What is Psychoanalysis?
When people ask what psychoanalysis is, they usually want to know about treatment. 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, 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.
Psychoanalytic treatment demonstrates how these unconscious factors affect current relationships and patterns of behavior, traces them back to their historical origins, shows how they have changed and developed over time, and helps the individual to deal better with the realities of adult life.
Analysis is an intimate partnership, in the course of which the patient becomes aware of the underlying sources of his or her difficulties not simply intellectually, but emotionally – by re-experiencing them with the analyst. Typically, the patient comes four or five times a week, 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. 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, 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 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, sense of self – changes in deep and abiding ways.
Psychoanalysts strive very hard to LISTEN to their patients– and to understand. This focus on listening and understanding is one of the dynamics that separates psychoanalysts from those mental health practitioners who see their prime goal as PRESCRIBING either behavior or medications.
Child and Adolescent Psychoanalysis
In addition to treating adults, psychoanalysts also treat adolescents and children after receiving special training. APsaA’s publication on child and adolescent psychoanalysistells how treatment can be beneficial.
Child and adolescent psychoanalysis, both offshoots of adult psychoanalysis, share with it a common theoretical framework for understanding psychological life, while also using additional techniques and measures to deal with the special capacities and vulnerabilities of children. For instance, the young patient is helped to reveal his or her inner feelings and worries not only through words, but also through drawings and fantasy play. In the treatment of all but late adolescents, parents are usually consulted to round out the picture of the child’s life. The goal of child and adolescent analysis is the removal of symptoms and of the psychological roadblocks that interfere with normal development.
Is Psychoanalysis only a Therapy?
Although psychoanalysis began as a tool for ameliorating emotional suffering, it is not only a therapy. It is, in addition, a method for learning about the mind, and also a theory, a way of understanding the processes of normal everyday mental functioning and the stages of normal development from infancy to old age. Furthermore, since psychoanalysis seeks to explain how the human mind works, it contributes insight into whatever the human mind produces. In so doing, it has had a profound influence on many aspects of 21st century culture.
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. Through its examination of the complex relationship between body and mind, psychoanalysis also furthers our understanding of the role of emotions in health as well as in medical illness.
In addition, psychoanalytic knowledge is the basis of all other dynamic approaches to therapy. Whatever the modifications, the insights of psychoanalysis form the underpinnings of much of the psychotherapy employed in general psychiatric practice, in child psychiatry, and in most other individual, family, and group therapies.
The Psychoanalytic Tradition
Sigmund Freud was the first psychoanalyst. Many of his insights into the human mind, which seemed so revolutionary at the turn of the century, are now widely accepted by most schools of psychological thought. Although others before and during his time had begun to recognize the role of unconscious mental activity, Freud was the preeminent pioneer in understanding its importance. Through his extensive work with patients and through his theory building, he showed that factors which influence thought and action exist outside of awareness, that unconscious conflict plays a part in determining both normal and abnormal behavior, and that the past shapes the present.
Although his ideas met with antagonism and resistance, Freud believed deeply in the value of his discoveries and rarely simplified or exaggerated them for the sake of popular acceptance. He saw that those who sought to change themselves or others must face realistic difficulties. But he also showed us that, while the dark and blind forces in human nature sometimes seem overwhelming, psychological understanding, by enlarging the realm of reason and responsibility, can make a substantial difference to troubled individuals and even to civilization as a whole.
Building on such ideas and ideals, psychoanalysis has continued to grow and develop as a general theory of human mental functioning, while always maintaining a profound respect for the uniqueness of each individual life. Ferment, change, and new ideas have enriched the field, and psychoanalytic practice has adapted and expanded. But psychoanalysts today still appreciate the persistent power of the irrational in shaping or limiting human lives, and they therefore remain skeptical of the quick cure, the deceptively easy answer, the trendy or sensationalistic.
Like Freud, they believe that psychoanalysis is the strongest and most sophisticated tool for obtaining further knowledge of the mind, and that by using this knowledge for greater self-awareness, patients free themselves from incapacitating suffering, and improve and deepen human relationships.
