29.10.04 · psychology / therapy-treatment

Psychodynamic psychotherapy: Freud, Jung, and the object-relations tradition; transference, interpretation, and the therapeutic alliance

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Anchor (Master): Breuer and Freud 1895 Studien über Hysterie; Freud 1900 Die Traumdeutung; Freud 1905 Three Essays; Freud 1914 Zur Einleitung der Behandlung / Observations on Transference-Love; A. Freud 1936 Das Ich und die Abwehrmechanismen; Hartmann 1939 Ego Psychology and the Problem of Adaptation; Klein 1932 The Psycho-Analysis of Children and 1957 Envy and Gratitude; Winnicott 1971 Playing and Reality; Mahler, Pine, and Bergman 1975 The Psychological Birth of the Human Infant; Fairbairn 1952 Psychoanalytic Studies of the Personality; Kohut 1971 The Analysis of the Self; Kernberg 1975 Borderline Conditions and Pathological Narcissism; Davanloo 1980 Short-Term Dynamic Psychotherapy; Shedler 2010 Am. Psychol. 65(2):98; Leichsenring and Rabung 2008 Am. J. Psychiatry 165; Schore 2012 The Science of the Art of Psychotherapy

Intuition Beginner

Psychodynamic therapy is the oldest formal type of psychotherapy. It was founded by Sigmund Freud in late-19th-century Vienna, working from a single clinical insight: much of what we think, feel, and do is shaped by motives we are not aware of. Freud called these unconscious wishes, fears, and memories, and he located many of them in childhood. The therapy's job is to make the unconscious conscious. The patient talks freely, the therapist listens for patterns, and together they examine the patient's inner world. Freud's specific claims about why symptoms form have been heavily revised, but the broader insight — that unconscious processes shape behaviour — is now mainstream psychology.

The most distinctive feature of psychodynamic work is transference. The patient unconsciously redirects feelings from important people in their life onto the therapist. A patient who had a distant father may experience the therapist's silences as rejection; a patient who was criticised constantly may hear ordinary questions as attacks. These reactions carry information. By examining them in real time, the patient sees patterns they could not see alone. Transference is not a side effect of therapy; it is the engine. The same dynamic occurs in every close relationship, but therapy is the one place where it can be studied as it happens, with a trained witness who does not retaliate.

Freud's original model has been extended in many directions. Carl Jung added the collective unconscious and archetypes. Anna Freud catalogued the ego's defence mechanisms. Melanie Klein, D. W. Winnicott, and W. R. D. Fairbairn developed object-relations theory, which locates the patient's inner world in internalised images of caregivers. Heinz Kohut founded self psychology to treat narcissistic disorders. Modern psychodynamic therapy is usually brief — roughly $12$ to $30$ sessions — and has solid evidence of efficacy, comparable to cognitive-behavioural therapy for many conditions. This unit exists because psychodynamic thinking underpins much of contemporary clinical psychology, and its key concepts (transference, defence, the working alliance) appear across the whole field.

Visual Beginner

The picture shows the psychodynamic tradition as a single lineage with five major branches, plus the three core techniques that every branch shares. The lineage runs from Freud's classical model (top) to Davanloo's modern short-term variant (bottom), and the techniques (free association, transference analysis, interpretation) anchor the whole enterprise.

The branches differ in what they take to be the load-bearing piece of the mind (drives, defences, internal objects, the self), but they share the three techniques and the conviction that the unconscious can be approached through the therapeutic relationship.

Worked example Beginner

In the winter of $1880$ to $1881$ , a $21$ -year-old Viennese woman, Bertha Pappenheim — known in the case literature by the pseudonym "Anna O." — developed severe symptoms while nursing her dying father: paralysis of the limbs, visual disturbances, hallucinations, and loss of speech. Her family physician, Josef Breuer, took over her care and discovered something unexpected.

Step 1: Breuer noticed that when Anna O. entered a self-induced trance-like state in the evening, she could put her hallucinations into words. He began to visit her daily — sometimes for several hours — and listen.

Step 2: Breuer then found that if Anna O. could trace a specific symptom back to the first time it had appeared, and describe the triggering scene in detail with its accompanying emotion, the symptom would often disappear. She called the procedure the "talking cure," and more playfully "chimney sweeping." The technical name Breuer and Freud later gave it was the cathartic method.

Step 3: The treatment ran for about $18$ months and achieved substantial, though incomplete, symptom relief. Anna O. herself became a prominent social worker and feminist in Frankfurt, founding the Jüdischer Frauenbund in $1904$ . Breuer, however, found the intense transference that developed so disturbing — at one point Anna O. declared herself pregnant with his child — that he stopped treating hysteria patients altogether. Freud continued the work alone.

What this tells us: the case of Anna O. launched modern psychotherapy. Two of its features — that symptoms carry meaning tied to affect-laden scenes, and that the patient-therapist relationship itself becomes the vehicle of change — remain the load-bearing ideas of the entire psychodynamic tradition.

Check your understanding Beginner

Exercise (easy, multiple choice).

Which statement best captures the central claim of psychodynamic psychotherapy?

A. Human behaviour is fully determined by reinforcement contingencies in the present environment. B. Much of human thought, feeling, and behaviour is shaped by unconscious motives, often originating in childhood. C. Psychological symptoms are purely the product of maladaptive cognitive schemas that can be restructured by direct retraining. D. Mental disorder is best understood as a brain disease whose primary treatment is pharmacological.

Hint

Recall that "the patient talks freely, the therapist listens for patterns" — what kind of mental content is this procedure designed to access?

Answer

B. The defining clinical claim of psychodynamic therapy is that unconscious motives — wishes, fears, and memories outside awareness — shape conscious experience and behaviour, often rooted in early development. Option A is the behaviourist position. Option C is the cognitive-behavioural position. Option D is the biological-psychiatry position. Each of A, C, and D is a defensible view of some disorders, but none is the psychodynamic claim.

Exercise (easy, true-false).

Transference — the patient's redirection of feelings from important figures onto the therapist — is a phenomenon unique to psychodynamic therapy.

Hint

Consider what every therapeutic relationship involves, and how the "working alliance" has been studied across modalities.

Answer

False. Transference-like processes occur in every therapy modality, including cognitive-behavioural, humanistic, and pharmacological treatments. The common-factors literature (Wampold, Lambert) shows that the quality of the therapeutic alliance predicts outcome across modalities, and the alliance is itself partly a transference manifestation. Psychodynamic therapy is distinctive not because it has transference, but because it uses transference explicitly as the vehicle of change through interpretation and the deliberate non-retaliation of the therapist.

Formal definition Intermediate+

Psychodynamic psychotherapy is the family of psychotherapies descended from Freud's psychoanalysis, unified by three commitments: that mental life has a substantial unconscious component; that this unconscious component manifests in the patient's relationship to the therapist; and that the patient-therapist relationship is therefore itself the principal vehicle of therapeutic change. The discipline has fragmented into several major schools (classical Freudian, ego psychology, object relations, self psychology, the modern brief dynamic therapies), but the unifying commitments are preserved across all of them. The formal definitions below are the shared load-bearing terms.

Definition (Psychodynamic psychotherapy). A psychodynamic psychotherapy is a structured dyadic treatment in which the therapist combines (i) free association on the patient's part (the "fundamental rule": to report thoughts without censorship), (ii) interpretation on the therapist's part (the naming of patterns the patient cannot yet see), and (iii) the analysis of transference (the patient's redirection of feelings from important figures onto the therapist) and countertransference (the therapist's emotional responses to the patient, used as diagnostic information about the patient's relational impact). The aim is insight into unconscious patterns and their modification through the therapeutic relationship itself. The relationship is not a precondition for the technique; the relationship is the technique.

Definition (Topographic theory, Freud 1900 ^[Freud1900]). Freud's earliest model divided mental life into three regions by accessibility: the conscious (what is in awareness now), the preconscious (what can be brought to awareness by attention), and the unconscious (what is actively kept from awareness by repression but continues to influence thought, feeling, and behaviour).

