Neurosis and Human Growth constituted the fourth and final version of Karen's psychoanalytic theory. It showed many changes from her earlier writings: in the style of writing, in emphasis and details of the theoretical structure and in the overall spirit of her thinking.

One modification was the different significance accorded to the idealized image of the self. Previously the creation of this irrational self-image had been seen as only one of four major defensive solutions to conflict. Now it became the nuclear process of neurotic development, a comprehensive solution that occurred in all neuroses regardless of their form. Spurred by the child's rich imagination, the process begins in early childhood as a reactive defense against basic anxiety. It has two stages. First is the creation of the fantastic idealized self image, starting in the child as a conscious process, later continuing in the adult as an unconscious one. It is derived from the person's special needs, abilities and experiences. In it, needed neurotic trends are idealized, contradictory attitudes isolated or transformed into positive traits so as to eliminate the conflicts. In the second stage, the person identifies with, actually becomes this image; it becomes an idealized self.

Several drives contribute to this self-idealization (otherwise known as actualization of the idealized image). These include the need for perfection, neurotic ambitiousness and the need for vindictive triumph. Such drives are compulsive, insatiable and absolute in their intensity.

Another new concept was self-realization. Growing in a healthy parental environment, the child would be able to develop his real native attributes, his given potentials. Such a milieu would require from parents a basic warmth, freedom of expression, encouragement and guidance, healthy friction and rational discipline. The child's positive qualities would include his spontaneous feelings, interests, wishes, personal abilities, will power and values. He can tap all his resources. Such a type and direction of growth is termed self-realization. The inner force which moves the person toward this end is the real self. It is not a specific form of personality or infantile homunculus; it refers to forces or energies, exerted in a certain direction, analogous perhaps to the Bergsonian "elan vital."

This healthy child can relate to others by pleasing, or drawing closer, by assertion or opposition, by withdrawal or being alone. As long as these attitudes are spontaneous, flexible and appropriate, they are complementary and easily integrated.

If, on the contrary, the child grows up in an atmosphere of neurotic attitudes in his parents, he can develop the feeling of insecurity, distrust and loneliness previously described as basic anxiety. His relations with his parents and others then become one-sided, rigid and compulsive, motivated by a need for safety and security. They become neurotic trends, in dynamic opposition with each other, therefore creating conflict. With each trend, particular needs, inhibitions, sensitivities and values also develop. The need to maintain such a defensive stance in the face of underlying conflicts and lack of self-confidence drives the neurotic toward actualization of an unreal façade, an artificial way of life and a false image of himself.

The neurotic expects to be treated by others as if he really were this grandiose self. His expectations and demands, unconsciously aggrandized, are endowed with feelings of entitlement, of being due him as if they were a right. They become claims on others or on the world and life. Their frustration brings an abused feeling, of being unfairly treated. Since demand is based on a neurotic need, its content varies with the predominant trend. It may be a claim for obedience or uncritical acceptance, for understanding, for happiness, for results without making any effort, for unconditional love, for immunity from aging or stressful events, for invulnerability to illness, suffering or change, for freedom from rules, problems, restrictions or limitations, for recognition of his superlative qualities, for special consideration or privilege.

All neurotic claims have several characteristics in common. They do not take into account the realistic possibilities of fulfillment. They are unreasonably egocentric and so do not allow for the needs of others. They should be satisfied without appropriate efforts. And as demands, they may include a feeling of vindictiveness. The degree of awareness of the entitled feeling can vary from conscious to completely unconscious.

But it is their effects that call attention to their presence. Frustration of a claim often leads to anger. If repressed, this feeling can be transformed into a psychosomatic symptom, a vindictive rage reaction, or a feeling of depression. The presence of chronic claims is often signaled by a chronic pessimism about life, an envy of others, or a general uncertainty about one's own rights.

The striving to maintain the idealized image is expressed differently toward oneself than toward others. Claims are directed toward others. The neurotic whips himself by a system of "shoulds" and "musts." These will also vary according to the major trend. As examples, he should be strong, stoic, enduring; loving, generous, self-sacrificing; omniscient, omnipotent; serene, tranquil, untouched by events; unemotional, in absolute control of feelings, or ultra-sensitive to emotions; wise, reasonable, understanding; infallible—the list is unending. And like claims, they ignore the reality of whether they can ever be achieved. Since they have an absolute quality, they do not represent attainable ideals or genuine moral standards.

