Psychoanalysis—A Cognitive Process (Bieber, 1980)

In his landmark paper “Psychoanalysis—A Cognitive Process,” Irving Bieber reviewed classical psychoanalytic theory with its emphasis on affect, instincts, and psychic energy. Bieber concluded that classical psychoanalytic theory was essentially a “cognitive system in the service of the theory of affects.” He proceeded to describe three categories of affect: (1) physiological: hunger, thirst, sexual; (2) anxiety and/or fear—psychophysiological responses to threat(s); and (3) a wide repertoire of “feelings” in which cognition is integrated with affect. In essence, he said, affect and cognition are invariably linked. Bieber contended that inappropriate affect and maladaptive behavior are governed by irrational beliefs, as well as expectations of injury. He defined psychopathology as a reaction of the individual to injury, real or imagined. The latter may include defective nurturing (e.g., negative attachment experience), abandonment, rejection, hostility, overcontrol, physical injury, and sexual abuse. The goal of therapy, according to Bieber, is the extinction of irrational fears, beliefs, and maladaptive defenses. This requires (1) insight into irrational fears and expectations of injury (real or imagined); (2) recovering the origin of these beliefs through anamnesis, dreams, and transference phenomena; (3) delineating the specific defenses and reparative reactions in order to neutralize them; and (4) replacing maladaptive behavior and inappropriate affect with realistic beliefs and perceptions. Although insight alone does not guarantee change, it provides the patient with the tools for replacing irrational beliefs, perceptions, and maladaptive behavior with realistic ones. Bieber pointed out that irrational beliefs and expectations of injury pervade work functions as well as sexual, romantic, and interpersonal relationships. He also made a distinction between cognitive-behavioral