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The main tenet of the psychoanalytic theory of phobias is that there is some fundamental anxiety behind every fear. Therefore, the therapist's task is to uncover this fundamental anxiety and the associated intrapsychic conflicts; without such an uncovering, the understanding of phobias is only superficial.

Moreover, if the conflicts are not resolved, the treatment may lead to a replacement of one type of phobia with another (''symptom substitution''), a claim that has generally not been supported by studies and clinical practice.

Freud (1909/1955a) illustrated the psychoanalytic approach to phobias with the case of ''little Hans.'' Freud proposed that Hans, who was frightened of horses, had, in fact, castration anxiety and was afraid of his father because of the unconscious sexual longings for his mother. Thus, the unresolved oedipal conflict was behind Hans' phobia of horses. Freud also postulated specific defense mechanisms-displacement, symbolization, and avoidance-that is used by people with phobia, with the goal of defending the ego against the unacceptable sexual urges. Displacement refers to transfer of the conflictual material to a neutral object, which has no obvious relationship with the conflict but becomes a focus of the phobia.

The true nature of the person's anxiety is disguised through displacement. The underlying issues are less concealed by the use of symbolization, because some aspects of the phobic object or situation symbolize the original conflict.

Post-Freudian psychoanalysis considered some phobias to be related to conflicts originating from different developmental stages (e.g., pre-Oedipal) or to reflect superego anxiety. However, the original idea-that there is something ''more fundamental'' behind every phobia-has remained, despite the general lack of support for it. This idea has hindered, rather than fostered, further development of the psychoanalytic theory of phobia. Not surprisingly, patients with specific phobias as their main or sole problem are unlikely to be treated by psychoanalysts or psycho dynamically oriented psychotherapists.

Reference:

Freud S. 1909/1955a. Analysis of a phobia in a five-year-old boy. In Strachey J, editor: The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. 10. London: Hogarth Press, pp. 3--149.

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