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The word psychoanalysis refers specifically to Freud's approach to conducting therapy. Freud was trained as a medical doctor before turning his attention to psychological disorders.
To this day a psychoanalyst is typically a psychiatrist: an MD who has taken a residency in psychiatry after completing medical school. Psychoanalysts without medical degrees are called lay analysts.
To what does the word "psychoanalysis" refer?
In psychoanalysis, an individual's life is reviewed and interpreted in accordance with Freud's theory. In classic psychoanalysis, considerable emphasis is placed on the family drama of sexual conflicts that Freud believed lay at the center of the unconscious mind.
Psychologists never found Freud's ideas about the family drama very plausible. Freud seemed to be writing about his own early experiences, memories, and feelings, then projecting them onto all humanity, to use a Freudian concept. Hornstein wrote:
Psychoanalysis was associated more with psychiatry than psychology. When psychoanalysis first arrived in the United States, most psychologists ignored it.
By the 1920's, however, psychoanalysis had so captured the public imagination that it threatened to eclipse experimental psychology entirely. (Hornstein, 1992)
Despite the negative opinions of most psychologists, psychoanalysis caught on with the public. By World War II it was the dominant type of psychotherapy.
Psychoanalysis had its heyday in the United States from 1940 to 1960. During that time it was hailed as the inspired hope for dealing with most, if not all, of the problems in mental health.
When did psychoanalysis have its heyday?
Psychoanalysis could not live up to such inflated promises. It suffered a decrease in popularity from the 1960s onward.
Today relatively few therapists in the United States practice psychoanalysis. It is still popular in some European and South American countries.
Psychoanalysis as a therapy is typically very time-consuming, sometimes requiring years. During this time, all facets of a patient's childhood are explored in detail, especially the relationship with the parents.
Techniques such as dream interpretation, free association, or inkblot interpretation may be used to explore unconscious conflicts. If the analyst accepts Freud's formulations, most of those conflicts are thought to involve repressed sexual urges of childhood.
Psychoanalytic therapy is usually quite expensive. The total cost may exceed $30,000 after years of therapy. Freud may no apologies for charging a high price; he claimed high costs were actually therapeutic, because they symbolized a commitment to change and a serious desire to expose the truth.
What are common features of psychoanalysis as a therapy?
Psychoanalysts expect the phenomenon of transference to occur in therapy. Transference is a tendency to put the psychoanalyst in the same role as an important other such as a parent or a spouse.
Transference results in intensely positive or negative feelings about the therapist (called positive and negative transference, respectively). Freud thought transference was useful for (1) understanding how the patient interacted with important others, and (2) achieving a certain power or social influence over the patient.
Critics of psychoanalysis point out the negative aspects of transference, such as the formation of an emotional attachment to the therapist that may add complications to a patient's life.
What is transference and how is it used in psychoanalysis? What do critics point out?
Many variations of psychoanalytic technique exist. Some therapists sit face-to-face with their patients and emphasize problem-solving in the present, rather than analyzing childhood problems. Some use hypnosis; some do not. Some agree with Freud's original theory, others accept only parts of it.
Research on psychotherapy shows that most forms of therapy work equally well, if success is measured by the percentage of clients who report improvement. That would appear to give an advantage to briefer and less expensive therapies.
However, there is no such thing as an average person. In the final analysis (so to speak) each person must make an individual judgment about what therapy is preferred.
Hornstein, G. A. (1992). The return of the repressed: Psychology's problematic relations with psychoanalysis, 1909-1960. American Psychologist, 47, 254-263.
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