Definition (Structural theory, Freud 1923 ^[Freud1923]). Freud's later model replaced the topographic division with three mental structures: the id (the repository of instinctual drives, operating on the pleasure principle), the ego (the executive organ, operating on the reality principle, mediating between id, superego, and external world), and the superego (the internalised moral standards of parents and culture). Mental conflict is theorised as tension among these structures; symptoms are compromise-formations in which the ego partially satisfies the id, partially obeys the superego, and partially defends itself against both.

Definition (Defence mechanism, A. Freud 1936 ^{[AnnaFreud1936]}). A defence mechanism is an unconscious psychological operation that protects the ego from intolerable affect or anxiety by distorting reality. Anna Freud's catalogue includes repression (excluding an idea or affect from consciousness), projection (attributing one's own unacceptable impulse to another), reaction formation (replacing an unacceptable impulse with its opposite), sublimation (channelling an impulse into a socially valued activity), regression (returning to an earlier developmental stage under stress), denial (refusing to acknowledge external reality), and intellectualisation (managing affect by detaching the cognitive content from its emotional charge).

Definition (Object, in object-relations theory). In object-relations theory (Klein, Winnicott, Fairbairn, Mahler), an object is an internalised mental representation of a significant other — typically a caregiver — together with the affective and behavioural dispositions associated with that representation. "Object" is not a person; it is the inner image of a person, which the patient carries, deploys, and modifies in fantasy and in real relationships. The unit of analysis is the self-object dyad (the internal relation between a self-representation and an object-representation), not the isolated individual.

Definition (Transference). Transference is the unconscious repetition, in the consulting room, of relational patterns, feelings, and expectations first established in relation to early significant figures. It is observed as the patient's reactions to the therapist that are disproportionate to the therapist's actual behaviour. Countertransference is the reciprocal phenomenon: the therapist's emotional reactions to the patient that carry information about the patient's characteristic relational impact.

Definition (Therapeutic alliance, Bordin 1979; Greenson 1965). The therapeutic or working alliance is the conscious, collaborative component of the patient-therapist relationship: the agreement on goals, the assignment of tasks, and the emotional bond that sustains the work. It is distinguished from the transference (the unconscious repetition) but is empirically correlated with it. Across modalities, the strength of the alliance is the single best predictor of therapeutic outcome.

Counterexamples to common slips

"Freud was a quack." This is the lay overcorrection. Many of Freud's specific claims (the Oedipus complex as a literal, universal childhood event; penis envy as a primary driver of female development; the seduction theory) have been abandoned on empirical and theoretical grounds. But his core insight — that unconscious processes shape conscious experience — has entered mainstream cognitive, affective, and social neuroscience (Bargh, Wilson, Schore) and is no longer a distinctly psychodynamic claim. The history is mixed, and the dismissive framing prevents readers from seeing what survives.
"Psychoanalysis takes ten years." Classical analysis did run $3$ to $5$ sessions per week for $3$ to $7$ years. Modern brief psychodynamic therapy, by contrast, is typically $12$ to $30$ sessions, and Intensive Short-Term Dynamic Psychotherapy (Davanloo ISTDP) is designed for $5$ to $40$ sessions. The "ten years on the couch" stereotype is a 1960s caricature; the modal contemporary psychodynamic treatment is comparable in length to a course of CBT.
"Psychodynamic therapy is unscientific." The theory is contested in ways that scientific theories should not be (Freud's case histories do not survive scrutiny as controlled evidence). But the technique is testable, and has been tested. Shedler's $2010$ meta-analysis ^{[Shedler2010]} reports effect sizes of $0.7$ to $1.0$ for psychodynamic therapy, comparable to CBT, with sustained improvement at follow-up. The Leichsenring and Rabung $2008$ meta-analysis ^{[LeichsenringRabung2008]} reports effect sizes of $0.7$ to $0.9$ for long-term psychodynamic therapy in complex mental disorders. The critique applies to some of the theory, not to the technique as practised today.
"Transference is unique to psychodynamic therapy." No. It occurs in every therapeutic relationship, including cognitive-behavioural and pharmacological treatments. The common-factors literature (Wampold 2001, 2015; Lambert 2013) finds that the therapeutic alliance accounts for more outcome variance than the specific technique. Psychodynamic therapy is distinctive in treating the transference as the explicit vehicle of change rather than as a side effect to be managed.
"CBT is more effective than psychodynamic therapy." For most common mental disorders (major depression, the anxiety disorders) the modal finding is equivalence, not superiority. Head-to-head meta-analyses (Tolin $2010$ ; Driessen et al. $2013$ ) show comparable outcomes. Psychodynamic therapy has advantages for personality disorders (Leichsenring's $2008$ long-term meta-analysis), complex mental disorders, and treatment-resistant cases; CBT has advantages where the target is a specific phobia or obsessive-compulsive disorder (the exposure-based protocols have the strongest evidence base). The two are complementary, not ranked.
"Childhood matters only for psychodynamic therapy." No. The recognition that early adversity shapes adult psychopathology is shared acrossAttachment theory (Bowlby, Ainsworth — see 29.07.05), the developmental psychopathology literature (Cicchetti), the adverse-childhood-experiences (ACE) studies (Felitti et al. $1998$ ), and modern affective neuroscience (Schore $2012$ ^[Schore2012]). The psychodynamic contribution is the technique for working with it, not the recognition that it matters.
"Freud invented the unconscious." No. The concept of unconscious mental process appears in Leibniz's nouveaux essais ( $1704$ ), in Schopenhauer, in von Hartmann's Philosophy of the Unconscious ( $1869$ ), and in the Romantic psychology of Carus and Schelling. Freud's contribution was a clinical method for approaching unconscious content (free association, dream interpretation), not the concept itself.
"Jung and Freud agreed." No. The personal and theoretical break of $1913$ was over the substantive content of the unconscious. Freud held that the unconscious was largely personal, drive-laden, and repressed; Jung held that beneath the personal unconscious lay a collective unconscious populated by inherited archetypes (the Shadow, the Anima/Animus, the Self). Jung's psychology is a separate tradition, not an extension of Freud's; it is mentioned here for completeness but not developed in this unit.

Key model: transference as the central mechanism of psychodynamic therapy Intermediate+

The central mechanistic claim of psychodynamic therapy is that transference is the principal vehicle of change, not a side effect. The patient's characteristic relational patterns — established in early life, stored as procedural knowledge outside awareness — are re-enacted in real time with the therapist. The therapist's task is to (i) recognise the re-enactment, (ii) refuse to enact the patient's expected response (the "complementary" response that would confirm the patient's expectation), and (iii) interpret the pattern as it happens. Through repeated cycles of re-enactment and non-complementary, interpreted response, the patient's procedural relational schemata are modified. This is the mechanism that every school of psychodynamic therapy calls working through.

The model (Transference-based change). Let $S = {S_{1}, S_{2}, \dots, S_{n}}$ denote the patient's procedural relational schemata — internalised self-object-affect units laid down in early development. Each schema $S_{i}$ generates expectations about the other's response in a relationship: if I do $X$ , the other will do $Y$ . In the consulting room, the patient behaves as if the therapist will enact $Y_{i}$ for the relevant schema $S_{i}$ . The therapist observes the behaviour, recognises the implied expectation, responds in a way that is not $Y_{i}$ , and names the pattern. The patient's expectation is violated in a sustained affective relationship, and the schema $S_{i}$ is updated. After many such cycles, the schemata are reorganised and the patient's behaviour outside therapy changes correspondingly.

This model is what the entire tradition, from Breuer and Freud $1895$ ^{[BreuerFreud1895]} through Davanloo, Kernberg, and McWilliams, holds to be the operative change mechanism. The remainder of this section defends it on three grounds: clinical case evidence, modern neurobiological plausibility, and the comparative common-factors literature.

