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Psychoanalysis is a very specialized treatment technique
that requires years of advanced training at an accredited
psychoanalytic institute. The indications for psychoanalysis
are generally that the "presenting problem" is of a more long-standing
nature, and is more deeply rooted than those issues that are
amenable to treatment by less frequent psychotherapy. The
person best suited for psychoanalysis is one who is impaired
by longstanding symptoms, yet at their core, has significant
emotional resources. A great many presenting complaints have
been helped through psychoanalysis: depression and anxiety,
interpersonal difficulties, and physical symptoms without
any demonstrable underlying cause. One person may suffer from
ongoing ruminative worries that are greatly exaggerated, while
another may come to analysis because of repeated failures
in work or love.
Psychoanalysis
requires a significant commitment of resources from both the
analyst and "analysand" (client). Sessions take place four
or five days per week and last from 45-50 minutes. The overall
time commitment to psychoanalysis is measured in months and
years, rather than weeks and months.
One
of the main differences between psychotherapy and psychoanalysis
concerns the relationship with the therapist, or "analyst."
As one might imagine, such frequent meetings often leads to
a more intense, and sometimes "heated" relationship with the
analyst than would occur in psychotherapy. The analyst hopefully
comes to know the client quite well. This lays the groundwork
for a situation in which the presenting difficulty becomes
an integral aspect of the very treatment relationship. The
analytic relationship becomes a type of "living laboratory"
in which the problems are not observed from afar, but enacted
and observed in the here-and-now by the analytic dyad.
Sigmund
Freud is considered the founder of psychoanalysis and one
of his great contributions was the demonstration that we each
have a part of our mind that is "unconscious," that is, there
are factors which influence thought and action which reside
outside of conscious awareness. The theory of contemporary
psychoanalysis, however, is markedly different than in 1900,
when he published "The Interpretation of Dreams." Although
modern psychoanalysts remain interested in unconscious motivations
and conflicts, they are generally more interactive and interpersonally
engaged than the stereotypical "distant and neutral" analyst.
Psychoanalysis is now considered to be more a search for understanding
and the discovery and creation of "meaning," than a search
to uncover repressed "id" impulses.
My
own theoretical orientation in psychoanalysis is somewhat
eclectic, as I find that each of the main theoretical "schools"
have something of value to offer. A few of the theoreticians
who have most heavily influenced my understanding and practice
of psychoanalysis include Heinz Kohut (Self Psychology), Robert
Langs and Merton Gill (Communicative Psychoanalysis), Robert
Stolorow (Intersubjectivity Theory), D.W. Winnicott (British
Middle School), and W. Bion (British Object Relations).
Additional Reading:
New York Times article (1/28/03)
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clients in psychoanalysis often make use of this traditional psychoanalytic couch
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