Freud did not operate in a vacuum. Many of his ideas came out of earlier philosophical works. For example, the German philosopher Arthur Schopenhauer (1788–1860) wrote about the primacy of unconscious sexual instincts as early as 1819. Moreover, Freud was not the first clinician to practice psychotherapy. By 1909, Freud’s approach to psychotherapy was just one among many competing forms of psychotherapy. Contemporary psychotherapy in the early twentieth century was very crude, however, and still focused largely on hypnotism and suggestion. Ultimately it was psychoanalysis that had the widest impact on the later development of psychotherapy.