Because, by the beginning of the twenty-first century, no laws were yet in place in the United States to define who could practice psychoanalysis, it remained difficult for the public to tell who was qualified. In the late 1990's, several national organizations of the core mental health disciplines came together in a coalition called the Consortium for Psychoanalysis. By the turn of the century, they had agreed upon baseline standards that would be used to develop a national organization to accredit psychoanalytic institutes. These organizations were the American Psychoanalytic Association, the divi sion of psychoanalysis of the American Psychological Association, the National Membership Committee on Psychoanalysis in Clinical Social Work, and the American Academy of Psychoanalysis.
Trained psychoanalysts in the twenty-first century who meet these standards already have a mental health degree, except in unusual cases, before becoming psychoanalysts. Once accepted for training at a psychoanalytic institute, these mental health professionals study many more years to become qualified psychoanalysts. They take courses and treat patients while supervised by experienced psychoanalysts. In addition, they are required to undergo psychoanalysis themselves in order to gain enough self-knowledge to keep their own problems from interfering with the treatment of patients.
All psychoanalytic theories are based on the idea that people are motivated by thoughts and feelings outside their awareness, that the past influences the present, and that each individual is unique. Because so much change and growth has occurred since Freud's era, psychoanalysis is no longer a single theory but encompasses many different theories. All psychoanalytic theories are theories of motivation (what makes people do what they do), theories of development (how people get to be the way they are), and theories of change (how psychoanalytic treatment works). Psychoanalytic theories are usually also theories of personality development (who people are) and personality disturbance.
Most theories emphasize the complexity of each person's symptoms and behavior and take into account many different influences. For example, the psychoanalytic theory called ego psychology describes development as a complex interaction of biology (inborn factors) and experience over time. Early childhood experiences are especially important because they influence the way a person's ability to cope with the world (ego functioning) develops. Each person adapts to the environment in a unique way that gradually becomes more consistent by the time the person grows to adulthood.
Psychoanalytic theories are comprehensive theories of mental functioning and disorder. For this reason, they originally formed the basis for the diagnosis and classification of mental disorders in the United States. The American Psychiatric Association published its Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952 and the second edition (DSM-II) in 1968. Many changes and developments took place in psychoanalytic theory during the second half of the twentieth century. The greatest changes took place in theories about psychotic illness, female psychology, homosexuality, and the nature of the patient/analyst relationship. By the turn of the twenty-first century, it was unusual to find, in real life, the silent analysts who were still sometimes depicted in films and cartoons.
Because of their complexity, psychoanalytic theories are more difficult to study and test than other theories. For example, Freud believed that dreams have meaning and are based on the fulfillment of unconscious wishes. Neuroscientists dismissed this theory for many years because it could not be demonstrated. Behavioral psychologists, who based their theories on observable behavior, did not consider thoughts and feelings outside a person's awareness to be important. Because of the emphasis on experimental testing and the increasing public expectation for quick cures during the last quarter of the twentieth century, psychoanalytic theories became less popular. The DSM-III, the third edition of the diagnostic manual for mental disorders which came out in 1980, was based on categories of symptoms and behaviors, without any reference to underlying theory. The categories of mental disturbance in DSM-III (and in later editions) were described in a way that would be easy to test in controlled experiments. People, and particularly insurance companies, became more interested in medicines and short-term treatments for symptoms and were less willing to pay for treatments like psychoanalysis that address the whole person.
Toward the end of the twentieth century and the beginning of the twenty-first, cognitive scientists (scientists who study the way people think) and neuroscientists (scientists who study the way the brain works) began to make discoveries that proved psychoanalytic theory to be correct in some important areas. For example, cognitive scientists proved that much of mental functioning goes on outside a person's awareness. Mark Solms, a neuro-scientist, proved that dreams are formed in the part of the brain that deals with motivation and emotional meaning. Psychoanalysts began a dialogue with neuroscientists and cognitive scientists. Although some psychoanalysts thought psychoanalysis could not be studied experimentally in the same way as shorter-term therapies, others began to publicize studies demonstrating the effectiveness of psychoanalysis and psychoanalytic psychotherapy. Others began to develop further ways to study psychoanalytic theory and treatment.
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