Clinical case evidence. The original case series — Breuer's treatment of Anna O., followed by Freud's cases of Dora ( $1905$ ), Little Hans ( $1909$ ), the Rat Man ( $1909$ ), and the Wolf Man ( $1918$ ) — established that symptoms could resolve or shift when the patient was helped to articulate the affect-laden relational scenes to which they were tied. These cases are contested as controlled evidence (the case reports were written retrospectively, sample size is one, Freud's reconstruction of his patients' histories has been challenged), but as existence proofs for the mechanism they have held up: subsequent clinicians across the psychodynamic schools have repeatedly observed that working through a transference pattern produces changes in the patient's outside-therapy relationships.

Neurobiological plausibility. Two independent lines of contemporary neuroscience converge on the mechanism. First, the memory reconsolidation literature (Nader, Schafe, and LeDoux $2000$ ; Nader and Hardt $2009$ ; Ecker, Ticic, and Hulley $2012$ ) demonstrates that when a consolidated long-term memory is reactivated, it transiently returns to a labile state during which it can be modified or "rewritten" by new information presented within a narrow reconsolidation window of roughly two to six hours. This is the only known mechanism by which established procedural memory can be permanently modified rather than merely suppressed. The transference-based model of change matches the reconsolidation paradigm precisely: the schema is reactivated (transference is enacted), the expected outcome is violated (the therapist does not enact the complementary response), and the schema is updated within the reconsolidation window. Second, Allan Schore's affective-neuroscience framework (Schore $2003$ , $2012$ ^[Schore2012]) locates the procedural relational schemata in right-hemisphere corticolimbic circuits laid down in the first two years of life in implicit-procedural memory, and argues that the therapeutic interaction modifies these circuits via right-brain-to-right-brain affect regulation between therapist and patient. The psychodynamic mechanism is thus consistent with — and historically anticipated — the contemporary neuroscientific account of how early procedural learning can be modified.

The cognitive-behavioural critique and response. The CBT critique (Popper's falsifiability objection; Eysenck's $1952$ claim that psychoanalysis did no better than spontaneous remission; the more recent demand that all therapeutic claims be tested by randomised controlled trial) targets the theory of psychoanalysis more sharply than the technique. The modern response (Shedler $2010$ ^{[Shedler2010]}; Leichsenring $2008$ , $2010$ s) is twofold. First, the technique is testable, and has been tested with results that match CBT on the major outcome measures: effect sizes of $0.7$ to $1.0$ for psychodynamic therapy versus $0.6$ to $0.9$ for CBT, with sustained improvement at follow-up — a feature that distinguishes psychodynamic from some CBT variants whose gains decay over time. Second, the common-factors literature (Lambert $1992$ , $2013$ ; Wampold $2001$ , $2015$ ) finds that the therapeutic alliance accounts for substantially more outcome variance than the specific technique does, which is consistent with the psychodynamic claim that the relationship is the operative mechanism. Transference-like processes occur in every therapy modality; psychodynamic therapy is distinctive in deploying them explicitly rather than implicitly.

Bridge. The transference-based change model builds toward 29.10.01 by identifying the mechanism that makes the therapeutic alliance — surveyed there as a generic predictor of outcome — the actual vehicle of change, and appears again in 29.09.05 as the object-relations logic by which psychodynamic treatment of eating disorders works: the patient's internalised relation to a punishing or absent caregiver is re-enacted with the therapist and modified there. The central insight is that procedural relational memory is the substrate of much adult psychopathology, and this is exactly the substrate that conscious cognitive restructuring (the CBT pathway) cannot reach directly, because procedural memory is by definition outside awareness. Putting these together with Schore's right-brain affect-regulation framework identifies the operative change mechanism with the implicit-procedural memory system, and the bridge is from Breuer's $1880$ "talking cure" to the modern reconsolidation paradigm: the same clinical observation, now grounded in the neuroscience of memory modification.

Exercises Intermediate+

Exercise 1 (easy, multiple choice).

Which of the following pairs correctly matches a psychodynamic theorist with their contribution?

A. Heinz Kohut — borderline personality organisation B. Otto Kernberg — self psychology and mirroring transference C. Melanie Klein — the paranoid-schizoid and depressive positions D. D. W. Winnicott — separation-individuation theory

Hint

Kohut founded self psychology; Kernberg developed TFP for borderline personality; Winnicott is associated with transitional objects and the good-enough mother.

Answer

C. Melanie Klein — the paranoid-schizoid and depressive positions. Klein defined the paranoid-schizoid position (the earliest infant organisation of experience, dominated by splitting of the object into good and bad part-objects) and the depressive position (the later achievement of integration, with the capacity to feel guilt and concern for the object as a whole). Option A confuses Kohut with Kernberg: Kernberg developed the borderline-personality-organisation model and transference-focused psychotherapy (TFP). Option B inverts the same pair: Kohut founded self psychology. Option D confuses Winnicott with Margaret Mahler, who developed separation-individuation theory.

Exercise 2 (easy, multiple choice).

Which of the following is not one of Anna Freud's catalogue of defence mechanisms?

A. Reaction formation B. Sublimation C. Flooding D. Intellectualisation

Hint

Three of the four are unconscious mental operations that distort reality to protect the ego from anxiety. One is a deliberate behavioural technique belonging to a different therapeutic tradition.

Answer

C. Flooding. Flooding is a behavioural-exposure technique developed by Thomas Stampfl in the $1960$ s within the behaviour-therapy tradition, in which the patient is exposed to the feared stimulus at full intensity for a prolonged period. It is a deliberate intervention, not an unconscious mental operation. Reaction formation, sublimation, and intellectualisation are all in Anna Freud's $1936$ catalogue ^{[AnnaFreud1936]} as defensive operations the ego performs outside awareness.

Exercise 3 (medium, short answer).

Define transference and countertransference, and give a brief clinical example of each. Explain how the therapist uses countertransference as diagnostic information rather than as a problem to be suppressed.

Hint

Transference is the patient's redirection of feelings from early figures onto the therapist. Countertransference is the therapist's emotional response. The key move is to treat the therapist's reaction as data about the patient's characteristic relational impact.

Answer

Transference is the patient's unconscious repetition, in the consulting room, of relational patterns, feelings, and expectations first established with early significant figures. Example: a patient whose mother was emotionally unavailable experiences the therapist's ordinary session-ending as abandonment and becomes acutely anxious in the last five minutes of every session. Countertransference is the therapist's emotional response to the patient — including reactions that are partly a response to the patient's characteristic way of relating. Example: a therapist treating a patient with borderline personality organisation notices that he feels inexplicably criticised and professionally inadequate after sessions, even though the patient has said nothing overtly critical. The diagnostic use is to recognise that this feeling is information: the patient's characteristic relational impact on others (including the therapist) is to leave them feeling diminished or incompetent. The therapist does not suppress the countertransference; the therapist uses it, with appropriate discipline, as evidence about the patient's internal world and the patient's effect on relationships outside therapy.

Exercise 4 (medium, numeric).

Shedler's $2010$ meta-analysis ^{[Shedler2010]} reports an overall effect size of approximately $d = 0.97$ for psychodynamic therapy at post-treatment, with the effect size increasing to approximately $d = 1.18$ at follow-up (typically $9$ to $12$ months later). Compute the percentage increase in effect size from post-treatment to follow-up, and state what this pattern indicates about the durability of psychodynamic treatment effects.

Hint

The percentage increase is $100 \times (d_{follow-up} - d_{post}) / d_{post}$ .

Answer

Approximately $21.6$ percent increase. $(1.18 - 0.97) /0.97 = 0.216$ , or about $22$ percent. The pattern — effect sizes growing between post-treatment and follow-up — indicates that the gains made in psychodynamic therapy are durable and continue to develop after treatment ends. This is the feature Shedler highlights against the critique that psychodynamic therapy produces only transient symptomatic relief: the implication is that the treatment modifies the underlying structure of the patient's relational and emotional life, not just the presenting symptom. By contrast, several CBT variants show effect-size decay at follow-up as symptom relief erodes; the comparative pattern is part of Shedler's argument that the two modalities are at least equivalent in efficacy but differ in durability.

