Why do any therapists trust The Interpretation of Dreams?
May 9, 2007 7:00 AM   Subscribe

I'm reading Freud's The Interpretation of Dreams, and the jumps he makes in interpreting dreams -- from a dream image to someone's long-ago memory to some quote to another quote to a childhood wet-nurse -- strike me as absolutely ludicrous. How and why do any therapists put any faith in this method of interpretation (I know many don't)?
posted by Malad to Science & Nature (19 answers total) 3 users marked this as a favorite
I'm not sure about that theory, but his attributing all Hamlet's rage towards Claudius and his mother to Oedipus Complex seems like a real stretch to me!

I can see a very very tenuous link, but there are other far more compelling and reasonable answers!

I must just not be smart enough to get Freud.
posted by jonathanstrange at 7:14 AM on May 9, 2007

There is very little similarity between Freud's methods of psychoanalysis and modern methods. He contributed many ideas that are vital to the practice (subconscious, etc.) but is not really practicable anymore. As far as dreams go, modern psychoanalytic interpretations would be much more easy to follow and definitely wouldn't reach. Having far-out theory-based interpretations is counterproductive since it's all about getting the patient to understand why certain behaviors happen.

I am not a psychotherapist, I've only studied Freud, Lacan, and other visionaries of the psychoanalytic movement as frameworks for critical theory.
posted by cowbellemoo at 7:15 AM on May 9, 2007

At this point I think that very few practicing psychotherapists actually take Freud word for word. He is more someone who is respected for basically "inventing" (for lack of a better word) the idea of the unconscious and the significance of dreams. Reading him nowadays and thinking about him literally, well, it just sounds like malarky. I think his contributions are now seen as a jumping off point to understand how our minds work through things unconsciously, rather than used whole cloth in therapy.

For what it's worth, I have no background in psychology! Just a passing interest.
posted by sneakin at 7:24 AM on May 9, 2007

I don't know the answer to your question, but I had the exact same reaction on reading "The Interpretation of Dreams" a few months ago. The leaps required to get from dream image A to conclusion Z made it seem (to me) a lot like numerology or some other pseudo-science where the answer is based on the perception of connections that aren't really there.
posted by GregW at 7:36 AM on May 9, 2007

They don't - Freud is well-respected as the first person to consider the mind and its processes analytically, and laid a quasi-framework for therapists to develop into a real science. Today, he's about as relevant as Copernicus.
posted by TheNewWazoo at 7:40 AM on May 9, 2007

Part of my decision to drop out of social work school was the heavy reliance in clinical settings on Freudian psychoanalytics. This isn't to say that Freudian psychoanalytics are entirely useless. However, it's pretty universally agreed upon at this point that Freud's claims to Platonic universality of mental phenomena is bunk. I.e., we're not all the same, basically, deep down, in some hidden psychic core. Though, in child sexual abuse situations, for example, where the parallels to Freud's theories are relatively explicit, I think some therapists sucessfully apply analytics.

An undergrad psych professor of mine, Bertram Cohler, has done a lot of work with at risk children applying Freudian analytics and claims such success. You can read a short article about his work on childhood adversity and resilience for a very general idea of how he does this.
posted by The Straightener at 7:42 AM on May 9, 2007

Freud not only didn't apply analytics to mental processes first, he didn't do it at all. He falsified case studies, generalized from single examples, and made crap up.

The only reason that this isn't widely accepted is embarrassment or mammoth ignorance.
posted by ewkpates at 7:59 AM on May 9, 2007 [1 favorite]

The PhD program in clinical psychology here at Penn doesn't even have Freud in the curriculum.

Freud is absolutely not relevant to modern psychology.
posted by dmd at 8:43 AM on May 9, 2007

I read somewhere that Freud should be considered the Model T of psychology. The Ford Model T was revolutionary when it came out and created (or at least greatly enlarged) an industry. But when compared to today's cars, it's quaint and ineffective. Same with Freud.

Or what sneakin said.
posted by Kronoss at 8:46 AM on May 9, 2007

Today, he's about as relevant as Copernicus.

Seconding that. He had a few great insights and people built on those insights.

This book provides a thumbnail sketch of some of those therapists and their work:

Freud and Beyond: A History of Modern Psychoanalytic Thought.
posted by jason's_planet at 8:58 AM on May 9, 2007

Freud did not do science outside his neurological work. Neither did Jung. They just made stuff up really - there is no empirical basis for it whatsoever.
posted by phrontist at 10:35 AM on May 9, 2007

I've seen quite a few shrinks in my day. Only one was ever interested in what I had dreamed about. And his interest was mostly in my interpretation of them — and then mostly just as a conversation-starter.

I think the idea was that if I had something embarassing I wanted to talk about, "finding" it in a dream would be an easy face-saving way for me to bring it up. "It's not that I want to talk about gay sex, doc! It's just that it keeps showing up in my dreams!"

But that's a far cry from Freud's take on the matter. I agree with the other posters who say that this aspect of Freud's thought, at least, is no longer accepted as true.
posted by nebulawindphone at 10:54 AM on May 9, 2007

There are two separate questions here. Do Freud's individual interpretations hold up? And, does psychoanalysis work as a cure for mental illness?

