What is psychoanalysis?
Psychoanalysis is a psychotherapy focused on developing deep and lasting psychic change. To accomplish this the therapist and patient spend time in sustained discourse, sometimes face to face, but also where the patient might be reclined on a couch. The theory understands the human mind to function in multiple conscious and unconscious ways and that the honest exploration of these processes, while challenging, leads to psychic growth. In the environment of the consulting room, we try to authentically express ourselves so we can explore these aspects of mind with as much depth as possible. The treatment then involves exploring these experiences in conjunction with the therapeutic relationship to appreciate, affect and develop the way the patient thinks, feels, and relates to themselves and others.
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Psychoanalysis has a substantial and continually growing body of scientific evidence supporting its efficacy that is on par or superior to other treatment including medication management and other talk therapies (see a talk I give to psychiatrists in training).
Psychoanalysis is one of the only treatments whose goal is to come to terms with the unique underlying reasons for a person’s distress. Psychoanalysis treats each person individually rather than assigning them rough (and scientifically dubious) categorizations or forcing them into scripted treatment protocols. |
Psychoanalytic therapies are hard work. They require a significant investment of time, finances and will. The process may also involve change which can at times feel uncomfortable or even threatening to the patient or the people around them. Also, it is quite normal for the results of dynamic therapy to not be exactly what either the patient or the therapist completely expect. It is a process that is unique to each person who engages in it. However, I also believe that the appropriate use of dynamic therapies are currently one of the most effective and lasting tools for treating mental distress, especially the kind of distress associated with a repetitive pattern of feelings or experience, where a person either feels 'stuck' or wonders why the same kind of process seems to happen over and over again in their lives. The results of psychoanalytic therapy can last a lifetime and do not have the degree of side effects associated with many medications. They can also provide a level of freedom and insight into current or past experiences that many people are surprised by. This new understanding can help people accomplish and overcome obstacles they never were able to do prior to treatment and help them lead more satisfying lives.
Psychoanalysis is not a treatment for people who want immediate results or quick fixes. While there can be changes relatively quickly in some treatments, many lasting results bear out over months and years of regular treatment. |
Dr. Norman Doidge is a psychoanalyst and neuroscientist describing the need for intensive psychotherapy.
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Other Perspectives and Psychoanalysis:
Nancy McWilliams, PhD, ABPP: “It seems to me that the overarching theme among psychodynamic approaches to helping people is that the more honest we are with ourselves, the better our chances for living a satisfying and useful life. Moreover, a psychoanalytic sensibility appreciates the fact that honesty about our own motives does not come easily to us. The diverse therapeutic approaches within the psychoanalytic pantheon share the aim of cultivating an increased capacity to acknowledge what is not conscious – that is to admit what is difficult or painful to see in ourselves.” Nancy McWilliams. Psychanalytic Psychotherapy: A Practitioners Guide, pg 1. 1st ed. : Guillford Press, 2004.
Thomas Ogden, M.D. : ”I view psychoanalysis as most fundamentally an effort by patient and analyst to put into words what is true to the patient's emotional experience. This articulation holds such great importance because the very act of thinking and giving “shape” to what is true to the patient's emotional experience alters that truth. This perspective underlies my conception of the therapeutic action of interpretation: In interpreting, the analyst verbally symbolizes what he intuits to be true to the patient's unconscious experience and, in so doing, alters what is true and contributes to the creation of a potentially new experience with which the analytic pair may do psychological work. Patient and analyst are not in search of truth for its own sake; they are principally interested in what is true to what is happening in the transference-countertransference. The analytic pair is doing so for the purpose of creating a containing human context in which the patient may be able to live with his past and present emotional experience (as opposed to evacuating it or deadening himself to it). In helping the patient to face the truth of his emotional experience, the analyst is respectful of the ways the patient (beginning in his infancy) has found to protect his sanity. The rhythm and pace of the patient's efforts to face the truth of his emotional experience is set by the patient. A large part of the analyst's role involves holding the tension between the patient's need for safety and his need for truth.” Ogden, T.H. (2005). What I Would Not Part With. Fort Da, 11:8-17.
