Psychoanalytic Psychotherapy

What is Psychoanalytic Therapy?

Psychoanalytic Therapy is a treatment for relieving mental and emotional distress. It is often known as the talking cure because its simple technique involves no action by either the patient or the therapist. It is also a method of self-investigation and a general study of human behavior. Psychoanalytic therapy is based upon the idea that much of our behavior, thoughts and attitudes are regulated by the unconscious portion of our mind and are not within ordinary conscious control. By inviting a patient to talk, the psychoanalytic therapist helps him to reveal unconscious needs, motivations, wishes and memories in order to gain conscious control of his life. This form of treatment for emotional troubles was first developed by Sigmund Freud in the early part of this century. Many psychoanalysts have expanded on Freud's work and enlarged the range of problems that can be treated. New treatment techniques and insights into human behavior have also been developed.

Who can benefit from Psychoanalytic Therapy?

Psychoanalytic therapy is usually appropriate for anyone who wants to have a happier life with greater personal and emotional flexibility. Adults, children, couples, and whole families are now frequently seen in psychoanalytic therapy. Individuals may have private or group therapy.

What kinds of problems can be treated with Psychoanalytic Therapy?

A wide range of emotional problems can be successfully treated with psychoanalytic therapy. Among them:

  • Emotional pain, depression, boredom, restlessness.
  • An inability to learn, love, work, or express emotion.
  • Irrational fear, anxiety without a known cause.
  • Pervasive feelings of meaninglessness, emptiness, unrelatedness.
  • Lack of goals, values, or ideals.
  • The feeling of being overwhelmed by responsibility and unable to relax and play.
  • An inability to set practical, reachable goals, and accept responsibility.
  • Unsatisfying relationships with spouse, children, or parents.
  • Inability to have friends or lovers.
  • The feeling that life is totally out of contrl and that one is not master of one's fate.
  • An excessively controlled life, dominated by ritual and obsession.
  • Compulsive overeating, or an inability to eat enough for good health.
  • Physical problems that have a psychological origin.

What does the Psychoanalytic Therapy patient do?

The psychoanalytic patient is a partner with his therapist in a unique exploration of his life. Just as no two human beings are alike, no two treatments are alike. The patient lies on a couch, with the therapist just out of view, and talks. There are no specific topics. The patient can say anything he wants to say, but he doesn't have to talk about anything he would rather not discuss. As he talks, he reveals the past, his present life situation and future plans. Dreams, fantasies, sexual thoughts, angry thoughts, and feelings about himself and others are shared in a comfortable manner. Over the course of time, the patient is helped by the therapist to tell the emotionally significant story of his life, permitting unconscious motives, fears, and memories to become integrated into current life.

What does the Psychoanalytic Therapist do?

The major function of the psychoanalytic therapist is to listen carefully and attentively to the patient in order to understand him and facilitate communication. The therapist uses both intelligence and feelings to obtain verbal and nonverbal clues to the patient's problems. The analyst must first understand these disguised communications and then transform them into information useful to the patient. To do this, the therapist asks questions, confronts distortions, and does anything else needed to help the patient share his thoughts and feelings comfortably.

What is the unconscious?

The unconcsious is composed of many mental processes, wishes, needs, attitudes, memories, and beliefs not directly available to ordinary awareness. It is hard for many people to accept the idea of the unconscious, the idea that something not under their direct control might influence their lives. However, close examinations shows that many of the choices in life such as spouse, friends, career, life style, and patterns of health are based upon motivations of which people are not ordinarily aware. Many bitter childhood memories are relegated to the unconscious, although they still control some day-to-day behavior. Handicapped by lack of awareness of the unconscious motivations, people can become victimized by emotional reactions and symptoms that inhibit their lives. Psychoanalytic therapy allows a patient to become aware of these unknown mental processes through behavior, slips of the tongue, dreams, and free associations.

Why are Dreams important to Psychoanalytic Therapy?

Dreams play a useful role in psychoanalytic therapy because (for those who remember them) they offer, in Sigmund Freud's words, the Royal Road to the Unconscious. In dreams people express unconscious needs, memories, conflicts and wishes. Dreams can become an avenue of understanding to hidden aspects of the self when examined with the interpretive help of the analyst.

Why is the Couch used?

Often the butt of jokes and cartoons, the couch is a much misunderstood, but useful tool in advancing the treatment process. For most psychoanalytic patients, it offers an opportunity to relax, undistracted by the therapist's visible presence, and comfortably report thoughts, and feelings as they arise. The use of the couch also emphasizes that therapy is not ordinary social conversation, but a specialized form of communication.

What is Resistance?

