What is Psychoanalytic Psychotherapy
My working definition of Psychoanalysis is the disciplined study of whatever it is people do not want toknow about themselves (Warren S Poland)
Psychoanalytic psychotherapy draws on theories and practices of analytical psychology and psychoanalysis.Psychoanalysis takes us from the darkness of the unconscious to the light of knowing and understanding who we are and who we can be. Psychoanalysis works to expose the unconscious and archaic areas of belief that silently govern our lives, impinge on ourselves and others, and this is one of the most liberating effects of analysis. One’s language, as a result, changes from self-reproach, self-depreciation and self-admonition for self-appraisal.
A psychoanalytic orientation implies: an expectation of long-term therapy; a focus on the psychodynamic context of symptoms or difficulties, their pattern, meaning and individual psychological background; and a non-directive technique, where interpretation of resistance and transference phenomena is essential and where fixed frames are emphasized. Patients may need more than one session per week as it aims to influence the deeper layers of the personality, at the sources of the troubling thoughts and behaviours. This big investment in one’s life can produce significant rewards in terms of the ability (as Freud put it) to love and to work. People find themselves freed to live life more to the full, to be more creative in all sorts of ways, and to relate to and care for others better. It has significant benefits over and above the behavioural, such as cognitive behavioural therapies - see link: https://www.theguardian.com/science/2016/jan/07/therapy-wars-revenge-of-freud-cognitive-behavioural-therapy and npsa-association.org/education-training/suggested-reading/the-efficacy-of-psychoanalyticpsychodynamic-therapies-reading-list/.
Most mental illnesses begin far more early in life than was previously believed due to the developmental and biological disruptions occurring during the early years of life – an epigenetic programming that alters gene expression (i.e. environment modifies how our genetics are expressed) and imparts either a risk for, or resilience to, later psychopathology. The epigenetic mechanism is centrally involved in creating individual differences in personality as well as more severe psychopathologies such as post-traumatic stress disorder, borderline personality disorder, schizophrenia and major depression.
The therapeutic relationship is the core of the change mechanism. Therapy changes brain structure and function; regional cerebral blood flow, neurotransmitter metabolism, gene expression and synaptic plasticity. Ongoing episodes of interactive regulation of affective arousal via intensive therapy, impact on a patient’s threshold for the activation of right brain stress responses. The processing of previously repressed affects, separated from awareness by defences and symptoms, allows them to become regulated and adaptively integrated into the patient’s emotional life. A patient’s tolerance for potential flooding or ‘triggering’ increases, allowing them to increasingly hold on to any experience as it is happening. Without the maladaptive defences and symptoms that block full right hemisphere maturation and affect regulation the patient is able to experience an integrated sense of self across state that transitions allows for a continuity of inner experience.
Thus, psychoananalytic psychotherapy differs from most other therapies in aiming for deep-seated change in personality and emotional development. Psychoanalytic psychotherapy aims to help people with serious psychological disorders to understand and change complex, deep-seated and often unconsciously based emotional and relationship problems, thereby reducing symptoms and alleviating distress. The role of the psychoanalytic psychotherapist is not limited only to those with mental health problems. Many people who experience a loss of meaning in their lives or who are seeking a greater sense of fulfillment or self-awareness may be helped by psychoanalytic psychotherapy.
Transference and countertransference
When Freud noticed people repeated troubled relationship patterns in the room with him, he discovered the phenomena of the transference. If, for example, a young man had a problem with a domineering father, he might appear pleasant and humble, but show secret rebellion about his father’s ambitions for him. In the consulting room, he might begin cooperatively saying what was in his mind, but then fall silent, commenting in a friendly way that, sorry, his mind was wandering; that he just wasn’t in the mood.
We now know that the counter-transference gives just as important clues as does the transference. The analyst might feel irritated at the patient’s silent resistance. He or she then steps back and becomes interested in his or her own irritation. In this way the analyst starts to get the picture of the relationship with the father, but also, more importantly, the whole way this young man deals with others he feels controlled by. This pattern is going to repeat itself with bosses at work. It may infuriate his partner, stop him getting what he really wants and needs in life, as so much energy will be wasted in automatically thwarting other people.
Whatever it is people tend to do, and to be, in close relationships, that is what happens sooner or later with your psychoanalyst. And it is for real, and can feel very unnerving. Uniquely, though, you will have a real chance of understanding and changing these patterns. Paul, who suffered a deprived and abusive childhood, managed a university degree but then after doing a few casual jobs, broke down in his early 20s. He lived a reclusive life over the next decade, unable to work, and beset with fears and grievances, though he continued to read in libraries, clinging on to some hope that he could find a way back into life. He read about a low-fee psychoanalytic clinic, and found the courage to apply. He was taken on by a trainee under supervision, numerous times a week.