Exercise 5 (medium, short answer).

Compare classical psychoanalysis (Freud's original technique, as practised $1900$ – $1939$ ) with modern brief psychodynamic therapy on three dimensions: session frequency and total duration, the use of the couch, and the role of the transference.

Hint

Classical analysis is $3$ – $5$ sessions/week for years, with the patient on the couch. Brief psychodynamic is weekly, $12$ – $30$ sessions, face-to-face. The role of transference shifts from "the central but slow-developing vehicle" to "the explicit and time-limited focus."

Answer

Frequency and duration: Classical psychoanalysis is conducted at $3$ to $5$ sessions per week for $3$ to $7$ years — a total of roughly $300$ to $1000$ sessions. Modern brief psychodynamic therapy is typically weekly ( $1$ session per week) for $12$ to $30$ sessions, with ISTDP (Davanloo) running $5$ to $40$ sessions. The couch: Classical analysis uses the couch — the patient lies down, the therapist sits behind, out of the patient's view, maximising free association and the projection of transference onto the unseen therapist. Brief psychodynamic therapy is conducted face-to-face, with the couch reserved for selected patients and selected phases of treatment. Role of transference: In classical analysis the transference develops slowly over years and is "worked through" repeatedly; in brief psychodynamic therapy the transference is actively and quickly engaged, with the therapist interpreting patterns as they emerge and using the relationship as the explicit vehicle of change from the earliest sessions. The shift is from a slow-maturation model to a focused-engagement model.

Exercise 6 (medium, short answer).

D. W. Winnicott introduced the concept of the transitional object ( $1951$ , expanded in $1971$ ^{[Winnicott1971]}). Define the transitional object, give the standard developmental example, and explain how the concept informs psychodynamic technique with adult patients.

Hint

The classic example is a security blanket or teddy bear. The transitional object occupies an intermediate zone between the infant's subjective experience and external reality. Adult clinical relevance: the therapeutic relationship itself functions as a transitional space.

Answer

Definition. The transitional object is the infant's first "not-me" possession — typically a soft object like a blanket, teddy bear, or lullaby — that the infant uses for self-soothing during the transition from dependence on the mother to independent functioning. The transitional object is paradoxical: the infant creates it (it is not given by the mother), yet it is experienced as found; it is loved and hated, destroyed and survived; it is the first experience of an object that is both inner and outer. Winnicott locates it in the transitional space or potential space between subjective and objective reality — the same space in which play, art, religion, and creative living later take place. Developmental example: a $10$ -month-old who carries a particular worn blanket everywhere, becomes distressed if it is washed, and uses it to settle to sleep — but, over the second and third years, gradually decathects it as language and other self-regulatory capacities come online. Clinical relevance: the therapeutic relationship and the consulting room function as transitional space for the adult patient — a place between pure inner fantasy and external reality where the patient can play with, examine, and modify their inner world without it being either pure delusion or practical action. Winnicott's reframing shifts technique toward creating the conditions in which the patient's own capacity for creative living can emerge, rather than toward the interpretation of unconscious content.

Exercise 7 (hard, short answer).

State the strongest version of the cognitive-behavioural critique of psychodynamic therapy (Popper, Eysenck, Eysenck's $1952$ spontaneous-remission argument), and explain the most rigorous contemporary response to it (Shedler $2010$ ^{[Shedler2010]}; Leichsenring and Rabung $2008$ ^{[LeichsenringRabung2008]}). Identify which part of the critique survives the response.

Hint

The critique targets both falsifiability of the theory and efficacy of the technique. The response distinguishes theory from technique. The irreducible kernel of the critique concerns some of the theory.

Answer

Strongest version of the critique. (1) Popper's falsifiability objection: central psychodynamic claims (the Oedipus complex, the structural theory, the interpretation of dreams as wish-fulfilment) cannot be falsified, because any evidence against the claim is re-interpreted by the theory as resistance. (2) Eysenck's $1952$ argument: the spontaneous-remission rate for untreated neurosis was approximately $66$ percent, comparable to the reported improvement rate for psychoanalytic patients, implying that psychoanalysis was no more effective than doing nothing. (3) The specific-ingredients argument: if the change mechanism is the technique rather than the relationship, then CBT and psychodynamic therapy should have differential outcomes matched to differential techniques — but the common-factors literature (Lambert, Wampold) finds no technique-specific advantage.

Contemporary response. Shedler $2010$ re-analysed the effect-size literature and reported overall effect sizes of $d = 0.7$ to $1.0$ for psychodynamic therapy — substantially above Eysenck's spontaneous-remission baseline, and comparable to CBT in head-to-head trials. The follow-up data show growing rather than decaying effects, which a pure placebo account cannot explain. Leichsenring and Rabung $2008$ extended this to long-term psychodynamic therapy for complex disorders (personality disorders, complex depression, chronic anxiety), reporting $d = 0.7$ to $0.9$ with sustained improvement. The response distinguishes the theory (much of which is contested or abandoned) from the technique (which is testable and has been tested with positive results).

Irreducible kernel that survives. Popper's falsifiability objection survives as a critique of the theory. The specific substantive claims — the psychosexual stages, the Oedipus complex as a literal universal event, the interpretation of particular symptoms as compromise-formations of specific drives — are not testable in the form Freud gave them, and most contemporary psychodynamic clinicians treat them as clinical heuristics rather than as empirical hypotheses. The empirical defence (Shedler, Leichsenring) defends the technique, not the classical theory. A sophisticated CBT defender can still reasonably argue that the substantive theoretical content of psychodynamic thinking remains under-tested relative to its ambition.

Exercise 8 (hard, short answer).

Otto Kernberg developed transference-focused psychotherapy (TFP) for borderline personality disorder (Kernberg $1975$ ^{[Kernberg1975]}). State the core theoretical model on which TFP rests (borderline personality organisation), the specific technical move that distinguishes TFP from supportive therapy, and the empirical status of TFP relative to alternative evidence-based treatments for borderline personality (notably DBT and schema therapy).

Hint

Kernberg explains borderline personality in terms of "splitting" as the dominant defence, with consequent unintegrated self- and object-representations and identity diffusion. The technical move is interpretation in the transference, applied early and consistently. Comparative trials (Clarkin, Doering, Giesen-Bloo) suggest TFP is effective but not uniquely so.

Answer

Theoretical model. Kernberg's borderline personality organisation is characterised by three features: (i) diffuse identity (a fragmented, unstable sense of self); (ii) use of splitting — keeping contradictory self- and object-representations unintegrated, so that the same person is idealised in one moment and devalued in the next — as the dominant defence, with associated primitive defences of projective identification, omnipotent control, and denial; and (iii) reality testing that is preserved in the formal sense (no psychosis) but fluctuates under stress. Kernberg traces this to early developmental failure to integrate "all-good" and "all-bad" self/object representations into a single whole-object representation, owing to a combination of temperamental aggression and inadequate early containment.

Distinguishing technical move. TFP interprets the splitting in the transference — the therapist names, as it happens, the patient's rapid oscillation between idealising and devaluing the therapist, and the unintegrated self-object dyads being enacted. TFP holds strict frame (session length, fee, no extra-session contact) and treats the patient's reactions to the frame as primary material. The interpretation is early, consistent, and focused on the here-and-now of the therapeutic relationship rather than on historical reconstruction. This contrasts with supportive therapy, which avoids transference interpretation and focuses on symptom management and reality-adaptive functioning.

Empirical status. Randomised trials (Clarkin et al. $2007$ ; Doering et al. $2010$ ) show TFP produces significant improvements in borderline symptoms, suicidality, and impulsivity, with effects comparable to dialectical behaviour therapy (DBT, Linehan) and schema therapy. Head-to-head trials (Giesen-Bloo et al. $2006$ ) found no clear superiority of any single treatment across all outcomes; the choice among evidence-based treatments is increasingly guided by patient preference and clinician competence rather than by demonstrated differential efficacy.

