Current Psychoanalytic theory and Practice: can there Be any one Valid Unitary Approach?

One hundred and one years ago this past winter, Sigmund Freud spent seventeen weeks studying with Charcot in Paris, an event that played a major role in turning Freud from a neurologist into a psychopathologist. Charcot's powerful influence inspired Freud to study the psychogenic causes of hysteria, and Freud's quest to create a scientifically acceptable general psychology became the central theme of his life's work. If one were to look for a beginning to psychoanalysis, this period would serve well, since Freud turned his genius from the study of the organic to a predominant focus on the ways subjective experience became organized and codified in behavior.

Psychoanalysis has continued to evolve since those early times, and the psychoanalysis of today would be barely recognizable to Freud. This evolution has taken place along distinctive lines, that is, mainly through the continuing reconsideration of theory in the light of clinical studies, often centered around the single case study reported in depth. Psychoanalytic theory has expanded so widely that an immense variety of metapsychologies and clinical theories of etiology and treatment now exist, with a massive accumulation of literature to support them. Along with the expansion of theory, the actual therapeutic capacities of psychoanalysis have expanded from a relatively narrow treatment of hysterical symptoms, to its present efficacy with psychoses, personality disorders of every kind and severity, and the broad spectrum of neurotic disorders. While other treatments in psychiatry have been effective with symptom disorders, psychotherapeutic treatment based on psychoanalytic principles remains the only definitive treatment, and the treatment “par excellence,” for personality disorders, particularly severely traumatized personality disorders, for which treatment objectives based on symptomatic improvement are extremely limited, if not irrelevant.