Among other things, Paul’s troubled relationships with his parents played themselves out in the analytic relationship. He could be submissive but subtly provoking, as he had been with his violent father, or passive and dependent, as with his mother. His analyst had to monitor, carefully, the ways in which she was being unconsciously set up to repeat the past in all sorts of actual and symbolic ways. Instead of automatically reacting, she worked on trying to make sense of what was happening, and talking to Paul about it.
Change was slow and painful but, in time, the liveliness and curiosity that had been squashed and distorted in Paul could re-emerge. He started to take back responsibility for himself and his life, inside and outside sessions. He began to recover his confidence and his pleasure in living and working, and made new friends. Through evening classes, he got back into work, and eventually managed to train and do very well as a teacher.
People reveal hidden things about themselves in all sorts of ways, inside and outside analysis. Examples are slips of the tongue, jokes and dreams. Dreaming is the way we think while we are asleep, and it’s much less carefully censored than our waking thoughts. Our imagination has a freer reign during sleep, and dream ideas can be revealing and sometimes creative. Dreams can be straightforward, but they often need decoding to reveal the ideas and feelings being expressed, and they can often be useful in analysis.
Sometimes people seek help for specific reasons such as eating disorders, psycho-somatic conditions, obsessional behaviour, or phobic anxieties. At other times help is sought because of more general underlying feelings of depression or anxiety, difficulties in concentrating, dissatisfaction in work or inability to form satisfactory relationships. The therapy can help people with emotional and behavioural difficulties, which are evident at home or work, which can include personality problems, depression, learning difficulties, school phobias, eating or sleeping disorders.
Will a patient get very dependent on the therapist/therapy, and not be able to stop?
The psychotherapist does become a very significant person for a patient while they are working with together, especially if it’s an exploratory sort of treatment, like client-centred or psychoanalytic therapy, rather than a short course of behavioural or cognitive therapy. However, people usually turn to help of this sort when something is going badly wrong in their lives. Their freedom is already limited by the way in which their work, family life and relationships keep going wrong in the same old way.
If a patient goes into psychotherapy, they may be starting a relationship that will become intense and deeply important, perhaps for a number of years. However, this is for the ultimate purpose of becoming more independent that is, freer of their dependence on stuck, unconscious patterns of feeling, thinking and behaving. If the psychotherapy seems to be never-ending, something may need to be looked at. If a patient is able to have an open-ended psychotherapy, with no set time limit, they will usually find that it turns out to be a naturally evolving process with a beginning, middle and end. If it is allowed to take its own course, it is likely to last years rather than months.
Both therapist and patient usually sense and agree when it’s time to set an ending date and to work towards this. That’s not to say that it’s easy to stop seeing someone they have worked so closely with and grown attached to. But giving up and mourning the therapy itself is actually an important phase of the work.
Can psychotherapy help someone if they are a mental health service user?
Whether psychoanalytic psychotherapy is the treatment of choice for a particular individual depends on a variety of factors. It is often helpful to have one or more preliminary consultations before deciding whether psychoanalytic psychotherapy is an appropriate treatment for the person concerned. Generally speaking psychoanalytic psychotherapy is best considered as a long-term treatment involving considerable commitment for both patient and therapist. Everyone in distress needs to be listened to carefully and respectfully by their professional helpers, and users frequently complain that they do not have enough access to talking treatments. It’s important that the right sort of treatment is provided, at the right moment.
At a time when someone might be feeling persecuted and terrified, or very suicidal, they will probably need an approach that is less probing and challenging than at another time when they are feeling stronger and more resourceful. So if a patient is suffering from a psychotic illness, the choice and timing of any psychotherapy or counselling has to be thought about and tailored to their needs very carefully. Exploratory psychotherapies often stir things up in the slow process of healing, and can make patients feel very much worse at times; for example during breaks from treatment. This is why psychotherapists will insist that a patient’s psychiatrist or GP are also in the picture.
Substance abuse
If a patient is a heavy user of drugs or alcohol, they are unlikely to benefit from exploratory psychotherapy until they are completely free of the substance they are dependent on, and physically recovered. Only then will you have a clear enough head, and enough self-control, to be able to work together with the therapist and to hold on to what happens in the sessions. While they are still using the substance, a structured educational approach aiming to help them free themselves of the addiction will probably make most sense, or a self-help approach like Alcoholics Anonymous.