Most important, shoulds have a coercive quality; operating from the unconscious, they exert a constant pressure. This attribute gives rise to their major symptomatic effects. Failure to measure up to them can produce a gamut of reactions: anxiety, self-criticism, self-hatred, depression, usually disproportionate to the apparent cause. Reactive feelings toward what is, in effect, an inner authority, can vary. One person may accept it, welcoming a system that checks disturbing feelings. Another may rebel against it passively, feeling only chronic strain, resentment or inertia. Or it may be an active rebellion, being "bad," acting out. If the inner authority is externalized on to others, he becomes hypersensitive to external authorities.

Finally, having to do, feel or be the way one should do, feel or be, results in a loss of spontaneous actions, emotions or attitudes. The neurotic's life becomes a spurious as-if façade or only a shallow unfulfilling existence.

What gives the idealized image its immense value and intense hold on the neurotic is that it becomes invested with pride. Such neurotic pride must be distinguished from a healthy form, real self-esteem. The latter is based on realistic factors: some true ability, a job well done, a real achievement, a sense of worth or self-confidence. Neurotic pride is based on the spurious, imagined irrational values of the idealized image. Therefore it is shaky, easily hurt, needed rather than appreciated for itself. Depending on his neurotic structure, the person will invest his pride in specific attributes. For instance, he may pride himself on his prestige, his intellectual functions like knowledge or reason, his ability to control through power or will, his lofty standards like wisdom, honesty, good judgment or Tightness, his goodness, his lovability, his invulnerability, his capacity to get away with things. It is here that the transformation of imperfections into virtues is best seen.

While such pride is needed to deny unwanted negative qualities, it inevitably leads to even greater distress. It renders the neurotic vulnerable to hurt pride reactions. Two of the most typical emotional reactions are to feel shame and humiliation. The former is felt when one becomes aware that the prideful standard is being disproved from within; the latter when it is violated in or by others, from without.

However, these simple reactive emotions frequently do not even come into awareness. Pride in self-control may cause their immediate and automatic repression. Or they may be unconsciously transformed into some other emotion, like grief. Or finally, only a secondary reaction to the shame may be experienced, such as rage or fear. In fact, a humiliating situation need not even occur. Sometimes even the anticipation of such a situation can produce the reaction—anticipatory anxiety or fear. Finally, when this rage does occur, it too may be immediately repressed and changed into depression, psychosis or somatic symptoms.

Several typical dynamic responses to hurt pride can occur as defensive means of restoring pride. Taking revenge is one way of assuring a vindictive triumph. Another is to lose interest in the event. A third is by frank denial or by forms therof, like forgetfulness or evasiveness. Still another can be the self-conscious use of humor.

When the neurotic identifies with his pride-invested grandiose image, he views his actual self from that vantage point. What he actually is becomes the ever-present obstacle to being the godlike creature he imagines himself to be. How he actually functions always highlights the discrepancy. He then must inevitably hate himself as he really is. Pride and self-hate are two unavoidable sides of the same coin, both encompassed by the term "the pride system." The neurotic is rarely aware of his self-hate, at least in its true intensity and ramifications. He only experiences its effects.

The expressions of self-hate can be grossly categorized into six forms. First are the coercive demands on the self. Failure to fulfil or violation of shoulds calls down intense hatred upon the self. Second, self-accusations are directed at any faults, difficulties or pretenses that give evidence of weakness in attaining one's ultimate standards. They carry a tone of moral condemnation and give rise to guilt feelings. And they will be felt despite their obvious irrationality or even if the failure is beyond one's real control. They can also be externalized, and then experienced as accusations by others. Neurotic standards differ from healthy conscience, which is a reminder to the real self of realistic shortcomings.

Third, self-contempt (self-disparagement, self-belittling) is a way of negating any attempt at achievement or improvement. Its symptoms can be seen in the neurotic's constant comparison of himself with others and envy of those perceived as better. When externalized, it may be a hypersensitivity to criticism or rejection—real or misinterpreted. Or it may exist as a constant need for the regard, admiration or recognition of others as a means of compensating for feelings of inferiority. Fourth, self-frustration inhibits hope, striving, choice, potential, enjoyment, inner freedom. Fifth, self-torturing attitudes go beyond even the torments of the other forms. These can include severe hypochondriacal fears and obsessions, masochistic fantasies or impulses. Sadistic urges may be active externalizations of these attitudes.

