Psychoanalysis

Psychoanalysis seeks to discover connections among the unconscious components of patients' mental processes. The analyst's goal is to help liberate the patient from unexamined or unconscious barriers of transference and resistance, that is, past patterns of relating that are no longer serviceable or that inhibit freedom.

The following has been adapted from the Wikipedia.org website.

Psychoanalysis was devised in Vienna in the 1890s by Sigmund Freud, a neurologist interested in finding an effective treatment for patients with neurotic or hysterical symptoms. As a result of talking with these patients, Freud came to believe that their problems stemmed from culturally unacceptable, thus repressed and unconscious, desires and fantasies of a sexual nature. As his theory developed, Freud developed and cast aside a myriad of different frameworks to model and explain the phenomena he encountered in treating his patients.

Freud's patients would lie on this couch during psychoanalysis. The basic method of psychoanalysis is the transference and resistance analysis of free association. The patient, in a relaxed posture, is directed to say whatever comes to mind. Dreams, hopes, wishes, and fantasies are of interest, as are recollections of early family life. Generally the analyst simply listens, making comments only when, in his or her professional judgment, an opportunity for insight on the part of the patient arises. In listening, the analyst attempts to maintain an attitude of empathic neutrality, a nonjudgmental stance designed to create a safe environment. The analyst asks that the analysand (patient) speak with utter honesty about whatever comes to awareness while interpreting the patterns and inhibitions that appear in the patient's speech and other behavior.

Many clinicians hold that psychoanalysis is not recommended in cases of serious psychological disruption, such as psychosis, suicidal depression, or severe untreated alcoholism. Such patients may be labeled "un-analyzable". More typical applications include treatment of clinical depression and personality disorders.

Some more recent forms of psychoanalysis seek to help patients gain self-esteem through greater trust of the self, overcome the fear of death and its effects on current behavior, and maintain several relationships that appear to be incompatible.

Although single-client sessions remain the norm, psychoanalysis has been adapted as a form of group therapy by Harry Stack Sullivan and others.

Efficacy
Currently, most psychoanalysts claim that analysis is most useful as a method in cases of neurosis and with character or personality problems. Psychoanalysis is believed to be most useful in dealing with ingrained problems of intimacy and relationship and for those problems in which established patterns of life are problematic. As a therapeutic treatment, psychoanalysis generally takes three to five meetings a week and requires the amount of time for natural or normal maturational change (three to seven years).  Analysis of previous randomized controlled trials have suggested that psychoanalytic treatment is more effective than the absence of treatment in specific psychiatric disorders.

Cost and length
The cost of psychoanalytic treatment ranges widely, from as low as ten dollars a session (with an analytic candidate in training at an institute) to over 250 dollars a session with a senior training analyst.

Length of treatment varies. Some psychodynamics approaches, such as Brief Relational Therapy (BRT), Brief Psychodynamics Therapy (BPT), and Time-Limited Dynamic Therapy (TLDP) limit treatment to 20-30 sessions. Full-fledged psychoanalysis, however, generally lasts longer, with an average of 5.7 years, according to a recent survey. Which treatment length is optimal depends on the individual's needs. Managed care has placed increased pressure on psychotherapy in general to restrict time devoted to patients.

Training
Throughout the history of psychoanalysis, most psychoanalytic organizations have existed outside of the university setting, with a few notable exceptions.  Psychoanalytic training usually occurs at a psychoanalytic institute and may last approximately 4-10 years. Training includes coursework, supervised psychoanalytic treatment of patients, and personal psychoanalysis lasting 4 or more years.

An ongoing debate in professional psychoanalysis concerns the qualifications candidates must have to enter analytic training. Freud believed that applicants from the humanities and many non medical disciplines are as well prepared as physicians for psychoanalytic training.

The American Psychoanalytic Association, however, limited access to training to medical doctors until quite recently. Later, after extensive debates and legal battles, psychoanalytic training in most institutes was opened to non medical mental health professionals, such as psychologists and clinical social workers. Currently, access to training by applicants from non clinical disciplines, such as literary studies and philosophy, is limited to a handful of institutes in the United States. By contrast, many or most institutes in Europe and Latin America admit candidates without formal clinical training.

Although the popularity of psychoanalysis was in decline during the 1980's and early 1990's, prominent psychoanalytic institutes have experienced an increase in the number of applicants in recent years.

The theories distinctive of psychoanalysis generally include the following hypotheses:

Human development is best understood in terms of changing objects of sexual desire.
The psychic apparatus habitually represses wishes, usually of a sexual or aggressive nature, whereby they become preserved in one or more unconscious systems of ideas.
Unconscious conflicts over repressed wishes have a tendency to manifest themselves in dreams, parapraxes ("Freudian slips"), and symptoms.
Unconscious conflicts are the source of neuroses.
Neuroses can be treated through bringing the unconscious wishes and repressed memories to consciousness in psychoanalytic treatment.

The unconscious and psychic structures
The unconscious refers to that part of mental functioning of which subjects make themselves unaware. The psychoanalytic unconscious is similar to but not precisely the same as the popular notion of the subconscious. For psychoanalysis, the unconscious does not include all of what is not conscious. It does not include e.g., motor skills, but only what is actively repressed from conscious thought. It does include instances of automatic processing such as stereotypes and the effects of past relationships on the present.

For Freud, the unconscious was a depository for socially unacceptable ideas, wishes or desires, traumatic memories, and painful emotions put out of mind by the mechanism of psychological repression. However, the contents did not necessarily have to be solely negative. In the psychoanalytic view, the unconscious is a force that can only be recognized by its effects—it expresses itself in the symptom.

The ego, super-ego, and id are the divisions of the psyche according to Freud's later "structural theory". The id contains "primitive desires" (hunger, rage, and sex), the super-ego contains internalized norms, morality and taboos, and the ego mediates between the two and may include or give rise to the sense of self.

Roots of neurosis
In his earliest writings on the subject, Freud theorized that all neuroses were rooted in childhood sexual abuse (the so-called seduction theory). Later, Freud came to abandon or de-emphasize this hypothesis, emphasizing instead the importance of unconscious fantasy as the cause of neurosis, particularly fantasy structured according to the Oedipus complex.

The Oedipus complex is a concept developed by Sigmund Freud to explain the origin of certain neuroses in childhood. It is defined as a male child's unconscious desire for the exclusive love of his mother. This desire includes jealousy towards the father and the unconscious wish for that parent's death. The idea is based on the Greek myth of Oedipus, who unwittingly kills his father Laius and marries his mother Jocasta.

The life and death instincts
Freud believed that humans were driven by two conflicting central desires: the life drive (Eros) (incorporating the sex drive) and the death drive (Thanatos). Freud's description of Eros/Libido included all creative, life-producing drives. The death drive (or death instinct) represented an urge inherent in all living things to return to a state of calm, or, ultimately, of non-existence. The presence of the death drive was only recognized in his later years, and the contrast between the two represents a revolution in his manner of thinking.

Scientific validity
An early and important criticism of psychoanalysis was that its theories were based on little quantitative and experimental research, and instead relied almost exclusively on the clinical case study method. In comparison, brief psychotherapy approaches such as behavior therapy and cognitive therapy have shown much more concern for empirical validation.

The more you understand about psychoanalysis and other therapeutic approaches, the better you can cope with mental health problems. Reaching out for information and assistance can help you live a healthier and more fulfilling life. People who suffer from mental health problems can get help from a mental health professional such as a psychologist, psychiatrist, or clinical social worker. For more information about psychoanalysis and other therapeutic approaches, please click on the linked websites listed below.

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