During the course of every psychoanalytic therapy, the patient demonstrates behavior that interferes with the progress of the treatment. This interference is called resistance. because psychoanalytic therapy helps the patient achieve freedom of thought and action by talking freely, the negative emotional forces that caused his symptoms manifest themselves as obstacles to the talking therapy. The patient may:

  • Become unable to talk any longer.
  • Feel he has nothing to say.
  • Need to keep secrets from his therapist.
  • Withold things from the therapist because he is ashamed of them.
  • Feel that what he has to say isn't important.
  • Repeat himself constantly.
  • Refrain from discussing certain topics.
  • Want to do something other than talk.
  • Desire advise rather than understanding.
  • Talk only about thoughts and not feelings.
  • Talk only about feelings and not thoughts.

These and many other forms of possible resistance keep the patient from learning about himself, growing and becoming the person he wants to be. Together the patient and the analyst study the meaning and purpose of the resistance and try to understand the key to unlocking it and allowing the patient to continue growing. Modern therapists recognize that a patient may need to resist, and use a relaxed approach to aid him in overcoming the problem.

What is Transference?

Psychoanalysts discovered early in their work that patients can have distorted views of the analyst. An analyst with a quiet, reserved manner may be perceived as an oppressive tyrant. Alternatively, a patient may become convinced that the analyst loves him even though no such feeling has been expressed. These types of feelings usually come from attitudes toward sifnificant individuals in a patient's past such as parents, teachers, or siblings. Sometimes the feelings toward the analyst represent actual feelings about a person in the patient's past, and at other times the feelings are those of a desired relationship with a significant individual. While not all patients develop classical forms of transference, many patients find it useful to study and understand the feelings they have toward the therapist. It aids understanding of current relationships, the need for personal growth, expectations of others and attitudes toward oneself.

Does psychoanalytic therapy focus only on childhood events?

Events in the first five or six years of life do have an important and lasting effect on the development of character. However, the origins of emotional distress may be in traumatic childhood events, early maturational needs that were not met, difficult family relationships, and/or events in later life. The past is important only if it interferes with the patient's ability to function in the present. The therapist helps a patient whose emotional disorder is rooted in childhood distress grow as an adult.

Is Psychoanalytic Therapy just about sex?

Most people have read or been told about Sigmund Freud's landmark discoveries regarding the crucial role that sexual thoughts and feelings have in life. However, modern psychoanalysts regcognize that anger, hostility, dependency, and many other motivations may be just as important in shaping personality. While Freud's patients, mostly Victorian women, needed help to understand their sexuality, modern patients tend to have more difficulty coping with feelings of anger, loneliness, or lack of a coherent sense of who they are.

Must a patient fall in love with his therapist to be cured?

Patients experience a wide range of emotions toward the therapist. Individuals who have received little love or understanding in life may respond to an analyst's understanding attitude with feelings of love. Equally frequent responses to therapists include hatred, amusement, disinterest or extended periods of no feeling. A psychoanalytic therapist never wants to prescribe which feelings a patient should experience. Instead, the analyst's goal is to help the patient learn to appreciate all of his feelings no matter what those feelings may be.

Is Psychoanalytic Therapy conducted in groups?

Psychoanalytic Therapy in groups is often quite effective either in addtion to, or in place of, individual therapy sessions.

How long does Psychoanalytic Therapy take?

There is no time limit on psychoanalytic therapy. Some patients may have benefits in a short period of time (six months or less), and others may wish to continue treatment for some years. The average patient remains in therapy for a minimum of two years. Staying in therapy longer is neither a sign of excessive dependence nor severity of illness. It takes a lifetime to develop the attitudes and character traits that contribute to emotional stress, and generally, although not always, time is required for change. A therapist of any persuasion who promises change in a specified period of time is not being completely honest.

When is therapy completed?

Therapy is terminated when the goals of the patient have been achieved. When the patient is able to comfortably experience all of his feelings, both good and bad, without having to act them out, and when he is able to comfortably relate all of these feelings to the analyst and act in his own best interest, the therapy is complete.

How has psychoanalysis changed since Freud?

Psychoanalytic theory and therapy have both evolved since Sigmund Freud. Freud placed his greates theoretical emphasis on the study of the sexual drives, in particular the Oedipal phase of psychosexual develpment between the ages of four to six when a child falls in love with the parent of the opposite sex. Since the time of Freud, greater emphasis has been placed upon the study of how an individual emerges into the world as a separate person with a sense of himself and positive self-esteem. Current theory also deals with aggression, early mother-child interaction, social relations, family dynamics and psychosomatics. Early Freudians only accepted for treatment relatively mature, neurotic patients, who were seen daily. The only interventions used by the analyst were to be interpretations or explanations of a patient's behavior. Today patients are generally seen less frequently. Analysts have more flexibility in their responses to a patient. Modern Analysis is modified to meet the needs of the individual, rather than expecting the patient to conform to the analyst's requirements.

Are there different schools of psychoanalsysis?

Since the birth of Freudian analysis in the early 1900's numerous approaches have been developed including those of Jung, Adler, Horney, Sullivan, Klein, Kohut, and Spotnitz. Each school of psychoanalytic therapy focuses on certain aspects of treatment or personality. The differences between these schools have become less dramatic with time. Frequently, the differences between analysts trained in the same tradition can be equal to or greater than those between analysts of different schools.

