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PSYCHOANALYTIC PSYCHOTHERAPY Psychoanalytic theory

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PSYCHOANALYTIC PSYCHOTHERAPY

By Jimmy Petruzzi Jimmy Petruzzi, Cert Ed, PGCert MH Psych, MSc (Psychology and Neuroscience of
Mental Health), BIH, MBPsS

Psychoanalytic theory is past-oriented, based on a disease model of pathology, and focuses on the
deficits of a person as a result of the influence of past early childhood experiences on current
functioning. In essence, psychoanalytic therapy is a reconstruction of a client’s past in the context
of adult analysis. Psychoanalytic theory and therapy was developed by Sigmund Freud from the late
19th century, and has undergone many refinements since his work, coming to its height of
prominence in the 1960s. Although its validity is now largely disputed and criticized, his examination
of the development aspects of the personality produced valuable insights into the personality
structure and how defence mechanisms are employed to balance the id and superego with the
perceived construct of reality, whereby a healthy state of consciousness is maintained.

Essentially, Freud laid the foundations of understanding the aspects of human thought and
behaviour that arise from our basic instincts and subconscious mind. From the foundations of early
experiences, a person projects his or her unconscious impulses and conflicts. Therefore, in
psychoanalytic

psychotherapy a client is encouraged to reveal such issues with the aid of various techniques such
as free association, behavioural observation, transference, and dream analysis. Freud believed that
changes in personality were possible, but was questioning the practical merits of psychoanalysis to
effect such a change (Ellis, Abrams, Abrams, Nussbaum & Frey, 2009). He conceded that the
process of psychoanalysis is a long and difficult one that requires sophisticated verbal, intellectual,
and analytical skills of the therapist, with a real possibility to provoke anxiety and distress by the
exploration of a client’s past.

Despite Freud’s inclination to emphasize the challenges that face the psychoanalytic approach,
there is empirical evidence of the efficacy of psychodynamic therapy. In addition, clients appear to
maintain therapeutic gains and continue to improve after treatment completion (Shedler, 2010). A
meta-analysis study by De Maat, De Jonghe, Schoevers, and Dekker (2009) also concluded that long-
term psychoanalytic therapy is effective in symptom reduction, as well as personality change, and,
to a lesser extent however, it is significant in terms of quality of life and relapse prevention.
Nonetheless, it is clear that psychoanalytic therapy is a long journey that may not be suitable or
effective for resistant and younger clients, and those patients with severe psychopathology. Freud
agreed that it is a long and intricate process:

Psychoanalytic observation, reaching back into childhood from a later time, and contemporary
observation of children combine to indicate to us still other regularly active sources of sexual
excitation. The direct observation of children has the disadvantage of working upon data which are
easily misunderstandable; psychoanalysis are made difficult by the fact that it can only reach its
data, as well as its conclusions, after long detours. But by cooperation the two methods can attain a
satisfactory degree of certainty in their findings. (2000, p. 67).

Several techniques are used to explore those aspects of the self that are not fully known as they are
manifested and influenced in the therapist-client relationship. In psychoanalysis, the focus areas of
exploration are (Shedler, 2010):

1. Affect and expression of emotion: The psychoanalytic

therapist helps the client to describe unpleasant, contradictory,

threatening, troubling, and repressed feelings to cultivate

emotional insight.

2. Attempts to avoid distressing thoughts and feelings:

Mechanisms of defence and resistance that are deliberately or

inadvertently applied to avoid aspects of undesired experiences

are focused on as avoidance is significantly related to negative

feelings and problematic behaviour. The client’s affect and role

in shaping events are examined directly and without

compromise.

3. Recurring themes and patterns: A client may be unaware of,

or aware but unable to manage painful or self-defeating

recurring themes and patterns in their thoughts, feelings, self concept, relationships, and life
experiences. The psychoanalytic

therapist guides the client to recognize and understand these.

4. Past experience: Our present experience is significantly

affected by past events, especially early experiences of

attachment figures. Therefore, the focus is on the past in

relation to present problems and the client is encouraged to

explore and understand the effects in order to free themselves

from the bonds of the past.

5. Interpersonal relations: When object and attachment

relationships are unsatisfying and do not meet emotional needs,

psychological difficulties often arise. The client is assisted to

establish adaptive personality and self-concept aspects to

improve prosocial skills and attitudes.

6. Therapy relationship: The therapist-client relationship is

considered vital in the psychoanalytic therapy process as

problematic themes and patterns tend to emerge in some form

in the therapeutic relationship. These aspects of transference

and countertransference provide an opportunity to explore and

analyse a client’s interpersonal themes in vivo.

7. Fantasy life: Clients are encouraged to speak freely and

engage in free association that provides a rich source of

information of their thoughts, desires, fears, fantasies, dreams

and hopes, which signals their views of themselves, others and

the world, as well as aspects of experiential avoidance and their

interpretation of reality.

It follows that psychoanalytic therapy sessions are largely unstructured, without a predetermined
agenda, and open-ended. The excessive long and costly nature of psychoanalytic therapy, together

with the potential to harm a client by deeply intrusive explorations and an unrelenting focus on
psychopathology as an illness that can increase internal conflict and instability, have caused
sustained criticism over time.

As an application of the principle of the cause and effect of human behaviour, psychoanalytic theory
arguably remains valuable in the sense that it explained the many features of behaviour as the
products of circumstances in the past experiences of an individual (Skinner,

1954). However, Freud’s conception also “encouraged misinterpretation and misunderstanding” (p.
77) because of its complex and abstract nature that are thought to have obscured

important details among the variables of which human behaviour is a function. The most
unfortunate effect of all, however, is the neglect of analysis of behaviour as a telling manifestation
of inner experiences.

Therefore, there is an unquantifiable sense of psychoanalytic theory that largely ignores the
dynamic nature of behavioural processes in a constant flux in favour of the notion of fixations on
early stages of development.

However, the conception of defence mechanisms that are at first short term solutions to cope with
distress and deprivation of emotional needs but are reinforced and firmly established through
repetition and overutilization, have remained valid and useful in the development of modern
cognitive theories. In that sense, it is true that the past lives on in the present. In other words, we
view the present through the lens of past experience and therefore tend to distort the present
reality by repeating and recreating aspects of our past.

REFERENCES

De Maat, S., De Jonghe, F., Schoevers, R., & Dekker, J. (2009). The effectiveness of

long-term psychoanalytic therapy: A systematic review of empirical studies. Harvard

Review of Psychiatry, 17(1), 1-23. DOI: 10.1080/10673220902742476

Ellis, A., Abrams, M., Abrams, L. D., Nussbaum, A., & Frey, R. J. (2009).
 Psychoanalysis in theory and practice. In Personality theories: Critical perspectives

(pp. 111-141). Thousand Oaks, CA: SAGE Publications. DOI:

10.4135/9781452231617.n5

Freud, S. (2000). Three essays on the theory of sexuality (revised edition). New York,

NY: Basic Books.

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American

Psychologist, 63(2), 98-109. DOI: 10.1037/a0018378

Skinner, B. F. (1954). Critique of psychoanalytic concepts and theories. Scientific

Monthly, 79, 300-305.

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