MARK J HILSENROTH, PhD.: This paper compared psychodynamic therapy with other therapies in the literature and determined seven features that distinguished psychodynamic therapy from other therapies. This is an extended description of these differences quoted from the textbook “Psychodynamic Psychotherapy Research: Evidence-Based Practice and Practice-Based Evidence.”
1. Focus on affect and expression of emotion. Psychodynamic psychotherapy encourages exploration and discussion of the full range of a patient’s emotions. The therapist helps the patient describe and put words to feelings, including contradictory feelings, feelings that are troubling or threatening, and feelings that the patient may not initially be able to recognize or acknowledge (this stands in contrast to a cognitive focus, where the greater emphasis is on thoughts and beliefs). There is also a recognition that intellectual insight is not the same as emotional insight which resonates at a deep level and leads to change; this is one reason why many intelligent and psychologically minded people can explain the reasons for their difficulties, yet their understanding does not help them overcome those difficulties.
2. Exploring attempts to avoid distressing thoughts and feelings. People do a great many things, knowingly and unknowingly, to avoid aspects of experience that are troubling. This avoidance (in theoretical terms, defense and resistance) may take coarse forms, such as missing sessions, arriving late, or being evasive. It may take subtle forms that are difficult to recognize in ordinary social discourse, such as subtle shifts of topic when certain ideas arise, focusing on incidental aspects of an experience rather than on what is psychologically meaningful, attending to facts and events to the exclusion of affect, focusing on external circumstances rather than one’s own role in shaping events, and so on. Psychodynamic psychotherapists actively focus on and explore avoidances.
3. Identifying recurring themes and patterns. Psychodynamic psychotherapists work to identify and explore recurring themes and patterns in patients’ thoughts, feelings, self-concept, relationships, and life experiences. In some cases, a patient may be acutely aware of recurring patterns that are painful or self-defeating but feel unable to escape them (e.g., a man who repeatedly finds himself drawn to romantic partners who are emotionally unavailable; a woman who regularly sabotages herself when success is at hand). In other cases, the patient may be unaware of the patterns until the therapist helps him or her recognize and understand them.
4. Discussion of past experience (developmental focus). Related to identifying of recurring themes and patterns is the recognition that past experience, especially early experiences of attachment figures, affects our relation to, and experience of, the present. Psychodynamic psychotherapists explore early experiences, the relation between past and present, and the ways in which the past tends to “live on” in the present. The focus is not on the past for its own sake, but rather on how the past sheds light on current psychological difficulties. The goal is to help patients free themselves from the bonds of past experience in order to live more fully in the present.
5. Focus on interpersonal relations. Psychodynamic psychotherapy places heavy emphasis on patients’ relationships and interpersonal experience (in theoretical terms, object relations and attachment). Both adaptive and nonadaptive aspects of personality and self-concept are forged in the context of attachment relationships, and psychological difficulties often arise when problematic interpersonal patterns interfere with a person’s ability to meet emotional needs.
6. Focus on the therapy relationship. The relationship between therapist and patient is itself an important interpersonal relationship, one that can become deeply meaningful and emotionally charged. To the extent that there are repetitive themes in a person’s relationships and manner of interacting, these themes tend to emerge in some form in the therapy relationship. For example, a person prone to distrust others may view the therapist with suspicion; a person who fears disapproval, rejection, or abandonment may fear rejection by the therapist, whether knowingly or unknowingly; a person who struggles with anger and hostility may struggle with anger toward the therapist; and so on (these are relatively crude examples; the repetition of interpersonal themes in the therapy relationship is often more complex and subtle than these examples suggest). The recurrence of interpersonal themes in the therapy relationship (in theoretical terms, transference and countertransference) provides a unique opportunity to explore and rework them in vivo. The goal is greater flexibility in interpersonal relationships and an enhanced capacity to meet interpersonal needs.
7.Exploration of wishes and fantasies. In contrast to other therapies where the therapist may actively structure sessions or follow a predetermined agenda, psychodynamic psychotherapy encourages patients to speak freely about whatever is on their minds. When patients do this (and most patients require considerable help from the therapist before they can truly speak freely), their thoughts naturally range over many areas of mental life, including desires, fears, fantasies, dreams, and daydreams (which in many cases the patient has not previously attempted to put into words). All of this material is a rich source of information about how the person views self and others, interprets and makes sense of experience, avoids aspects of experience, or interferes with a potential capacity to find greater enjoyment and meaning in life.