What are some of the differences between Psychoanalysis and other forms of therapy?

There are literally hundreds of types of psychotherapy available to the public, and it would be useful to understand something about each of them before selecting a therapist. Unfortunately, much of what has been written or said about psychoanalytic therapy has been by people who have little experience of modern advances in the field of psychoanalysis. Here are to main elements that set psychanalytic therapy apart from other forms of psychotherapy:

  • The Psychoanalytic therapist prefers to treat patients without medications, although on occasion he may refer a patient to a psychiatrist for drugs to be used in the treatment of depression, psychosis, or overwhelming anxiety.
  • The psychoanalytic therapist does not ussually give specific recommendations about how the patient ought to manage his life or solve problems. Instead, the analyst prefers to help the patient understand why he is unable to solve problems or what internal conflict is preventing him from knowing what to do in his life. When necessary, the analyst may suggest postponing a particular decision until a later date, or may act to prevent a patient from harming himself or sabotaging the treatment.

Is Psychoanalytic Therapy a fad or Outdated?

Some social circles consider psychoanalytic therapyin: others feel that the gestalt or behavioral schools represent the latest in treatment. The truth is that psychoanalysis is no more a fad than dentistry or surgery. While current practice is based upon the early work of Sigmund Freud, the field's one hundred year long history has brought new discoveries about character and technique, enriching the therapist's ability to help patients. This specific method of treatment has much to offer patients who choose it. 

Is Psychoanalytic Therapy an escape or a crutch?

Psychoanalytic therapy is at times pleasurable and comforting, but it is also hard work. While relatives or friends sometimes imagine that it is self indulgence or a crutch, anyone who has had an analysis can readily report that rather than escaping from reality, the patient learns to face reality comfortably. He is not encouraged to be dependent, but to become appropriately independent.

Can a person change by exerting willpower?

A strong-willed person may certainly modify the symptoms of emotional problems by willpower, but the unconscious will then often express itself in a different symptom. Certainly many people have radically changed the form and substance of their lives without psychoanalytic therapy, but emotional distress caused by unconscious conflict can only be adequately met by psychoanalytic therapy.

Is it possible to Analyze Oneself?

Most people have such a high degree of resistance that an insight gained by self-analysis tends to be either superficial or confirm already-held beliefs, rather than promote change. Of course, many have treid and anfenefited to some extent from self-analysis, but a regimen of regularly scheduled appointments, comined with the assistance of an experienced analyst, is vital to the process. In addtion, much of who we are is determined by our relationships with other people. An analyst provides an opportunity to observe ourselves in a close relationship and safely try out new ways of relating to others.

How is the Psychoanalytic Therapist Trained?

The psychoanalyst is the most rigorously trained of all therapists. In order to practice, a psychoanalyst must complete a deep personal analysis, complete a comprehensive course of theoretical training, and treat patients under the supervision of senior analysts. This training is usually not available at universities or graduate schools. Most psychoanalysts are trained at independent training institutes. These institutes are run by senior anlysts and are monitored by accreditation bodies such as the ABAP or APA. Psychoanalysts usually have had prior training as psychiatrists, psychologists, social workers, or nurse practitioners, although this training is not required by all psychoanalytic training institutes. Analysts may have the degree M.D., Ph.D., M.S.W., or M.S.N. Psychoanalytic training usually takes five to ten years because the trainee must experience the treatment in-depth himself, and he must treat cases under supervision until his supervisors feel he is competent to practice independently. Unlike graduate school courses lasting one or two semesters, this training continues until supervisors, teachers and the trainee agree that it is complete.

What does treatment cost?

Fees are agreed upon by the patient and therapist and are comparable to other forms of psychotherapy. Fees for psychoanalytic therapy may be partially reimbursed by some medical insurance plans. Patients unable to pay the standard fees of private practitioners may obtain treatment at psychoanalytic clinics with public or other sources of funding.

How frequently are sessions scheduled?

Freud and other classical psychoanalysts saw all of their patients four to six times a week. Today's therapists see patients according to the needs of the individual.

How does one choose a psychoanalytic therapist?

A psychoanalytic therapist should be a certified graduate of an accredited training institute and have had experience treating the problem the prospective patient is experiencing. Once you have located a therapist you should arrance for a trial period of four to six sessions to determine whether you and the therapist can work cooperatively together.

Should the Therapist be Male or Female?

For most people the sex of an analyst is not important. Exceptions might include patients who have lost a parent in childhood and are often advised to seek a therapist of the same sex as the lost parent; and individuals who hold a strong antipathy toward one sex or the other that might inhibit their treatment with a therapist of that sex. Although many theories have been put forth in support of male or female therapists for particular types of patients, these theories have not held up over time. The bottom line is that a patient should choose a therapist in whom he can feel trust and confidence.