Psychoanalytical Psychotherapy

by Andrea M. Darcy
Reviewed by Dr Sheri Jacobson

Psychoanalytical psychotherapy is actually the oldest of all modern talk therapies, with roots right back to Freud. A now controversial therapy, it is not for everyone. But there are still many who find it their therapy of choice.

What is psychoanalysis?

Psychoanalytical psychotherapy is the modern term for what Freud called ‘psychoanalysis’. (Although note that many others have contributed to forming this type of therapy since he started things).

The main concept of this therapy is that we repress our childhood experiences in a hidden part of our mind called the ‘unconscious’. And that our unconscious than secretly controls our thoughts and behaviours, meaning our current challenges are all the result of our unresolved past.

By using tools to access our unconscious we can then release repressed emotions, understand ourselves, and make better choices that lead to a life we are happier in.

What are the tools of psychoanalytical therapy?

The biggest tool is simply speaking your mind freely. Not just what you think, but anything that comes into your mind. You might sometimes be asked to loosely riff from one thing into the next, saying whatever strange thing arrives, called ‘free association’.

Then there is dream work. Freud liked to work with dreams, which he felt were a road to the unconscious. Although not all modern psychoanalytical practitioners will focus on them and it’s not a pre-requisite of the approach.

The therapeutic relationship in psychoanalysis

Finally, one of the biggest tools here is the relationship you have with your psychoanalyst. Unlike other, more modern talk therapies where your therapist works to be their authentic selves with you, and it’s an equal relationship? Your psychoanalyst will choose to not bring their personality into your sessions.

Their aim is to be a sort of blank wall you can project onto in order to learn about your own ways of relating.

This is called ‘transference’. The idea is that we tend to ‘transfer’ our feelings and thoughts about other important people in our life onto our therapist. We might, say, see them as domineering like our father, or too passive like our ex partner. By examining how you feel about your therapist you can resolve old issues and find better ways of relating.

How is psychoanalysis different than other talk therapies?

1. It firmly sees the past as the solution to the present.

Modern therapies like CBT focus on your present behaviours and thoughts. Psychoanalytic counselling believes it’s unresolved past issues that are the root of the problem. You’ll be discussing the past in each session.

2. It’s a long-term commitment.

It’s definitely one of the longer-term forms of therapy out there, it can go on for years. And sometimes people even attend two, three, or even more sessions a week, that is decided between you and your psychoanalyst.

3. Your therapist talks less.

Some modern forms of therapy are quite interactive, and you might work through exercises with your therapist which sees them talk quite a bit. Or you might have a therapist who asks many questions about each utterance you make.

Psychoanalytical sessions can seem very quiet in contrast. Your therapist may say very little, as it’s up to you to speak or not speak. Remember, they are a blank wall. But even if nobody is talking they are learning about you from your body language, and your comfort or discomfort.

When you do talk, they are looking for hidden meaning and patterns.

4. There might be a couch.

Modern therapies don’t see you lying down like you see in TV, more often therapy is carried out seated in chairs. But the cliche of lying down staring at the ceiling comes from psychoanalysis and Freud, and some analysts will still have a couch. Of course it’s your choice whether to lie down or sit.

5. It uses tools other therapies don't.

Most other therapies won't use dreamwork, and only psychoanalysis uses free association.

What can a psychoanalytical psychotherapist help me with?

Psychoanalysis is more suited for general issues than severe mental health problems like psychosis or bipolar disorder. The sorts of issues that can suit this type of therapy include:

Trauma and the psychoanalytic approach

While some feel it helps with trauma, this is not always the case. For some people talking about the past so excessively can re-trigger their trauma response and leave them feeling self-destructive.

So it’s a question of whether your trauma has left you very sensitive and easily triggered. If you have c-PTSD, for example, if you are very vulnerable and trigger easily? You might be better off trying a therapy that helps you stabilise yourself, like CBT, dialectical behaviour therapy, schema therapy, or clinical hypnotherapy.

The controversy around psychoanalysis

Once very popular, psychoanalysis has fallen out of favour except for in France and Argentina, where it still has a stronghold.

It is criticised on several fronts, such as for giving the therapist special powers and presenting a ‘client/patient’ relationship instead of the client and therapist being equals.

It's also critiqued for promoting an ‘illness’ format, where you are ‘mentally ill’ and ‘need to get better’. More modern therapies like humanistic therapies see you as resourceful, but just in need of support finding and using your innate resources.

And then there is no scientific evidence to prove that things like free association and dreams do tell us the ‘truth’ about ourselves.

Finally, the idea that all our issues come from childhood is challenged. While many root issues can come from early experiences, we develop as people and can experience traumas at all ages.

Then there is of course Freud’s theories around ‘psychosexual development’ and the ‘Oedipus complex’, his idea that much of our troubles arises as we all fancy the parent of the opposite sex. But these ideas were long dropped by more modern contributors to psychoanalysis so you won't be dealing with this in sessions.

So then should I try this therapy or not?

On the other hand, those who defend psychoanalysis would point to the modern obsession with fast results and short-term therapies. And that funding for research goes towards these therapies as they save money, not as they are more effective. They argue that psychoanalysis is thorough, and creates a committed client/therapist dynamic.

And therapy is an individual choice. Some people still really enjoy psychoanalysis and find it works very well for them.

It's also important to note that most modern psychoanalysts will have also studied other forms of modern psychotherapy, so would offer a more integrative approach in any case. Or lean towards the psychodynamic approach.

If you really feel your past is the issue, and if you love the idea of a deep dive into who you are and what you've lived through, and of working with dreams and your unconscious? Then this might be just the therapy you need.

Time to stop being trapped in the past and move forward? Find your perfect psychoanalytic psychotherapist today.

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