The last sentence hints at a larger goal that is implicit in all of the others: The goals of psychodynamic psychotherapy include, but extend beyond, symptom remission. Successful treatment should not only relieve symptoms (i.e., get rid of something) but also foster the positive presence of psychological capacities and resources. Depending on the person and the circumstances, these might include the capacity to have more fulfilling relationships, make more effective use of one’s talents and abilities, maintain a realistically based sense of self esteem, tolerate a wider range of affect, have more satisfying sexual experiences, understand self and others in more nuanced and sophisticated ways, and face life’s challenges with greater freedom and flexibility.”
MD, Hilsenroth MJ. Distinctive activities of short-term psychodynamic-interpersonal psychotherapy: a review of the comparative psychotherapy process literature. Clin Psychol Sci Pract. 2000;7:167–88.
Kächele, Horst; Levy, Raymond A.; Ablon, J. Stuart (2011-12-22). Psychodynamic Psychotherapy Research: Evidence-Based Practice and Practice-Based Evidence (Kindle Locations 657-670). Springer. Kindle Edition.
Nancy McWilliams, PhD, ABPP: “It seems to me that the overarching theme among psychodynamic approaches to helping people is that the more honest we are with ourselves, the better our chances for living a satisfying and useful life. Moreover, a psychoanalytic sensibility appreciates the fact that honesty about our own motives does not come easily to us. The diverse therapeutic approaches within the psychoanalytic pantheon share the aim of cultivating an increased capacity to acknowledge what is not conscious – that is to admit what is difficult or painful to see in ourselves.” Nancy McWilliams. Psychanalytic Psychotherapy: A Practitioners Guide, pg 1. 1st ed. : Guillford Press, 2004.
Thomas Ogden, M.D. : ”I view psychoanalysis as most fundamentally an effort by patient and analyst to put into words what is true to the patient's emotional experience. This articulation holds such great importance because the very act of thinking and giving “shape” to what is true to the patient's emotional experience alters that truth. This perspective underlies my conception of the therapeutic action of interpretation: In interpreting, the analyst verbally symbolizes what he intuits to be true to the patient's unconscious experience and, in so doing, alters what is true and contributes to the creation of a potentially new experience with which the analytic pair may do psychological work. Patient and analyst are not in search of truth for its own sake; they are principally interested in what is true to what is happening in the transference-countertransference. The analytic pair is doing so for the purpose of creating a containing human context in which the patient may be able to live with his past and present emotional experience (as opposed to evacuating it or deadening himself to it). In helping the patient to face the truth of his emotional experience, the analyst is respectful of the ways the patient (beginning in his infancy) has found to protect his sanity. The rhythm and pace of the patient's efforts to face the truth of his emotional experience is set by the patient. A large part of the analyst's role involves holding the tension between the patient's need for safety and his need for truth.” Ogden, T.H. (2005). What I Would Not Part With. Fort Da, 11:8-17.
MARK J HILSENROTH, PhD.: This paper compared psychodynamic therapy with other therapies in the literature and determined seven features that distinguished psychodynamic therapy from other therapies. This is an extended description of these differences quoted from the textbook “Psychodynamic Psychotherapy Research: Evidence-Based Practice and Practice-Based Evidence.”
1. Focus on affect and expression of emotion. Psychodynamic psychotherapy encourages exploration and discussion of the full range of a patient’s emotions. The therapist helps the patient describe and put words to feelings, including contradictory feelings, feelings that are troubling or threatening, and feelings that the patient may not initially be able to recognize or acknowledge (this stands in contrast to a cognitive focus, where the greater emphasis is on thoughts and beliefs). There is also a recognition that intellectual insight is not the same as emotional insight which resonates at a deep level and leads to change; this is one reason why many intelligent and psychologically minded people can explain the reasons for their difficulties, yet their understanding does not help them overcome those difficulties.
2. Exploring attempts to avoid distressing thoughts and feelings. People do a great many things, knowingly and unknowingly, to avoid aspects of experience that are troubling. This avoidance (in theoretical terms, defense and resistance) may take coarse forms, such as missing sessions, arriving late, or being evasive. It may take subtle forms that are difficult to recognize in ordinary social discourse, such as subtle shifts of topic when certain ideas arise, focusing on incidental aspects of an experience rather than on what is psychologically meaningful, attending to facts and events to the exclusion of affect, focusing on external circumstances rather than one’s own role in shaping events, and so on. Psychodynamic psychotherapists actively focus on and explore avoidances.
