Pain Management and Nursing

Introduction
Few 20th century thinkers were as controversial, or as influential, as Sigmund Freud. Freud’s writings, his contributions to the field of psychology, and his therapeutic techniques have been influential not just in psychology, but in all the social sciences. At the same time, many of Freud’s theories and practices proved problematic or in need of revision. Thus, a cadre of important social science researchers the likes of Adler, Fromm, Jung, and even Skinner borrowed the best of Freud’s theories while advancing the field and study of psychology. Known as the neo-Freudians because of their revisionist approach to updating Freud’s substantive contributions, this informal group of theorists helped to refine Freudian psychoanalytic theory and methods. Some of the main themes in Neo-Freudian discourse include self-awareness, the drivers of behavior, and the application of therapeutic techniques. Self-awareness had been one of the goals of Freudian psychoanalysis. The Neo-Freudians helped show why self-awareness was important from a therapeutic standpoint. The Neo-Freudians also illuminated the drivers of human behavior in less deterministic ways than Freud. Finally, Neo-Freudian therapeutic techniques tended to be more optimistic than Freud’s methods. This paper will synthesize scholarly literature on three Neo-Freudian themes: self-awareness, the drivers of behavior, and therapeutic techniques. The Neo-Freudians capitalized on Freud’s astute analysis of unconscious motivations and personality development, while offering a more solution-focused orientation to helping clients in the process of psychotherapy.
Self-Awareness
The first theme that emerges in literature on Neo-Freudian theories is related to self-awareness. In “Executive Development and Psychoanalytic Therapy,” Axelrod (2012) focuses on self-awareness from a psychoanalytic point of view. Axelrod (2012) first describes how Freud conceptualized self-awareness. Freud differentiated between self-reflection and self-observation, showing that self-observation is defined by the relaxation of the superego. Self-reflection does not suspend the self-monitoring or judgmental processes of the superego. Moreover, Axelrod (2012) introduces important material by a contemporary of Freud, Sterba, who also demonstrated the process of self-confrontation. Self-confrontation is superego driven. Together, self-confrontation and self-observation are critical components of the psychoanalytic therapeutic process. Through psychoanalysis, the client uses techniques like free association, a type of self-observation. With the therapist’s assistance, the client uses free association to gain insight into his or her own psyche, thereby initiating a self-driven change that has the potential to transform lives. As Axelrod (2012) shows the Neo-Freudians also introduced related concepts include self-monitoring, which can be used outside of the therapeutic relationship, as well as in therapy. The Neo-Freudians helped lay the foundation for further research into how therapists can use self-awareness in career coaching and leadership development. Furthermore, Axelrod (2012) focuses on emotional awareness, which can be connected to emotional intelligence. Finally, the author suggests ways therapists can incorporate self-awareness methods and techniques.
The Drivers of Human Behavior
Hall & Lindzey (1957) show how the concept of self-realization was only implicit in Freud’s work, which was more focused on the processes and structures of the subconscious mind. Neo-Freudians, like Alfred Adler, Eric Fromm, Karen Horney, and Harry Stack Sullivan became interested in humanistic issues like self-realization. Through an assessment of these four Neo-Freudian theorists, Hall & Lindzey (1957) reveal a second theme that emerges in the literature on Neo-Freudian theory: the drivers of human behavior. Freud believed that almost all human behavior is driven by the psychosexual developmental process. In “Social Psychological Theories: Adler, Fromm, Horney, and Sullivan,” Hall & Lindzey (1957) show how the Neo-Freudians presented the drivers of human behavior quite differently, not in terms of sexuality but more in terms of other factors like relationships and culture. Hall & Lindzey (1957) discuss Neo-Freudians like Adler, Fromm, Horney, and Sullivan and their contributions to understanding the drivers of human behavior. Building on Freud’s theories, Adler, Fromm, Horney, and Sullivan all drew from Freud’s research on the subconscious and unconscious, as well as human development. Yet instead of focusing on psychosexual stages or sexual hang-ups as driving human behavior, these four Neo-Freudian theorists stressed other psychological issues and environmental stimuli including interpersonal relationships, attachment styles, and coping mechanisms. Furthermore, Hall & Lindzey (1957) show how another major Neo-Freudian, Carl Jung, added to the discussion a deeper investigation of dreams. Jung focused on the concept of the collective consciousness, expanding on Freud’s theory of the unconscious mind. To Jung, human behavior is driven not just by childhood memories but also of the collective memories of one’s culture and social milieu. Hall & Lindzey (1957) also stress Jung’s contributions to personality theory.
