For many people, the word ‘psychotherapy’ conjures up images of the client, lying on a long couch, professing their inner-most secrets and conflicts to a note-taking therapist. In reality, most modern psychotherapy sessions look nothing like this. So where did this picture come from? One of the earliest forms of psychotherapy, based on the theory of psychoanalysis.
The theory behind psychoanalysis and psychoanalytic therapy was developed in the late 1800s by Sigmund Freud. One of the most well recognised names in the history of psychotherapy, Freud developed psychoanalysis through his work with a neurologist, Jean-Martin Charcot, who was using hypnosis to treat women who were suffering from ‘hysteria’.
The basic premise of psychoanalysis is that repressed emotions and experiences (which are unconscious) become released (i.e. they become conscious). Freud and many psychoanalysts suggest that psychological problems are rooted in hidden disturbances. These disturbances exist in the unconscious mind and are typically caused by repressed trauma or unresolved issues during childhood. They are manifested through psychological symptoms, such as anxiety, neurosis and depression. Through psychoanalysis, these repressed disturbances are brought into consciousness so that the client can deal with them.
Psychoanalysts use a number of techniques to access the unconscious of their clients. Some of the better known include:
Free association is a technique used by the psychoanalyst in attempting to reach the most painful and important repressed memories of the client. In free association, the client is asked to speak whatever comes into their mind. This leads to an uninterrupted flow of thoughts which the psychoanalyst then helps the client to interpret. The use of the couch arrangement in psychoanalysis is particularly important for the process of free association to occur. By lying back and looking upwards at the ceiling rather than facing the therapist, it is believed that the client will feel less pressure to conform to the normal rules of social interaction, less distracted and more open to letting their mind wander.
Psychoanalytic dream interpretation involves explaining the meaning of dreams. According to this practice, dreams represent the unconscious thoughts and emotions that the mind processes during sleep.
A Freudian slip is an unintentional error in speech that is regarded by psychoanalysts as revealing the speaker’s true subconscious feelings.
Although more short-term and effective therapies such as Cognitive Behavioural Therapy (CBT) have become increasingly popular in recent years, therapeutic approaches that draw from psychoanalysis have also been demonstrated to show long-term therapeutic change that continues to improve long after treatment ends. Psychoanalytic therapy usually takes place over a long period of time – from one year to an entire lifetime. Due to the intensity, frequency and longevity of therapy, the therapist often becomes a significant person in the life of the client. Such therapies aim to help the client to increase their awareness of their own inner world and understand how these inner thoughts and feelings influence their relationships throughout their life. This greater understanding can alleviate distress, reduce symptoms of mental health problems and provide a greater sense of fulfilment.