Lastly, direct self-destructive impulses may be acute or chronic, conscious or unconscious. They can consist of minor activities like nailbiting or scratching; transitory thoughts of harming oneself; reckless conduct in sports or driving or neglect of physical infirmities; drug or alcohol use; accident-proneness; and possibly chronic illnesses like cancer or tuberculosis. Often such attitudes will only be expressed in a disguised form in dreams.

Alienation from self is now seen as the core process of neurosis. It is defined as a remoteness from one's genuine, spontaneous feelings, wishes, energies, self-directedness, values—from the real self. It can also involve the body, manifesting itself as a numbing of sensations, loss of identity, or feelings of depersonalization, "like being in a fog."

The many processes occurring in every neurosis combine to produce this result. All compulsive drives remove a person from his real spontaneity and autonomy. The movement toward actualization of the idealized image, with all its shoulds, determines a mode of existence other than what one really is. Externalization further removes one from all inner phenomena; they are experienced from without. Self-hate is an attitude of active rejection of the self. When pride governs feelings, then true feelings are ignored. The inertia resulting from inner conflicts saps one's energies. Lastly, the need to maintain spurious values denies one's genuine values and responsibility for oneself.

And yet, however comprehensive a solution like self-idealization may be, the personality still remains poorly integrated, unstable, caught in conflicts and tensions. Five additional factors must also be present in order to relieve such tension, corresponding to the seven listed in her previous book as auxiliary measures or approaches to inner harmony.

One of these is alienation from self, which is thus not only a result of the neurotic process but an active defensive measure. By blurring all inner experiences, it lessens the intensity of inner conflicts. The second is externalization. Any inner quality, whether admired or despised, healthy or neurotic, can be seen in others. Compartmentalization (or psychic fragmentation) is another. Inner processes are experienced as disconnected and isolated rather than as parts of a whole, or contradictory or causally related, as the case might be. The fourth is automatic control of impulses, actions and feelings. This can take place at their unconscious source or as they emerge into consciousness. The fifth is supremacy of the mind or intellectualization. This refers to the use of the mind or knowledge to avoid participation in one's feelings and conflicts. The person becomes a disinterested spectator of his own experiences. He may believe that knowing in itself means changing.

All these various dynamic solutions to conflict, comprehensive and auxiliary, operate in all neurotics, but they will be expressed differently in each type of personality. The three initial ways of relating were described as "moving-against," "moving-toward" and "moving-away from others" in the previous version. Now they are termed "major solutions," and grouped into expansive, self-effacing and resigned orientations. They are seen to involve not only attitudes toward others, but toward the self as well.

The expansive personality identifies with his glorified self. He is bent on mastery and superiority; he despises self-effacement—helplessness, failure, timidity, weakness. Three subforms of this orientation are distinguished.

Narcissism is the psychic state of loving the attributes of one's idealized image. The narcissist believes in his greatness, uniqueness, omnipotence, infallibility and freedom from limitations. He must impress others and needs their admiration. He overlooks flaws or transforms them into virtues. But his relations with others are poor; he imagines criticism and becomes easily enraged by it. He disregards the needs and feelings of others. His work suffers from being too grandiose in its aims. So he often incurs failure through real limitations. He may seem optimistic and happy, but just underneath the surface are pessimism and despondency.

The perfectionist neurotic identifies with his demanding standards and feels superior to others because he alone carries them out. So he denigrates and despises others. He needs to be perfect in behavior, attitudes and values. The discrepancy between what he believes he is (and tries to be) and what he really is is blurred by his self-deception. Since he feels himself to be fair, dutiful, just, he feels entitled to fair treatment, fortune or success. But he can collapse with self-hate when misfortune contradicts this claim, or when he makes mistakes.

With the arrogant-vindictive solution, the neurotic has identified with his pride. The need for vindictive triumph makes him highly competitive. He cannot tolerate losing and when it threatens, he can be subject either to violent rage or to distrust of others; they are out to beat him. Therefore he is constantly scheming to frustrate others. These attitudes enter into his sexual relations also. He needs to dominate and exert power. On this basis he builds extreme claims: to be right, to be respected despite his disregard for others, to be invulnerable and immune. His pride in strength, power and control is so absolute that any "softer" feelings like love, compassion or sympathy are crushed. When they might emerge, his self-contempt is tremendous. When he perceives these traits in others, he may feel disposed to punish them.

