The famous psychiatrist, Dr Sigmund Freud, who began practicing in the late 19th century, first developed psychoanalysis. The classic image, often seen in movies and cartoons, of a patient lying on a couch with the therapist behind them writing on a notepad comes directly from the psychoanalytic technique.
The theory of psychoanalysis suggests that a large amount of information and feeling experienced in early childhood development is stored in the unconscious part of the mind. This implies that a patient is not normally aware of what is present in his/her unconscious mind. Early traumatic experiences, which are postulated by the theory to be able to stop appropriate emotional development occurring during the first five years of life can, it is proposed, later produce depression, anger, fear and also cause significant distress within a person's relationships and in her/her occupational life.
The goal of the psychoanalytic therapist is to gradually bring out into conscious awareness material that is thought to have been repressed (because of the pain it causes) and stored in the unconscious mind. The therapeutic process then requires that this previously repressed material is then slowly integrated into the total structure of the person's personality. As this occurs, psychoanalytic theory postulates that the strong emotions of depression, fear and anger associated with such repressed memories should begin to settle as these traumatic and disturbing materials, previously hidden, become harmonized in the person's overall personality and life.
For example, a woman who was sexually abused by a loved uncle, a keen horseman, has experienced fear and hatred of horses from her adolescence onwards. She underwent psychoanalysis where the therapist allowed her to explore the underlying meaning behind her fear of horses. Over time, they made a link between her hatred of horses, and horses representing aggressive sexuality.
How does psychoanalysis work?
The main goal of psychoanalysis is the gradual integration of previously repressed material into the total structure of the personality. This is a slow process. The first technique developed by Freud was 'free association' where patients say, in response to a stimulus word or phrase, everything and anything that comes to mind without any sort of censoring. The person must be completely honest with the analyst. As the patient talks, the analyst starts studies these associations, looking for underlying themes which might be clues to what is represented in the patient's unconscious mind. As more information is presented over time, the psychoanalyst makes interpretations and starts linking pieces of these 'unconscious thoughts' together. The patient and the analyst seldom follow a straight path in this presumed exploration of the unconscious. Instead, the process of analysis is more like putting together pieces of an immense and complicated jigsaw puzzle.
Throughout this process, the therapeutic relationship between the analyst and the patient is thought to develop and come to mirror aspects of the patient's earlier relationships with parents or parental figures. These feelings, thought to be largely unconscious, may be either positive or negative. The patient is described as struggling to gratify his/her unconscious infant-like wishes and desires through the analyst who becomes a substitute parental figure. This whole process of transferring onto the analyst, feelings thought to have developed originally in infancy in respect of important figures in the infant's life, is called transference and was first described by Freud. Handling 'the transference relationship' and making well-timed interpretations of related psychological material is considered to be the key area of the skill and artistry of a good psychoanalyst.
Over time, such 'unconscious' early repressed thoughts and damaged feelings, it is hoped, will become integrated into the person and reworked and corrected through the therapeutic relationship with the psychoanalyst.
What is involved in a session?
The patient and psychoanalyst must be prepared to persevere in the process for an indefinite period. Psychoanalysis takes time, often between three to six years and sometimes even longer. Sessions are usually held four or more times per week for 45 to 50 minutes each. Some analyses are conducted with less frequency and with the sessions varying from 20 to 30 minutes. In order to be effective, the patient must agree to be completely honest with the analyst and tell him/her everything without selection or any mental screening. This is thought essential no matter how embarrassing or unacceptable the patient might believe the thoughts to be.
Who provides psychoanalysis?
Only a qualified and properly trained psychoanalyst should undertake psychoanalysis. This is particularly important because of the strong therapeutic relationships that occur in psychoanalysis, the frequent contact that the patient has with the therapist over a long period of time and the fact that strong transference issues make the patient potentially very vulnerable to a predatory or unethical psychoanalyst. It is usually expected that psychoanalysts be trained through an Accredited Psychoanalytic Institute with high ethical, psychological and professional standards. Candidates are normally doctors who have completed training in psychiatry, or psychologists or social workers who have often achieved a doctoral degree in their fields or a clinical masters' degree in the mental health field. All candidates should have extensive previous clinical experience. Training to be a psychoanalyst normally 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.
To find a psychoanalyst it is appropriate to contact the local Psychiatric Association. These associations should have a list of accredited psychoanalysts and can normally provide information with regard to contact numbers and availability.
Who can be helped by psychoanalysis?
Because psychoanalysis is a highly individualized treatment, therefore, people wishing to know if this type of therapy would be of benefit for them should first be assessed by an experienced psychoanalyst. However, certain generalizations can be made.
A certain level of robustness of personality is necessary for an individual to undergo psychoanalysis successfully. Though people might be significantly impaired by longstanding symptoms of depression, anxiety or sexual incapacities, they have often already achieved important goals and satisfactions in their lives, with friends, in marriage, in work or in special interests and hobbies. The individual must also be intelligent enough to be able to understand the procedure and to be able to cooperate in the process. The client should also have some ability for introspection and must also have a desire for change.
Most psychoanalysts would agree that an inability to relate to other individuals is probably the single most negative predictor of a good psychotherapeutic response. The true antisocial personality disorder, where there is a lack of remorse and an inability to achieve emotional attachment, makes engagement in therapy almost impossible.
Are there any negative side effects?
Negative effects of psychoanalysis may occur if the patient is not robust enough to handle underlying repressed information or does not have the psychological tools to integrate it into their personality structure. Negative side effects can also occur with an inexperienced analyst who misuses or does not fully understand his/her power and interpretative ability. Such a circumstance can have a seriously traumatic effect on patients. In some cases these adverse outcomes may repeat and mirror early abusive relationships the patient has suffered.
