What is psychoanalytic therapy and how does it work?

For more than two years I have been going to psychoanalytic therapy - the “light version of psychoanalysis”.

I did not choose this method because before studying the relevant literature I knew nothing at all about it. I don’t want to insist on efficiency - this is a matter of many factors. In my case, the process is slow, but I feel that I am getting rid of annoying cognitive distortions, challenging them, learning to build relationships and respond to difficult situations differently. Abstract anxiety and its main symptom—panic attacks, which had tormented me since school—went away in the first six months.

Every year I am haunted by the eternal, as I call it, change of cycles: autumn and winter are always productive for me, full of ideas and the meaning of life; spring and summer are a viscous depressive background, which I tried to cope with through self-harm. All my life I have had a hard time controlling my own impulsiveness and emotional swings. I decided to try something different instead of the usual destructive way - I realized that I should trust someone.

It seems to me that the main role is played not so much by the method as by the participants in the process themselves. The relationship between two people, which unfolds within the narrow confines of a setting, is the value and goal that psychotherapists should ideally adhere to, whatever direction they prefer.

Before that, I went to a psychotherapist for an eating disorder, but it didn’t go beyond the first session. We weren't right for each other, that's how it happens. But then I was demotivated: I thought that all therapists are the same and I couldn’t find a better one. Also a kind of cognitive distortion.

I met my current psychotherapist a year later. I searched on the specialized website, went through the options, called everyone personally - I completely trusted my intuition, and not the recommendations of my friends. The best advice: do not go to the first number, but communicate in person, at least on the phone, study the information (diplomas, qualifications) and understand whether the specialist is attractive to you. This is difficult internal work, but the result is worth it.

The most interesting things begin in the office - at four consultation (introduction) meetings and directly during psychotherapy.

What are counseling meetings and how can they help you?

This is a format of conversation when you and the psychotherapist get to know each other better.

You talk about yourself, your problem or request (what you want to get or what to fix during psychotherapy), ask questions. The psychotherapist, in turn, informs you about the method in which he specializes. Essentially, you study each other: the patient, relying on intuition, finds out for himself how comfortable he will be in opening up to this psychotherapist, and the psychotherapist himself, analyzing the patient’s request, understands how he can help him. And can it help at all?

Consultation meetings are strategically important - this way you will understand from the very beginning whether the alliance will work out.

You need to keep in mind that we are all different. For some it is easier to open up to a stranger right away, for others it takes more time. In addition, a psychotherapeutic session is limited in time, and it is difficult to fit the events of a whole life into a short time. This is not necessary.

What's really useful:

1. Formulate your problem (request) so as not to miss the most important thing.
2. Don't prepare your speech in advance. Rely on improvisation; in the free association method, it is your uncontrollable thoughts that are of greatest interest. In case of “deviation from the course”, the psychotherapist will bring you back to the topic with questions.
3. Try to relax, but don't resort to alcohol or drugs. In general, the use of any kind of psychoactive substances before therapy is a taboo and a significant reason for the therapist to refuse a session. If you have an alcohol or drug addiction and come with this specific problem, openly discuss this issue and possible solutions.
4. Don't be afraid to ask your therapist questions. It is absolutely normal to ask about work experience, specialization, session cancellation policy, payment system, and regularity of sessions. If a question arises in your mind during the conversation, ask it right away, it’s easier than suffering later. A competent specialist will not react negatively to questions and think that in this way you doubt his competence (even if so, then what?). Psychotherapy itself is not such a pleasant experience, so it is better to minimize discomfort in advance.

Counseling meetings are not exactly psychotherapy in the conventional sense, but they are an important start to your therapeutic relationship. Personal problems are very difficult to entrust to someone. But if you feel that:

• the psychotherapist is pleasant to you,
• you feel comfortable being in the office,
• working conditions suit you,
• you would trust this person and you do not feel pressured/devalued by him,

- welcome, it's time to go to the dark side of consciousness with your chosen guide.