Exercise 9 (hard, numeric).

A clinician trained in Davanloo's Intensive Short-Term Dynamic Psychotherapy (ISTDP) ^{[Davanloo1980]} treats a patient with treatment-resistant anxiety and character pathology. The ISTDP protocol specifies a range of $5$ to $40$ sessions delivered at one to two sessions per week. Compute (a) the total treatment duration in weeks at the modal $20$ -session dose delivered once weekly; (b) the total contact hours at $1.5$ -hour sessions, $20$ sessions; and (c) the ratio of modal ISTDP contact hours to a classical psychoanalysis of $4$ sessions per week for $4$ years at $50$ -minute sessions ( $192$ weeks of treatment, $768$ sessions).

Hint

Compute each part separately: weeks = sessions / sessions-per-week; contact hours = sessions × session-length; ratio = ISTDP-hours / analysis-hours.

Answer

(a) $20$ weeks. Twenty sessions delivered once weekly gives $20$ weeks of treatment — roughly five months. This is the modal ISTDP dose and is comparable to a standard course of CBT.

(b) $30$ contact hours. Twenty sessions at $1.5$ hours each gives $20 \times 1.5 = 30$ hours of contact. ISTDP sessions are longer than standard $50$ -minute psychotherapy sessions because the work is more intensive within each session.

(c) Approximately $0.078$ , or about $7.8$ percent. Classical analysis at $4$ sessions per week for $192$ weeks gives $768$ sessions. At $50$ minutes ( $0.833$ hours) per session, this is $768 \times 0.833 \approx 640$ contact hours. The ratio of ISTDP to analysis is $30/640 \approx 0.047$ , or about $4.7$ percent. (If the comparison is computed in sessions rather than hours — $20$ versus $768$ — the ratio is $0.026$ , about $2.6$ percent.) Either way, the modern brief dynamic format delivers treatment in a small fraction of the classical-analysis contact budget, which is the point of the brief-dynamic reformulation: to make the technique testable in randomised trials and economically accessible to non-wealthy patients.

Interpretive debates and developments Master

Result 1 (Breuer and Freud $1895$ : the cathartic method). Josef Breuer and Sigmund Freud's Studien über Hysterie ^{[BreuerFreud1895]} introduced the cathartic method — the recovery, under hypnosis and then under free association, of the affect-laden memory of the trauma's first occurrence, with the accompanying emotion, leading to symptom relief. The five case histories (Anna O., Emmy von N., Lucy R., Katharina, Elisabeth von R.) established the empirical baseline for all subsequent psychodynamic technique. Breuer's discomfort with the erotic transference of Anna O. led him to withdraw; Freud continued alone, dropping hypnosis in favour of the fundamental rule of free association by $1904$ .

Result 2 (Freud $1900$ : the dream as the royal road). Die Traumdeutung ^[Freud1900] introduced the topographic theory of mind (conscious/preconscious/unconscious) and the technique of dream interpretation as the "royal road to the unconscious." The book sold poorly for $15$ years and then became one of the canonical texts of $20$ -century intellectual life. The topographic model was superseded in $1923$ by the structural theory (id, ego, superego), but the fundamental claim — that dream content is the disguised fulfilment of an unconscious wish, distorted by censorship and secondary revision — remains the load-bearing proposition of classical dream interpretation.

Result 3 (Anna Freud $1936$ : the catalogue of defences). Anna Freud's Das Ich und die Abwehrmechanismen ^{[AnnaFreud1936]} systematised the defensive operations of the ego — repression, projection, reaction formation, sublimation, regression, intellectualisation, denial, undoing — and shifted the analytic focus from drive-content to the ego's management of conflict. This was a precondition for ego psychology and for the later integration of psychodynamic thinking with adaptive-functioning models.

Result 4 (Hartmann $1939$ : ego psychology and the conflict-free sphere). Heinz Hartmann's Ego Psychology and the Problem of Adaptation ^{[Hartmann1939]} argued that the ego has autonomous functions (perception, memory, motor development, thinking) that develop independently of drive conflict — the "conflict-free ego sphere." This moved psychoanalysis toward a general psychology of adaptation, opened the way for the empirical study of ego functioning (Rapaport, Holt), and prepared the ground for the integration of psychodynamic thinking with mid- $20$ -century cognitive psychology.

Result 5 (Klein $1932$ / $1957$ : the paranoid-schizoid and depressive positions). Melanie Klein's The Psycho-Analysis of Children ( $1932$ ) and Envy and Gratitude ( $1957$ ) ^[Klein1957] recast psychodynamic development around two positions: the paranoid-schizoid position (the first three to four months of life, dominated by splitting of the object into idealised and persecutory part-objects, and by the defences of projective identification, omnipotent control, and idealisation) and the depressive position (achieved in the second six months, in which the infant comes to recognise the mother as a whole object, with the concomitant capacities for guilt, concern, reparation, and ambivalence). Klein also developed play therapy as the standard child-analytic technique. Her disagreements with Anna Freud's Vienna school constituted the "Controversial Discussions" of $1941$ – $1945$ in the British Psychoanalytic Society.

Result 6 (Winnicott $1971$ : transitional objects and the good-enough mother). Donald Winnicott's Playing and Reality ^{[Winnicott1971]} introduced the transitional object and the transitional/potential space between inner and outer reality — the locus of play, art, religion, and creative living. Winnicott also formulated the good-enough mother: the caregiver who initially meets the infant's omnipotence near-completely, then gradually and tolerably disappoints it, allowing the infant to develop a sense of a real external world and a capacity to tolerate frustration. Winnicott's reframing shifted the analytic focus from interpretation of content to the creation of a relational environment in which the patient's own capacity to play and create can emerge.

Result 7 (Mahler, Pine, Bergman $1975$ : separation-individuation). Margaret Mahler's The Psychological Birth of the Human Infant ^[Mahler1975] mapped the separation-individuation process across subphases (differentiation, practising, rapprochement, consolidation) occurring roughly between $5$ and $36$ months. Mahler's empirical work — observational study of mother-infant dyads — integrated classical developmental psychoanalysis with attachment research, and remains a reference point for the developmental psychopathology of borderline and narcissistic conditions.

Result 8 (Fairbairn $1952$ : pure object-relations theory). W. R. D. Fairbairn's Psychoanalytic Studies of the Personality ^{[Fairbairn1952]} reformulated psychoanalysis on object-relations foundations: the basic motivational drive is not the discharge of libidinal tension but the seeking of relationship with a real other. The infant's structuralisation of the mind follows from internalisation of the actual caregiving relationship, including the splitting of bad object-experiences into rejecting and exciting internal objects. Fairbairn's framework is the purest object-relations alternative to the drive/structure model of classical Freudian theory.

Result 9 (Kohut $1971$ : self psychology and the treatment of narcissism). Heinz Kohut's The Analysis of the Self ^[Kohut1971] introduced self psychology, locating narcissistic pathology not as a fixation at an early psychosexual stage but as a deficit in the structure of the self, owing to the failure of caregivers to provide adequate mirroring (the responsive validation of the child's grandiosity) and idealising (the availability of an admired, calm, powerful other with whom the child can merge). Kohut reformulated the transference in narcissistic patients as the reactivation of these two self-object transferences, and the technical task as the analyst's tolerating and surviving them until the patient's self-structure consolidates. The Kohut-Kernberg debates of the $1970$ s remain the central polemic on the treatment of narcissistic personality disorder.

Result 10 (Kernberg $1975$ : TFP for borderline personality). Otto Kernberg's Borderline Conditions and Pathological Narcissism ^{[Kernberg1975]} formulated the borderline personality organisation as a stable structural diagnosis (identity diffusion, primitive defences centred on splitting, preserved-but-fluctuating reality testing) and developed transference-focused psychotherapy (TFP) as its specific treatment: the systematic interpretation of splitting as it is enacted in the transference, with a strict frame. TFP was the first manualised psychodynamic treatment for borderline personality and has been validated in randomised trials (Clarkin et al. $2007$ ; Doering et al. $2010$ ).

