Why be interested in Freud today?

Some people dismiss the psychoanalytic approach as dated, unscientific and lacking supporting evidence. However, we would argue that this underestimates the importance of Freud’s legacy, and that in fact there is plenty of contemporary empirical research and professional practice directly linked to Freud’s ideas.

Freud’s ideas are still relevant

Nowadays we all agree that ‘talking helps’, but before Freud this would have been considered absurd. Freud was the first psychologist to recognise the therapeutic value of a confidential, judgement-free space where people could explore their thoughts and try to come to terms with painful aspects of their lives. The fact that talking therapy has become a fundamental part of the treatment of mental distress is largely thanks to him, and it’s no exaggeration to say that every form of talking therapy in use today can be traced back to his pioneering work — an extraordinary contribution.

However, it would be a mistake to see Freud as a mere historical figure, and the fact that some still do see him in this way simply points to the gap that exists between psychology as an academic research subject and the field of psychological therapy. Like most therapies, Freud’s theory is not widely taught, researched or practised in academic psychology departments. Yet psychoanalysis, and the psychodynamic approach in general, is alive and well.

Freud’s ideas continue to inspire empirical research in many areas. One such area is neuroscience, where there is now an interdisciplinary field called neuro-psychoanalysis. Neuroscientist and psychoanalyst Mark Solms suggests that psychoanalysis currently provides the best conceptual starting point for understanding subjective experience scientifically. Solms has, for example, provided some intriguing support for Freud’s idea of dreaming as wish fulfilment by isolating neural mechanisms that are closely involved with dreaming (Solms 2000).

Freud’s ideas have also found growing influence in the very different field of corporate management. Frans Cilliers (2018) studied accounting executives who were given psychodynamic coaching. The executives reported that they gained valuable insights into the origins of their anxieties and their motives for leadership, and that these insights significantly aided them in their roles.

Psychoanalysis offers a way to understand and treat serious mental disorder

Some psychology textbooks still report that there is no evidence to suggest that psychodynamic therapies are effective as a treatment for mental health problems. In fact, there is growing scientific evidence that treatment approaches based on psychodynamic principles benefit patients with depression, anxiety, personality disorders, eating disorders and somatic problems. Longer psychoanalytic therapies (lasting over a year) appear to benefit individuals with complex disorders who have both severe symptoms and generally high vulnerability to psychopathology.

Recently, a major depression study (TADS) demonstrated that long-term psychoanalytic therapy provides relief for people experiencing chronic depression. TADS was a randomised control trial conducted by the NHS (Fonagy et al. 2015). Long-term psychoanalytic therapy is expensive to deliver, so it is not a first-line treatment, i.e. the most commonly chosen response to mental disorder on the NHS. There is, however, a strong case for retaining such therapies in the mental health system for complex and treatment-resistant cases. (It is worth noting that there are also a growing number of effective shorter-term forms of psychoanalytic therapy. For example, Dynamic Interpersonal Therapy (DIT) is offered as an alternative to the popular short-term cognitive-behavioural therapy.)

The success of the psychodynamic approach raises some uncomfortable questions for the prevailing medical model of serious mental illnesses such as schizophrenia. The medical model sees schizophrenia as an illness to be cured, whereas from a psychodynamic approach it is thought about more as a way of being in the world: if you take away the schizophrenia, you take away the person too. Where the medical model assumes that the schizophrenic patient has lost touch with reality, the assumption in psychoanalytic theory is that everyone’s experience of reality is distorted by past experience and the unconscious, which means that it would be a mistake to assume that there is some unproblematic standpoint from which ‘normal’ people can assess reality.

This view has some striking parallels with the trauma-informed approach to mental health that has become an extremely important part of practice in clinical psychology and social work over the last decade (see PSYCHOLOGY REVIEW, Vol. 27, No. 1 for a discussion by Lucy Johnstone). Indeed, psychoanalytic therapies are sometimes used as part of a trauma-informed approach.

Problems of testability have been exaggerated

Psychology places great emphasis on its status as a science. Broadly speaking, scientists seek objectivity and evidence. The mid-twentieth-century philosopher Karl Popper suggested that a good scientific theory should be both testable and falsifiable, and he famously dismissed psychoanalysis as a body of unfalsifiable theories. However, claims that psychoanalysis is unfalsifiable tend to overlook the crucial difference between an idea that is untestable and one that is simply hard to test. Many of Freud’s ideas (such as the Oedipus complex) are very complex and therefore methodologically difficult to study, especially experimentally. This is actually very similar to the situation in physics, where experimental physicists cannot directly test the propositions of theoretical physics, yet physics remains at the top of the ‘scientificness’ hierarchy.

Many of Freud’s original theories were impossible to verify at a larger scale at the time. While for some of them the jury is still out, many have gained empirical support. For example, we have already seen that dreaming is linked to wish fulfilment on a neurological level and that psychoanalytic therapies provide effective treatment for various mental health conditions (an empirical test of their value).

Conclusion

Psychology and psychoanalysis have largely developed separately, and most psychologists do not have a good idea of the current state or influence of psychoanalysis. This has led to psychoanalytic ideas being described in simplistic and overly critical ways in psychology. We argue that, far from being obsolete, psychoanalysis is alive and inf luential. Some ideas are more open to scientific scrutiny than others, but in general psychoanalysis is less resistant to testing than you might expect after reading many psychology textbooks. To learn more about Freud’s enduring relevance, check out the free special edition of The Psychologist where distinguished contemporary psychologists evaluate his specific theories and ideas (see www.tinyurl. com/388s49mt).

Stefan Marianski and Emilia Raczkowska are education managers at the Freud Museum, London.