What is Psychoanalytic psychotherapy?

Psychoanalytic Therapy is one of the first type of psychotherapy developed by Sigmund Frued. This approach is based on the concept that the human personality is composed of three parts:

1. Id: This part of personality is based on the basic instincts with which we are born with and it works on the principle of doing things which give pleasure.

2. Ego: This part of the personality deals with the logic and realistic thinking. It also balances the needs of id and superego.

3. Superego: It sets a person’s moral code and values, thus helps in determining whether an action is good or bad.

The conflict resulting because of the tussle between the id and the superego can lead to Anxiety i.e. the state of tension which motivates the ego to do something about it and resolve the conflict.

There is another way of understanding the mind – in terms of the two parts i.e. the conscious (what we know about ourselves) and the unconscious. The unconscious is not very apparent to our consciousness and it constitutes the memories and experiences from the past. According to the psychoanalytic perspective, the human nature at present is determined by previous experiences stored in the unconscious.

To protect itself from being overwhelmed by this anxiety the ego uses certain defence mechanisms.  In childhood one uses more primitive defence mechanisms such as denial and projection. As one matures, they start using more mature defence mechanism in order to deal with issues arising in various situations. A successful resolution of the early instinctual urges of aggressive and sexual nature are helpful in the development of a healthy personality. The problem arises when the person is fixed at using primitive (which may be normal in childhood) defence mechanisms in later developmental stages and they learn to avoid facing the reality.

In the psychoanalytic therapy the goal is to develop a conscious insight to this unconscious process of personality development. Rather than solving immediate problems and removing symptoms psychoanalytic therapy aims at restructuring of the personality from where the problems started.

What can I expect from a session of Psychoanalytic Therapy?

Traditionally the setting would include the client resting on the couch and the therapist sitting on the head end of the couch behind them. However, this kind of therapy arrangement is rarely used in the contemporary therapy settings.

In a typical session client discusses their thoughts without any hinderance. The therapist in this process remains neutral observer and maintains objectivity. The client and therapist together try to understand the meaning and the origin of these thoughts.

During the process the client develops “transference” i.e. the client relives their emotional experiences and fantasies with significant people from their past and they are projected onto the therapist who then tried to work on those experiences.

The client may also have “resistance” in sharing their thoughts with the therapist. The client-therapist work through these feelings by having an elaborate discussion and try to identify the defence mechanisms due to which these originate (usually early childhood experiences). Other techniques like dream analysis, interpretation of actions may also be employed. This will result in the client becoming more aware of their unconscious processes and conflicts  and working towards their resolution and developing a new path of making choices.

When should one get Psychoanalytic Therapy?

Psychoanalytic Therapy including the brief version is proven to be effective in many disorders including:

• Depression
• Borderline Personality Disorder
• Bulimia Nervosa
• Anorexia Nervosa
• Somatoform Disorders
• Post-Traumatic Stress Disorder
• Substance Use Disorder

What is the course of Psychoanalytic Therapy?

The course of treatment is usually long-term and each session can last between 30 and 60 minutes with a weekly or fortnightly frequency. There are no set goals to the therapy so these figures may be variable. The therapy in itself requires personal commitment in addition to time and money. There is also a brief version of the therapy and a group version which may be appropriate to different clients.

Is it better than drugs?

Psychoanalytic Therapy is an effective treatment for the conditions mentioned above. It mainly helps in finding a connection between the present symptoms and past experiences. In addition to that it focusses more on the restructuring of the entire psyche rather than solving immediate issues.

How it is different from other therapies?

Psychoanalytic Therapy has no specific direction during the course of therapy. The ultimate goal is to develop a conscious insight into the unconscious processes with the goal of personality development.

The Client knows why they are thinking in a particular way and how it is linked with their past experiences. This realisation helps them to change themselves from the point when they deviated from healthy pattern of decision making.

In order to provide psychoanalytic therapy the therapist themselves  undergo extensive therapy and also training with the objective of understanding their own conflicts and unconscious processes and they also learn the process of therapy.

Previous versions of the therapy could not be studied in an objective manner, so the evidence is lacking. But the newer formats are more standardised and structured than before thus have been measured in many trials to be an effective option for the above mentioned conditions. The evidence is almost equal for different kind of therapies. One should consult a psychiatrist to know what kind of psychotherapy is suited for their problem.

Where should I seek help from?

If you or your dear ones are experiencing significant distress or problems in carrying out normal everyday activities, you should consult your GP or psychiatrist immediately. The psychiatrist will evaluate thoroughly the need for treatment, whether you require psychoanalytic therapy or some any other form of therapy.

Recommended Reading:

• Psychoanalytic Therapy | Royal College of Psychiatrists [Available from: www.rcpsych.ac.uk/docs/default-source/members/faculties/medical-psychotherapy/med-psy-evidence-support-of-psychodynamic-psychotherapy-march-2018.pdf