Result 11 (Davanloo $1970$ s– $80$ s: ISTDP). Habib Davanloo's Intensive Short-Term Dynamic Psychotherapy ^{[Davanloo1980]} developed a manualised, time-limited ( $5$ – $40$ sessions) psychodynamic protocol built on the "central dynamic sequence": systematic pressure toward the patient's avoided core affect, the identification and clarification of the defence that blocks the affect, the challenge to the defence, the rise of the transference as the patient resists, and the interpretation of the transference in the moment of breakthrough. ISTDP was the first psychodynamic protocol designed to be testable in randomised trials of comparable length to CBT trials, and has accumulated an evidence base for treatment-resistant depression, anxiety, somatisation, and personality disorder (Abbass et al. $2006$ , $2014$ meta-analyses).

Result 12 (Shedler $2010$ : the modern efficacy defence). Jonathan Shedler's American Psychologist paper "The Efficacy of Psychodynamic Psychotherapy" ^{[Shedler2010]} re-analysed the psychodynamic outcome literature and reported effect sizes of $d = 0.7$ to $1.0$ at post-treatment, with growing effect sizes ( $d \approx 1.0$ to $1.3$ ) at follow-up, in head-to-head equivalence with CBT. The paper is the most-cited single defence of psychodynamic therapy in the contemporary literature and reframed the field's empirical claim: not "psychoanalysis cures all" but "modern psychodynamic therapy is empirically supported, durable, and equal to CBT on most common mental disorders."

Result 13 (Leichsenring and Rabung $2008$ : long-term efficacy for complex disorders). Leichsenring and Rabung's American Journal of Psychiatry meta-analysis ^{[LeichsenringRabung2008]} showed that long-term psychodynamic psychotherapy (defined as $50$ sessions or more) is effective for complex mental disorders (personality disorders, complex depression, chronic anxiety) that have failed shorter treatments, with effect sizes of $d = 0.7$ to $0.9$ and sustained follow-up benefit. The study was significant because the affected patient group is precisely the one for which short-term CBT trials show least benefit, identifying the psychodynamic niche in the contemporary evidence-based ecosystem.

Synthesis. The foundational reason the psychodynamic tradition has fragmented into five major schools (classical, ego psychology, object relations, self psychology, the brief dynamic therapies) without dissolving is that the central insight — that unconscious procedural relational schemata, laid down in early development and modified through the therapeutic relationship, drive much of adult psychopathology — has survived the abandonment of nearly every specific theoretical claim that originally housed it. The central insight is exactly what binds Breuer and Freud $1895$ to Shedler $2010$ : the same clinical observation that symptoms carry relational meaning and respond to its therapeutic articulation appears again in Schore's right-brain affective-neuroscience framework and in the memory-reconsolidation paradigm of Nader and LeDoux, and putting these together identifies the operative substrate with implicit-procedural memory in right-hemisphere corticolimbic circuits. The bridge is from a $21$ -year-old Viennese woman's "talking cure" in $1881$ to a modern brief psychodynamic protocol whose efficacy is confirmed by meta-analysis: the pattern generalises from the treatment of conversion disorder to the treatment of personality disorder, depression, anxiety, and complex trauma, and the bridge appears again in 29.10.01 as the principle that the therapeutic alliance — common to all modalities — is the operative vehicle of change, with the specific technique modulating the form but not the underlying mechanism.

Full argument set Master

Proposition (Transference-based change satisfies the reconsolidation paradigm). Let ${S_{1}, \dots, S_{n}}$ be the patient's procedural relational schemata, each schema $S_{i}$ consisting of a self-representation, an object-representation, an affect, and a behavioural expectation ("if I do $X_{i}$ , the other will do $Y_{i}$ "). Let $T$ denote the therapeutic relationship and $τ$ the reconsolidation window (the empirically established period, roughly $2$ – $6$ hours after reactivation, during which a reactivated memory can be permanently modified). A transference-based therapeutic intervention consists of (a) the reactivation of $S_{i}$ in $T$ (the patient enacts $X_{i}$ toward the therapist, expecting $Y_{i}$ ), (b) the therapist's non-complementary response (the therapist responds with $Z \neq = Y_{i}$ , while remaining relationally present), and (c) the therapist's interpretation naming $S_{i}$ as the pattern. Under these conditions, $S_{i}$ is updated during $τ$ to a schema $S_{i}^{'}$ whose expectation is no longer strictly $Y_{i}$ . After repeated cycles, the updated schemata govern the patient's outside-therapy relationships.

Proof. The proof proceeds in three stages corresponding to the three conditions. (a) Reactivation. Procedural memory is activated by contexts that resemble the original encoding context. The therapeutic dyad is structurally similar to the early caregiving dyad (a powerful, attentive other on whom the patient depends for relief), so the schemata $S_{i}$ encoded in those early dyads are activated in therapy. This is the empirical basis of transference and is supported by the contemporary procedural-memory literature (Clyman $1991$ ; Bornstein $1999$ ). (b) Mismatch within $τ$ . The reconsolidation literature (Nader, Schafe, LeDoux $2000$ on fear memory in rats; Walker, Brakefield, Hobson, Stickgold $2003$ on humans; Ecker, Ticic, Hulley $2012$ on therapeutic translation) establishes that a reactivated long-term memory can be permanently modified if and only if a "mismatch" — a prediction error between the expected outcome $Y_{i}$ and the actual outcome — occurs during the reconsolidation window $τ$ . The therapist's non-complementary response $Z \neq = Y_{i}$ , delivered within $τ$ of the schema's activation, supplies this mismatch in a sustained affective relationship.

(c) Re-encoding. The interpretation names the schema, allowing the patient to integrate the new relational experience into a revised self-object representation. After repeated cycles (the "working-through" process), the schema $S_{i}$ is replaced by a differentiated schema $S_{i}^{'}$ with a more flexible, less rigidly negative expectation. The revised schema governs the patient's behaviour outside therapy because procedural memory governs behaviour by definition. The mechanism therefore satisfies the reconsolidation paradigm and predicts that durable therapeutic change requires the schema to be reactivated in the relationship with the therapist and mismatched there. $□$

Corollary (Why cognitive restructuring alone is insufficient for procedural-level pathology). Under the assumptions of the Proposition, interventions that operate on declarative-propositional content without reactivating and mismatching the procedural schema (for example, purely didactic cognitive restructuring of the patient's beliefs about relationships) cannot directly modify the schema $S_{i}$ . They can modify the patient's conscious narrative about their relationships but cannot reach the procedural level at which the schema operates. Modifications of $S_{i}$ require the schema to be activated and mismatched in vivo — that is, in the therapeutic relationship itself.

This formalises the long-standing psychodynamic argument that conscious insight is necessary but insufficient, and that the working-through of transference is the route by which procedural-level change becomes possible. The corollary is consistent with the comparative outcome literature showing that pure cognitive interventions are most effective for disorders (specific phobia, panic, obsessive-compulsive disorder) whose content is largely declarative, and that disorders with deep procedural components (borderline personality disorder, complex trauma, narcissistic personality disorder) require sustained relational treatment — whether psychodynamic or another modality that engages the therapeutic relationship as the vehicle of change.

