1. What is the difference between psychoanalysis and psychotherapy?
2. Who can benefit from psychoanalysis?
3. Who is a psychoanalyst?
4. What is transference?
5. What is the purpose of the couch?
6. How long does psychoanalysis take?
7. Will insurance pay for psychoanalysis?
8. What is the evidence that psychoanalysis is effective?
Psychoanalysis and psychoanalytic psychotherapy share many goals and methods. Both approach each person as an individual with a unique history and personal experience. Both work to reduce symptoms and help people to progress toward goals they have chosen in life. Both involve an intensive effort to listen and understand the uniqueness of each person. A psychoanalytic psychotherapist meets less frequently with their patients. The focus of the work may be more on current situations and problem solving than on deep unconscious conflicts or beliefs.
What distinguishes psychoanalysis is the opportunity for an exploration of unconscious processes. Psychoanalysis gives patients the fullest opportunity to examine their assumptions about themselves and the world, understand their origins, modify them, and make freer choices for themselves. The aim of psychoanalysis is a full examination of individual development and character in order to resolve central underlying conflicts and alter maladaptive defenses and/or beliefs. The greater intensity of psychoanalysis, meeting four or five times a week, typically using a psychoanalytic couch, facilitates these deeper explorations and therapeutic gains.
Psychoanalysis is particularly useful with problems which have been enduring or repetitive. Some individuals seek psychoanalysis after having tried other forms of treatment without lasting relief or improvement. Others may wish to understand the sources of their difficulties. Many people may function satisfactorily at work or home but are troubled inside. Being worried or persistently unhappy, feeling blocked, having troubles in intimate relationships or jobs, or being puzzled about yourself and your behavior are valid reasons for speaking with a psychoanalyst. Typical issues include:
- trouble in work situations such as conflicts with employers or co-workers or failure to advance
- repetitive patterns of disappointment or conflicts in personal relationships
- a pattern of self-defeating choices
- difficulty in achieving life goals
- feeling lethargic and disconnected from friends and colleagues
- physical complaints which might be manifestations of underlying emotional conflict
- coping with depression, anxiety, or anger without success in spite of attempts to alleviate these symptoms through less intensive therapy modalities
A psychoanalyst is usually a licensed mental health clinician (a psychiatrist, psychologist, or social worker, or mental health counselor) who has completed psychoanalytic training. The PINE Psychoanalytic Center is a member of the American Psychoanalytic Association (APsaA). Training at PINE conforms to the standards of the APsaA. Psychoanalysts trained under their auspices must meet high ethical, psychological, and professional standards.
Psychoanalytic training takes a minimum of five years as a "candidate." Candidates undertake a rigorous and extensive program consisting of seminars in psychoanalytic theory and technique, a personal psychoanalysis, and the experience of conducting multiple psychoanalytic treatments under close supervision by "training analysts" who have passed though an advanced program that prepares them to supervise and analyze candidates. Candidates who plan to treat children attend additional classes and, under supervision, conduct analyses of boys and girls ranging in age from toddlerhood to late adolescence.
This kind of thorough education in normal and abnormal psychopathology enhances the quality of whatever professional work psychoanalysts are engaged in subsequently in addition to conducting psychoanalysis. Psychoanalysts also see individuals in psychotherapy and provide supervision to other mental health professionals. Analysts may choose to treat couples, families or groups. they may also conduct research, write for professional journals, and teach mental health trainees in various settings such as hospitals, clinics, medical schools, colleges, and daycare centers. They may provide consultation in schools, businesses, and to professional groups such as teachers, judges, and religious leaders.
The designation "psychoanalyst" is not protected by federal or state law: anyone, even an untrained person, may use the title "psychoanalyst." It is therefore important to know the practitioner's credentials before beginning treatment.
In the course of a psychoanalytic treatment, patient and analyst create an intimate relationship, built on trust and shared curiosity about the mind of the patient. It is inevitable that the patient develops strong feelings about the analyst, often repeating important aspects of early formative relationships. These emotional experiences, referred to as transferences, reflect unconscious needs which are powerfully recreated in the treatment. Understanding them in this context produces important insight and frees the person to move beyond problematic repetitions.
In psychoanalysis, the analyst usually sits behind the patient who lies on the couch. This arrangement minimizes distractions and increases the patient’s relaxed introspection. Facing away from the analyst enables the patient to more easily access thoughts, feelings, and fantasies, and to have associations emerge more freely, giving the patient and analyst more access to the workings of the patient's mind.
Although most psychoanalytic treatments have a definite beginning and ending, there is no pre-set time for patients to resolve longstanding difficulties. Patients generally find it useful to think in terms of years rather than months. This is because deeply entrenched inner conflicts take some time to understand and work through in a lasting way. As part of the treatment, the patient's capacity for self-analysis is enhanced. Therapeutic gains achieved during the analysis often continue and are consolidated following termination of an analysis.
In this age of tightly managed regulated care, the majority of insurance plans do not pay for psychoanalysis. Many plans do cover one (or more) sessions per week which may be used to cover a portion of your analysis. If you cannot afford psychoanalysis given your financial resources, it is also appropriate to ask your analyst if it is possible to have a reduced fee.
There is a large body of empirical data supporting the benefits of psychoanalytic therapy and psychoanalysis. These studies demonstrate positive changes in subjective symptoms, life functioning, and psychological flexibility. Two sources that you may find useful include: "The Efficacy of Psychodynamic Psychotherapy" by Jonathan Schedler in The American Psychologist, February-March 2010; https//www.apa.org/pubs/journals/releases/amp-65-2-98.pdf and J. Barber et al's "Research on Dynamic Therapies" in Handbook for Psychotherapy and Behavior Change, Bergin and Garifel, eds.
To learn more about specific studies, please go to the research site of the American Psychoanalytic Association.