Psychoanalysis is among the deepest forms of psychotherapy available. Using tools like dream interpretation, transference interpretation and examination of the repetition compulsion, psychoanalysis furthers a patient’s understanding of the role of conscious (explicit) and unconscious (implicit) emotions in healthy mental functioning, as well as in medical and psychiatric illness. Psychoanalysis stresses the importance of understanding that each individual has a unique developmental history, that life experience stored and operating outside of a person’s awareness influences his or her conscious thoughts and actions, and that as a result the past profoundly affects how the present is experienced.
As a general theory of individual human behavior and experience, psychoanalytic ideas enrich and are enriched by the study of the biological and social sciences, group behavior, history, philosophy, art, and literature. As a developmental theory, psychoanalysis contributes to child psychology, education, law, and family studies. Although Sigmund Freud, the founder of psychoanalysis first developed a theory of the mind largely functioning outside of conscious awareness, over the past one-hundred years there have evolved several distinct schools of psychoanalysis… Drive Theory, Object Relations, Relational, Interpersonal, Self-Psychology, Intersubjective, Lacanian… each of which contributes to the richness and diversity of psychoanalytic theory and practice.
Many scientists still doubt the validity of psychoanalytic models and methods because they were derived initially from clinical observation rather than empirical research. They also feel psychoanalysis underestimates the importance of biological factors in the development of mental illness. However while most psychoanalysts today accept that biology plays a role in symptom formation and treatment, they feel that biological psychiatry underestimates the importance that life experience has on the development of psychiatric syndromes. They also point out that while empirical research (the scientific method) is best at detecting phenomena that can be readily observed across a population of subjects, clinical research (the case study method) is better at detecting phenomena that result from the unique interactions of forces within individual cases.
In fact psychoanalytic models, sometimes disparaged as “pre-scientific” because they are better at generating hypotheses than in suggesting ways to test hypotheses, are often much more useful to mental health clinicians than are scientifically validated “facts”. Additionally over the past fifty years an impressive array of empirical research findings in the areas of infant-toddler research, attachment theory, neuroscience and non-linear dynamic systems theory now support the most fundamental of psychoanalytic tenants [references]. Empirical research demonstrating the effect of unconscious mental processing (Psychology Department) supports the need for patients and therapists to attend to thoughts and feelings that usually occur out of awareness. Studies have demonstrated that transference interpretations – explicit statements about how unconscious feelings are being projected onto the person of the analyst/therapist – are particularly helpful to seriously disturbed patients (Transference Interpretation). In fact there are several recent studies demonstrating the superior effectiveness of psychoanalytic therapy over other psychotherapies in specific patient populations (Psychoanalytic Therapy, Therapy Effectiveness).
For a recent review of other empirical research in psychoanalysis, see Fonagy (1999). For a detailed review of how research in cognitive neuroscience is starting to integrate with psychoanalytic concepts, see Westen & Gabbard (2002). For a discussion of the clinical implications of this research, see Gabbard & Westen (2003). Each year more and more empirical studies are being published that demonstrate that talk therapy actually changes brain structure and functions. For example, the entire April 2006 edition of the journal, “Psychiatric Annals” (Volume 36, Number 4) was devoted to “The Neurobiology of Psychotherapy”.
It is also becoming clear that an over-reliance on descriptive (DSM-V) diagnoses to conceptualize a patient’s clinical presentation and to formulate an effective treatment plan is reifying the denial of the importance of life experience and secondary personality functioning in mental illness. In response psychoanalysts recently published a new reference called the “Psychodynamic Diagnostic Manual” (PDM). This manual is designed to complement, rather than compete with DSM-V. According to one of the authors, Nancy McWilliams, Ph.D., the authors hope the manual will be used by psychiatrists and psychologists to more accurately understand not just the symptoms from which their patients suffer, but how life experience was involved in their development and thus how better to integrate pharmacotherapy and psychotherapy treatments. The work of skilled clinician-researchers like Dr. McWilliams is leading to a new vision of what psychoanalysis will and should become in the next century (Next Generation Analysis).
Key Benefits
- Psychoanalysis is an effective treatment for many people with a variety of difficulties who have had at best only a partial response from briefer therapies that focus on symptom management.
