18.6: Psychoanalysis

Learning Objectives

• Describe psychoanalysis as a treatment approach

One of the goals of therapy is to help a person stop repeating and reenacting destructive patterns and to start looking for better solutions to difficult situations. This goal is reflected in the following poem:

Autobiography in Five Short Chapters by Portia Nelson (1993)

Chapter One

I walk down the street.
There is a deep hole in the sidewalk.
I fall in. I am lost. . . . I am helpless.
It isn’t my fault.
It takes forever to find a way out.

Chapter Two

I walk down the same street.
There is a deep hole in the sidewalk.
I pretend I don’t see it.
I fall in again.
I can’t believe I am in this same place.
But, it isn’t my fault.
It still takes a long time to get out.

Chapter Three

I walk down the same street.
There is a deep hole in the sidewalk.
I see it is there.
I still fall in . . . it’s a habit . . . but,
my eyes are open.
I know where I am.
It is my fault.
I get out immediately.

Chapter Four

I walk down the same street.
There is a deep hole in the sidewalk.
I walk around it.

Chapter Five

I walk down another street.

Two types of therapy are psychotherapy and biomedical therapy. Both types of treatment help people with psychological disorders, such as depression, anxiety, and schizophrenia. Psychotherapy is a psychological treatment that employs various methods to help someone overcome personal problems, or to attain personal growth. Biomedical therapy involves medication and/or medical procedures to treat psychological disorders. First, we will explore the various psychotherapeutic orientations outlined in Table 1 (many of these orientations were discussed in the Introduction module). In addition to psychotherapy and the biomedical approach, there is also a social approach to treatment, which focuses on family or group therapies.

Table 1. Various Psychotherapy Techniques

Type	Description	Example
Psychodynamic psychotherapy	Talk therapy based on belief that the unconscious and childhood conflicts impact behavior	Patient talks about his past
Play therapy	Psychoanalytical therapy wherein interaction with toys is used instead of talk; used in child therapy	Patient (child) acts out family scenes with dolls
Behavior therapy	Principles of learning applied to change undesirable behaviors	Patient learns to overcome fear of elevators through several stages of relaxation techniques
Cognitive therapy	Awareness of cognitive process helps patients eliminate thought patterns that lead to distress	Patient learns not to overgeneralize failure based on single failure
Cognitive-behavioral therapy	Work to change cognitive distortions and self-defeating behaviors	Patient learns to identify self-defeating behaviors to overcome an eating disorder
Humanistic therapy	Increase self-awareness and acceptance through focus on conscious thoughts	Patient learns to articulate thoughts that keep them from achieving their goals

Psychotherapy Techniques: Psychoanalysis

Figure 1. This is the famous couch in Freud’s consulting room. Patients were instructed to lie comfortably on the couch and to face away from Freud in order to feel less inhibited and to help them focus. Today, a psychotherapy patient is not likely to lie on a couch; instead he is more likely to sit facing the therapist (Prochaska & Norcross, 2010). (credit: Robert Huffstutter)

Psychoanalysis was developed by Sigmund Freud and was the first form of psychotherapy. It was the dominant therapeutic technique in the early 20th century, but it has since waned significantly in popularity. Freud believed most of our psychological problems are the result of repressed impulses and trauma experienced in childhood, and he believed psychoanalysis would help uncover long-buried feelings. In a psychoanalyst’s office, you might see a patient lying on a couch speaking of dreams or childhood memories, and the therapist using various Freudian methods such as free association and dream analysis (Figure 1). In free association, the patient relaxes and then says whatever comes to mind at the moment. However, Freud felt that the ego would at times try to block, or repress, unacceptable urges or painful conflicts during free association. Consequently, a patient would demonstrate resistance to recalling these thoughts or situations. In dream analysis, a therapist interprets the underlying meaning of dreams.

Psychoanalysis is a therapy approach that typically takes years. Over the course of time, the patient reveals a great deal about himself to the therapist. Freud suggested that during this patient-therapist relationship, the patient comes to develop strong feelings for the therapist—maybe positive feelings, maybe negative feelings. Freud called this transference: the patient transfers all the positive or negative emotions associated with the patient’s other relationships to the psychoanalyst. For example, Crystal is seeing a psychoanalyst. During the years of therapy, she comes to see her therapist as a father figure. She transfers her feelings about her father onto her therapist, perhaps in an effort to gain the love and attention she did not receive from her own father. 

Today, Freud’s psychoanalytical perspective has been expanded upon by the developments of subsequent theories and methodologies: the psychodynamic perspective. This approach to therapy remains centered on the role of people’s internal drives and forces, but treatment is less intensive than Freud’s original model.

 

Link to Learning

View a brief video that presents an overview of psychoanalysis theory, research, and practice.

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Glossary

biomedical therapy: treatment that involves medication and/or medical procedures to treat psychological disorders

dream analysis: technique in psychoanalysis in which patients recall their dreams and the psychoanalyst interprets them to reveal unconscious desires or struggles

free association: technique in psychoanalysis in which the patient says whatever comes to mind at the moment

psychoanalysis: therapeutic orientation developed by Sigmund Freud that employs free association, dream analysis, and transference to uncover repressed feelings

psychotherapy: (also, psychodynamic psychotherapy) psychological treatment that employs various methods to help someone overcome personal problems, or to attain personal growth

transference: process in psychoanalysis in which the patient transfers all of the positive or negative emotions associated with the patient’s other relationships to the psychoanalyst

Contributors and Attributions

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