PSYCHOANALYTIC PSYCHOTHERAPY: WHO IS IT FOR AND HOW IT WORKS - ECONOMÍA - 2024

The psychoanalytic psychotherapy is based on an increased understanding of our inner world aimed at solving our emotional problems. Its roots lie predominantly in Freud's psychoanalytic approach, but other authors such as Carl Jung and Melanie Klein have also dedicated themselves to expanding and developing the concept and application of these therapies.

In therapy, the patient's world is explored and he manages to make sense of his situation, feelings, beliefs, behaviors and memories. The purpose of this is to increase understanding of how to relate to yourself and to other people.

Psychoanalytic therapy is related to the concepts of the topographic model on the mind that Freud developed. The Austrian neurologist saw the human psyche structured in three parts: the id (instinctual component of the personality), the ego (part of the id modified by the influence of the external world and which is rational), and the superego (incorporates values ​​and society's morality to control id impulses).

Psychoanalytic therapy also makes use of the concept of "unconscious", the level of consciousness that, according to Freud, includes mental processes that are inaccessible to consciousness but that influence people's judgments, feelings and behaviors.

Who is psychoanalytic therapy for?

Although originally designed to help people with neuroses, psychoanalytic therapy is not limited to people with mental health problems; many people who experience a loss of meaning in their lives or who are seeking personal fulfillment can also benefit from this type of therapy.

This therapy provides effective treatment for a wide variety of psychological disorders, both as a treatment by itself and as an adjunct to other types of therapy.

Sometimes people seek help for specific reasons such as an eating disorder, psychosomatic conditions, obsessive behaviors, or phobias. Other times, help is sought because of more general feelings of depression, anxiety, difficulty concentrating, dissatisfaction with work, or an inability to form satisfying relationships.

Psychoanalytic therapy can benefit adults as well as children and adolescents. You can help children who have obvious behavioral difficulties at home or at school. This includes personality, learning, bedtime problems…

How does psychoanalytic therapy work?

The relationship with the therapist is a crucial element in psychoanalytic psychotherapy. The therapist offers a private and safe environment that facilitates the therapy process through the following techniques:

Free association

Psychoanalytic therapy, unlike other modalities, is a poorly structured approach. The therapist, in this case, invites the patient not to have to plan what he is going to say.

Free association encourages the patient to say whatever comes to mind regardless of whether it is related to what was discussed in last week's session or a few minutes ago.

The underlying theory states that only when the patient does not feel the need to produce purposeful and coherent communications will he be able to allow unconscious meanings to emerge through their spontaneous associations.

Interpretation

Traditionally, psychoanalysis has been associated with the notion of "interpretation." Interpretation was originally defined as "bringing the unconscious to consciousness." The main function of the therapist in Freud's time was to interpret, that is, to translate the unconscious meanings of the conscious associations made by the patient.

Currently, interpretation is also defined as those interventions related to interpersonal issues.

Transfer

Therapeutic transference refers to the redirection of feelings that the patient feels for a significant person in his life to the therapist. The transference is a projection of feelings and attitudes towards the therapist that arises through the psychoanalytic dialogue that is maintained during the sessions.

The transference can be positive, when positive feelings are displaced towards the therapist, or negative, when the projected feelings are of hostility.

Contemporary models emphasize the “here and now”, referring to an exploration of the patient's current relationships including, and prioritizing, the relationship with the therapist, understood as an update of internal relational models.

Interpretations, therefore, emphasize the process of interaction between the patient and the therapist (a transference interpretation), leading to connections to other relationships in the patient's life).

Countertransference

It refers to the set of conscious or unconscious affective attitudes and reactions that the therapist forms towards his patient throughout the therapy.

It is necessary for the psychotherapist to take into account their limitations, complexes and resistances before starting a therapy, so that they do not have a negative influence on it.

Goals of psychoanalytic therapy

In general terms, psychoanalytic therapy differs from other types of therapy because it aims to make permanent changes in personality and emotional development.

This therapy helps to alleviate distress through understanding and changing the emotional and relational problems of the person, rooted in the unconscious. These problems are solved by helping the individual to experience and understand the feelings they carry.

The goals of psychoanalytic therapy have evolved over time. At first, they were formulated in general metapsychological terms; "Making the unconscious conscious" was the central aim of Freud's topographical model.

In accordance with his subsequent structural model of the mind, the treatment was aimed at strengthening the position of the self within the personality structure, promoting its autonomy, and improving the control of instinctual impulses.

"Psychoanalysis is not presented to make pathological reactions impossible, but to give the patient's ego sufficient freedom to decide one way or another" (Freud, 1923)

Surely the most significant change in goals in therapy since Freud's time is that far fewer psychotherapists now consider the retrieval of repressed memories to be the primary goal of analytic work.

