If you ask psychotherapists what they are discussing these days, they will answer you: "About the effectiveness of our work".
Updated colleagues will say in no uncertain terms: psychotherapy works. Not always, not for everyone and not practiced by anyone, but a modern psychotherapist is likely to give you a real benefit. Less depression and anxiety, better interpersonal relationships. If you then ask: "Which psychotherapy works best? ", they will begin to debate. It can be said for sure that cognitive therapies have more supporting studies, but there is no evidence that they achieve superior and more stable results (that it is not proven that cognitive therapies have and achieve superior and more stable results in some disorders is an opinion of the author that we respect, but remember that this is not the orientation of many internationally considered authoritative health guidelines, such as the National Institute for Health and Care Excellence and the American Psychological Association - NDR).
In this context, twenty years ago, the discipline invented by Freud was cornered. Overwhelmed by the inability to answer the question: "Does this stuff you do really work? " it had fallen into disgrace in the eyes of practitioners, training schools were emptying, and patients were looking for it less, directed towards cognitive therapies. Today, 80 years after the death of the inventor of psychoanalysis, the situation is less dramatic. Enlightened followers have found the strategy that saved them from mere survival in the same peeling and moldy studies in which they were locking themselves up.
Many psychoanalysts have opened up to research: they are looking for evidence of what psychic suffering generates, how it is cured and how beneficial it is to cure. Freud"s disciples of the last generation find territory in the era of scientific psychotherapy.
Those who follow the public debate will be surprised, a different panorama was imagined. He listened in the agora to lovers of esoteric and sequential psychoanalysis, claiming the primacy of a discipline that, alone, would allow the analysand to access the mysteries of the soul and come out with new awareness. We who live in the scientific era do not take them seriously. They hinder the rectification of Freud"s legacy.
This is the news: in the eighty years since the death of its inventor, psychoanalysis is alive and, we can say, given to the hand, in many useful forms. Caveat emptor. I said: in many forms, often better listed as psycho dynamic psychotherapies.
If instead, you enter the study of someone who says: "Lay down on the bed, dreams, associates, over the years we will see that it will come out, our journey is unpredictable" here is, as I say, good luck. What remains of the scaffolding raised by Freud? I talk about it with two psychoanalyst friends. Francesco Gazzillo, associate professor of dynamic psychology at the Sapienza University in Rome, suggests to me: "The centrality of unconscious contents and mental processes". True. It is an unconscious who now has nothing of the properties that attributed to him Freud, it is not the seat of erotic fantasies and mortiferous primordial, that the person can not admit to consciousness. The unconscious today is the place where automatisms of thought dwell and above all our ways of being in relation to which we have not learned to be aware. I always say to Gazzillo that today"s unconscious is what Pierre Janet described, he reiterates that Freud"s work is more important, and we will never get to the bottom of it. For us cognitivists, in fact, Janet is the forerunner of modern psychotherapy; for psychoanalysts, Freud remains the beacon.
It's the beauty of being able to choose your ancestors. The point is that more than a century ago Freud helped to demolish the self-deception of the conscience of a bourgeois, repressive and sexophobic society.
Today the field of the inadmissible has narrowed down, but we are only aware of a small part of our thinking processes, especially those that intoxicate us into social life. Another fundamental element: what happens to the child in the first years of life moulds it for the rest of its existence, both psychological and physical. If today we psychotherapists are so careful to collect episodes of childhood, we owe it to Freud. But in his work he has often changed his point of view. He was right at the beginning: real traumatic events generate the symptoms of what was once called hysteria. Then he ran. It"s not the real trauma that counts, but the child"s imagination. There is little left to debate: it is the real trauma, violence, abuse, extreme neglect that breaks the mind.
Successors had to amend the founder"s mistake. Advertising message Another legacy: the importance of the anguish and the damage that does the protection from the anguish itself. That the world frightens us is normal, fair and evolutionarily useful. In the absence of a well-dosed fear one dies very young. Among predators, poisonous foods and natural catastrophes, the homo sapiens has had to pass some ugly ones. But at times the fear takes extreme, catastrophic forms, ignites circuits which feed themselves. Chain reactions like those that led Chernobyl to explode. The only radioactive isotope they release is fear itself. The human mind then manufactures shields to protect itself from psychological pain.
Sigmund Freud and his daughter Anna call them defense mechanisms. They have a paradoxical effect: if on the one hand, they reduce anxiety, they generate more suffering and problems on the other. Like plugging a small hole in the dam with your finger. Another one opens. Once the ten fingers have finished, trouble begins. Today, whether we are psychoanalysts or cognitivism, we pay attention to the damage generated by the mechanisms of pain reduction. But, attention. Freud spoke of the protection from unacceptable impulses that the person was hatching inside. Classic example: Oedipal fantasy. The child wants to replace the father in his mother"s bed.
The psychic symptom, in this schema etiology, was born from the effort to keep this forbidden and, precisely, distressing fantasy away from the conscience. Defense mechanism: removal. What did the science of this idea do with it? Robert De Niro"s objection to Billy Crystal in Therapy and Bullets is a jurisprudence: "Did you see it for my mother? " Apart from Oedipus, the idea of both protective and harmful mechanisms holds.
Cognitivists call them adaptive coping. Do I feel imperfect? I work like a damned until late at night. An annoying sense of emptiness? Alcohol and women. They soothe the pain, accentuate the damage. Giuseppe Magistrale, the intersubjective psychoanalyst, handed me a note under the counter: "He left us the concepts of transference and countertransference as an inheritance". I come straight to how we understand them today, even in the absence of consensus on their definition. The patient builds the therapist according to patterns constructed during development.
My father laughed at me, the therapist will do the same. In the face of what I was doing, my mother howled: "you let me die", so the therapist will be overwhelmed by my problems. Countertransference: the therapist reacts almost guided by a reflex. It gives me a superior healing power, I believe it. Be wary of me, I"m afraid of making mistakes. In reality, the therapist also brings his past into the session, the patient evokes ghosts that had long resided in the peripheries of the mind.