Therapist

What is the difference between psychoanalysis and psychotherapy

Mode Lyon/CC0 Public Domain

Source: Mode Lyon/CC0 Public Domain

Whether you are seeking mental health treatment or training to become a mental health provider, you will encounter many different approaches to therapy. It can be confusing to tell the difference between them and to figure out which one is right for you. So, in this post, I’d like to address the question: what is the difference between psychotherapy and psychoanalysis?

Everyone who practices psychotherapy is first trained to be a general practitioner, also called a psychotherapist. We learn the foundational model of Carl Rogers—the “client-centered” approach—which is built on the values and skills of congruence, empathy, and positive regard for the client and his or her struggles, strengths, and weaknesses. It harnesses the power of a genuine relationship to facilitate a client’s natural tendency toward growth and development. We are also trained in the foundational model of cognitive behavioral therapy—CBT—which is a theory and technique for addressing the influence of our thoughts on our behaviors and emotions, and seeks to correct our distorted thinking so that we can solve problems and deal with life in a more practical and effective way.

These models have an assumption that the client wants to change and to get better. The idea is that if they are given tools and support, and think about their problems in a different way, then therapy will help them. Think of the metaphor of swimming. If you have fallen into a pool or were hit hard by an ocean wave, then you will have to overcome your fear of drowning and learn how to swim. Psychotherapists can help with both. Once you see this fear for what it is (a fear, not a fact) and learn to swim, then you will be more capable of managing your life when you find yourself in water again.

But many psychotherapists have discovered that some clients have conflicting desires and motivations. They want to change and they also don’t want to change. They seem to take the tools offered to them but then reject them, fight them, or ignore them. In other words, the metaphor of swimming has another layer that must be considered. As you have more experience in psychotherapy—either as a therapist or a patient—you inevitably will be confronted with another question. Why do some people remain stuck in the water, even when given support, tools, and different ways of thinking?

This is where psychoanalysis comes in, and where Freud found his starting point. Freud was working with patients who had not been helped by traditional methods of the day. He discovered that listening and talking to these patients was helpful at first, but that their initial improvement faded and they reverted back to their starting point or developed another problem. This is how he discovered the psyche’s unconscious resistance to change. This is the factor that most psychotherapies don’t really address. For some people, the forces that oppose change are stronger than the forces that fuel change. In other words, some people stay stuck in the water on purpose—at least, unconsciously speaking.

But why? Freud believed that people resist being rescued and learning to swim for two reasons. First, because change would mean being aware of and in contact with mental pain. This could involve the fear of the unknown, the pain of loss, and the responsibilities and hard work that come with moving forward, to name a few. Second, Freud believed that people resist change because there is something positive that they get out of staying the same and they may even get something useful out of being ill—at least, unconsciously speaking.

So, to use the swimming metaphor, some people need an approach that helps them face and work with the fact that, at least in part, they don’t want to learn to swim. They may be frightened of moving forward or do not want to do the hard work it would take. Some might even fight to stay where they are because it suits them in some unconscious way to be drowning.

This is where psychoanalysis has something unique to offer. It offers a way to address the unconscious factors that support a person’s tendency to stay stuck in their difficulties. Freud called it the analysis of resistances.

Psychoanalysis, as a theory and treatment model, was developed to address these unconscious factors. Psychoanalysts are trained first as psychotherapists, and then they have a second training to become psychoanalysts. Think of it as training to become a specialist, like a general practitioner of medicine must have additional training to become a cardiologist. Psychoanalytic training, which is a minimum of five years long, is especially designed to help the psychoanalyst address the unconscious levels of a client’s mind so that the resistances to change lose their grip and the forces toward health, growth, and development gain strength. For people who have not been helped by psychotherapy, psychoanalysis is a model that might make a difference.

Copyright 2017 Jennifer Kunst, Ph.D.

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Psychoanalysis? Psychotherapy? Aren’t they the same thing?… Not exactly. Psychoanalysis is an experience – you cannot call yourself a psychoanalyst without having done your own analysis. The same is not always true for psychotherapy – not all psychotherapists have gone through their own therapy. In order to become a therapist you need to go through years of schooling, practice for at least two years after graduate school and pass your licensure exam. Only then you can go for psychoanalytic training.