Instead, the purpose of therapy is more related to an enrichment of the capacity for self-reflection. Self-reflection refers to the mind's ability to understand its own behavior and the behavior of others in terms of mental states (thoughts, feelings, motivations, intentions).

What are the differences between psychoanalysis and psychoanalytic psychotherapy?

Psychoanalysis, in its original form conceived by Freud, was a method of treatment restricted to a very specific patient population.

Freud claimed that psychoanalysis could only be of help to those patients with neurotic problems who could develop a transference relationship, who were motivated, educated, and not currently in crisis.

Freud was not an optimistic therapist. According to him, the best that psychoanalysis could hope for was to exchange neurotic misery for a "common sadness", and he maintained that man's happiness had never been included in the plan of Creation, so that he did not consider it as one of the goals of psychoanalytic treatment.

According to these standards, psychoanalysis would not have had much to offer those patients who are now referred for psychological help in public health services.

Patient restriction in psychoanalysis

As Freud conceived it (and as some psychoanalysts continue to think even now), psychoanalysis should be restricted to those patients sick enough to require extensive work, but who were healthy enough to make use of this type of analysis. therapy.

In other words, patients who were distressed but who retained strength in the ego to cope with the challenges and frustrations of classical analytic mechanics.

Same theoretical origins

The differences between psychoanalysis and its descendants, like psychoanalytic psychotherapy, raise interesting questions. From the outset, it was clear that although psychoanalytic therapy shared its theoretical origins with psychoanalysis and employed the same techniques and was therefore a legitimate descendant, it was not one of the most favored.

Many saw it as a weakening of the classical approach, arguing that it produced a much more superficial change. With the rise of psychoanalytic therapy, psychoanalysis, as Freud predicted, found itself in jeopardy.

Difference in number of sessions

Conventionally, the difference between psychoanalysis and psychoanalytic therapy is conceptualized, partly pragmatically, in terms of the frequency of sessions. Psychoanalysis speaks of at least four or five weekly sessions, while psychoanalytic therapy refers to a maximum of three sessions a week.

goals

Psychoanalysis is also usually characterized by the absence of specific objectives, with the aim of a significant change in the personality, while psychoanalytic therapy is described as a type of therapy more focused on more specific objectives, such as modifying behavior and the structure of the character.

In reality, the objectives of the two approaches do not differ significantly; there are hardly any differences in the techniques used or in the theories on which they are based.

Both approaches are focused on the interpretation of the transference, although in some shorter and less intense psychoanalytic therapies only some aspects of the transference are interpreted.

Is psychoanalytic psychotherapy effective?

The last two decades have seen an increase in the number of investigations related to psychoanalytic psychotherapy and its efficacy. At present, it can be safely stated that the empirical evidence about this therapy is strong and credible. Psychoanalytic psychotherapy has been shown to be effective in treating a wide variety of mental health conditions and disorders.

The evidence from studies and reviews indicates that the benefits of psychoanalytic treatment are not transitory: they last over time and even after the remission of symptoms.

For many people, these therapies promote the development of internal resources and capacities that allow them to live richer, freer and more satisfying lives. In 2009, the American Psychological Association (APA) recognized the effectiveness of psychoanalytic-based therapies due to the strong empirical evidence demonstrated.

It has been suggested that the effectiveness of therapy is more related to the quality of the therapist than to the technique used or the training obtained.

Criticisms, empirical evidence and current status

Psychoanalysis and psychoanalytic therapy have created much controversy throughout history and have received numerous criticisms. Although the main ones have to do with the lack of empirical research, psychoanalysis has been criticized for other reasons.

Duration

Some criticisms of classical psychoanalysis have to do with the duration of the therapies, which made the resolution of emotional problems too costly and lengthy, and with the essentially conflictual nature of the unconscious.

Biological and cultural aspect

Psychoanalytic theory also holds that certain psychic processes occur the way they occur due to a fixed biological determinant and justifies certain ideologies and values ​​on the basis of a supposed biological origin.

These assumptions ignore the importance of culture in the development of people, which greatly influences the attitudes, values ​​and thoughts of each one.

Obsolete theories and lack of rigor

It must be borne in mind that the time in which Freud established his theories is very different from the current one, so there are few that are not obsolete. Freud lived in a time when sexuality was very repressed; hence his theories are so closely related to sex.

Historically, the psychoanalytic community has not gotten along very well with empirical research. Freud had a position of rejection of empirical research under the argument of opposing establishing laws in the name of the particularity of individuals.

Thus, psychoanalysis has been labeled pseudoscience on some occasions due to the lack of scientific rigor to demonstrate that theories and therapies were effective. Cognitive psychology, evolutionary psychology, neurolobiology, and psychiatry have criticized psychoanalysis for relying on outdated theories and hypotheses that lack empirical proof.

References

1. Lemma, A. (2003). Introduction to the practice of psychoanalytic psychotherapy. Chichester: John Wiley & Sons.