……Or Is The Therapy Couch destined for the Scrapheap?
In this short-term, throwaway, bargain-basement culture, we may wonder whether an approach that inclines towards the long-term, and the more expensive, can be helpful to us. Or will it fall by the wayside?
Image: Brandon Giesbrecht. Flickr.
What IS Psychoanalytic Thinking?
This way of thinking involves a focus on the unconscious, the part of the mind that is not immediately available to our conscious awareness. The unconscious is a repository for hidden fantasies, thoughts, feelings and memories, which may motivate us in our daily lives.
Psychoanalysis aims to help us access such concealed aspects of ourselves, to bring the unconscious into the conscious, in order that we can learn to live more fully and be less afraid of what might lie within.
Psychoanalysis also uses the relationship between therapist and patient as an arena within which to explore sometimes self-defeating ways of being in relationships. These may have developed in childhood.
Past behaviours will inevitably be repeated symbolically in the therapy relationship. The space between therapist and patient becomes a kind of ‘theatre’ in which to reactivate and re-act aspects of one’s past experience. Feelings and behaviours towards the therapist will inevitably reflect aspects of the patient’s primary caregivers. This is called the transference.
Psychoanalytic ways of thinking emphasise the importance of early experience in contributing to personality development.
Psychoanalysis itself is a long and intensive form of therapy, aimed at discovering with the patient repressed thoughts and feelings. This is achieved through the interpretation of dreams, fantasies and memories, using the technique of free association. We all have defense mechanisms which protect us from painful thoughts, feelings and memories.
Psychoanalytic psychotherapy resembles psychoanalysis in terms of technique and approach, but it is often shorter and less intensive.
Psychoanalytic Thinking Has Changed with the Times
Freud was the founder of psychoanalysis; however, this school of thought has not remained static, but has developed and grown over the years. Whilst there may be fewer people practising ‘pure’ psychoanalysis than there were, the influence of psychoanalytic theory has been enormous. Many therapists are more eclectic in their approach, whilst valuing the learning from psychoanalysis.
As W.H. Auden said in his poem In Memory of Sigmund Freud:
to us he is no more a person now but a whole climate of opinion under whom we conduct our different lives: (Auden)
Sigmund Freud with Stephan Gabriel, (1921-2015) his grandson and brother of Lucian and Clement.
Image: Wikimedia Commons
Psychoanalytic Congress, 1911. Wikimedia Commons.
Addressing Criticisms of Psychoanalysis.
Some have criticised psychoanalysis for the fact that it takes time and is therefore expensive, especially in this throwaway and short-term culture, where thinking for oneself has been eroded.
Others regard psychoanalysis as having insufficient evidence-base for its effectiveness; they feel it is lacking in scientific credibility. Bowman sees this attack as ‘a defence against psychoanalysis.’
Indeed, it is so often the case that insights into the unconscious that emerge through the process of psychoanalysis may be experienced as threatening. Confronting one’s true feelings and motivations is not for the faint-hearted. Perhaps sometimes it is easier to criticise than to consider.
Manualised treatments, such as cognitive behavioural therapy, may be researched in a way that takes into account their ability to be predictive and generalised in approach. Psychodynamic psychotherapy, however, can never be so reduced, technique-driven or inflexible; nor can it be fitted into such mechanized and systematized methods of measuring efficacy:
‘Evidence-based demands and standardisation sought through State regulation and the NHS approach are contradictory to the psychoanalytic view of the uniqueness of the individual. What may prove therapeutic for one client may be totally inappropriate and ineffective with another. Psychotherapy is not a technique to be learnt and universally applied but is an exploring of human subjective history and experience. It cannot be ‘forced to happen’ and certainly cannot be guaranteed in the form of an ‘offer.’’
However, despite these issues, reliable and thorough research has been successfully carried out. It has indicated that there is definitely ample evidence for the efficacy of psychoanalytic approaches. (Peter Fonagy)
This research revealed that, as a treatment for severe depression, psychoanalysis was much more successful than CBT. The effects lasted longer after therapy than with CBT, and the research appeared to reveal that CBT became less effective as time passed.
With this in mind, will psychoanalysis and its ideas survive in the 21st Century? To find out, read next week’s post.
Have you found psychoanalytic thinking helpful? Please leave a comment below.