What is Psychoanalysis?

Psychoanalysis is based on clinical and scientific evidence that people are often unaware of many of the feelings and thoughts that determine their emotions and behavior. These unconscious parts of our emotional lives may lead to unhappiness, that can’t be resolved by simple means of reassurance or efforts of will. This can take the form of recognizable symptoms and troubling personality traits, including difficulties in work or in love relationships; anxiety; mood problems such as depression or difficulty regulating anger; and self-esteem issues. Psychoanalysis is an effective and durable therapy for these problems. Psychoanalysis changes lives.

 

Analysis is an intimate partnership, in the course of which the patient becomes aware of the underlying sources of his or her difficulties - not simply intellectually, but emotionally, by re-experiencing them with the analyst. Treatment often goes beyond symptoms being ameliorated or resolved - but also includes expanding the freedom to feel authentic feelings, to work to love, and to become a more full and real individual.

 

Eventually the patient's life - his or her behavior, relationships, sense of self - changes in deep and abiding ways. Typically, the patient comes three to five times a week, lies on a couch, and attempts to say everything that comes to mind. These conditions create the analytic setting, which permits the emergence of aspects of the mind not accessible to other methods of observation and therapy. As the patient speaks, hints of the unconscious sources of current difficulties gradually begin to appear - in certain repetitive patterns of behavior, in the topics which the patient finds hard to talk about, and in the ways the patient relates to the analyst.

 

The analyst helps create a setting in which the fullness of each individual patient emerges, and helps the patient to understand repetitive patterns that are associated with distress and that interfere with more freedom to feel, think freely, and make better choices. In response to the analyst’s comments, the patient refines, corrects, rejects, and adds perspective.

 

During the years that an analysis takes place, the patient wrestles with these insights, going over them again and again with the analyst and experiencing them in daily life, in fantasies, and in dreams. The “going over again and again” is by no means an unproductive repetition. Our experiences as analysts have taught us that the patient’s experiential learning in fact depends upon repeated demonstrations – often taking different forms – of the powers of unconscious mental life in determining so many facets of our emotional lives and behavior. Addressing the painful feelings that often emerge in treatment is an important part of the process. Patient and analyst join in efforts to understand and ameliorate these painful feelings, and to modify crippling life patterns and diminish incapacitating symptoms. Treatment often goes beyond symptoms being ameliorated or resolved - but also includes expanding the freedom to feel authentic feelings, to work to love, and to become a more full and real individual. Eventually the patient's life - his or her behavior, relationships, sense of self - changes in deep and abiding ways.

People come to analysis because of repeated failures in work or in love, or by self-destructive patterns of behavior. Some may have already achieved important satisfactions - with friends, in marriage or long-term romantic partnerships, in work, or through special interests and hobbies - but are nonetheless significantly impaired by long-standing symptoms: depression or anxiety, sexual incapacities, or physical symptoms without any demonstrable underlying physical cause. Others might have problems experiencing and expressing healthy levels of anger or aggression, whether excessively angry or bossy, or the opposite - insufficiently assertive. And still others seek analysis definitively to resolve psychological problems that were only temporarily or partially resolved by other approaches.

 

Whatever the problem - and each is different - that a person brings to the analyst, it can be properly understood only within the context of that person's strengths and life situation. Hence, the need for a thorough evaluation, which we call a consultation, to determine if psychoanalysis would be beneficial.

A psychoanalyst is a psychotherapist with expertise in a special kind of talk therapy. This therapy emphasizes a method designed for the patient to experience and gain insights into ways of experiencing and knowing the complexities and depth of human emotional experience and mental life.

 

Graduate psychoanalysts trained under the guidelines of the  American Association for Psychoanalytic Education (AAPE) and American Psychoanalytic Association have had a rigorous and extensive clinical education. 

