How does Freudian therapy work?

You've probably heard of psychotherapy, also called "psychoanalysis," “psychoanalytic therapy,” or “Freudian therapy.” Some people talk about Freud’s psychoanalysis and advances in psychoanalytic treatment in tones of the deepest respect and admiration. Others believe he and his psychoanalytic theory of human development and behavior deserves a little less respect. Whatever you may have heard, Freud is most popularly considered to be the father of psychoanalysis, and many of his methods – namely his psychoanalytic therapies and his contribution to personality theory – are still used today. Contemporary psychoanalysts may refer to psychological theories introduced by Freud in a modified form that reflects current perspectives. A few of Freud’s most notable ideas include the separation of the personality into the id, ego, and superego, the subconscious mind, the use of hypnosis, the idea of transference, and dream interpretation. If you’re interested in trying psychoanalytic therapy yourself, you may find a suitable mental health professional in person or online.

Sigmund Freud

Sigmund Freud may not have been the very first psychologist, but he is often viewed as one of the first modern therapists, specifically the first of what would become a community of thousands of psychoanalytic therapists in the world. 

Psychiatry was not Freud’s original specialty; he first worked as a neurologist providing professional medical advice, diagnosis, or treatment to people living with brain conditions. At this time, most psychologists were more interested in understanding the mind than curing it. One of Freud's data-gathering methods included now-famous case studies of patients, which is attributed to leading to certain insights on his part. Freud was generally viewed as revolutionary in that he wanted to help his patients, but he can also be seen as a product of his time. That may be one explanation why his approach to therapy and mental illness can be viewed fairly cold and detached by later, modern standards. Freud generally approached psychology and emotional disorders with a more pathological view than most psychologists today, but he also helped gain insight into the human mind, contributing to psychology as the "soft science" that it is often viewed as today.

The ego, the superego, and the id 

Freud is largely known for his personality theory stating that the personality is composed of three different parts: the superego, the ego, and the id. According to the American Psychoanalytic Association, the id can be considered an animalistic instinct that controls all of our most primal urges. The superego may be viewed as the source of all our moral ideals. Meanwhile, the ego may compromise or mediate between the other two.

Perhaps more significant than the theory itself was the concept of splitting the personality. The same idea in Freud's theory would come into play in the later identity theory of Carl Rogers. It would also be influential to later Freudian psychologists like Carl Jung.

The id isn't generally seen as bad or wrong; it's simply filled with thoughts, feelings, and childlike impulses that usually do not consider consequences or planning and could occasionally lead to poor choices and self-destructive behaviors. As a result, according to Freud’s psychoanalytic approach, we typically need to learn to control the id to live in society appropriately.

The subconscious mind

Perhaps the greatest contribution of Sigmund Freud to psychology could be the idea of the subconscious mind, which he sometimes also referred to as the “unconscious mind.”

The idea of the subconscious mind would later play a role in the development of cognitive and developmental psychology. The subconscious has also been linked to what is called the "monkey mind" in mindfulness therapy. However, the subconscious may also be one of Freud's most inflammatory ideas. The generation of board-certified physicians, psychiatrists, and psychologists that followed Freud generally viewed the idea that all of our thoughts and actions are determined by an almost inaccessible inner mind formed during childhood as too deterministic for their liking. These thinkers founded what is called "humanistic psychology" largely in response to Freud.

Freud generally believed that it was possible to release repressed emotions, but understanding and completely controlling the conscious mind usually required understanding the subconscious mind. Tapping the subconscious mind could be difficult, according to Freud, but not impossible. Helping the patient to understand the subconscious mind was largely the goal of Freud’s psychoanalytic technique and Freudian psychoanalytic therapy. This could usually be done by interpreting how the individual interpreted the world, both waking and sleeping.

Hypnosis

Freud’s early psychoanalytic approach often involved the use of hypnosis to try to reach the subconscious of his patients in psychoanalytic treatment. Freud believed that it could be possible to unlock repressed emotions, unconscious conflicts, and forgotten past experiences during hypnosis. 

