Demystifying Psychoanalytic Psychotherapy

People often come to therapy not knowing what to expect.

This can cause anxiety in the beginning of therapy. What will the appointments be like? What can I expect in the 50 minutes that we meet? Who leads the conversation? What do I talk about? How long will it take until I feel better? Do I have to lay on a couch? Do I have to talk about my dreams? How will it help me feel better? 

When we think of psychoanalysis, we often have cartoon-like images in our mind of a patient lying on a couch and an old man seated in a chair behind the client, out of sight. In media portrayals about therapy, often the therapist is disinterested in what the patient is sharing, or they may be depicted as having more personal problems than the clients they meet with. None of these images portray a sense of trust in the experience.

There is also a general belief that therapy is about blaming one’s parents for any current problems in a person’s life. It is believed that therapy keeps you stuck in the past, focusing on what happened years ago. Others even assume that therapy is about absolving oneself from responsibility and see therapy as self-indulgent. 

The truth is that most people who seek out psychotherapy are looking to be understood, to understand themselves better, and to find a solution to a pressing problem. People are looking for expertise from the therapist with the hope that a positive connection can be formed with the therapist that will facilitate personal growth.

At the heart of therapy, specifically psychoanalytic psychotherapy, is a desire to understand oneself better, to get a sense of the dynamics operating in a person’s life, to identify the patterns that continue to repeat, and to find some freedom in the day-to-day. Ultimately, psychotherapy is about personal growth. Psychoanalytic therapy can assist us with understanding our past and our development and using that understanding to illuminate changes and reducing emotional distress in the present. 

A key technique in psychotherapy is talking freely about anything and everything that comes to mind. (This technique has evolved from “free association” in Freud’s day.) When we speak freely about anything top of mind, often our unconscious thoughts and feelings are able to be acknowledged. It is very common in therapy when speaking about a situation and in hearing yourself talk aloud that suddenly you gain clarity, as you realize more fully what you think and feel about a situation. This clarity provides insight and self-awareness which are two necessary ingredients to change.

Another key part of psychoanalytic psychotherapy is focusing on the emotion felt in the session. What emotions arise as you talk about a situation in the session? By getting in touch with the emotional experience, you are able to understand themselves better and to make connections in his/her life events. 

Therapy will often include talking about the past, whether it’s early family life, childhood experiences, or past events in adulthood. We use the past to help us identify and clarify patterns in the present. Once a pattern is identified, there is a better chance of not repeating patterns in the present. 

The relationship between the therapist and the client is often the most healing part of the therapy experience. Among all the studies conducted about therapy, this is often cited as the most significant factor in change (accounting for at least 51% of improvement). The rapport that grows between client and therapist and if the relationship is a “good fit” for both people is essential to the work. Do you feel like you can open up and be honest? Do you feel that you can speak freely? Are you comfortable talking with the therapist? 

The therapist functions as a guide in the therapy. Often people think that therapy is about giving advice, and this expectation can lead to frustration in therapy. When people come to me asking for my advice about a situation in their life, I usually resist providing it. I believe that therapy is about the exploration of a person’s life and the situations that trouble them. Giving advice means I am inserting myself, the way I would handle a situation, with all my biases and opinions, on to another person’s life. Thus, that person will be living the life I think they should, rather than carving out a life of their own. I envision myself like a guide as we journey together, pointing out sights along the way and places to stop and rest, but ultimately, it’s the client’s journey and their life. 

Hopefully this gives you a taste of what to expect in therapy. Stay tuned for the second part of Demystifying Psychoanalysis.