Psychoanalysis

Psychoanalysis is a family of psychological theories and methods within the field of psychotherapy that seeks to elucidate connections among unconscious components of patients' mental processes, and to do so in a systematic way through a process of tracing out associations. In classical psychoanalysis, the fundamental subject matter of psychoanalysis is the unconscious patterns of life as they become revealed through the analysand's (the patient's) free associations. The analyst's goal is to help liberate the analysand from unexamined or unconscious barriers of transference and resistance, that is, past patterns of relatedness that are no longer serviceable or that inhibit freedom. More recent forms of psychoanalysis seek, among other things, to help patients gain self-esteem through greater trust of the self, overcome the fear of death and its effects on current behavior, and maintain several relationships that appear to be incompatible.

Techniques

The basic method of psychoanalysis is the transference and resistance analysis of free association. The patient, in a relaxed posture, is directed to say whatever comes to mind. Dreams, hopes, wishes, and fantasies are of interest, as are recollections of early family life. Generally the analyst simply listens, making comments only when, in his or her professional judgment, an opportunity for insight on the part of the patient arises. In listening, the analyst attempts to maintain an attitude of empathic neutrality, a nonjudgmental stance designed to create a safe environment. The analyst asks that the analysand speak with utter honesty about whatever comes to awareness while interpreting the patterns and inhibitions that appear in the patient's speech and other behavior.

Related Topics:
Free association - Dream - Judgment - Patient - Empathic

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A general rule of thumb in psychoanalytic treatment is that more insight-oriented techniques are to be used with healthier patients, whereas more supportive techniques are to be used with more disturbed patients. The most common example of an insight-oriented technique is an interpretation, in which the analyst delivers a comment to the patient that describes one or more cluster of unconscious wishes, anxieties, and defenses. An example of a supportive technique might be reassurance, in which the analyst tries to lower the patient's level of anxiety by assuring he/she that what he or she fears will not come to pass, or will be manageable. Analysts usually prefer to make more insight-oriented interventions when possible, as they feel that such interventions are usually less judgmental than other techniques.

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Although psychoanalytic techniques have sometimes been attempted to treat psychosis, evidence on the results is at best mixed. Previously, work by analysts such as Bertram Karon and colleagues at Michigan State University, has claimed that when trained properly, psychodynamic therapists can be effective with schizophrenic patients. More recent work casts doubt on these claims. The Schizophrenia Patient Outcomes Research Team (PORT)report, which sets out best patient treatment practices based on evidence, states in its Reccomendaton 22 against the use of psychodynamic therapy in cases of schizophrenia, noting that more trials are necessary to verity its effectiveness. Similarly, a review of current medical literature in The Cochrane Library, (the upated abstract of which is available online0, claimed that no data exist supporting claims that psychoanalyis is effective in treating schizophrenia.

Related Topics:
Psychosis - The Cochrane Library

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Currently, most psychoanalysts claim that analysis is most useful as a method in cases of neurosis and with character or personality problems. Psychoanalysis is believed to be most useful in dealing with ingrained problems of intimacy and relationship and for those problems in which established patterns of life are problematic. As a therapeutic treatment, psychoanalysis generally takes three to five meetings a week and requires the amount of time for natural or normal maturational change (three to seven years).

Related Topics:
Neurosis - Personality

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Much recent psychoanalytic work has been devoted to exploring the use of psychoanalytic principles and techniques in shorter face-to-face psychodynamic psychotherapy, and integrating psychoanalysis with other psychotherapeutic techniques such as those of cognitive behavior therapy. Empirical research on the efficacy of psychoanalysis and psychoanalytic psychotherapy has also become prominent.

Related Topics:
Psychodynamic psychotherapy - Cognitive behavior therapy

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An open-door review of outcome studies of psychoanalysis can be found here

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Cost

Although psychoanalysis used to be an expensive treatment, cost today ranges from as low as ten dollars a session (with an analytic candidate in training at an institute) to over 250 dollars a session with a senior training analyst.

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