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Status quo of psychoanalysis and similar insight-oriented techniques is not alike in different nations, due to a number of cultural, pedagogic or economic reasons.
Bypassing Freud and his methodology or failure to distinguish between his pragmatic hints and meta-psychological remarks has founded a big dilemma in the course of training or practicing clinical psychoanalysis and psychodynamic psychotherapy in developing societies. Methodical study, training and practice of psychoanalysis, as the highest level of psychodynamic approaches, is the only possible and effective way for supporting and promotion of psychodynamic perspectives and therapies. If not, there is no outcome except than bewilderment and fruitlessness in learners and approximately complete ignorance of this genuine exploratory technique and its substitution with more superficial psychotherapeutic approaches like cognitive therapy, behavior therapy and etc., which operate just at the conscious and subconscious levels of mind. Bio-psych-social approach in modern psychiatry cannot be attainable without sensible and clinical considering of ‘unconsciousness’. In this article, which is devoted primarily to developing cultures, a quantity of obstacles against training and development of applied (clinical) psychoanalysis and related procedures has been discussed briefly.
Keywords: Psychoanalysis, Psychodynamic psychotherapy, Developing societies, Developed societies, Core curriculum
Psychoanalysis is a theory of psychopathology and a treatment for mental disorders. Fifty years ago, this paradigm had great influence on the teaching and practice of psychiatry. But some believe that today, psychoanalysis has been marginalized and is struggling to survive in a hostile academic and clinical environment [1,2]. This raises the question as to whether the paradigm is still relevant in psychiatric science and practice. In a difficult climate for the theory and practice of psychoanalysis, several responses have emerged, either by attempting to bridge the gap with science or by redefining the field as lying outside of science. Thus, some analysts have supported revised paradigms, such as attachment theory, that are better supported by evidence [3]. Others have taken the view that Freud’s ideas concerning the unconscious mind are compatible with modern neuroscience [4]. Still others have moved in the opposite direction, arguing that it is sufficient to offer a coherent interpretation of psychological phenomena [5]. Since Sigmund Freud (1856-1939) formulated his first psychoanalytic theories about 100 years ago, there has been a rapid development in psychoanalytic theory and therapy, which is evident in central concepts in the four psychoanalytic "psychologies"--drive/ego psychology, object relations theory, self-psychology and interpersonal psychoanalysis. Basic concepts in psychoanalysis have been under a continuous critical review, and psychoanalytic theories remain versatile. The unconscious and the exploration of subjective experience are central common themes. For many analysts, the role of the psychoanalyst has changed from expert to explorer, working together with the patient. At the same time, the analyst has become more active in the therapy room. Also, the analyst's contribution to what is happening between the analyst and the patient has been increasingly emphasized. The development in psycho-analysis has paralleled both developments in the theory of knowledge as well as the change in cultural trends. Creating meaning is central to the psychoanalytic process, but there are divergent views as to how this happens: by articulating meaning, by uncovering meaning, by constructing or deconstructing meaning [6]. Modern medicine and psychiatry expect all forms of therapy to be supported by evidence [7]. While Fonagy [8], a psychoanalyst who is also a respected researcher, has acknowledged that the evidence base for psychoanalytic therapy remains thin. The German psychoanalyst Leichsenring [9] has published meta-analyses of extended forms of psychoanalytic treatment, claiming that there is sufficient evidence to support this treatment in complex mental disorders and other recent reviews of this literature have made a similar argument [10]. Today’s there is an inclination for development of psychoanalytic theory based on data derived from empirical studies other than clinical case study. Particularly noteworthy is the convergence that followed between neuroscience and psychoanalysis and the rise of the so-called neuro-psychoanalysis.