The answer to the first is yes and no. Many of the things he wrote read as stretches, many of the ideas that make up his model of the mind go a long way toward explaining the phenomenology lived human experience for a lot of folks. Witness the wide currency of notions like the unconscious (which has been conceived of differently, also, but in common parlance is pretty much Freudian), the Freudian slip, the formative nature of childhood experience, an abiding sense that emotions matter and are descriptive of deeply rooted mental states. I would never argue that these are unmitigated goods, but nor do I think that it's possible to argue that many people don't find a basic Freudian model of the mind to be very descriptive.

The second question, does psychoanalysis work, is interesting because the answer goes a long way toward describing why people might grant credence to Freud. The answer is an unalloyed Yes. Individual studies and meta-analyses are completely clear that psychotherapy is very effective with an effect size of ~.80. This means that ~79% of people treated with some form of psychotherapy do better than people who want treatment but do not receive it. These are in studies and meta-analyses of studies comparing treatment to a no treatment control. There are some real problems making blinded studies of psychotherapy.

Now, the interesting part. If the effect size is .80 in terms of absolute efficacy, what's the relative efficacy? Which kinds of therapy work best? Cognitive Behavioral? Psychoanalysis? EMDR? DBT? Some other form of long-term Freudian psychodynamic talk therapy? The answer is that they all work about equally well. The range in improvement attributable to the specific form of therapy engaged in is 1-20%, depending on the study. (Bruce Wampold and Michael Lambert are the two people publishing the most on this right now, both absolute and relative efficacy.) In other words, most reputable therapy works as well as most other reputable therapy. The overall benefits far outweigh the specific benefits and techniques.

All of this is relevant because it explains a lot about why psychoanalysis was and is popular: it works. It's one of the therapies studied which has an absolute efficacy ~79%. So, if the confirmation you seek for your theories, or those of your hero, Freud, is that patients get better, you're going to find it in most of the people that you treat. It doesn't take a willful disregard for truth to end up thinking that the theories are the important thing, when the really important thing, as the relative efficacy studies prove, is the general milieu of therapy.

(Of course, the flipside is that the psychoanalytic claims that only psycholanalysis really helps people, are just as false as the claims that it doesn't. All reputable therapies help some people some of the time, and so there's no reason to get psychoanalysis if you'd rather get CBT, nor is there a reason to get CBT if you'd rather get family therapy.)
posted by OmieWise at 11:36 AM on May 9, 2007 [4 favorites]

In other words, most reputable therapy works as well as most other reputable therapy. The overall benefits far outweigh the specific benefits and techniques.

I'd never heard this... and it's very interesting. It makes all therapy sound like pure placebo, if none of them are any better than any other. Since we don't have any real understanding of how the mind works (is there really an unconscious mind? How would we know?), we can't really establish any therapy as more of a "control" (thought to have no effect given a theoretical framework) than any other.

In other words, most reputable therapy works as well as most other reputable therapy.

Because they're reputable and thus give people the expectation of a cure?

Then again, how do you even explain subject-expectancy without a psychological framework?

I'm going to go calm myself down by reading math.
posted by phrontist at 12:32 PM on May 9, 2007

In other words, most reputable therapy works as well as most other reputable therapy. The overall benefits far outweigh the specific benefits and techniques.

I'd never heard this... and it's very interesting. It makes all therapy sound like pure placebo, if none of them are any better than any other.

No . . not pure placebo. Not at all. What seems to matter most -- over and above any theoretical model -- is the relationship formed between therapist and client. This seems to hold true even for therapies such as CBT that de-emphasize this relationship.
posted by jason's_planet at 2:07 PM on May 9, 2007

Given that most therapies lead to comparable outcomes, it's hard to see why someone would choose Freudian psychoanalysis -- which tends to be very expensive and runs an average of 5-6 years -- over something like cognitive behavioral therapy, which often shoots for wrapping things up in a couple of months.
posted by svenx at 2:50 PM on May 9, 2007

I always like to compare Freud with Tolkein. Smart guy. Capable of creating amazingly elaborate fantasies.

I'm just as likely to believe that the Similarillion is an accurate history of the world as I am that Freud's theories have ANY bearing on reality.

Freud's ideas are taught more today in literature and in drama classes than they are in psychology classes. I'm actually sad that there is even an obligation to pay him the lip service he gets in history of psychology classes. You can't deny that he was influential, but I'd argue that his influence sent psychology down a dead end. I wonder how many people's lives were ruined by his theories.

The only positive thing you can say about Freud is that he talked to his patients. He certainly wasn't the first to do this, he borrowed the practice from Josef Breuer.

Better Freud than Mesmer; I guess.
posted by Telf at 5:25 PM on May 9, 2007

jason's_planet is correct, it's relationship, hope and a plan for change that make people get better in therapy. Hope is one way of talking about the placebo effect, but relationship is the biggest contributor. (Wampold is very good on this.) We have a pretty good idea of what placebo does for mental health issues because there are plenty of placebo controlled studies for mental health, the active treatment is just medication, not therapy. If you look at the medication studies, the thing to notice is that medications are not all that much better than placebo controls, and that's in studies using inert placebos and controlling for outlying placebo responders...in other words, in studies that aren't really blinded.
posted by OmieWise at 8:21 PM on May 9, 2007

it's hard to see why someone would choose Freudian psychoanalysis

Some people have a theory of change which suggests that they won't get better without the kind of intense insight-driven experience that psychoanalysis provides, just like some people have a theory of change that favors medications, with all their medications and the need to take them longterm, over comparably effective psychotherapy.
posted by OmieWise at 8:25 PM on May 9, 2007

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