What is psychoanalytic therapy?

Psychoanalysis is the original form of psychotherapy. When most people think of mental health therapy or whenever psychology is portrayed in the movies, they envision psychoanalysis. Created by Dr. Sigmund Freud and then sensationalized throughout popular media, the method involves a person lying on a couch or sitting in a chair while basically talking freely about the various things that are going on in their life. The idea is that from this reflective conversation, eventually certain patterns and underlying truths will emerge that the therapist can decipher and then help the patient deal with.

How does psychoanalysis work?

The premise of psychoanalysis is that the mind is like an iceberg, as Freud once famously remarked. Meaning the 10% or so you see is governed by the 90% or so of what you don’t see, which resides underneath the surface of conscious awareness (the subconscious). The superego (our conscious awareness) is constantly being influenced by the id (our unconscious desires) and the ego (our hidden insecurities and molded behavioral patterns). These three categories are rarely referred to in practice anymore, yet the premise remains that a variety of unconscious drives and behavioral patterns, often those established in childhood, govern our current behaviors. Psychoanalysis practitioners believe that by seeking out and uncovering these hidden desires or unconscious thoughts, and then making the patient aware of them, it will miraculously cure whatever problems ail them, which presumably, have originated out of this suppressed thought or desire.

The potential dangers of psychoanalysis

Psychoanalysis is one of the more dangerous types of therapy, and psychoanalysts have largely been responsible for some of the biggest debacles in the field of psychology; from Oedipus complexes and penis envy to the “repressed memories” fraud and other such nonsense that has harmed untold numbers of people. Far too often, psychoanalysts have turned out to be the “bad wizards” we warn people about.

Many of the underlying principles of psychoanalysis are very sound indeed, and backed by research. Modern science has proven Freud right in many regards: Unconscious thought is very real and can be measured on brain scans; it does indeed comprise the bulk of what goes on in the brain, with our conscious thoughts being only the tip of the iceberg that is built upon these hidden motivations; and human behavior is indeed dictated largely by this vast sea of unconscious memories, desires, associations, and other subconscious influences. The problem resides in how psychoanalysts have attempted to turn this knowledge into a usable therapeutic practice.

Psychoanalysis as a practice is more creative art than science, and generally involves a therapist playing a game of connect the dots, trying to tie in a patient’s current problems to their past “traumas” or childhood experiences. It also too often descends into scientific hogwash, much akin to creating constellations out of the stars. I don’t know about you, but when I look to the night sky, I can spot the three stars that make Orion’s belt, but a bow and arrow wielding warrior fails to jump out at me. I could also take those same three stars, and with the use of the other numerous stars in the sky, string them together with a little imagination to create any picture I wanted.

Psychoanalysis too often works in much the same way. Though nobody doubts our past experiences can shape who we become, both therapists and laymen alike are great at stringing together random events in a person’s life and coming up with bogus explanations that seem plausible as to how they might be connected. Yet at the end of the day, this wild speculation has yet to be confirmed by research.

The danger comes in the well-established fact that people are profoundly influenced by suggestion, and so the therapist’s speculations readily become the patient’s reality. This in itself might be benign, except that when these inferences are biased towards negative interpretations, they harm rather than heal. Unfortunately, the very foundation of psychoanalysis (which promotes the belief that in order to help a patient in the present you must uncover or root out past traumas and injustices that will release them of these repressed thoughts) leaves psychoanalysts in the precarious position of being trained as advocates for trauma. They are taught, in a nutshell, that current problems can only be resolved by wallowing in personal pain of the past, and so their work has tended to revolve around amplifying the significance of past traumas…something that harms rather than heals.