My working definition of Psychoanalysis is the disciplined study of whatever it is people do not want toknow about themselves (Warren S Poland)
Psychoanalytic psychotherapy draws on theories and practices of analytical psychology and psychoanalysis.Psychoanalysis takes us from the darkness of the unconscious to the light of knowing and understanding who we are and who we can be. Psychoanalysis works to expose the unconscious and archaic areas of belief that silently govern our lives, impinge on ourselves and others, and this is one of the most liberating effects of analysis. One’s language, as a result, changes from self-reproach, self-depreciation and self-admonition for self-appraisal.
A psychoanalytic orientation implies: an expectation of long-term therapy; a focus on the psychodynamic context of symptoms or difficulties, their pattern, meaning and individual psychological background; and a non-directive technique, where interpretation of resistance and transference phenomena is essential and where fixed frames are emphasized. Patients may need more than one session per week as it aims to influence the deeper layers of the personality, at the sources of the troubling thoughts and behaviours. This big investment in one’s life can produce significant rewards in terms of the ability (as Freud put it) to love and to work. People find themselves freed to live life more to the full, to be more creative in all sorts of ways, and to relate to and care for others better. It has significant benefits over and above the behavioural, such as cognitive behavioural therapies - see link: https://www.theguardian.com/science/2016/jan/07/therapy-wars-revenge-of-freud-cognitive-behavioural-therapy and npsa-association.org/education-training/suggested-reading/the-efficacy-of-psychoanalyticpsychodynamic-therapies-reading-list/.
Most mental illnesses begin far more early in life than was previously believed due to the developmental and biological disruptions occurring during the early years of life – an epigenetic programming that alters gene expression (i.e. environment modifies how our genetics are expressed) and imparts either a risk for, or resilience to, later psychopathology. The epigenetic mechanism is centrally involved in creating individual differences in personality as well as more severe psychopathologies such as post-traumatic stress disorder, borderline personality disorder, schizophrenia and major depression.
The therapeutic relationship is the core of the change mechanism. Therapy changes brain structure and function; regional cerebral blood flow, neurotransmitter metabolism, gene expression and synaptic plasticity. Ongoing episodes of interactive regulation of affective arousal via intensive therapy, impact on a patient’s threshold for the activation of right brain stress responses. The processing of previously repressed affects, separated from awareness by defences and symptoms, allows them to become regulated and adaptively integrated into the patient’s emotional life. A patient’s tolerance for potential flooding or ‘triggering’ increases, allowing them to increasingly hold on to any experience as it is happening. Without the maladaptive defences and symptoms that block full right hemisphere maturation and affect regulation the patient is able to experience an integrated sense of self across state that transitions allows for a continuity of inner experience.
Thus, psychoananalytic psychotherapy differs from most other therapies in aiming for deep-seated change in personality and emotional development. Psychoanalytic psychotherapy aims to help people with serious psychological disorders to understand and change complex, deep-seated and often unconsciously based emotional and relationship problems, thereby reducing symptoms and alleviating distress. The role of the psychoanalytic psychotherapist is not limited only to those with mental health problems. Many people who experience a loss of meaning in their lives or who are seeking a greater sense of fulfillment or self-awareness may be helped by psychoanalytic psychotherapy.
Transference and countertransference
When Freud noticed people repeated troubled relationship patterns in the room with him, he discovered the phenomena of the transference. If, for example, a young man had a problem with a domineering father, he might appear pleasant and humble, but show secret rebellion about his father’s ambitions for him. In the consulting room, he might begin cooperatively saying what was in his mind, but then fall silent, commenting in a friendly way that, sorry, his mind was wandering; that he just wasn’t in the mood.
We now know that the counter-transference gives just as important clues as does the transference. The analyst might feel irritated at the patient’s silent resistance. He or she then steps back and becomes interested in his or her own irritation. In this way the analyst starts to get the picture of the relationship with the father, but also, more importantly, the whole way this young man deals with others he feels controlled by. This pattern is going to repeat itself with bosses at work. It may infuriate his partner, stop him getting what he really wants and needs in life, as so much energy will be wasted in automatically thwarting other people.
Whatever it is people tend to do, and to be, in close relationships, that is what happens sooner or later with your psychoanalyst. And it is for real, and can feel very unnerving. Uniquely, though, you will have a real chance of understanding and changing these patterns. Paul, who suffered a deprived and abusive childhood, managed a university degree but then after doing a few casual jobs, broke down in his early 20s. He lived a reclusive life over the next decade, unable to work, and beset with fears and grievances, though he continued to read in libraries, clinging on to some hope that he could find a way back into life. He read about a low-fee psychoanalytic clinic, and found the courage to apply. He was taken on by a trainee under supervision, numerous times a week.
