Psychoanalysis and Contextual Analysis of Phobias

In his paper, “Turnings in the Ways of Psychoanalytic Therapy,” Freud (1919) wrote of “new developments towards which our therapy is tending.” He stated that people with severe agoraphobia who could not venture out alone had to be induced by the analysis “to go about alone and to struggle with their anxiety while they made the attempt.” In this way, he believed, “relevant associations and memories” would come to mind, “enabling the phobia to be solved.”

This partial departure from the “pure gold” of psychoanalysis, and venture into what today is called “in vivo” or “exposure treatment,” had germinal possibilities for psychoanalysis that Freud, unfortunately, did not pursue and that have yet to be recognized and appreciated. If, with an additional “turning,” the psychoanalyst actually accompanied the patient into the phobic situation, it would become possible, for the first time, to observe directly examples of phobic behavior changing in their natural contexts. A whole realm of new data, not accessible in the office using traditional psychoanalytic or behavior therapy approaches, would then emerge concerning factors and relationships causing these observable changes. Many phenomena termed “transference,” “resistance,” “repression,” “dependency,” etc. by the psychoanalyst would indeed be again observed, but would take on altogether different meanings. From the new empirical data, including quantitative and temporal elements, new ideas would develop about currently operative pathogenic and therapeutic processes, and new