- As a therapy, psychoanalysis is based on the observation that individuals are often unaware of many of the factors that determine their emotions and behavior. These unconscious factors may create unhappiness, sometimes in the form of recognizable symptoms and at other times as troubling personality traits, difficulties in work or in love relationships, or disturbances in mood and self-esteem. Because these forces are unconscious, counseling, the advice of friends and family, the reading of self-help books, or even the most determined efforts of will often fail to provide relief.
- The analyst helps elucidate these for the patient, who refines, corrects, rejects, and adds further thoughts and feelings. During the years that an analysis takes place, the patient wrestles with these insights, going over them again and again with the analyst and experiencing them in daily life, in fantasies, and in dreams. Patient and analyst join in efforts not only to modify crippling life patterns and remove incapacitating symptoms, but also to expand the freedom to work and to love. Eventually the patient’s life – his or her behavior, relationships and sense of self – changes in deep and abiding ways.
Capabilities
Most graduate psychoanalysts have had very rigorous and extensive clinical education (to review the educational standards maintained by most psychoanalytic institutes in the United States, go to www.acpeinc.org). Candidates accepted for training at a psychoanalytic institute must meet high ethical, psychological, and professional standards. These candidates are either physicians who have completed a four-year residency program in psychiatry, psychologists or social workers who have completed a doctoral program in their fields or hold a clinical master’s degree in a mental health field where such a degree is generally recognized as the highest clinical degree. All must have had extensive clinical experience. Psychoanalytic training consists of three parts. Candidates attend classes in psychoanalytic theory and technique. They undergo a personal analysis. Finally, they conduct the psychoanalysis of at least three patients under the close and extended supervision of experienced analysts. At the completion of clinical training they usually must then write a publishable thesis that is peer-reviewed before they can graduate. Besides conducting psychoanalysis, most graduate analysts practice insight-oriented and brief supportive psychotherapy. Many psychoanalysts who are also psychiatrists prescribe medications when indicated. Many treat couples, conduct family or group therapy sessions, and work with the aging. Because psychoanalysts are provided with the most thorough education available in normal and pathological development, their training enhances the quality of all their work, no matter what clinical services are being provided. It also informs their community activities as teachers, supervisors, consultants, and researchers, in the many different settings where analysts are found such as hospitals, medical schools, colleges and day-care centers.
Unique Therapeutic Relationship
Psychoanalyst and patient form an intimate partnership. During the course of treatment the patient becomes aware of the previously unconscious sources of his or her difficulties – not simply intellectually, but emotionally, by re-experiencing them with the analyst. Minimizing the gap between conscious truth and unconscious truth is considered an important goal of psychoanalysis. Truth in this sense is an evolving understanding that becomes clearer to both analyst and patient as a result of their inter-subjective relatedness. This relatedness provides the patient the necessary strength and freedom to face reality with less defensive distortions and fewer self-deceptions.
Intensive Clinical Setting
Typically, the patient comes four or five times a week for several years, lies on a couch, and attempts to say everything that comes to mind. These conditions create the analytic setting, which permits the emergence of aspects of the mind not accessible to other methods of observation. A less intensive form of psychoanalytic treatment, Psychoanalytic Psychotherapy, is a once or twice per week process that utilizes many of the same techniques used in psychoanalysis but is shorter term and attempts to help patients understand and work through specific issues rather than to analyze all of their core conflicts and relationship patterns.
Exploration of the Repetition Compulsion
As the patient speaks, hints of the unconscious sources of current difficulties gradually begin to appear in certain repetitive patterns of behavior, in the subjects which the patient finds hard to talk about, and in the ways the patient relates to the analyst. The analyst helps elucidate these for the patient, who refines, corrects, rejects, and adds further thoughts and feelings. During the years that an analysis takes place, the patient wrestles with these insights, going over them again and again with the analyst and experiencing them in daily life, in fantasies, and in dreams. Patient and analyst join in efforts not only to modify crippling repetitive behavior patterns and remove incapacitating symptoms, but also to expand the freedom to work and to love. Eventually the patient’s life – his or her behavior, relationships, sense of self – changes in deep and abiding ways as he or she feels freer to consciously choose how to behave rather than compulsively repeating the past.
For more information about Psychoanalysis, please visit the official web site of the American Psychoanalytic Association.