section_path: Legacy/Psychotherapy
section_name: Psychotherapy
paragraph_text: Psychotherapy
  
  Though not the first methodology in the practice of individual verbal psychotherapy, Freud's psychoanalytic system came to dominate the field from early in the twentieth century, forming the basis for many later variants. While these systems have adopted different theories and techniques, all have followed Freud by attempting to achieve psychic and behavioral change through having patients talk about their difficulties. Psychoanalysis is not as influential as it once was in Europe and the United States, though in some parts of the world, notably Latin America, its influence in the later 20th century expanded substantially. Psychoanalysis also remains influential within many contemporary schools of psychotherapy and has led to innovative therapeutic work in schools and with families and groups. There is a substantial body of research which demonstrates the efficacy of the clinical methods of psychoanalysis and of related psychodynamic therapies in treating a wide range of psychological disorders.
  
  The neo-Freudians, a group including Alfred Adler, Otto Rank, Karen Horney, Harry Stack Sullivan and Erich Fromm, rejected Freud's theory of instinctual drive, emphasized interpersonal relations and self-assertiveness, and made modifications to therapeutic practice that reflected these theoretical shifts. The neo-Freudian analysis places more emphasis on the patient's relationship with the analyst and less on the exploration of the unconscious.
  
  Jacques Lacan approached psychoanalysis through linguistics and literature. Lacan believed that most of Freud's essential work had been done before 1905, and that ego psychology and object relations theory were based upon misreadings of Freud's work. Lacan saw desire as more important than need.
  
  Wilhelm Reich developed some of Freud's ideas, such as Actualneurosis. Freud applied that idea both to infants and to adults. In the former case, seductions were sought as the causes of later neuroses and in the latter incomplete sexual release. Unlike Freud, Reich retained the idea that actual experience, especially sexual experience, was of key significance. By the 1920s, Reich had "taken Freud's original ideas about sexual release to the point of specifying the orgasm as the criteria of healthy function." Reich was also "developing his ideas about character into a form that would later take shape, first as "muscular armour", and eventually as a transducer of universal biological energy, the "orgone"."
  
  Fritz Perls, who helped to develop Gestalt therapy, was influenced by Reich, Jung, and Freud. The key idea of gestalt therapy is that Freud overlooked the structure of awareness, "an active process that moves toward the construction of organized meaningful wholes... between an organism and its environment." These wholes, called gestalts, are "patterns involving all the layers of organismic function – thought, feeling, and activity", to which improper formation, in Perls' view, gives rise to neurosis and anxieties. Gestalt therapy attempts to cure patients by placing them in contact with "immediate organismic needs." Perls rejected the verbal approach of classical psychoanalysis; favoring a workshop style approach.
  
  Arthur Janov 's primal therapy, which has been influential post-Freudian psychotherapy, resembles psychoanalytic therapy in its emphasis on early childhood experience but has also differences with it. While Janov's theory is akin to Freud's early idea of Actualneurosis, he does not have a dynamic psychology but a nature psychology like that of Reich or Perls, in which need is primary while wish is derivative and dispensable when need is met. Despite its surface similarity to Freud's ideas, Janov's theory lacks a strictly psychological account of the unconscious and belief in infantile sexuality. While for Freud there was a hierarchy of dangerous situations, for Janov the key event in the child's life is an awareness that the parents do not love it. Janov writes in The Primal Scream (1970) that primal therapy has in some ways returned to Freud's early ideas and techniques.
  
  Ellen Bass and Laura Davis, co-authors of The Courage to Heal (1988), are described as "champions of survivorship" by Frederick Crews, who considers Freud the key influence upon them, although in his view they are indebted not to classic psychoanalysis but to "the pre-psychoanalytic Freud... who supposedly took pity on his hysterical patients, found that they were all harboring memories of early abuse... and cured them by unknotting their repression." Crews sees Freud as having anticipated the recovered memory movement by emphasizing "mechanical cause-and-effect relations between symptomatology and the premature stimulation of one body zone or another", and with pioneering its "technique of thematically matching a patient's symptom with a sexually symmetrical 'memory. ' " Crews believes that Freud's confidence in accurate recall of early memories anticipates the theories of recovered memory therapists such as Lenore Terr, which in his view have led to people being wrongfully imprisoned.