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Psychoanalysis and Psychotherapy
Psychoanalysis and its derivative, psychoanalytically informed psychotherapy (sometimes referred to as psychodynamic psychotherapy), are psychotherapies designed to treat individuals with psychological problems involving emotional, behavioral, interpersonal, social, and/or vocational symptoms . They are humanisitic in nature--that is, the analyst is there to assist the individual, as a fellow human being, with his or her difficulties, in a mutual effort to overcome impediments to greater fullfilment and improved functioning. Guided by a principle of respect for the patient's autonomy, the analyst helps patients understand themselves, discerns in depth the nature and origin of their psychological problems, and attempts to help them, through empathic understanding, to help themselves.
It is not the desire of analysts to impose themselves on the patient or to force the patient into any sort of "mold." Rather, the analyst is interested in, as the therapeutic work progresses, the patient's developing his or her capabilities in whatever way the patient ultimately chooses.
Because psychoanalysis is a comprehensive theory of human mental functioning, analysts treat a spectrum of psychological difficulties--from brief crises in life to more ingrained personality problems, to severe disturbances. In terms of psychiatric diagnostic labels and symptomatology, this would include patients with neurotic problems, personality disorders, narcissistic (self esteem) difficulties, depressions, anxiety and panic disorders, sexual difficulties, phobias, obsessions and compulsions, borderline and identity disturbances, and in some instances psychoses.
While psychoanalysts work with the "mind" of the patient, they are also aware of the usefulness of medication at times, and use them as adjuncts to psychoanalytic treatment where indicated.
Traditional psychoanalysis is generally conducted at a frequency of 4-5 times per week. The sessions are 45 minutes in length and the couch is used by the patient. Patients are encouraged to speak freely about whatever is on their mind. For example, important daily events, significant interactions with others, feelings about themselves and what troubles them, the past, dreams, etc. Amongst other things, the analyst begins to notice patterns in the patient's behavior, notices feelings that seem to be missing in important situations, sees where the patient avoids problematic situations, observes where the past is influencing the present, listens to thoughts and feelings about dreams, and discusses his or her observations with the patient. Likewise, the analyst explores and helps the patient understand those concerns which the patient notices.
At times, the patient has thoughts and feelings about, and sometimes problems with the analyst him or herself. These, too, become a focus for therapeutic discussion. This is what is known as the transference, a central feature of a psychoanalytic treatment. The transference refers to the "transfer" of feelings and conflicts with significant others in the patient's past onto the analyst in the present. Because we have all been psychologically "molded" by our past experiences with significant others, our relationship to ourselves and others is reflected in the transference in both beneficial and problematic ways. Transference occurs in all relationships; therefore its understanding and resolution can contribute to significant changes in our relationships to ourselves and others.
Most individuals who are reflective about themselves realize that their childhoods, and/or later events have had a great deal to do with who they are now--both the satistying aspects of themselves and the problematic.
Traditional psychoanalysis is the most in-depth and intensive of any psychotherapy. Emotional problems are complex and there is no easy, fast solution for them. The length of time this process continues is open-ended and determined by the patient, ideally in consultation with the analyst. It takes time to heal, overcome, and grow.
Traditional psychoanalysis is usually for individuals who have had long-standing problems. Generally, these patients may have had sucesses in life, and have many strengths, but are plagued with problems which are making their relationships with themselves or others less than satisfying. Some of these patients have been in other types of therapies, have had less extensive treatments, or have only tried medications to relieve their difficulties without adequate success.
Psychoanalytically informed psychotherapy is generally conducted one to three times per week with the patient sitting and facing the therapist, although the couch may be used if the patient so decides. Basically the same principles and range of patients apply here as in traditional analysis. The depth of exploration may be limited by the decreased frequency of sessions, but many patients are able to accomplish their goals by this approach, and may not require a traditional analysis.
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