Although not typically considered a Neo-Freudian, B.F. Skinner nevertheless built on Freud’s theory of the unconscious mind when considering the more mechanistic drivers of behavior. In “Looking for Skinner and Finding Freud,” Overskeid (2007) shows how Skinner’s theory of behaviorism is related to Freudian psychoanalysis. Although historians of psychology claim that Skinner is “one of the least psychoanalytic thinkers in twentieth-century psychology,” Overskeid (2007) proves that in fact, Skinner deeply admired Freud. Both Freud and Skinner believed in determinism: that human behavior was in some ways pre-determined by unconscious processes and tendencies. Both Freud and Skinner were interested in human behavior and what motivates people to act they way they do. Also, Overskeid (2007) claims that Freud and Skinner believed that human behavior could be studied empirically. Both Skinner and Freud also believed that human behavior can be changed by making the unconscious conscious. In other words, the theme of self-awareness in Neo-Freudianism is directly connected with the second theme of the drivers of human behavior. When the client in psychotherapy becomes aware of what motivates them, or what causes their habitual responses to external stimuli, then it is possible to create new habits. Psychoanalysis is the process of making the unconscious conscious. Although Skinner did not himself use the tools of psychoanalysis with clients as Freud did, Skinner did help lay the foundation for what would become cognitive-behavioral therapy.
Therapeutic Techniques
As much as Freud focused on theories of the unconscious mind, dreams, and other abstract concepts, ultimately he was interested in how to help clients through the process of psychotherapy. Neo-Freudians also advanced the concept of psychotherapy, by moving away from Freud’s fixation on psychosocial development and introducing a more optimistic and solution-driven approach. In the article, “Clinical Dilemmas in Psychotherapy: A Transtheoretical Approach to Psychotherapy Integration,” Scaturo (2005) focuses on elements of the therapeutic relationship and the therapeutic process including transference; counter-transference, and resistance. These elements of the therapeutic relationship were especially important to Freud. The Neo-Freudians understood that transference, counter-transference, and resistance to change were important to the therapeutic process and collectively referred to these interpersonal dynamics as the “Unconscious Determinants of Dilemmas.” Just as unconscious processes are the drivers of human behavior, unconscious processes can also drive human communication with a direct impact on relationships. The therapeutic process can be improved and become more successful by making these relationship dynamics more apparent. In other words, self-awareness in the therapeutic process is critical for the success of psychotherapy.
In the article on clinical dilemmas, Scaturo (2005) addresses unique elements of Neo-Freudian theory, specifically as it relates to therapy and clinical decisions. Scaturo’s (2005) emphasis on clinical dilemmas allows for a richer understanding of how therapists engage in clinical reasoning. The Neo-Freudians believed that the individual client is not just a passive entity, but an active participant in the therapeutic process. Whereas Freud might have presented the client as being somewhat passive, the Neo-Freudians aimed for a more empowering view of therapy that encourages individuals to take responsibility for actively changing their behaviors. The processes of transference and counter transference arise as both the client and therapist engage one another to achieve the therapeutic goals. Scaturo (2005) discusses the tendency of clients to struggle between the two tendencies of approach, on the one hand, and avoidance, on the other. Approach refers to the active seeking of change, and avoidance to the unconscious resistance to change. When transference and counter transference issues arise, many therapists will extricate themselves from the relationship rather than working through the deeper issues. Thus, Scaturo (2005) shows how therapists also need to take responsibility for their own unconscious motives and drivers of behavior during psychoanalysis.
