Wednesday, July 1, 2015

Step Aside, Freud: Josef Breuer Is the True Father of Modern Psychotherapy

The Viennese physician Josef Breuer (1842-1925) has a unique and prominent place in the history of psychotherapy. From 1880-82, while treating a patient known as Anna O., Breuer developed the cathartic method, or talking cure, for treating nervous disorders. As a result of that treatment, he formulated many of the key concepts that laid the foundation for modern psychotherapy. This month marked the 90th anniversary of Breuer’s death, offering an opportunity to reflect on the value of his contributions.

Breuer is best known for his collaboration with Sigmund Freud and for introducing Freud to the case of Anna O. (whose real name was Bertha Pappenheim). The ideas emerging from that case so fascinated Freud that he devoted the rest of his career to developing them, in the form of psychoanalysis. The two men co-authored Studies on Hysteria, published in 1895, which is considered the founding text of psychoanalysis. However, the significance of Breuer’s contributions goes well beyond his role as Freud’s mentor and collaborator. In fact, Breuer laid the groundwork for modern talk therapy by, for example, considering all aspects of his patients's life and personality and focusing on emotional expression as opposed to the Freudian emphasis on insight and interpretation.

I discovered Breuer early in my training as a therapist, after I realized that helping my clients gain insight into their problems, as the principal focus of treatment, was rarely effective in causing fundamental change. I found Freud’s technique of free association unhelpful, because many clients who are anxious or depressed have difficulty associating freely. The most therapeutic sessions were the ones that elicited an emotional response from my clients. If I could guide them to access feelings and memories, relevant to their area of concern, they would often report a sense of something shifting inside them, which dramatically accelerated the process of growth and change. [...]

If we compare Breuer’s theory with Freud’s formulation of psychoanalysis, there are three main differences: psychic trauma (Breuer) vs. sexual conflict (Freud) as the primary cause of psychopathology, hypnoid states (dissociation) vs. repression (defense) as the primary mechanism, and emotional expression (catharsis) vs. interpretation (analysis) as the primary means of recovery. Ironically, in each of those points, the modern view of psychotherapy has increasingly come to favor Breuer.[...]

Setting aside personal details, the key question is whose ideas were more valid, and in that regard history is squarely on the side of Breuer. Freud’s emphasis on sexuality as the dominant factor shaping human development and causing psychopathology is no longer taken seriously today. Instead, the role of dissociation due to trauma is increasingly recognized as more fundamental. Also, most therapists today realize the importance of helping clients access and integrate painful emotions due to past trauma, which is the essence of Breuer’s cathartic method. [...]

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