to identify with that person and strike out against one’s self as if
one’s self was the other.
6. Intellectualization, a more recently articulated defense and one considered
of higher order, involves the avoidance of disturbing feelings or conflicts
through a pseudo-objective stance. Such distancing from discomforting sit-
uations relies on abstract thinking and results in a somewhat cold, aloof
manner.
Transference
Transference was described in Freud’s early writings (Freud 1912/1958) and rep-
resents the process by which the patient is not satisfied with seeing the therapist
as a helper and adviser. Rather, the therapist comes to represent some important
figure out of the patient’s past such that all feelings and reactions related to this
person are consequently transferred to the therapist. Thus, because the therapist
and some important past figure in the patient’s life are seen by the patient as sim-
ilar, the patient relates to the therapist as if the therapist was the significant other.
Within treatment, transference can be critically important because it embodies both
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Countertransference
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In its basic form, countertransference represents the therapist’s personal and gen-
eral responses to the patient’s transference. That is, countertransference is a pattern
of miscommunication in which the client’s responses—which are based on other
relationships in the client’s life—are responded to by the therapist from the per-
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spective of the therapist’s experience with significant others. Until recently, coun-
tertransference was to be avoided because it meant that the therapist’s personal
experiences were entering into the treatment of the client. However, countertrans-
ference is now seen as inevitable in the treatment process and is embraced as a
way to recognize and better understand the patient’s transference.
Resistance
Resistance is an in-therapy behavior in which the patient can slow the rate of
change. This concept involves recognition of two competing processes: the move
toward change and the move to block change. Rather than repressing uncomfortable
feelings or anxiety through the use of defenses, resistance involves the conscious
(and sometimes unconscious) act of avoiding the emergence of repressed feelings.
By wanting change yet desiring to do so without emotional discomfort, the client
continually shifts between movement toward change and resistance to issues that
would lead to change. Recently, theorists and researchers have argued that the
movement toward and away from change is representative of the dynamic between
resistance and alliance such that resistance blocks the formation of a good working
alliance (Berg 2000, Callahan 2000, Cho & Lee 1997, Konzelmann 1995, Piper
et al. 1999, Rennie 1994).
Interpretation
Interpretation describes the types of messages within the therapist’s statements
that are shared with the client. The concept involves a search for the essence of
the client’s statements. In other words, interpretation is a means by which the
therapist offers an explanation of cause and effect for events in the patient’s life.
Often, interpretation involves an explanation of the transference and of how it
relates to other patterns of relating in the client’s life. It is through interpretation
that the patient is made aware of previously unrecognized patterns of behavior that
are negatively affecting their interpersonal relationships.
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8 LUBORSKY BARRETT
Accuracy of Interpretation
The degree to which interpretations are accurate depends upon the extent to which
the client agrees with the cause-effect relationship articulated by the therapist as
drawn from client behavior or statements. For example, Kubie (1952) stated that
the accuracy of an interpretation would be evident if the patient’s associations to it
confirmed the content, symptoms were reduced, and future behavior could be pre-
dicted. Although some measures assess the amount or usefulness of interpretations
(see Ogrodniczuk & Piper 1999, Sachs 1983), the measure by Crits-Christoph et al.
(1998) offers the only systematic method for estimating the degree of accuracy for
therapist’s interpretations. In their method, accuracy is determined by the level of
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reasons for the patient’s thoughts, feelings, or behaviors that are congruent with the
CCRT, tend to be followed by the patient’s presentation of increased understanding.
these findings suggest that dynamic unconscious processes exist and are confirmed
by brain activity. Moreover, the subjective judgment of the clinician regarding these
conflicts is supported by objective measures of unconscious processes.
10 LUBORSKY BARRETT
pattern than are infants who not maltreated (Cicchetti & Barnett 1991). In research
with rhesus monkeys, Suomi (1999) found significant differences in attachment
between monkeys raised by peers and those raised by their mothers. Still others
have found that the quality of attachment at one year of age is related to a child’s
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and single case studies continue to address this issue (see van Dam 1991). Given
that the Oedipus complex is considered an unconscious phenomenon, it might be
inferred from research on dreams using the CCRT method. Recall that the central
relationship pattern is determined from the wishes and interpersonal behaviors (de-
fined in affective terms) evident in patient narratives about relationships. Research
on the CCRT has shown that the wishes and interpersonal responses obtained in
therapy are reliably similar to the wishes and affective responses obtained from
dreams (Popp et al. 1996). Despite the connection of content between dreams and
therapy, specific evidence for recurring relationship patterns involving an Oedipal
triangulation have not been forthcoming.
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12 LUBORSKY BARRETT
the CCRT demonstrated similar patterns of relating with the therapist, others, and
the self.
The CCRT has also found similar patterns of relating to people described prior
to treatment as that found early in therapy (Barber et al. 1998). An examination of
the CCRT in various populations has found that within each person’s narratives a
pattern appears across relationships with different other people. For instance, Fried
et al. (1992) found that in a sample of 35 patients, the CCRT for the relationship
with therapist was significantly similar to the CCRT with other people.
In addition to evidence for the presence of transference in the therapy relation-
ship, research has also found that a better outcome and more positive alliance are
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able evidence for the concept of transference, its usefulness in treatment, and the
stability of interpersonal patterns across time, populations, and significant others
in a person’s life.
ferent perspective, Patton and colleagues (Patton et al. 1997) examined resistance
and alliance across several sessions of treatment. Whereas the working alliance
increased over the course of therapy, resistance decreased. Resistance has also
shown a relation to treatment dropout such that high levels of resistance are as-
by BOSTON COLLEGE on 02/03/10. For personal use only.
sociated with higher rates of dropout (Piper et al. 1999). One explanation for the
connection between resistance, alliance, and outcome is that more directive ap-
proaches increase patient resistance for change, which then negatively affects the
working alliance. For instance, Patterson & Chamberlain (1994) examined studies
of resistance in parent training therapy. They found that parent pathology was as-
sociated with higher levels of resistance, and therapists’ efforts to intervene were
met with immediate resistant behaviors. These findings have been corroborated in
a number of studies reviewed by Beutler et al. (2002). Although there continues to
be debate about the appropriate definition of resistance, research strongly supports
the notion of resistance and its importance in psychotherapy.
14 LUBORSKY BARRETT
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CONTENTS
THE HISTORY AND EMPIRICAL STATUS OF KEY PSYCHOANALYTIC
CONCEPTS, Lester Luborsky and Marna S. Barrett 1
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vii
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viii CONTENTS
INDEX
Subject Index 499
ERRATA
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