Another major difference between Freud and Jung lay in what they identified as the primary motivators of human behavior, says Nancy M. Boksenbaum, a clinical psychologist/psychoanalyst practicing in Stamford. For Freud, it was sex and aggression; for Jung, self-actualization.
In the first half of the 20th century, Freudianism influenced other isms, including Cubism and Surrealism, while analysts were cast as heroic mind detectives in a number of Hollywood classics. (See related story.) But with the rise of feminism, which attacked Freud for reinforcing patriarchal values and straitjacketed views of women, psychoanalysis lost some of its luster.
The advent of managed care as well – spurred by the Health Maintenance Organization Act of 1973 – shifted the emphasis from mental health to behavioral health, from the qualitative effects of the talk therapy that was at the heart of psychoanalysis to the quantitative results of medication.
“At that point, the internal world was devalued by insurance companies,” Boksenbaum says. “Instead of mapping the internal landscape, everyone started looking at overt behavior.”
“The advent of managed care…served to limit access to mental health professionals, especially psychologists,” says psychologist Wendy McKenna, a professor at Purchase College who specializes in gender and sexuality. “Psychiatrists still got patients to manage medication. Clinical social workers got referrals, because they were cheaper than psychologists. Over time, however, many mental health professionals of all types have just stopped taking insurance because they can't tolerate the paperwork or the low rate of reimbursement.”
Revamping Siggy
However, McKenna adds, “The Mental Health Parity Act (of 1996) has changed things for clients, who now get the same co-pays and coverage for mental health benefits as for physical health benefits. Now I think more people feel they can afford to at least try therapy.”
At the same time, psychoanalysts have put themselves on the couch to expand their thinking and approaches.
“There’s been a reformulation of psychoanalysis,” Boksenbaum says. “The analyst was once all powerful.”
Now in relational psychoanalysis, the analyst and analysand (patient) collaborate on the therapy, exploring different systems of motivation, she says. Instead of sex (Hello, Sigmund) or self-expression (Hey, Carl) being the motivating factors, they might be fight/flight or attachment.
“Contemporary psychoanalysis looks at relational patterns that were once adaptive but no longer are and need to be transformed,” Boksenbaum says. “For example, a compliant child to a self-involved parent needs to live in his own integrity as an adult.”
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