Psychoanalysis and Psychodynamic Approaches to Therapy

It has been over a century since Sigmund Freud first introduced psychoanalysis to the world and since “Anna O,” one of the earliest and most famous psychoanalytic patients, described the treatment she was receiving as “the talking cure.” Since those pioneering days of psychoanalysis, the influence of this theory can be seen in the myriad theories that have come into being either as extensions of psychoanalytic ideas or as reactions to them. Psychoanalysis is a form of treatment in which the client typically lies on the psychoanalyst's couch and “free associates,” while coming multiple times per week over the course of several years. Psychodynamic psychotherapy utilizes the constructs that inform psychoanalysis proper, but clients typically sit facing their therapists and are seen for one or two appointments per week. Treatments are often of shorter duration and some interventions may be of only a few weeks. More generally, however, psychoanalytic concepts are used in a variety of treatment contexts, including group psychotherapy, assessment, and crisis intervention. Thus, psychoanalysis has been profoundly influential in mental health interventions far beyond the classical format of the patient on the couch.

Psychoanalytic theory is simultaneously a developmental theory, a personality theory, and a theory of intervention. Freud's original instinctual theories emphasized the role of sexuality and aggression. Since that beginning, psychoanalysis has evolved in significant new directions. Significant developments include object relations theory (which emphasizes the way in which people's history of relationships form part of their psychology and shape them in profound ways), ego psychology (which emphasizes the complex relationship between the evolving ego and reality), separation-individuation theory (which describes the trajectory from psychological symbiosis to a sense of autonomy), self psychology (which theorizes about narcissism as a normal developmental line and about the emotional forces that create and shape people's sense of self), and relational and interpersonal models (which emphasize the interpersonal context of the therapeutic situation and its role in resolving conflicts).

Each of these psychoanalytic theories evolved from Freud's original framework and each emphasizes different aspects of psychological development or different ways of intervening therapeutically. Today psychoanalysis or psychoanalytic treatments refer to this collection of concepts and theoretical positions that have evolved over the past century. Within psychoanalytic theory, there are schools that favor one of these views over others, and practitioners whose work may be more informed by one of these [Page 795]approaches over the others. These psychoanalytically informed therapies represent a complex set of assumptions and processes. They tend to be less directive or concretely problem solving in spirit than many other therapeutic approaches. Instead, they tend to emphasize the importance of insight and self-understanding as key curative elements in psychotherapy. Nevertheless, the different psychoanalytic schools are all derived from the core tenets of psychoanalytic theory and most psychoanalytic practitioners are conversant in all of these languages even if they emphasize one approach over the others in their own work.