Key Elements of Psychoanalysis and Psychoanalytic Psychotherapy

Historical

Freud’s discovery and development of psychoanalysis as theory and therapy of psychological disorders was historically ground breaking. The psychodynamic psychotherapies derive from psychoanalysis. There are differences, but there are significant similarities.

Clinical

  1. Therapeutic situation. Patients in analysis lie on a couch with the analyst seated behind out of the patient’s field of vision. In psychoanalytic psychotherapy, patients and analysts are seated face-to-face.
  2. Basic rule. Both psychoanalysis and psychoanalytic psychotherapy employ the basic rule of free association whereas, for example, counselling does not. Patients are asked to communicate whatever thoughts, imaginings, memories occur to them and whatever feelings may be aroused in them during each session.
  3. Frequency. Psychoanalysis has a frequency of three to five sessions per week. Psychoanalytic psychotherapy has a frequency of one to three sessions per week. Frequency is a function of the depth and intensity of the therapeutic work needed.
  4. Transference. Transference consists of the repetition of neurosis generating conflicts with parents and siblings in the patient’s relation to the therapist. It occurs in and is useful therapeutically in both psychoanalysis and psychoanalytic psychotherapy.
  5. Non-judgemental evenly suspended attention. Analysts and psychoanalytic psychotherapists are non-judgemental. Their orientation is one of attentive listening to the patient no matter where the patient’s associations may lead and whatever the patient’s transference thoughts and feelings may be. The patient’s sexual and aggressive feelings and emotions are especially important.
  6. Interpretation. Analysts and psychoanalytic psychotherapists seek to improve their patient’s self-understanding by interpreting psychological defences that inhibit their ability to become aware of the motivations of their attitudes, beliefs, relations and actions – the inner sources of their symptoms, inhibitions and moods. Analysts and psychoanalytic psychotherapists interpret these motivations to facilitate their becoming less conflicted and more maturation.

Theoretical

There are currently several psychoanalytic theoretical orientations which overlap but with differences:

  • Classical Freudian theory is the mainstream orientation albeit modified (for example, using Freud’s earlier rather than later theory of aggression),
  • Kleinian theory retains Freud’s theory of aggression as a death instinct,
  • Self-psychology and the primacy of narcissism rather than object love,
  • Relational psychology without or with a modified classical drive theory.

 
The theoretical differences involved are significant but adherents of these theories employ them equally in both psychoanalysis and psychoanalytic psychotherapy and share the elements of the clinical technique enumerated above. These theoretical differences do not alter the basic clinical similarities between psychoanalytic psychotherapy and psychoanalysis: free associations, transference, non-judgemental attention and their interpretation. The differences have to do with frequency, duration and the therapeutic set-up.