The self-effacing neurotic identifies with his despised self. He shuns, even fears any expansive qualities. Suffering and helplessness in fact have a certain unconscious appeal for him. He craves the help and care they could procure for him. He can accept failure, inferiority, self-denial. If any self-contempt comes up, it is passively externalized; others are looking down on him. He fears hostility in himself and in others. Arguments must be avoided. He must be loving, giving, understanding, self-sacrificing. These attitudes are glorified into the "good," the lovable qualities in himself, even though it may mean completely eliminating his own interests. But intense self-hatred is generated when any awareness of his repressed hostility, pride or vindictiveness emerges. He needs others not only for love, but also to avoid being alone—proof of his being unwanted and unloved. When his claims for love or help are not met, he feels chronically abused. This can make for chronic resentment of others or for accusations against himself—often in the form of somatic symptoms and suffering.

Neurotic suffering serves several purposes. It acts as a justification for claims. It often is a means of being vindictive or exploitative without having to consciously admit it. One avoids accusing oneself by accusing others and suffering becomes an excuse for not making more of life. In extreme cases, helplessness, illness or even psychic suicide present themselves as the ultimate way out of difficulties. They can even be experienced as the final triumph over the world or fate.

Morbid dependency is an extreme form of this orientation, occurring mainly in erotic love relationships. The self-effacing person is often attracted to a dominating partner in whom he sees those traits that he misses in himself. These he admires in others, and concludes, consciously or unconsciously, that their absence in himself is responsible for his suffering. Besides, even though he wants to obtain love and sympathy, he can be repelled by another compliant person, who displays the same irritating weaknesses as himself. The need for surrender through self-degradation or self-elimination is compulsive. And once begun, the person is too fearful of asserting himself to take a stand—a situation that eventually makes for increased inner conflicts.

The third major solution, resignation, differs dynamically from the first two. Here the neurotic removes himself totally from all conflicts instead of simply repressing one contradictory side, as in the other solutions. It provides a freedom "from" the unpleasant rather than "for" something positive. Typically, he gives the impression of being an observer of himself and of life. This nonparticipation is much broader than the simple intellectualizing described previously. Here, the neurotic avoids being emotionally touched by anything that happens within himself. He eliminates awareness of painful conflicts by distancing himself from all feelings.

A second trait is the aversion to any serious striving toward a goal, to any effort or to any psychic movement.

To achieve peace and serenity may be a conscious aim, but at a deeper level this means an absolute freedom from change, an unrealistic nirvana-happiness. Detachment from others is a typical quality, especially insofar as relations will demand emotional involvement. Sex is usually only physical contact.

Characteristic, too, is a hypersensitivity to coercion, influence, obligation, restriction, limitation, pressure or intrusion. This occurs because one's pride is invested in stabilizing or immobilizing the dynamic forces of two repressed orientations, both of which are still compulsive. The person still identifies with the attributes of his idealized image but he has renounced the active drive to make it real in life. He therefore may show self-effacing or expansive attitudes at various times, but these are not compelling drives. Nevertheless, he still feels the shoulds from both sets of attitudes. In addition, newer shoulds express needs for independence, stoicism, privacy, freedom from want or desire, passionless and unruffled serenity. This combination accounts for his sensitivity to any coercion. Then by externalization, his own inner dictates will be experienced as coerciveness and authoritarianism in others.

Different inner reactions to this basic process can be observed clinically. Persistent resignation may be low-keyed and still permit some activities. Feelings of inertia and chronic strain then often accompany sustained effort and work. Inner feelings are restricted, including interest, curiosity and enjoyment. If any of these are felt, they quickly fade. A deadness or emptiness is sometimes experienced. However, since freedom is always sought, this inertia always contains an element of passive rebellion.

Another reactive type is the actively rebellious person, who may rebel against the external environment or his own inner restrictions. To a limited degree this can be a healthy movement.

Behavior of the third group is characterized by shallow living. Increasing emptiness, loss of feeling, futility and lack of direction can result in an attempt to fill one's life with meaningless distractions. Emphasis is then placed on having fun: on parties, sex, socializing, amusements; or on opportunistic success, on money, seizing the advantage—but solely for the freedom these offer from life's difficulties; or on automatic adaptation to the prevailing codes and habits of others.