In the late nineteenth century, Freud formulated a theory of the human mind, psychoanalysis, which had at its basis the discovery of the unconscious. He pursued a theory of treatment to help patients bring traumatic memories and their accompanying affect into consciousness in ways that would allow them to form associative connection with other conscious thoughts and achieve expression.
There are currently diverse approaches to treatment within psychoanalysis, yet these approaches all share the aim of helping patients bring to their consciousness what is unconscious or difficult to acknowledge. Unconscious occurrences may include, for example, an individual’s vulnerabilities, motives, tensions, impulses, guilt, fantasies, or urges. One of the goals of psychoanalysis is to help the patient develop insight into his/her unconscious processes. Psychoanalysis encourages us to search for personal truthfulness and focuses specifically on the irrational dimensions of our mental life, as it applies rational procedures to achieve its goals.
Who can benefit from psychoanalysis?
Psychoanalysis is an effective treatment for many people with moderate to severe difficulties and who have had unsuccessful attempts with briefer therapies.
Because analysis is a highly individualized treatment, people who wish to know if they would benefit from it should seek consultation with an experienced psychoanalyst. Still, some generalizations can be made. The person best able to undergo psychoanalysis is someone who, no matter how incapacitated at the time, is basically, or potentially, a sturdy individual. This person may have already achieved important satisfactions – with friends, in marriage, in work, or through special interests and hobbies – but is nonetheless significantly impaired by longstanding symptoms: depression or anxiety, sexual incapacities, or physical symptoms without any demonstrable underlying physical cause. One person may be plagued by private rituals or compulsions or repetitive thoughts of which no one else is aware.
Another may live a constricted life of isolation and loneliness, incapable of feeling close to anyone. A victim of childhood sexual abuse might suffer from an inability to trust others. Some people come to analysis because of repeated failures in work or in love, brought about not by chance but by self- destructive patterns of behavior. Others need analysis because the way they are – their character – substantially limits their choices and their pleasures. And still others seek analysis definitively to resolve psychological problems that were only temporarily or partially resolved by other approaches.
Whatever the problem – and each is different – that a person brings to the analyst, it can be properly understood only within the context of that person’s strengths and life situation. Hence, the need for a thorough evaluation to determine who will benefit – and who will not – from psychoanalysis.
Who is a Psychoanalyst?
The designation “psychoanalyst” is not protected by federal or state law: anyone, even an untrained person, may use the title. It is therefore important to know the practitioner’s credentials before beginning treatment.
Graduate psychoanalysts trained under the auspices of the American Psychoanalytic Association have had very rigorous and extensive clinical education. Candidates accepted for training at an accredited training 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 masters 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. Outstandingly qualified scholars,researchers, educators, and selected other professionals may also be approved for psychoanalytic training. All accepted candidates, whatever their background, then begin at least four years of psychoanalytic training..
This training consists of three parts. Candidates attend classes in psychoanalytic theory and technique. They undergo a personal analysis. And they conduct the psychoanalysis of at least three patients under the close and extended supervision of experienced analysts. Candidates who plan to treat children attend further classes and, with supervision, analyze boys and girls ranging in age from toddlers to late adolescents.
Besides conducting psychoanalysis, most graduate analysts also practice intensive and brief psychotherapy, sometimes prescribing medication. 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 therapeutic work. It also informs their community activities as teachers, supervisors, consultants, and researchers, in the many different settings – hospitals, medical schools, colleges, daycare centers – where analysts are found.
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. Through its examination of the complex relationship between body and mind, psychoanalysis also furthers our understanding of the role of emotions in health as well as in medical illness. APsaA’s publication, “About Psychoanalysis”, is a valuable reference tool.
The psychoanalytic framework stresses the importance of understanding:
- that each individual is unique,
- that there are factors outside of a person’s awareness (unconscious thoughts) which influence his or her thoughts and actions,
- that the past shapes the present.