Psychoanalytic Psychotherapy
What is psychoanalysis? and What does Psychoanalysis look like in Practice?
Psychoanalysis operates on the premise that there exists a knowledge not known to ourselves, an unconscious knowledge. If one worked in one’s own best interests and if one is in control we wouldn’t be capable of our own destruction such as in cases of anorexia, addiction, gambling, puzzling anxiety or depression.
Psychoanalytic psychotherapy is a practice that focuses primarily on speech. Language is our connection to reality as reality is grounded in speech. Psychoanalysis is an effective method of treatment for those experiencing disturbances in affect, thought or behaviour. Clinical experience shows that when one symptom disappears it is often replaced by another. Psychoanalysis aims to undo the identifications and fixations that have led to the repetition in symptom-formation.
Clinical practice in the psychoanalytic orientation is preoccupied with the singularity of each client in a case-by-case tradition not a one solution fits all model. Speech provides the means to access what is symptomatic to come to light and allow the conflict and compromises of the symptom to become analysable.
What is the role of the therapist?
The role of the psychoanalytic psychotherapist is to direct the treatment: to follow the speech of the client to where the symptom and the unconscious are connected. Through speech the symptom manifest content such as anxiety, depression, addiction, eating disorders, panic attacks, OCD and so on give way to the meaning of the symptom. Language plays a role into how an individual experiences their symptom.
Generally, an analysis is conducted by inviting the client to speak freely about their suffering. The psychoanalyst provides a very specific listening which aims at hearing something beyond what is said. This will be exemplified below with two clinical vignettes.
The session framework?
Psychoanalytic psychotherapists work with the variable-length session which means that ending the session on the articulation of a crucial question or the encounter with a contradiction; the time in between sessions is supposed to be used as a time to comprehend the material raised in the sessions and it can be developed and worked on by the client for the next session.
The point of an analytical session is not to achieve closure or resolution to a particular problem in a certain amount of time but through questioning ideas and untangling multiple associative threads, the question then becomes less “What time is it?” or “how long have I got?” to “Why did my analyst stop me at that particular moment?” The sessions become sequences on a continuum.
What are some of the interventions/methods used in session?
The psychoanalytic technique consists in listening and hearing: – “Freud remarked that there is perhaps a kind of speaking that is worthwhile precisely because up until now it was merely interdicted- which means spoken between the lines. That is what is called the repressed.” Lacan 1975
Psychoanalysis teaches that knowing and understanding cannot take place independently of the client/practitioner relationship. The psychoanalytic position refrains from offering advice or being suggestive as no two people are the same and the appropriate solution for one person can be completely unbeneficial for another. Furthermore, each person is capable of constructing their own solutions to their symptoms; the role of the analyst is to facilitate the client in becoming aware of the resources she or he possesses.
The ethics of psychoanalysis involve hearing something of what the client wants outside of the ideals imposed on him or her, it is not about a highly functioning or well-adapted individual but rather about formulating a question regarding one’s desire.
The issues Psychoanalytic Psychotherapy can treat.
Psychoanalytic psychotherapy welcomes anyone that has a question about their own symptom; it can help one to gain greater clarity in regards to their position. Psychoanalysis does not only treat symptoms but thoroughly questions their origins and for this reason consistency and commitment to therapy are essentially important.
Two Clinical Vignettes:
- In the first example the practitioner was working with a client with a history of addiction that thwarted a previous attempt at attending college, the client is overcome with anxiety about continuing his education.
Client: “I dreamt I was on a train and placed my suitcase in the overhead compartment, but it was stolen…”
Therapist: “Are you in over your head?”
Client: (looking confused) -Oh my God, actually it wasn’t stolen, I lost it!”
Outcome: The client made a sudden empowering discovery that because he “lost it” it on the previous attempt, he had the ability to create a different outcome.
- The clinical work discussed here shows how though paying close attention to the symptom in the clinical setting exemplifiers the effect of the client’s speech in the therapeutic encounter.
Two slips of the tongue characterize the next clinical case. In the first session the client stated she had built herself up for “this appointment” – the therapist made an interpretation: “disappointment?”
In the second slip the client corrected herself when she said: “My a-parents is letting me down” evidently meaning to say to say “appearance”.
Questioning the slips gave rise to a series of associations which led to articulating something of her disappointment with her parents.