In the last chapters of Neurosis and Human Growth, some of the therapeutic problems posed by this character analysis are discussed. Actually, to speak of a "cure" of neurosis is not appropriate. Psychoanalysis only helps the patient overcome his growth-obstructing needs and attitudes, thus relieving his conflicts and obviating the necessity for solutions. This includes dissipating his illusions about himself. Then, and then only, can he grow in a healthier direction and develop his potentials.

But this goal of the analyst is not the goal of the patient in therapy. He feels that analysis should help him retain—even strengthen and perfect—his neurotic solutions and values. To renounce them would endanger his psychic existence. It would be too dangerous to obtain real insight into what he feels to be his shortcomings. He wishes to remove only the disturbing situation, the immediate problems, the painful symptom. Furthermore, since his unconscious expectations of therapy depend on his particular neurotic solution, he seeks change through his own will power and control, or without effort and involvement, or through the analyst's magic wand. Each growing awareness will bring some blockage: evasiveness, argument, hostility, spurious agreement, apathy or forgetfulness, periods of self-hate, anxiety, etc. All the specific defenses must be understood and laid bare: needs, claims, shoulds, prides, solutions, values. In this process, intellectual knowledge is insufficient. There must occur an emotional experience of each specific defensive attitude as well. This aspect of the therapy constitutes a disillusioning process, occurring during the first phase of analysis. At the beginning, conflicts are still blurred. The second phase must consist of delineating and mobilizing constructive assets of the patient. Then a gradual moving forward will occur, with more spontaneity and vitality. But this, in turn, will bring repercussions in the form of periods of self-contempt, with rapid upand-down shifts in mood and symptoms. Rapid changes later in the analysis are indicative of the central conflict, the struggle between all the obstructive, neurotic forces and the constructive, healthy forces. Passing through each of these phases will eventually result in a strengthening of self-confidence.

In this book, the final version of Karen's theory differs from the previous ones in several ways. In the first place, she modified the theoretical structure of the neurotic (and healthy) personality. The role and importance of the idealized self-image have been changed. From simply one tactic (out of four) of resolving inner conflicts, it became the crucial defensive move of neurosis. The relation between self-glorification and self-hate were clarified. The entire concept of self-hate assumed a greater significance. The new concepts of self-realization and real self were introduced. This led to an expansion of the notion of conflict. It occurred not only between opposing compulsive solutions, but also between the pride-system and the real self (central inner conflict). Alienation from self was now seen to constitute a key process of neurotic development. Yet with all these modifications, the theory remained a personology, a study of character structure.

In the second place, this work is much more sophisticated and complex, both theoretically and stylistically. In her previous books, Karen's view of personality was relatively simple—perhaps even deceptively oversimplified. Here one senses a much greater realization of the profundity of the human psyche and the complexity of human relations, whether healthy or disturbed. Even a well-demarcated symptom like anxiety cannot be ascribed to some limited conflict between basic drives. It can result from active opposition between more complex trends or their secondary and tertiary products, like claims, values or shoulds. Conflicts breed further conflicts; reactions to conflicts may create new reactions, and so forth. The degree to which the neurotic is enmeshed in his web of defensive devices becomes more evident here. The intensity of feelings (or lack of them) is conveyed much more dramatically here, whether it be despair, self-hate, pride or emptiness.

In the third place, the theory has evolved in terms of psychodynamics. The concepts of peremptory forces, psychic movement and directions have become as important as descriptive traits and behavior types. Consider the concept of direction. In the first version of the theory, emphasis was primarily placed on the influence of the culture on the individual personality. The direction was mostly from the outside inward. In this final version, the main focus is on the influence of intrapsychic forces on interpersonal relations. The direction is from within outward. Even within the self, growth is seen to occur in a healthy direction (self-realization) or neurotic direction (self-idealization). The neurotic rises above conflicts and then looks down on others.

Direction also implies movement, both microcosmic and macrocosmic. The child moves toward, against, away from parents; alienation is movement away from self. Movement is implicit in the very notion of dynamic, active conflict and active escape from it.