3. Identifying recurring themes and patterns. Psychodynamic psychotherapists work to identify and explore recurring themes and patterns in patients’ thoughts, feelings, self-concept, relationships, and life experiences. In some cases, a patient may be acutely aware of recurring patterns that are painful or self-defeating but feel unable to escape them (e.g., a man who repeatedly finds himself drawn to romantic partners who are emotionally unavailable; a woman who regularly sabotages herself when success is at hand). In other cases, the patient may be unaware of the patterns until the therapist helps him or her recognize and understand them.
4. Discussion of past experience (developmental focus). Related to identifying of recurring themes and patterns is the recognition that past experience, especially early experiences of attachment figures, affects our relation to, and experience of, the present. Psychodynamic psychotherapists explore early experiences, the relation between past and present, and the ways in which the past tends to “live on” in the present. The focus is not on the past for its own sake, but rather on how the past sheds light on current psychological difficulties. The goal is to help patients free themselves from the bonds of past experience in order to live more fully in the present.
5. Focus on interpersonal relations. Psychodynamic psychotherapy places heavy emphasis on patients’ relationships and interpersonal experience (in theoretical terms, object relations and attachment). Both adaptive and nonadaptive aspects of personality and self-concept are forged in the context of attachment relationships, and psychological difficulties often arise when problematic interpersonal patterns interfere with a person’s ability to meet emotional needs.
6. Focus on the therapy relationship. The relationship between therapist and patient is itself an important interpersonal relationship, one that can become deeply meaningful and emotionally charged. To the extent that there are repetitive themes in a person’s relationships and manner of interacting, these themes tend to emerge in some form in the therapy relationship. For example, a person prone to distrust others may view the therapist with suspicion; a person who fears disapproval, rejection, or abandonment may fear rejection by the therapist, whether knowingly or unknowingly; a person who struggles with anger and hostility may struggle with anger toward the therapist; and so on (these are relatively crude examples; the repetition of interpersonal themes in the therapy relationship is often more complex and subtle than these examples suggest). The recurrence of interpersonal themes in the therapy relationship (in theoretical terms, transference and countertransference) provides a unique opportunity to explore and rework them in vivo. The goal is greater flexibility in interpersonal relationships and an enhanced capacity to meet interpersonal needs.
7.Exploration of wishes and fantasies. In contrast to other therapies where the therapist may actively structure sessions or follow a predetermined agenda, psychodynamic psychotherapy encourages patients to speak freely about whatever is on their minds. When patients do this (and most patients require considerable help from the therapist before they can truly speak freely), their thoughts naturally range over many areas of mental life, including desires, fears, fantasies, dreams, and daydreams (which in many cases the patient has not previously attempted to put into words). All of this material is a rich source of information about how the person views self and others, interprets and makes sense of experience, avoids aspects of experience, or interferes with a potential capacity to find greater enjoyment and meaning in life.
The last sentence hints at a larger goal that is implicit in all of the others: The goals of psychodynamic psychotherapy include, but extend beyond, symptom remission. Successful treatment should not only relieve symptoms (i.e., get rid of something) but also foster the positive presence of psychological capacities and resources. Depending on the person and the circumstances, these might include the capacity to have more fulfilling relationships, make more effective use of one’s talents and abilities, maintain a realistically based sense of self esteem, tolerate a wider range of affect, have more satisfying sexual experiences, understand self and others in more nuanced and sophisticated ways, and face life’s challenges with greater freedom and flexibility.”
MD, Hilsenroth MJ. Distinctive activities of short-term psychodynamic-interpersonal psychotherapy: a review of the comparative psychotherapy process literature. Clin Psychol Sci Pract. 2000;7:167–88.
Kächele, Horst; Levy, Raymond A.; Ablon, J. Stuart (2011-12-22). Psychodynamic Psychotherapy Research: Evidence-Based Practice and Practice-Based Evidence (Kindle Locations 657-670). Springer. Kindle Edition.