Some Neo-Freudians show how the therapeutic process can be applied to resolve specific crises or conflicts. Freud was concerned with a more generalized approach to self-awareness and making the unconscious conscious. The Neo-Freudians wanted to apply the therapeutic process to more specific issues like mid-life crises. In “Mid-life - A Time of Crisis or New Possibilities?” Weaver (2009) applies a Neo-Freudian approach to the specific issues and conflicts related to mid-life crises. Mid-life crises are defined by periods of intense self-doubt, according to Weaver (2009). Moreover, the mid-life crisis is culturally constrained, and related to the unconscious processing of external stimuli. The mid-life crisis has a potent emotional component that can impact a person’s self-concept and their overall level of satisfaction with life. For example, central to the mid-life crisis is the realization that life is “half over,” (Weaver, 2009, p. 69). Freud focused on the death wish; the Neo-Freudians wanted to show how the individual becomes able to better understand the unconscious urges like the death wish. The individual may struggle with fear of mortality or feelings of inadequacy during the mid-life crisis. Stress is a common experience during mid-life, due to the dichotomy between one’s self-concept or ideals, and the reality of the life one created. In psychotherapy, the client can reflect on life’s achievements or reflect on why some goals were not being met. According to Weaver (2009), the mid-life crisis can occur any time between the ages of 35 and 50 and can last any amount of time but usually between three and ten years. Focusing on the mid-life crisis helps the client to develop self-awareness and understand their drivers of behavior.
With the Neo-Freudians, the therapeutic process became broader in scope, according to Eagle (2007). In “Psychoanalysis and Its Critics,” Eagle (2007) shows how the Neo-Freudians expanded Freud’s psychoanalysis by making therapy more multi-disciplinary in its approach. Eagle (2007) advocates for an “integrated theory of mental functioning,” which does not discount Freud, but which also moves beyond self-awareness as a goal (p. 18). Self-awareness is important, but behavioral change is the primary goal of psychotherapy from a Neo-Freudian perspective. Neo-Freudianism is about understanding the determinants of behavior in a more cross-disciplinary manner. Finally, Eagle (2007) shows how abstract theories like those of Freud and Jung can be combined with empirical research along the lines of Skinner and other behaviorists. To be of any lasting value, therapeutic processes do need to yield measurable results. The Neo-Freudians showed that therapeutic processes need to be solution-focused.
Conclusion
Three of the most important themes in Neo-Freudian theory include self-awareness, the drivers of human behavior, and the therapeutic process. Self-awareness is more than just self-monitoring. Whereas Freud remained content with self-awareness as a goal of therapy, the Neo-Freudians helped to show how individuals can use self-awareness to understand the drivers of human behavior through a more rigorous and solution-focused therapeutic process. The drivers of human behavior are not just repressed sexual urges but also habituated thoughts and patterns. Freud was instrumental in showing how unconscious processes impact personality, self-concept, and even behavior. The Neo-Freudians showed how it was not just sexuality and repressed urges that determined human behavior or personality but other issues like environmental factors, culture, and communication.
Synthesizing research on Neo-Freudianism helps psychologists better understand how to help clients in a clinical setting. Similarly, researchers in psychology can use Neo-Freudian theory to guide future investigations into everything from mental illness to organizational behavior and leadership. The field of psychology has limitless potential, as it is at its foundation the study of human behavior. Freud was the father of psychoanalysis; the Neo-Freudians were the progenitors of a multidisciplinary social science.







References

Axelrod, S. D. (2012). "Self-awareness: At the interface of executive development and psychoanalytic therapy. Psychoanalytic Inquiry, 32(4), 340–357.
Eagle, M. N. (2007). Psychoanalysis and its critics. Psychoanalytic Psychology, 24(1), 10–24.
Hall, C. S., & Lindzey, G. (1957). Social psychological theories: Adler, Fromm, Horney, and Sullivan. In Theories of personality (pp. 114-156). Hoboken, NJ: John Wiley & Sons Inc. doi:10.1037/10910-004
Overskeid, G. (2007). Looking for Skinner and finding Freud. American Psychologist, 62(6), 590–595.
Scaturo, D. J. (2005). Clinical dilemmas in psychotherapy: A transtheoretical approach to psychotherapy integration. Washington, DC: American Psychological Association.
Weaver, Y. (2009). Mid-life - A time of crisis or new possibilities? Existential Analysis, 20(1), 69–78.