S. Giac Giacomantonio Psychologist

Psychoanalysis: Quaint antique or modern alternative?

What is psychoanalysis?
When most people think of psychoanalysis, one of two things typically springs to mind. Many picture the distinctive setting of a psychoanalytic therapy, like we see in the cartoons: a patient on a couch, a psychoanalyst complete with beard, glasses, and notepad, sitting behind the couch, saying little if anything. When others think of psychoanalysis, they may think of its controversial founder Sigmund Freud. For psychologists of all persuasions, Freud is the prototypical father figure, and as we might find in any large family, there are children who take after their father, others that rebel against him, and some who are determined to be precisely the opposite of whatever they perceive him to be.
Over 100 years ago, Freud and his colleagues were pioneers in uncharted territory. Since these earliest days of psychotherapy, there have been many disagreements amongst therapists about how best to help patients. Some disagreements were thought to be so important that many a therapist has felt the need to separate from the rest of his or her colleagues, in order to “safeguard” some new and treasured ideas. Others were simply expelled from the “main group” for their disagreements, and as the lovers and haters of Freud went on to acquire their own sets of lovers and haters, the number of approaches to the business of psychotherapy increased to the plethora we see today. While most psychologists like to organise this messy state of affairs by identifying a few groups or “types” of therapy, there remain literally hundreds of different approaches to this task of talking cure.
Among the many approaches to psychotherapy in general, psychoanalysis remains a unique approach in the minds of many. Psychoanalysis is over 100 years old, so as a science, it is relatively young, but as a form of psychotherapeutic treatment, it is regarded by many as the oldest of all. In the Australian Psychological Society, one of the largest of all the Interest Groups is the psychoanalytic one. While this suggests that it remains popular, we can also say that it remains somewhat controversial in the minds of some. Many psychologists, both those practising and those in the academy, hold very strong opinions about psychoanalysis and about Sigmund Freud—even those who do not practice, teach, or have any training in psychoanalytic therapies. While it may not be every psychologist’s cup of tea, psychoanalysis has somehow managed to retain a certain kind of “aura” or status in the minds of those who love it and—curiously—of those who loathe it. If people can have a strong opinion about psychoanalysis without knowing much about it, it makes one all the more curious about exactly what psychoanalysis is.

The therapy of psychoanalysis—a few basics
In a typical analysis, analyst and patient meet in a quiet place for about an hour, several times a week, over an essentially unpredictable period of time. Typically, the patient lies on the couch and tries to say whatever comes into his mind as freely as possible, while the analyst sits out of sight. The patient and analyst work together to explore and to try to understand the inner world of the patient. Together, they come to discover the ways in which the patient’s otherwise unconscious thoughts and feelings impact her ways of experiencing herself, the world, and other significant people in her life.

Alternative therapy of 100 years ago
In his time, Freud and his new treatment were considered alternative. Freud felt that his new discoveries were important for psychiatry, and he found that this new treatment of just talking actually helped his patients in new and striking ways. But the medical establishment was extremely sceptical, and very reluctant to embrace his theories about “unconscious” thinking, and about sexual and aggressive feelings.

What makes psychoanalysis different from other psychotherapies?
One way—perhaps an important way—in which psychoanalysis is different from many other psychotherapies is in its attitude towards the patient’s symptoms. Other therapies, which many psychologists practice today, tend to view the patient’s problem as the sum of his observable symptoms. Consequently, such approaches will base the treatment around helping or perhaps “teaching” the patient how to overcome these specific symptoms, perhaps by the therapist suggesting other ways to behave or to think, or by giving the patient “skills” to apply to himself. Psychoanalysis does not generally do this. For the psychoanalyst, the symptoms are not to be targeted in treatment, but rather to be understood. The symptoms are seen to be a side-effect of other, typically deeper issues. One idea here is that if the symptoms are not targeted in themselves, then they should improve as a result of the treatment dealing with the more central problem. If the patient’s experiences can be understood instead of “treated” or acted upon, it permits a more natural rather than an enforced change to take place. In this way, many of us choose psychoanalysis as a therapy to help us discover ourselves, to help us develop as people, and to know more about who we really are.

Why would anyone want psychoanalytic therapy today?
Psychoanalysis takes a long time, it becomes expensive over time, and it is often an intensive and emotional process. Other approaches to psychotherapy today often boast that they are problem-focused, brief, that they will target your symptoms and that they can train you in using skills that you can continue to use throughout your life, as future troubles might arise. So why would anyone opt for a therapy that is longer, more expensive, and more intensive than others on offer? Perhaps we can find some answers to this issue of attitudes to mental health by looking at people's attitudes towards their physical health.
In the area of general medicine, we have seen, for many years, a shift in popularity from Western medical approaches to so-called “alternative” or traditional medicines. More recently, this increase has led to health insurers offering the rebate-worthy “stamp of approval” for many such treatments. The reasons for this shift are usually given with familiar mantras like “treating the cause and not the symptoms”, and “building health rather than treating sickness”, as more and more are choosing herbs over antibiotics; subtle, gentle interventions over rougher physical or chemical interventions.
People seem to be interested not only in getting rid of their symptoms, but also in working with whatever is generating their symptoms. The logical extension of this approach is the idea that we treat the person, bring the person to health and see the symptoms disappear as a side-effect. People today seem more prepared to take a longer journey to arrive at a better level of functioning, creativity, productivity, health, and wellbeing.
Psychoanalysis no longer carries the unanimous prestige it once enjoyed as “the best treatment of all”; neither is it in a position to prove beyond all reasonable doubt that it makes more people better than other psychotherapies. Its unique contribution lies not in its ability to make people feel better, because patients of other therapies feel better too. Rather, its unique contribution lies in the unique kind of better that it offers. If someone becomes depressed, any number of treatments, for example, medication, may reduce her depressive symptoms. However, if someone is depressed because his second marriage ended as badly as his first, the medication will not likely improve the prognosis for marriage number three. For those who are interested to know themselves better, to understand in depth what makes them tick, and to understand why they make the same mistakes in relationships and in life over and over again, then perhaps psychoanalysis is a worthy alternative.

© Bissotto