Connections Master

Therapy and treatment approaches 29.10.01. This unit deepens the brief survey of psychodynamic therapy sketched in the chapter anchor from one section of a multi-modality overview to a full-tiered account grounded in the primary sources. The general framework of 29.10.01 — common factors, the empirical status of the major modalities, the cultural and ethical contexts of treatment — is exactly the framework within which the present unit's specific defence of psychodynamic therapy should be read; the efficacy meta-analyses cited here (Shedler $2010$ , Leichsenring and Rabung $2008$ ) are the same evidence base invoked in the survey, and the distinction between the theory and the technique of psychodynamic therapy is the load-bearing distinction for the survey's balanced framing.
Eating disorders: anorexia, bulimia, binge-eating, and the biology of starvation 29.09.05. Psychodynamic treatment — particularly object-relations-informed therapy — is one of the evidence-based modalities for severe anorexia nervosa, especially in adult presentations where family-based treatment is not the first-line intervention. Hilde Bruch's reframing of anorexia as a disorder of self and interoception (Bruch $1973$ , cited in 29.09.05) is continuous with Winnicott's and Kohut's accounts of self-structure deficit, and modern psychodynamic treatment of anorexia draws on the same mechanism — the patient's internalised relation to a punitive or absent caregiver is re-enacted with the therapist and modified there — defended in the Key model section above. The bridge is that the same object-relations concepts that explain how early caregiving shapes the self also explain how the therapeutic relationship can modify that structure.
Interpersonal attraction and close relationships: adult attachment 29.07.05. Bowlby's attachment theory — the empirical and theoretical foundation of 29.07.05's account of close relationships — was developed in the same milieu as the object-relations tradition and was from the start intended as a corrective to the classical drive model. The therapeutic mechanism defended here (the procedural relational schema reactivated and modified in the transference) is the clinical extension of the same attachment dynamic that 29.07.05 traces in adult close relationships; secure-base, anxious-ambivalent, and avoidant attachment patterns in adults are the outside-therapy expressions of the schemata that psychodynamic therapy works to modify. The bridge is between the developmental and clinical wings of the same research programme.
Cognitive revolution and the computational mind 29.14.02. The cognitive revolution of the $1950$ s — surveyed in 29.14.02 — was constituted in part as a polemical rejection of behaviourism and of psychoanalysis, both of which were judged to be insufficiently computational and insufficiently testable. The cognitive-behavioural critique of psychodynamic therapy (Popper, Eysenck, Beck) is the philosophical wing of the same historical movement, and the contemporary defence (Shedler, Leichsenring) is in part an answer to the cognitive-revolution critique. Reading 29.14.02 alongside this unit makes visible what the psychodynamic and cognitive traditions share — the hypothesis that mental process has a substantial internal structure — and what they continue to contest: whether the structure is best articulated in the language of unconscious relational schemata (psychodynamic) or in the language of explicit propositional content (cognitive).

Historical & philosophical context Master

Sigmund Freud and Josef Breuer's Studien über Hysterie ( $1895$ ) ^{[BreuerFreud1895]} established the cathartic method and the case-history genre that would define the discipline; Freud's Die Traumdeutung ( $1900$ ) ^[Freud1900] added the topographic theory and the interpretation of dreams. The structural theory (id, ego, superego) was introduced in Das Ich und das Es ( $1923$ ) ^[Freud1923], replacing the topographic model. Anna Freud's Das Ich und die Abwehrmechanismen ( $1936$ ) ^{[AnnaFreud1936]} systematised the defences and opened the way for Heinz Hartmann's ego psychology (Ego Psychology and the Problem of Adaptation, $1939$ ^{[Hartmann1939]}).

Melanie Klein's work on the paranoid-schizoid and depressive positions ( $1932$ , $1957$ ^[Klein1957]) and her development of play therapy with children constituted, together with the wartime "Controversial Discussions" in the British Psychoanalytic Society ( $1941$ – $1945$ ), the founding of object-relations theory in Britain. W. R. D. Fairbairn's Psychoanalytic Studies of the Personality ( $1952$ ^{[Fairbairn1952]}) gave the purest object-relations reformulation, and Donald Winnicott's Playing and Reality ( $1971$ ^{[Winnicott1971]}) added the transitional object and the good-enough mother. Margaret Mahler's The Psychological Birth of the Human Infant ( $1975$ , with Pine and Bergman ^[Mahler1975]) supplied the developmental observation.

Heinz Kohut's The Analysis of the Self ( $1971$ ^[Kohut1971]) founded self psychology and reframed the treatment of narcissistic pathology; Otto Kernberg's Borderline Conditions and Pathological Narcissism ( $1975$ ^{[Kernberg1975]}) supplied the structural model of borderline personality organisation and the manualised transference-focused psychotherapy. Habib Davanloo developed Intensive Short-Term Dynamic Psychotherapy from the late $1960$ s ^{[Davanloo1980]}, and the modern efficacy defence was articulated by Jonathan Shedler (American Psychologist $65$ , $2010$ ^{[Shedler2010]}) and by Falk Leichsenring and Sven Rabung (American Journal of Psychiatry $165$ , $2008$ ^{[LeichsenringRabung2008]}). Allan Schore's The Science of the Art of Psychotherapy ( $2012$ ^[Schore2012]) integrated the tradition with contemporary affective neuroscience.

Bibliography Master

@book{BreuerFreud1895,
  author = {Breuer, Josef and Freud, Sigmund},
  title = {Studien über Hysterie},
  publisher = {Franz Deuticke},
  address = {Leipzig and Vienna},
  year = {1895},
}

@book{Freud1900,
  author = {Freud, Sigmund},
  title = {Die Traumdeutung},
  publisher = {Franz Deuticke},
  address = {Leipzig and Vienna},
  year = {1900},
}

@book{Freud1905,
  author = {Freud, Sigmund},
  title = {Drei Abhandlungen zur Sexualtheorie},
  publisher = {Franz Deuticke},
  address = {Leipzig and Vienna},
  year = {1905},
}

@article{Freud1914Transference,
  author = {Freud, Sigmund},
  title = {Bemerkungen über die Übertragungsliebe},
  journal = {Internationale Zeitschrift für ärztliche Psychoanalyse},
  year = {1915},
  note = {Written 1914; Standard Edition vol. 12, pp. 159--171},
}

@book{Freud1923,
  author = {Freud, Sigmund},
  title = {Das Ich und das Es},
  publisher = {Internationaler Psychoanalytischer Verlag},
  address = {Leipzig and Vienna},
  year = {1923},
}

@book{AnnaFreud1936,
  author = {Freud, Anna},
  title = {Das Ich und die Abwehrmechanismen},
  publisher = {Internationaler Psychoanalytischer Verlag},
  address = {Vienna},
  year = {1936},
  note = {English: The Ego and the Mechanisms of Defence, Hogarth Press, 1937},
}

@book{Hartmann1939,
  author = {Hartmann, Heinz},
  title = {Ich-Psychologie und Anpassungsproblem},
  publisher = {International Universities Press},
  address = {New York},
  year = {1958},
  note = {German original 1939},
}

@book{Klein1932,
  author = {Klein, Melanie},
  title = {The Psycho-Analysis of Children},
  publisher = {Hogarth Press},
  address = {London},
  year = {1932},
}

@book{Klein1957,
  author = {Klein, Melanie},
  title = {Envy and Gratitude: A Study of Unconscious Sources},
  publisher = {Tavistock},
  address = {London},
  year = {1957},
}

@book{Fairbairn1952,
  author = {Fairbairn, W. R. D.},
  title = {Psychoanalytic Studies of the Personality},
  publisher = {Tavistock},
  address = {London},
  year = {1952},
}

@book{Winnicott1971,
  author = {Winnicott, Donald W.},
  title = {Playing and Reality},
  publisher = {Tavistock},
  address = {London},
  year = {1971},
}

@book{Mahler1975,
  author = {Mahler, Margaret S. and Pine, Fred and Bergman, Anni},
  title = {The Psychological Birth of the Human Infant: Symbiosis and Individuation},
  publisher = {Basic Books},
  address = {New York},
  year = {1975},
}

@book{Kohut1971,
  author = {Kohut, Heinz},
  title = {The Analysis of the Self: A Systematic Approach to the Psychoanalytic Treatment of Narcissistic Personality Disorders},
  publisher = {International Universities Press},
  address = {New York},
  year = {1971},
}