Among other things, Paul’s troubled relationships with his parents played themselves out in the analytic relationship. He could be submissive but subtly provoking, as he had been with his violent father, or passive and dependent, as with his mother. His analyst had to monitor, carefully, the ways in which she was being unconsciously set up to repeat the past in all sorts of actual and symbolic ways. Instead of automatically reacting, she worked on trying to make sense of what was happening, and talking to Paul about it.
Change was slow and painful but, in time, the liveliness and curiosity that had been squashed and distorted in Paul could re-emerge. He started to take back responsibility for himself and his life, inside and outside sessions. He began to recover his confidence and his pleasure in living and working, and made new friends. Through evening classes, he got back into work, and eventually managed to train and do very well as a teacher.
People reveal hidden things about themselves in all sorts of ways, inside and outside analysis. Examples are slips of the tongue, jokes and dreams. Dreaming is the way we think while we are asleep, and it’s much less carefully censored than our waking thoughts. Our imagination has a freer reign during sleep, and dream ideas can be revealing and sometimes creative. Dreams can be straightforward, but they often need decoding to reveal the ideas and feelings being expressed, and they can often be useful in analysis.
Sometimes people seek help for specific reasons such as eating disorders, psycho-somatic conditions, obsessional behaviour, or phobic anxieties. At other times help is sought because of more general underlying feelings of depression or anxiety, difficulties in concentrating, dissatisfaction in work or inability to form satisfactory relationships. The therapy can help people with emotional and behavioural difficulties, which are evident at home or work, which can include personality problems, depression, learning difficulties, school phobias, eating or sleeping disorders.
Will a patient get very dependent on the therapist/therapy, and not be able to stop?
The psychotherapist does become a very significant person for a patient while they are working with together, especially if it’s an exploratory sort of treatment, like client-centred or psychoanalytic therapy, rather than a short course of behavioural or cognitive therapy. However, people usually turn to help of this sort when something is going badly wrong in their lives. Their freedom is already limited by the way in which their work, family life and relationships keep going wrong in the same old way.
If a patient goes into psychotherapy, they may be starting a relationship that will become intense and deeply important, perhaps for a number of years. However, this is for the ultimate purpose of becoming more independent that is, freer of their dependence on stuck, unconscious patterns of feeling, thinking and behaving. If the psychotherapy seems to be never-ending, something may need to be looked at. If a patient is able to have an open-ended psychotherapy, with no set time limit, they will usually find that it turns out to be a naturally evolving process with a beginning, middle and end. If it is allowed to take its own course, it is likely to last years rather than months.
Both therapist and patient usually sense and agree when it’s time to set an ending date and to work towards this. That’s not to say that it’s easy to stop seeing someone they have worked so closely with and grown attached to. But giving up and mourning the therapy itself is actually an important phase of the work.
Can psychotherapy help someone if they are a mental health service user?
Whether psychoanalytic psychotherapy is the treatment of choice for a particular individual depends on a variety of factors. It is often helpful to have one or more preliminary consultations before deciding whether psychoanalytic psychotherapy is an appropriate treatment for the person concerned. Generally speaking psychoanalytic psychotherapy is best considered as a long-term treatment involving considerable commitment for both patient and therapist. Everyone in distress needs to be listened to carefully and respectfully by their professional helpers, and users frequently complain that they do not have enough access to talking treatments. It’s important that the right sort of treatment is provided, at the right moment.
At a time when someone might be feeling persecuted and terrified, or very suicidal, they will probably need an approach that is less probing and challenging than at another time when they are feeling stronger and more resourceful. So if a patient is suffering from a psychotic illness, the choice and timing of any psychotherapy or counselling has to be thought about and tailored to their needs very carefully. Exploratory psychotherapies often stir things up in the slow process of healing, and can make patients feel very much worse at times; for example during breaks from treatment. This is why psychotherapists will insist that a patient’s psychiatrist or GP are also in the picture.
Substance abuse
If a patient is a heavy user of drugs or alcohol, they are unlikely to benefit from exploratory psychotherapy until they are completely free of the substance they are dependent on, and physically recovered. Only then will you have a clear enough head, and enough self-control, to be able to work together with the therapist and to hold on to what happens in the sessions. While they are still using the substance, a structured educational approach aiming to help them free themselves of the addiction will probably make most sense, or a self-help approach like Alcoholics Anonymous.
