Psychoanalytic psychotherapy (once or twice per week) is a form of psychotherapy that is more intensive than cognitive-behavioral therapy or counseling but is less intensive than psychoanalysis (three to five times per week). Whereas cognitive therapy generally focuses on understanding the conscious thoughts that trigger problematic feelings and behavior, and counseling generally focuses on improving the ability to cope with external stressors that are difficult to bear, psychoanalytic psychotherapy puts current problems in context of one’s developmental history and unconscious mental processes. This is because, more often than not, problems in adulthood start out as solutions to problems in childhood that have outlived their usefulness.
The solutions to early life problems are generally defensive strategies that operate outside of one’s conscious awareness. For example, a child might have had to adapt to parental expectations that were experienced as unreasonable, such as the expectation that the child must always keep angry feelings to him- or herself in order to be seen as “good”. Faced with that expectation, the child must find a way to adapt when angry, such as by distracting him- or herself. If that strategy repeatedly helped the child avoid conflict, it usually becomes habituated. Later, that habit follows the child into adulthood.
Unfortunately, such a solution fails to adequately help the child deal with the source of the anger. When unconsciously repeated in adulthood, the original reason why the child was angry is not consciously recognized. Rather, it ends up amplifying feelings caused by the adult situation. As a result, the adult ‘s current behavior is seen as the sole source his or her anger and the roots of that unresolved anger are not recognized. At that moment the person who made the adult angry “catches it” for the person that originally made him or her angry. That is why, more often than not, these patterns repeat themselves in intimate relationships and why they are so hard to recognize and change.
Psychoanalytic psychotherapy takes time and requires a higher level of intensity than other therapies because it takes time to develop trust in the therapist and because patients are largely unaware of the sources of their problems. They also must learn to relax their guard and share whatever comes to mind, which is not easy before the therapist is able to prove he or she is worthy of the patient’s trust. Unfortunately, memories are stored in disconnected fragments, much like a jigsaw puzzle that has yet to be assembled. The therapeutic dyad must work together to get the pieces “out of the box” and assemble them into an understandable narrative. Only then does the context of one’s backstory inform the therapist and patient about why the patient is struggling.