Therapy is a rather generic term – social workers, counselors, psychologists and psychiatrists can all call themselves therapists. Before there was psychotherapy, however, there was psychoanalysis. Freud “invented” the psychoanalytic method, or the “talking cure,” together with his friend and mentor Breuer, a Viennese psychiatrist, who worked with female hysterics (an old-fashioned diagnostic term for what today is classified as conversion disorder). In his work with his patient Anna O., a pseudonym for Bertha Pappenheim, one of the first feminists, Breuer discovered that after she was able to speak about the origin of her symptoms, they disappeared. Hence, “the talking cure.” The presumption that talking has healing powers fuels many psychotherapeutic practices today. No one argues against that. What is the difference between psychotherapy and psychoanalysis then?

First, psychotherapy deals with what we call the ego, the I or the active agency with which you make decisions on a daily basis. In contrast, psychoanalysis deals with the unconscious – those experiences that are beyond language, outside of our awareness; the part of us that was vastly suppressed by culture, social norms, rules and regulations. Second, the goals of psychoanalysis and psychotherapy are also different. Psychotherapy attempts to restore a persons relationship to the social norms and regulations, while psychoanalysis works to restore a person’s relationship to their sexuality. Psychotherapy works to strengthen the ego, while psychoanalysis works to strengthen the subject’s relationship to their own unconscious. Psychotherapists use their relationship with you, the client, to influence your decision-making, to teach coping strategies, change behaviors or thoughts, and to modify the ways you relate to others. Psychoanalysts use their relationship with you to help you reorganize the way you relate to yourself and your body with all of its human qualities. What happens with your relationships afterwards is secondary and entirely up to you!

Many people are skeptical that such thing as the unconscious actually exists. Certainly, there is no way to physically grasp the unconscious but the evidence in support of it speaks quite loudly. Freud, for instance, discovered that he could plant a thought into his patient’s mind under hypnosis that the patient executed into an action after being released from the hypnotic state, having no recollection of the fact that Freud asked them to do the action in the first place. Instead, the patient fabricated an explanation and was convinced in its validity. Believe it or not, the unconscious does exist and psychoanalytic practice, which has changed dramatically since its invention, has proven it over and over again throughout the years. The question is, do you want to know about your unconscious? Do you wish to have a deeper understanding of yourself and your actions?

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The talking cure

Psychotherapy is a rather generic term – social workers, counselors, psychologists and psychiatrists can all call themselves therapists.Psychoanalysis is an experience – you cannot call yourself a psychoanalyst without having done your own analysis. The same is not always true for psychotherapy – not all psychotherapists have gone through their own therapy.

Before there was psychotherapy, however, there was psychoanalysis. Freud invented the psychoanalytic method, or the talking cure, together with his friend and mentor Breuer, a Viennese psychiatrist, who worked with female hysterics (an old-fashioned diagnostic term for what today is classified as conversion disorder).

In his work with his patient Anna O., a pseudonym for Bertha Pappenheim, one of the first feminists, Breuer discovered that after she was able to speak about the origin of her symptoms, they disappeared. Hence, the talking cure.

The difference

The presumption that talking has healing powers fuels many psychotherapeutic practices today. No one argues against that. What is the difference between psychotherapy and psychoanalysis then?

First, psychotherapy deals with what we call theego, theIor the active agency with which you make decisions on a daily basis. In contrast, psychoanalysis deals with theunconscious– those experiences that are beyond language, outside of our awareness; the part of us that was vastly suppressed by culture, social norms, rules and regulations.

Second, the goals of psychoanalysis and psychotherapy are also different. Psychotherapy attempts to restore a persons relationship to the social norms and regulations, while psychoanalysis works to restore a persons relationship to their sexuality. Psychotherapy works to strengthen the ego, while psychoanalysis works to strengthen the subjects relationship to their own unconscious.

A different therapeutic relationship

Psychotherapists use their relationship with you, the client, to influence your decision-making, to teach coping strategies, change behaviors or thoughts, and to modify the ways you relate to others. Psychoanalysts use their relationship with you to help you reorganize the way you relate to yourself and your body with all of its human qualities. What happens with your relationships afterwards is secondary and entirely up to you!

To put this visually for you, I created the following infographic:

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