Can I benefit from psychoanalytic treatment?

While numerous studies show that psychoanalysis can provide deeper and longer-lasting results than other forms of therapy, symptom relief is often not as immediate. Those patients who seem to most benefit from psychoanalytic treatment are those who are curious about the underlying sources of their symptoms or distress, are able to set aside sufficient time in their schedules to consistently participate in treatment, feel a sense of urgency regarding the need to change, and are able to be patient in achieving long-term and significant results (Source: PINC).

Psychoanalysis is often indicated as a treatment of choice when less intensive therapies have failed to achieve lasting results. Psychoanalysts are trained to treat severe and long-standing symptoms and distress; however, your problems need not be severe in order to seek help from a psychoanalyst. In fact, some choose to begin psychoanalytic treatment because they are curious about themselves and wish to learn more about their inner-worlds.

To speak with a psychoanalyst or psychoanalytic psychotherapist, see our directory or contact us for additional assistance.

Is there a difference between psychoanalysis and psychoanalytic psychotherapy?

Psychoanalytic (sometimes called psychodynamic) psychotherapy is based on the theory and techniques of psychoanalysis. The primary differences between psychoanalytic psychotherapy and psychoanalysis are frequency of sessions and use of the couch. In psychoanalysis, patient and analyst often meet four or five times a week. While more frequent sessions typically deepen the treatment, frequency is worked out between patient and analyst. In psychoanalytic therapy, patient and therapist meet less frequently, sometimes only once a week. Those in psychoanalysis often recline on a couch, with the analyst out of view, while those in psychoanalytic psychotherapy usually sit upright and facing the therapist. While the couch is intimately intertwined with the history of psychoanalysis and its public image, it is no longer a necessity. Many patients find the couch useful in helping them to relax and speak freely, while others prefer face-to-face sessions. Read this article for information about the history, benefits, as well as disadvantages of the couch in psychoanalytic treatment.

(information adapted from the American Psychoanalytic Association)

What differentiates psychoanalytic treatment from other forms of therapy?

(excerpt taken from Jonathan Shedler’s article: The Efficacy of Psychodynamic Psychotherapy)

1.  Focus on affect and expression of emotion. Psychodynamic therapy encourages exploration and discussion of the full range of a patient’s emotions. The therapist helps the patient describe and put words to feelings, including contradictory feelings, feelings that are troubling or threatening, and feelings that the patient may not initially be able to recognize or acknowledge (this stands in contrast to a cognitive focus, where the greater emphasis is on thoughts and beliefs.). There is also a recognition that intellectual insight is not the same as emotional insight, which resonates at a deep level and leads to change (this is one reason why many intelligent and psychologically minded people can explain the reasons for their difficulties, yet their understanding does not help them overcome those difficulties).
2. Exploration of attempts to avoid distressing thoughts and feelings. This avoidance (in theoretical terms, defense and resistance) may take coarse forms, such as missing sessions, arriving late, or shifts of topic when certain ideas arise, focusing on incidental aspects of an experience rather than on what is psychologically meaningful, attending to facts and events to the exclusion of affect, focusing on external circumstances rather than one’s own role in shaping events, and so on. Psychodynamic therapists actively focus on and explore avoidances.
3.  Identification of recurring themes and patterns. Psychodynamic therapists work to identify and explore recurring themes and patterns in patients’ thoughts, feelings, self-concept, relationships, and life experiences. In some cases, a patient may be acutely aware of recurring patterns that are painful or self-defeating but feel unable to escape them (e.g., a man who repeatedly finds himself drawn to romantic partners who are emotionally unavailable; a woman who regularly sabotages herself when success is at hand). In other cases, the patient may be unaware of the patterns until the therapist helps him or her recognize and understand them.
4. Discussion of past experience (developmental focus). Related to the identification of recurring themes and patterns is the recognition that past experience, especially early experiences of attachment figures, affects our relation to, and experience of, the present. Psychodynamic therapists explore early experiences, the relation between past and present, and the ways in which the past tends to “live on” in the present. The focus is not on the past for its own sake, but rather on how the past sheds light on current psychological difficulties. The goal is to help patients free themselves from the bonds of past experience in order to live more fully in the present
5. Focus on interpersonal relations. Psychodynamic therapy places heavy emphasis on patients’ relationships and interpersonal experience. Both adaptive and nonadaptive aspects of personality and self-concept are forged in the context of attachment relationships, and psychological difficulties often arise when problematic interpersonal patterns interfere with a person’s ability to meet emotional needs.
6. Focus on the therapy relationship. The relationship between therapist and patient is itself an important interpersonal relationship, one that can become deeply meaningful and emotionally charged. To the extent that there are repetitive themes in a person’s relationships and manner of interacting, these themes tend to emerge in some form in the therapy relationship. The recurrence of interpersonal themes in the therapy relationship (in theoretical terms, transference and countertransference) provides a unique opportunity to explore and rework them in vivo. The goal is greater flexibility in interpersonal relationships and an enhanced capacity to meet interpersonal needs.
7. Exploration of fantasy life. In contrast to other therapies in which the therapist may actively structure sessions or follow a predetermined agenda, psychodynamic therapy encourages patients to speak freely about whatever is on their minds. When patients do this (and most patients require considerable help from the therapist before they can truly speak freely), their thoughts naturally range over many areas of mental life, including desires, fears, fantasies, dreams, and daydreams (which in many cases the patient has not previously attempted to put into words). All of this material is a rich source of information about how the person views self and others, interprets and makes sense of experience, avoids aspects of experience, or interferes with a potential capacity to find greater enjoyment and meaning in life.

Empirical evidence supports the efficacy of psychodynamic therapy. Effect sizes for psychodynamic therapy are as large as those reported for other therapies that have been actively promoted as “empirically supported” and “evidence based.” In addition, patients who receive psychodynamic therapy maintain therapeutic gains and appear to continue to improve after treatment ends. Finally, non-psychodynamic therapies may be effective in part because the more skilled practitioners utilize techniques that have long been central to psychodynamic theory and practice.

© 2010 American Psychological Association 0003-066X/10/12.00 Vol. 65, No. 2, 98–109 DOI: 10.1037/a0018378