Psychoanalytic theory was the first modern approach to psychotherapy, and even today many schools of psychotherapy are defined by the ways they differ from psychoanalysis.

Psychotherapy's concerned with instincts and the unconscious mind, based on the idea that we may have memories or thoughts that we've masked using our mental energy in getting on with the demands of everyday life.

Andy-Garland-Logo-Dev2In psychoanalysis you uncover these thoughts and memories, which is a long and demanding process. This is where the popular view of the patient lying on the couch comes from. The client must say whatever comes into their head, and allow their thoughts to follow their instincts and see where they lead.

Psychoanalytic theory suggests that, for some people, the tension between their repressed thoughts and their conscious thoughts leads to psychological problems, which is when psychoanalytic psychotherapy is required. The therapist uses psychoanalytic theory to confront, interpret or reconstruct the patient's interpretations of the world in a way that helps to solve their problems.

Sigmund Freud, the father of psychoanalysis, and his colleagues noticed that when people with psychological problems were listened to attentively and sympathetically they tended to develop strong positive feelings towards the listener. They called this 'transference'.

Freud and his colleagues realised they developed their own feelings - counter-transference - towards the patient, which affected their own reaction. When therapy goes wrong and becomes abusive, it's normally because the therapist has mismanaged this part of the process.

Coupled with psychoanalytic theories of repressed emotion, this brought a whole new dimension to Freud's work. There were, however, thinkers who disagreed with Freud, which led to the proliferation of schools of psychoanalytic thought.

One group felt that the operation of transference and counter-transference in everyday activity was the core of many problems, which led to what's now known as the psychodynamic approach to psychotherapy.

There are some therapists who see no real difference between psychoanalytic approaches and psychodynamic ones. Certainly, they're very closely related. But the influence of psychodynamic theories has been felt in many other areas of psychotherapy.

Games People Play: The Psychology of Human Relationships (ISBN 0345410033) by Eric Berne is an accessible look at psychodynamic theories.

Psychotherapy in the last half of the 20th century

By the 1950s, various forms of analytic and dynamic psychotherapy were well established. Into this came the figure of Carl Rogers, who approached therapy from a humanist point of view, believing that all individuals are unique. This led to the understanding that each individual has unique problems, for unique reasons, and needs unique solutions.

This led to person-centred psychotherapy. The therapist enables the client to explore their feelings by asking a series of open questions, needing more than a simple yes or no answer. Each question refers to what the client has just said about their feelings, so in each session the issues are explored more deeply.

According to this approach, psychological problems are not based in unconscious thoughts but in a failure to examine your conscious thoughts thoroughly. In the 1960s, a group of therapists developed cognitive therapy from this view. They believe in good 'mental hygiene'. The sort of routine they get their patients to go through goes something like:

  • What am I thinking about?
  • How does that thought make me feel?
  • Do I believe in that thought?
  • If I become aware that I don't really believe the thought, does it make me feel different?

People who use this type of therapy find it effective for specific problems, and it's been used as the basis of the self-help packages on this site. But, of course, a Freudian might say that to take instinctive thoughts and rationalisation them in this way is simply to repress the problem even further.

(BBC, 2012)



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