Candidates accepted for training at an accredited psychoanalytic institute must meet high ethical, psychological, and professional standards. Candidates in training are either physicians who have completed a four-year residency program in psychiatry; psychologists or social workers who have completed a doctoral program in their field or hold a master’s degree in a mental health field where such a degree is generally recognized as the highest clinical degree; or other clinicians such as nurse practitioners, mental health counselors, marriage and family therapists, and creative arts therapists. All must have had extensive clinical experience. All accepted candidates, whatever their background, then begin at least four years of psychoanalytic training.

 

During psychoanalytic training, candidates develop their skills through classwork, individual supervision of their work with patients by experienced faculty, and their own treatment.

 

Besides conducting psychoanalysis, most graduate analysts practice other forms of psychotherapy, and sometimes prescribing medication. Many treat couples, conduct family or group therapy sessions.  Psychoanalytic training also informs analysts’ other roles as teachers, supervisors, consultants, and researchers, in the many different settings - hospitals, medical schools, colleges, day-care centers - where they work.

Child and adolescent psychoanalysis, both offshoots of adult psychoanalysis, share with it a common theoretical framework for understanding psychological life, while also using additional techniques and measures to deal with the special capacities and vulnerabilities of children. For instance, the young patient is helped to reveal his or her inner feelings and worries not only through words, but also through drawings and fantasy play. In the treatment of all but late adolescents, parents are usually consulted to round out the picture of the child's life. The goal of child and adolescent analysis is the removal of symptoms and of the psychological roadblocks that interfere with normal development.

Sigmund Freud was the first psychoanalyst. Many of his insights into the human mind, which seemed so revolutionary at the turn of the century, are now widely accepted by most schools of psychological thought. Although others had begun to recognize the role of unconscious mental activity, Freud was the preeminent pioneer in understanding its importance. Through his extensive work with patients and through his theory building, he showed that factors which influence thought and action exist outside of awareness, that unconscious conflict plays a part in determining both normal and abnormal behavior, and that the past shapes the present.

 

Building on such ideas, psychoanalysis has continued to grow and develop as a general theory of mental functioning and treatment, while maintaining a profound respect for the uniqueness of each individual. Ferment, change, and new ideas have enriched the field, and psychoanalytic practice has adapted and expanded.

 

Psychoanalysis as it is practiced today is a very different discipline and treatment than as practiced in Freud’s time. But psychoanalysts today still appreciate the persistent power of the irrational in shaping or limiting human lives. Like Freud, we believe that psychoanalysis is the most sophisticated tool for obtaining further knowledge of the mind, and that by using this knowledge for greater self-awareness, patients free themselves from incapacitating suffering, and improve and deepen human relationships.

Although psychoanalysis began as a tool for ameliorating emotional suffering, it is not only a therapy. It is, in addition, a method for learning about the mind, and also a theory, a way of understanding the processes of everyday mental functioning and the stages of development from infancy to old age. Furthermore, because psychoanalysis seeks to explain how the human mind works, it contributes insight into whatever the human mind produces. In so doing, it has had a profound influence on many aspects of twentieth-century culture.

 

As a general theory of behavior and individual experience, psychoanalytic ideas enrich and are enriched by the study of the biological and social sciences, group behavior, history, philosophy, art, and literature. As a developmental theory, psychoanalysis contributes to child psychology, education, law, and family studies. Through its examination of the complex relationship between body and mind, psychoanalysis also furthers our understanding of the role of emotions in health as well as in medical illness.

Psychoanalytic knowledge is the basis for other therapeutic approaches. Insights from psychoanalysis form the underpinnings of much of the psychotherapy employed in general psychiatric practice, in child psychiatry, and in most other individual, family, and group therapies.

 

Psychoanalysts appreciate that the entire mental health field has much to offer the variety of patients who come for help. Forms of treatment such as psychodynamic psychotherapy, psychopharmacology, group therapy, family and couples therapy, cognitive-behavioral therapy (CBT), dialectical behavioral therapy (DBT), specialized substance abuse treatments, and many other therapeutic approaches can be appropriate and helpful. Psychoanalysts are interested in choosing the best treatment or combination of treatments for each individual.