Consequently, this led to eject empirical hypotheses and begin research on defense mechanisms, self, memory, dreams, empathy, dynamic unconscious and emotional-motivational processes (theory of drives). Currently neuro-psychoanalysis constituted itself as a discipline contained in itself three separate areas: the psychodynamic neuroscience, clinical neuro-psychoanalysis and theory building. For example, the theory of Panksepp [4,11] emotional systems is an example of an integrated neurobiology of affect, behavioral biology, evolutionary psychology and psychoanalysis. In this regard, the theory of emotional systems includes the description of the SEEKING system representing basic motivational system of the organism. Apart from a new perspective on the theory of drives described by Sigmund Freud, it offers the possibility to take into account the emotional and motivational systems within the understanding of mental disorders such as depression, addiction and psychosis, which is the core of psychoanalytic thinking [11]. As an extra example, while bio-imaging studies indicate that during REM sleep there is activation of the pons, the amygdala bilaterally, and the anterior cingulate cortex and deactivation of the posterior cingulate cortex and the prefrontal cortex and the images suggest there is a neuroanatomical frame within which dreams can be generated and then forgotten, psychoanalysis studies the dream from a completely different angle. Freud believed it was the expression of hallucinatory satisfaction of repressed desires. Today it is interpreted as the expression of a representation of the transference in the session. At the same time, it also has symbol-generating functions which provide an outlet by which affective experiences and fantasies and defenses stored as parts of an unrepressed unconscious in the implicit memory can be represented in pictorial terms, then thought and rendered verbally. From the psychoanalytical point of view, the dream transcends neurobiological knowledge and looks like a process of internal activation that is only apparently chaotic, but is actually rich in meanings, arising from the person’s affective and emotional history [12]. Another attempt to reconcile psychoanalysis with science has come from the literature on neuroplasticity [13]. It is now known that neurogenesis occurs in some brain regions (particularly the hippocampus) during adulthood and that neural connections undergo modification in all parts of the brain. There is also evidence that CBT can produce brain changes that are visible using imaging [14]. These findings have not been confirmed in psychoanalytic therapies. However, Doidge [15], a Canadian psychoanalyst, has argued that psychoanalysis can change the brain. This may be the case for all psychotherapies. However, more recently, Doidge [15] has claimed that mental exercises can reverse the course of severe neurological and psychiatric problems, including chronic pain, stroke, multiple sclerosis, Parkinson’s disease, and autism. In 2009, the British Journal of Psychiatry published a debate about whether the journal should accept psychoanalytic case reports [16]. The debate pitted a biologist, Wolpert, against a psychoanalyst-researcher, Fonagy [16]. Wolpert argued that psychoanalytic case reports should be excluded because they are in no way scientific. Fonagy, while conceding some of his opponent’s points, defended analysis by pointing out that research is possible and is now beginning to be conducted. But while Fonagy himself is committed to empiricism, he represents a very small minority in a field that lacks that commitment. Unfortunately, the modern revisions of psychoanalysis do not offer a coherent response to critics. It is difficult to see how any of the current responses to criticism can save psychoanalysis from a continued and lingering decline. Analysis has separated itself from psychiatry and psychology by teaching its method in stand-alone institutes. The field may only survive if it is prepared to dismantle its structure as a separate discipline and rejoin academia and clinical science. Whatever its limitations, psychoanalysis left an important legacy to psychiatry. It taught a generation of psychiatrists how to understand life histories and to listen attentively to what patients say. In an era dominated by neuroscience, diagnostic checklists, and psychopharmacology, we need to find a way to retain psychotherapy, whose basic concepts can be traced back to the work of Freud, as part of psychiatry [1,17].
ANALYTIC TRAINING BASED ON CLINICAL EXPERIENCE AND PERSONAL THERAPY
TEACHING APPROACHES IN DEVELOPING CULTURES
Psychoanalysis and its modified versions like psychodynamic psychotherapy constitute important components of modern psychotherapy. Psychodynamic theories stress that early childhood experiences are crucial in shaping the personality. In psychodynamic approaches unconscious conflicts are explored and the insight gained aims to change patients’ maladaptive behavior. The main goals of such kind of psychotherapies are symptom relief and personality modification through exploration of the unconscious. So, the relationship between the therapist and patient is crucially important. Therapies can be offered on an individual, couple, group and therapeutic residential community basis. Psychodynamic psychotherapy has been shown to be a highly efficacious treatment in a range of psychological disorders but patient selection for therapy is important, with consideration of psychological mindedness and a concern with the antecedents as well as the relational contexts of the presenting problem being key [22].
CONCLUSION
Bypassing Freud and his methodology, or failure to distinguish between his pragmatic hints and meta-psychological remarks has founded a big dilemma in the course of training or practicing clinical psychoanalysis and psychodynamic psychotherapy in developing and traditional societies. If such a trouble does not resolve wisely, then the progression of psychoanalysis and its modified versions will not succeed smoothly, in spite of its historical and vital position in the realm of psychotherapy and its logical and practical independence from public ethics. Methodical study, training and practice of psychoanalysis, as the highest level of psychodynamic approaches, is the only possible and effective way for supporting and promotion of psychodynamic perspective in conservative societies. Ignorance of genuine and pragmatic literatures, based on any kind of reason or motivation, may not have any outcome except than divergence from true pathway and ending into bewilderment and fruitlessness in learners. Bio-psych-social approach in modern psychiatry cannot be attainable without sensible and clinical considering of ‘unconsciousness’.
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