Thus, psychoanalysts have far too often taught patient’s to reinterpret benign childhood experiences as “traumas” (harmless childhood sex play or simple fondling is transformed into a horrifying trauma that has ruined their life). They encourage patients to imagine up injuries and insults that never occurred, often tearing apart families in the process (the “repressed memory” epidemic is one such example). They encourage patients to blame their current conditions on past injustice (if only Daddy had hugged me more, I wouldn’t have alcohol problems now). They promote a method of “healing” that requires patients to hash out, amplify the significance of, and dwell upon negative experiences. All of these things directly contradict what research has shown to be beneficial, while reading like an instruction manual for the methods studies have shown to be harmful. And as for the premise that current problems are rooted in isolated or repressed childhood traumas, this is one of Freud’s tenets that has been repeatedly disproven. (Even geniuses aren’t right 100% of the time.)

Unfortunately, the track record for psychoanalysis is so bad that they’ve earned the ire of other professionals in the field for their role in giving psychology such a bad name. So while there are many wonderful, helpful, knowledgeable and well-rounded psychiatrists out there who practice psychoanalysis, we would urge extreme caution in going with this form of therapy. It’s a field littered with bad wizards, whose history of devastating patients and their families cannot be easily forgiven.

The Pro’s and Con’s of Psychoanalytic Therapy

The disadvantages of psychoanalysis

  1. It is generally expensive. By its very nature, it tends to require ongoing sessions, often for years. Some therapists require patients to commit to as much as four or five sessions a week into the foreseeable future. Though as Peter Fonagy, Freud chair in psychiatry at University College London advises, “If a psychoanalyst tried to persuade you that you need five-times-a-week analysis for five years, you should run a mile.” (Psychology Today, May 2011, p. 83) Even if your therapist isn’t so obsessive about it, their method requires getting to know you well, so be prepared for the commitment.
  1. We DO NOT recommend psychoanalytic therapy IN ANY FORM for children or teens. Psychoanalysis is too often full of untested assumptions, hypothesis, guesses, inferences and other nonsense that has no credibility. Yet this doesn’t stop psychotherapists from planting ideas, many of which can be harmful. As such, it’s also one of the most dangerous types of therapy. The therapist may plant suggestions based on their own biases, beliefs, or personal prejudices. Children are too young and open to suggestion for psychoanalysis to be worth the risk. Furthermore, its basic premises are rendered rather obsolete in a still developing youth, since much of it focuses on rooting out unconscious patterns that are still being developed. Stick with a cognitive psychologist for children.
  1. Psychoanalysis is great for people who are looking for an excuse to blame their current problems on past injustices, which is also why it’s one of the most popular forms of therapy. It helps people avoid tackling the unpleasantness of personal responsibility for their current condition. If I struggle with drug problems, it’s not my fault; it must be because that neighbor boy touched me when I was little. Therefore it’s not my problem I’m a drug addict, it’s a “disease” that was brought on by the actions of others. It’s their fault. While this gives many patients exactly what they want to hear (an excuse to disown their problems and pin blame on others) it also creates a death-spiral of destruction, and is the least likely to help a person. So people often turn to psychoanalysis for all the wrong reasons. They want an excuse; they don’t want to confront the difficult steps necessary to get better. Too many therapists oblige the customer, giving them exactly what they ask for. The patient gets their excuse, while the therapist gets paid for ongoing sessions that can last years or even decades. This is why you’ll commonly see patients in therapy for PTSD 20 years later. If PTSD is still an issue after even a few years of therapy, it’s time to fire your therapist and find one that actually accomplishes something.

The benefits of psychoanalysis

  1. Talking itself can be helpful. As such, for certain adults who lack other safe outlets to open up and spill their guts to, psychoanalytic therapy may be highly beneficial, so long as you find a good therapist.
  1. Psychoanalysis practitioners are generally psychiatrists, whose medical degree allows them to prescribe medications such as anti-psychotics or antidepressants.
  1. In recent years, some psychoanalytic practitioners have regained their sanity and began to modernize the approach. They’ve emerged from the land of make-believe and are relying less on repression theories or dream interpretations, and more on principles that can be defended scientifically. A well-grounded and positively-leaning psychoanalyst with education in other methods that will balance out the nonsense can make for a talented psychotherapist.