@book{Kernberg1975,
  author = {Kernberg, Otto F.},
  title = {Borderline Conditions and Pathological Narcissism},
  publisher = {Jason Aronson},
  address = {New York},
  year = {1975},
}

@book{Davanloo1980,
  author = {Davanloo, Habib},
  title = {Short-Term Dynamic Psychotherapy},
  publisher = {Jason Aronson},
  address = {New York},
  year = {1980},
}

@article{Shedler2010,
  author = {Shedler, Jonathan},
  title = {The Efficacy of Psychodynamic Psychotherapy},
  journal = {American Psychologist},
  volume = {65},
  number = {2},
  year = {2010},
  pages = {98--109},
}

@article{LeichsenringRabung2008,
  author = {Leichsenring, Falk and Rabung, Sven},
  title = {Effectiveness of Long-term Psychodynamic Psychotherapy: A Meta-Analysis},
  journal = {Journal of the American Medical Association},
  volume = {300},
  number = {13},
  year = {2008},
  pages = {1551--1565},
}

@article{LeichsenringLengerking2009,
  author = {Leichsenring, Falk and Rabung, Sven and Leibing, Eric},
  title = {The Efficacy of Short-term Psychodynamic Psychotherapy in Specific Mental Disorders: A Meta-Analysis},
  journal = {Archives of General Psychiatry},
  volume = {61},
  number = {12},
  year = {2004},
  pages = {1208--1216},
}

@book{Schore2012,
  author = {Schore, Allan N.},
  title = {The Science of the Art of Psychotherapy},
  publisher = {W. W. Norton},
  address = {New York},
  year = {2012},
}

@article{NaderSchafeLeDoux2000,
  author = {Nader, Karim and Schafe, Glenn E. and LeDoux, Joseph E.},
  title = {Fear Memories Require Protein Synthesis in the Amygdala for Reconsolidation after Retrieval},
  journal = {Nature},
  volume = {406},
  year = {2000},
  pages = {722--726},
}

@article{EckerTicicHulley2012,
  author = {Ecker, Bruce and Ticic, Robin and Hulley, Laurel},
  title = {Unlocking the Emotional Brain: Memory Reconsolidation and the Clinical Sciences},
  journal = {Current Directions in Psychological Science},
  volume = {21},
  year = {2012},
  pages = {128--132},
}

@article{Clarkin2007,
  author = {Clarkin, John F. and Levy, Kenneth N. and Lenzenweger, Mark F. and Kernberg, Otto F.},
  title = {Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study},
  journal = {American Journal of Psychiatry},
  volume = {164},
  number = {6},
  year = {2007},
  pages = {922--928},
}

@book{Gabbard2014,
  author = {Gabbard, Glen O.},
  title = {Psychodynamic Psychiatry in Clinical Practice},
  edition = {5th},
  publisher = {American Psychiatric Publishing},
  address = {Washington, DC},
  year = {2014},
}

@book{McWilliams1999,
  author = {McWilliams, Nancy},
  title = {Psychoanalytic Case Formulation},
  publisher = {Guilford Press},
  address = {New York},
  year = {1999},
}

@book{Lear2015,
  author = {Lear, Jonathan},
  title = {Freud},
  edition = {2nd},
  publisher = {Routledge},
  address = {London},
  year = {2015},
}

Prerequisites

29.10.01

Tier anchors

beginner: Jonathan Lear, Freud (2nd ed., Routledge, 2015), accessible chapters; Nancy McWilliams, Psychoanalytic Case Formulation (Guilford, 1999); Mikkel Borch-Jacobsen, The Freud Files (Cambridge, 2006) for the Anna O. case
intermediate: Gabbard, G. O. — Psychodynamic Psychiatry in Clinical Practice (5th ed., American Psychiatric Publishing, 2014); Cabaniss, R. D. — Psychodynamic Psychotherapy: A Clinical Manual (2nd ed., Wiley-Blackwell, 2016); McWilliams, N. — Psychoanalytic Psychotherapy (Guilford, 2004)
master: Breuer and Freud 1895 Studien über Hysterie; Freud 1900 Die Traumdeutung; Freud 1905 Three Essays; Freud 1914 Zur Einleitung der Behandlung / Observations on Transference-Love; A. Freud 1936 Das Ich und die Abwehrmechanismen; Hartmann 1939 Ego Psychology and the Problem of Adaptation; Klein 1932 The Psycho-Analysis of Children and 1957 Envy and Gratitude; Winnicott 1971 Playing and Reality; Mahler, Pine, and Bergman 1975 The Psychological Birth of the Human Infant; Fairbairn 1952 Psychoanalytic Studies of the Personality; Kohut 1971 The Analysis of the Self; Kernberg 1975 Borderline Conditions and Pathological Narcissism; Davanloo 1980 Short-Term Dynamic Psychotherapy; Shedler 2010 Am. Psychol. 65(2):98; Leichsenring and Rabung 2008 Am. J. Psychiatry 165; Schore 2012 The Science of the Art of Psychotherapy

References

Breuer, J. and Freud, S. — Studien über Hysterie (Franz Deuticke, Leipzig/Vienna, 1895) · Case histories (Anna O., Emmy von N., Katharina); the cathartic method
Freud, S. — Die Traumdeutung (Franz Deuticke, Leipzig/Vienna, 1900) · Chapter VII: the psychology of the dream-process; the royal road to the unconscious
Freud, S. — Three Essays on the Theory of Sexuality (1905) · Psychosexual development; the foundational Freudian account
Freud, S. — Observations on Transference-Love (Int. Z. ärztl. Psychoanal., 1915 [written 1914]) · Standard Edition vol. 12, pp. 159-171
Freud, S. — The Ego and the Id (International Psychoanalytic Library, 1923) · The structural model: id, ego, superego
Freud, A. — The Ego and the Mechanisms of Defence (Hogarth Press, London, 1937 [written 1936]) · The catalogue of defences; repression, projection, sublimation, reaction formation
Hartmann, H. — Ego Psychology and the Problem of Adaptation (International Universities Press, New York, 1958 [German orig. 1939]) · Conflict-free ego sphere
Klein, M. — Envy and Gratitude (Tavistock, London, 1957) · The paranoid-schizoid and depressive positions
Winnicott, D. W. — Playing and Reality (Tavistock, London, 1971) · Transitional objects and transitional phenomena; the good-enough mother
Mahler, M. S., Pine, F., and Bergman, A. — The Psychological Birth of the Human Infant (Basic Books, New York, 1975) · Separation-individuation theory
Fairbairn, W. R. D. — Psychoanalytic Studies of the Personality (Tavistock, London, 1952) · Pure object-relations theory
Kohut, H. — The Analysis of the Self (International Universities Press, New York, 1971) · Self psychology; mirroring and idealising transferences
Kernberg, O. F. — Borderline Conditions and Pathological Narcissism (Jason Aronson, New York, 1975) · Borderline personality organisation; transference-focused psychotherapy
Davanloo, H. — Short-Term Dynamic Psychotherapy (Jason Aronson, New York, 1980) · ISTDP technique and the central dynamic sequence
Shedler, J. — The Efficacy of Psychodynamic Psychotherapy, American Psychologist 65(2), 98-109 (2010) · Effect-size meta-analysis; the modern defence
Leichsenring, F. and Rabung, S. — Effectiveness of Long-term Psychodynamic Psychotherapy: A Meta-Analysis, American Journal of Psychiatry 165(11), 1443-1451 (2008) · The long-term efficacy meta-analysis
Schore, A. N. — The Science of the Art of Psychotherapy (W. W. Norton, New York, 2012) · Right-brain affect regulation; the neurobiology of the therapeutic alliance
McWilliams, N. — Psychoanalytic Case Formulation (Guilford Press, New York, 1999) · The modern integrative formulation framework
Lear, J. — Freud (2nd ed., Routledge, London, 2015) · Accessible philosophical reconstruction of the Freudian programme

Estimated time

beginner: 25m
intermediate: 50m
master: 85m