Often when people think of psychoanalysis, they picture Freud smoking a cigar and scratching his white beard. Unfortunately, such a picture gives the impression that psychoanalysis belongs to the antiquated past, repression laden Vienna, and distant intellectual theories about penis envy and the Oedipus Complex. Yikes! Psychoanalysis certainly has an image problem. What we need instead is an updated image—as well as updated information—that conveys a sense of what psychoanalysis really is: a cutting-edge psychological treatment that can help regular folks with their real psychological troubles, right here in 2014.
As a psychological treatment, psychoanalysis is a method of modern psychotherapy that can be very useful for people who are struggling with longstanding difficulties in the ways that they think and feel about themselves, the world, and their relationships with others. To be sure, there are short-term treatments that are better suited for short-term problems such as anxiety or depression brought on by a specific stressor, loss, or trauma. But for psychological troubles that have been around in one’s life for a long time—often since childhood—a deeper treatment is needed. That’s where psychoanalysis comes in.
In fact, psychoanalysis was first developed as a treatment for patients who did not respond to other medical and psychological methods available at the time. Freud is the face of psychoanalysis for a reason, as he made the game-changing discovery that certain types of problems have their roots below the surface of conscious life. Since then, psychoanalysts have discovered more and more about how unconscious factors greatly influence us, for good and for ill. When these unconscious forces are the source of significant and enduring psychological troubles, therapeutic methods that rely on suggestion, common sense reasoning, or behavior modification are not very effective. In such cases, a method that reaches the unconscious level is needed.
The psychoanalytic method involves meeting with a mental health professional with specialized, advanced training in working with people at this unconscious level. Psychoanalytic training involves an additional 5 to 8 years of doctoral study beyond a psychotherapist’s psychological, psychiatric, social work or other mental health training. Patients attend 45-50 minute sessions frequently—3 to 5 days a week. In my own practice, I see most of my psychoanalytic patients four times each week. I have found that some good work can be done in a three-times-a-week treatment and five times (no surprise!) is optimal.
Why does psychoanalysis require such frequency, you ask? The frequency of sessions helps the work go deeper, maintain intensity, and shift from outside life to inside life. When you’re meeting most days of the week, you’re able to keep pretty current about what’s happening in your outside life; then there’s time to go inside to reflect and explore. Further, the greater frequency can help because it keeps the heat on. The painful work uncovered one day has less time to go underground. The links from the unconscious to the conscious mind—from one day to the next—can be kept fresh and alive, both in the analyst’s mind and in the patient’s mind.
In the psychoanalytic method, patients are encouraged to speak freely about whatever comes to their minds, to follow their thoughts and feelings wherever they may go. This allows for the unconscious to reveal itself which is no easy task, as the unconscious wishes to remain hidden. Such openness is further facilitated by the patient lying on the couch with the therapist in the background, out of sight. While the idea of lying on the analyst’s couch may seem old-fashioned or even a bit cliché at first, it does seem to open up people’s minds to better see what’s going on inside.
With disciplined effort, the patient gradually reveals more and more to the analyst, not only what is in the foreground but what is in the background and underground. By doing so, the patient inevitably will live out his or her unconscious dynamics in the relationship with the therapist. This is expected and by design. The patient comes to see and relate to the analyst as a “double” of important figures from an earlier time and from an unconscious place inside. As a result, both patient and analyst get an emotionally live, real-time sense of the patient’s unconscious dynamics—the passions, intentions, confusions, distortions, hopes, and dreads that influence his or her life, everywhere he or she goes. You’ve probably heard this called transference. It is the bread and butter of an effective analysis.
In response to all that the patient does, the analyst spends a lot of time (more than the typical psychotherapist) listening and thinking. For the analyst, it takes careful attention, mental digestion, and time to develop a thorough understanding of what is going on inside the patient, why it is going on, and how it shapes his or her life today. When the analyst has some understanding of these unconscious dynamics, he or she puts that understanding into words. This is called interpretation. Over the years, analytic interpretation has evolved to be less remote and intellectual than it was in the early days. Most analysts try to be free of jargon, clear, straightforward, and as emotionally engaged as possible. A good analyst tries to make contact with the patient, to convey both insight and emotional understanding. Interpretation is offered as food for thought. Analysts try their best to serve understanding in a way that patients can take it in, chew it, digest it, and be nourished by it.
These are the essential features of psychoanalysis that help people change at the root. In future posts in this series, I will explore related questions such as: Is psychoanalysis dead or alive? Is psychoanalysis right for me? Does it really help? How will I know if it is working? What kind of changes would I expect to see? How long should it take? Does everyone need it? Do I need it? In the end, I hope to add a thoughtful, experienced, insider point of view which might make a psychoanalytic treatment worth considering, even for you.
Copyright 2014 by Jennifer Kunst, Ph.D.
To see more of Jennifer’s approach to psychotherapy, check out her book: Wisdom from the Couch: Knowing and Growing Yourself from the Inside Out.