Freud and early psychologists - as well as some psychologists practicing psychoanalysis today – sometimes utilized this kind of hypnosis to treat depression and certain mental health disorders, such as anxiety disorder. Through the process of hypnosis, the psychoanalyst might have gained an entry to internal conflicts stemming from unconscious thoughts. When the patient was in the altered state of consciousness of hypnosis, they were usually more in touch with their subconscious mind. When the patient returned to their regular state of consciousness, the patient and the therapist would generally discuss responses that the patient gave to the therapist's questions while hypnotized. Nowadays, the method of hypnosis is still considered by some therapists to enable access to the unconscious state, a state in which the use of suggestions may be used to therapeutic effect. In such sessions, a patient may benefit even if awareness of the suggestions is forgotten by the conscious mind. Freud, however, eventually abandoned the use of hypnosis in favor of other techniques.

Free association

When Freud replaced hypnotism in his practice, he replaced it largely with what he called "free association" - another practice still sometimes used by psychotherapists, mainly in patients with depressive symptoms.

The simplest form of free association is usually word association. In word association, the psychoanalyst normally gives a word, and the client is asked to state the first word that comes to mind in relation to the given word. The idea is generally that if the two words aren't obviously connected, they may be connected using a relationship on the subconscious rather than the conscious level. Trying to determine this relationship can then help the psychoanalyst and the patient to understand the patient's subconscious and achieve a correct diagnosis.

Another common form of free association is the Rorschach test. Developed by Hermann Rorschach, a contemporary of Freud, this test can be similar to a word association test but uses a series of ten inkblot images. In general, the therapist shows the slides, the patient says what they see, and they go from there. Again, the underlying idea is that if a connection is not obvious on the conscious level, it may be obvious on the subconscious level.

Transference

One key concept of psychoanalytic theory that quickly spilled over to other forms of psychotherapy is transference. According to Freud, transference can occur in psychoanalysis when patients attach or redirect their feelings, frustrations, anger, or symptoms onto their therapists. 

In transference analysis, the analyst evaluates how the patient's early experiences reflect on how they behave and express themselves to the therapist. Transference may be viewed as a kind of projection in which repressed emotions and resulting behaviors gets transferred from the original source, such as a parent, to someone else—in this case, the analyst. 

In the site Simply Psychology, the three kinds of transference are discussed: negative, positive, and erotic/sexual transference. In addition, there is also maternal and paternal transference.  A patient's belief that they have fallen in love with their therapist in one example where erotic transference may be at play. Another example of negative transference is when a patient lashes out at the therapist for reminding them of their mother's tone of voice. In this type of therapy, the resurfacing of these emotional patterns allows the analyst to reexamine, address, and possibly alleviate the issues the patient may be experiencing. One of the goals is to assign new meaning to these patterns by examining them openly. 

Conversely, countertransference may also occur in certain circumstances, a process in which the therapist transfers their own unconscious patterns onto the patient, a phenomenon that is also addressed.

Dream interpretation

Freud may have been the first modern psychoanalyst to take a serious interest in (and even offer professional medical advice and treatment based on) dreams and dream analysis. Freud generally believed that dreams were another window into the subconscious but that they had a language of their own. Learning about what the subconscious has to say through dreams can require learning to speak that language.

Much of that language was deciphered not by Freud, but by his student, colleague, future rival, and later successor, Carl Jung. Jung studied dreams and broke them down into recurring themes and symbols. He didn't necessarily believe that dreams could predict the future, but he did believe that they could be used to understand and guide our current behavior and interpersonal relationships.

Jung noticed that many of the dream themes and elements that he identified had the same meaning and significance to people, regardless of what culture they were raised in. In Jung’s psychoanalysis, these themes and elements are called "archetypes."

As a result of Freud and Jung's work, including peer-reviewed studies, dream interpretation has since become largely mainstream. There are all kinds of “dream dictionaries” online and in print to help laymen interpret dreams. Definitions may vary very slightly from source to source, but most of them are largely the same because of their common roots in Jung’s psychoanalytic therapy work.

More information and treatment

If you’re interested in learning more about Freud’s ideas and psychoanalytic perspective, much of the information can be reached for free online. Freudian therapy, however, typically requires a licensed mental health professional. However, talking to a therapist near you may not always be an option, or it may not be the best option for your specific situation. If this is the case for you, you may want to consider meeting with a therapist online. Online therapy can empower you to get the help you deserve from the comfort of your home, on your own schedule. 

While psychotherapy is usually associated with long-term treatment to increase positive outcomes, how long therapy lasts also depends on many factors, and can either be short- or long-term. 

As this study explains, online therapy can be as effective as traditional in-office therapy for treating a variety of mental health concerns. If you believe you’d benefit from working with a therapist to reach your mental health goals, we encourage you to reach out!