Lastly, a holistic spirit is now quite evident here. Despite her emphasis on intrapsychic phenomena, she makes clear that these only occur in a context. The cultural, the interpersonal and the intrapsychic, the mental, the emotional and the somatic, the past and the present are all closely in tertwined. Even though one aspect can be observed and studied, the other aspects of the individual are still very much present, and must be taken into account. In the first version of her theory, personal attitudes and inner conflicts were seen to be a reflection of similar factors in society. The two could nonetheless be easily differentiated. In this version, the distinction is not so clear. At numerous points we are told that what is described as past history may be a projection of one's present attitudes. What is seen as outside situations may really be an externalization of internal events. Subjective and objective are often difficult to separate. The individual produces his needs, claims, shoulds, conflicts at the same time that he directs their effects back upon himself; it is a reflexive influence, even though he may feel that he is being acted upon by "something" within himself. But hopefully, as therapy progresses, the person grows closer to his real self. Then he will come to feel active in his own being and life, responsible for himself and "the captain of his own ship."

This final version of her theory was to have many long-term effects that Horney neither intended nor would have completely wished, and in any event could not have foreseen. She was basically trying to systematize her concepts of personality but was attempting to do so by extending and building only upon her previous ideas. The major exception to this was her introduction of the real self and the process of self-realization. She often stated that any one of her ideas could not be really understood if isolated, taken out of context of the whole framework. When she did discuss her ideas in her classes or her Academy lectures, she always linked them with their dynamic emotional causes and effects. Unfortunately, others who have followed her and who have borrowed or "rediscovered" ideas she enunciated have either changed their meaning or have failed to convey their scope. And this is usually done without giving credit to her.

A number of her ideas have become incorporated into the then new ego psychology begun by Freud and developed by his followers. For example, her notion of pride, transformed from healthy into an exaggerated neurotic form, was elaborated upon by Heinz Hartmann, a distinguished Freudian analyst. He called attention to the neglect of this emotion in classical analytic writing and the need to give it its rightful importance. Horney's concept of irrational self-idealization was further amplified by Annie Reich, Jeanne Lampl-de Groot and Samuel Novey. It was redefined much as Horney conceived it to be, as a narcissistic defensive operation against anxiety, rather than simply as part of the normal ego-ideal. These authors still linked it directly to traumatic experiences of the infant; grandiose fantasies would be a compensation for feelings of helplessness. More recently, younger Freudian analysts like Heinz Kohut and Otto Kernberg have extended and refined her concept of neurotic, defensive narcissism, especially in relation to the "borderline" personality. Their work is replete with terms introduced by Horney, such as the splitting of the self into omnipotent and selfdevaluative attitudes, pathological self-esteem and integration of the self.

Karen's idea that the relationship between the patient and analyst consisted of more than the simple repetition of the infant's attitudes toward parents has also been confirmed in recent years. Many classical analysts now speak of the broader "therapeutic alliance" or the "working" or "real" relationship during psychoanalysis. Following Karen—and Franz Alexander, who also stressed this point at about the same time—they believe that healthy, later-developed, here-and-now aspects of both patient and analyst enter into the analysis as much if not more than infantile ones. Her insistence on the need to experience emotionally all on-going feelings, that is, on emotional instead of only intellectual awareness, has appeared in the so-called experiential schools of psychology. These include the client-centered therapy of Carl Rogers, the Gestalt-therapy of Fritz Perls and Whitaker and Malone's experiential therapy.

One of her most far-reaching contributions was the introduction of the concept of self-realization—the innate tendency of the individual to grow in a healthy direction—into her systematized theory of personality and neurosis. Following this principle, there have appeared several schools of "self-actualizing" psychotherapy, the so-called third force in psychology to counterbalance the Freudian biological views as well as the culturalist approach. Notable among these are Kurt Goldstein's organismic approach (although he also influenced Horney and was himself previously affected by Gestalt psychology), and especially Abraham Maslow's theories.

Aside from these specific derivations, Horney's theory presaged other more general currents in psychological thought that have become popular today. One has been the increasing emphasis on socio-cultural factors as the causes of emotional illness. She would have found this overall trend congenial. But not completely! She would have disagreed with the degree to which society is blamed for neurosis and the resulting attempts to treat neurosis by simply changing social conditions. In point of fact, even though she continues to be considered a "Neo-Freudian culturalist" psychoanalyst, this classification is misleading. It was based on her earlier work; she remained individual-oriented and in her later work focused almost exclusively on the inner structure of the psyche.

The second current popular today is related to this, namely her holistic emphasis on the dynamic, continuous interaction between external cultural conditions, interpersonal relations and inner emotional experiences. This view is described today as "systems-theory." Her contribution to this trend was significant, though, like so many of her other advances, it has been largely overlooked.