Sources

• Tenyi T. . // Psychiatr Hung - 2022 - Vol36 - N2 - p.225-227; PMID:33870909
• Dembińska E., Rutkowski K. The reception of Dr Ludwik Jekels' “apostolic activity” to promote psychoanalysis in Poland before the outbreak of World War I. Part 2. // Psychiatr Pol - 2022 - Vol54 - N6 - p.1231-1254 ; PMID:33740807
• Dembińska E., Rutkowski K. The reception of Dr Ludwik Jekels' “apostolic activity” to promote psychoanalysis in Poland before the outbreak of World War I. Part 1. // Psychiatr Pol - 2022 - Vol54 - N6 - p.1209-1230 ; PMID:33740806
• Botbol M. Psychoanalysis and Psychodynamic Psychiatry in France. // Psychodyn Psychiatry - 2022 - Vol49 - N1 - p.19-23; PMID:33635105
• LaMothe R. Psychoanalysis and the Ungovernable Self: Further Explorations. // Psychoanal Rev - 2022 - Vol108 - N1 - p.27-50; PMID:33617335
• Miller IS. BALANCING THE GENERAL WITH THE PARTICULAR IN PSYCHOANALYSIS. // Am J Psychoanal - 2022 - Vol81 - N1 - p.1-5; PMID:33597722
• Holmes J. Friston's free energy principle: new life for psychoanalysis? // BJPsych Bull - 2022 - Vol - NNULL - p.1-4; PMID:33597069
• Ruberg W. Infanticide and the influence of psychoanalysis on Dutch forensic psychiatry in the mid-Twentieth century. // Hist Psychiatry - 2022 - Vol - NNULL - p.957154X21989174; PMID:33569987
• Schröter M. . // Nervenarzt - 2022 - Vol - NNULL - p.; PMID:33512564

About psychoanalytic therapy itself

After four introductory meetings, we move directly to work. It will not be radically different from those first four sessions (maybe the price will increase slightly). The mechanism of work will depend on the method in which the psychotherapist specializes.

— Is psychoanalytic therapy different from psychoanalysis? Why did I choose this particular direction?

Any psychotherapy has one task: to help work through the internal conflict and find out at what stage the “closure” occurred - when certain attitudes or behavior appeared.

In psychoanalysis and psychoanalytic therapy, a specialist uses the method of free association: a person tells everything that comes to his mind, and the psychoanalyst interprets it based on the emotions that accompany the story. In cognitive behavioral therapy, gestalt therapy, acceptance and commitment therapy and many others, the method will be different.

Psychoanalytic therapy differs from psychoanalysis in that the role of a specialist is more felt in it. He does not act as a “silent witness” who simply listens to your experiences and makes meaningful notes in a notebook, but is actively involved in the process: asks questions, reacts non-verbally to what is said.

— How long does therapy last and how long do you need to walk?

Psychoanalytic therapy involves regular meetings and intensive work (three times a week). Session time is 50 minutes (sometimes 45 minutes, sometimes an hour, this needs to be checked with a specialist). How long to walk is an individual question. On average, they promise two years, but it all depends on the characteristics of your personal structure and the complexity of the injury. In my case, you need to go for at least three years.

Therapy cannot last a lifetime, otherwise it will be a different format of relationship.

It is also important to understand that psychotherapy is always an equal responsibility. The specialist makes only half the effort, the rest is your soul-searching, motivation to change your life.

- How much does it cost? And why is it so expensive?

Each specialist has his own price. With intensive work (2-3 times a week), a decent amount can accumulate in a month, but the high price is the main motivation for work.

— Do you have any doubts about the effectiveness of psychotherapy?

Constantly. After all, far from the most pleasant things can be hidden in the subconscious: childhood traumas, repressed grievances, unprocessed emotions. It is very painful to become aware of them, and in therapy you meet them and live them again. This is the only way to get rid of it.

In order not to come into contact with pain as much as possible and not to go crazy from the number of sad stories, the psyche can block any attempts to interfere with the established world (even if it’s destructive - it’s familiar!).

There is such a psychological defense - resistance. This is when at a certain point in therapy the patient thinks that he has reached a dead end and the effectiveness of the sessions has reached zero.

It is important to track these states, talk through them during the session and often ask yourself the question: what is happening and why do I want to stop halfway?

Of course, no one is safe from an incompetent specialist. If three months have passed and you have never gotten better (let me remind you that psychotherapy is not a linear process and there will always be good and bad moments), your symptoms have worsened and you are thinking about suicide, this is a sure sign that something is going on This is not the case and you should look elsewhere for help.

— Does psychoanalytic therapy have side effects?

I do not want to give the reader the impression that psychotherapy will magically heal a person and help him in a couple of sessions. It would be too promotional and one-sided. This process also has a lot of side effects, and sometimes it is they that force you to leave therapy.

The main disadvantage is the high risk of so-called false memories.

Psychoanalytic theory insists that personality disorder is a consequence of childhood trauma, that something

, because of which the emotional regulation apparatus has closed and now works differently. Great efforts of the psychotherapist and the patient go into searching for a “black cat in a black room” and not always a certain event can be considered a trauma.

Also, the formation of a certain personality structure is influenced not only by upbringing and relationships with caregivers, but also by other factors: genetic predisposition, organic brain damage, environment, mentality and much more.

How does psychoanalysis help?

On the couch or in the chair, having accepted the safety of the psychoanalyst's office, the patient, making sure that he can, in fact, say whatever comes to mind

, as it were, returns to a childish state, to those times when he could still be sincere, including sincere to himself, while simultaneously preserving all his adult experience.
This process in psychoanalysis is called psychotherapeutic regression
.
This duality provides a unique opportunity to analyze the unconscious in the waking state - this is the main discovery of psychoanalysis
.

The harm from neurosis and depression lies not only in the fact that they create symptoms that prevent you from living a full life, they create obsessive repetitions that lead to chronic failures. Childhood traumas hinder the development of the individual as a whole. The task of psychoanalysis is to launch the process of psychotherapeutic regression

, so that the patient can “return” to his childhood traumas (fixations) and survive them, thereby resuming his personal development (see also
Transference and developing child
).
Therefore, modern psychoanalysis
, by eliminating neurotic delays, helps the patient resume his development, and the psychoanalyst supports and accompanies his patient along this path, in a sense, replacing the parental figure whose participation the patient lacked in childhood (this is why psychoanalysis takes a long time) .

Followers of Freud.

After the First World War, psychoanalysis not only revolutionized the entire psychiatry and psychotherapy, but also introduced a lot of new things into the study of man and his motivational sphere. Psychoanalytic concepts such as “Freudian slips,” “rationalization,” “sublimation,” “repression,” “ambivalence,” and “substitution” have even entered everyday language (see also PSYCHOLOGY).

Some of Freud's early students, most notably Carl Jung (1875–1961) and Alfred Adler (1870–1937), used psychoanalysis as a starting point for developing their own psychological concepts. Jung interpreted the nature of drives in many ways differently than Freud. In addition to the personal conflicts of the individual, culturally determined and unconsciously transmitted symbolic representations of the main “themes” of human existence are important. According to his concept, at the center of individual experience are constantly emerging mythological themes common to all humanity. At the heart of all struggling tendencies in a person’s life are archetypal (primary) images that conflict with each other. Jung's idea of ​​transmitting unconscious fantasies through the collective unconscious seemed purely theoretical and even mystical to Freud and his followers (see JUNG, CARL GUSTAV).

Alfred Adler believed that Freudian psychoanalysis underestimates the role of social factors, emphasizing the primacy of sexual desires. He associated the causes of individual conflicts with more superficial factors, especially feelings of inferiority and a sense of uncertainty about one’s social status, physical abilities, or sexual capabilities. Many of Adler’s ideas contributed to the further development of the concepts of self-esteem and especially to the analysis of its violations in the so-called. narcissistic personality disorders (see ADLER, ALFRED).

Otto Rank (1884–1939) was amazed by the discoveries that were made during research on the negative consequences of separation of a child from his mother. He developed Freud's hypothesis about birth trauma as a prototype of an anxious situation and proposed a system of psychotherapy based on overcoming separation trauma. Rank considered the will to be the decisive factor in the relationship between patient and psychoanalyst, and his system of psychotherapy is known as will therapy (see RANK, OTTO).