The main therapeutic approaches – Part 1 – Psychoanalysis

Psychoanalysis is one of the oldest therapeutic approaches.  It was proposed in early part of the 20th century by Sigmund Freud who is one of the most recognised names in psychotherapy.  Freud help to coin many phrases such as the “Freudian slip”, which is a reference to when a word or phrase is said when it was not intended.  The Oedipus complex is another well-known Freudian theory, where male children were supposed to go through a phase of desiring their mothers.  But perhaps the most well-known word we get from Freud is the “Ego” which in modern language is often used to describe people who believe themselves to be better than they are.      

Although some of Freud’s theories have been dismissed or revised over the years, the overriding ideas on which he founded psychoanalysis remain:

  • Issues in adult life are rooted in unresolved childhood traumas

  • The issues are usually at an unconscious level and needed to be brought into conscious to be resolved.

  • Using dream analysis, symbol interpretation (e.g. the ink blot test) and free association all help to reveal unconscious issues.

In a psychoanalytic approach, the therapist will usually present with a “blank slate”, having very little interaction with the client.  The patient will usually be invited to lay on a couch, sofa or other comfortable surface with the therapist sitting out of their line of sight.  They are then asked to begin to talk about a particular subject (often to do with their childhood) and use free association to allow their monologue to take them wherever it goes.  The therapist’s role is to make interpretations as to what is going on in the client’s unconscious. 

The basic idea behind this approach is that words, feelings or thoughts from unconscious, unresolved issues will pop into the clients mind whilst they are talking.  Without the therapists interactions to distract them, they can better identify and vocalise these unconscious things, bringing them into a conscious awareness and allowing them to be resolved.   

Clients are often asked to keep a dream diary to allow dreams to be discussed and interpreted during the sessions.  Again, it is believed that dreams are the unconscious trying to communicate awareness’s to the conscious mind.

There are several main criticisms to the psychoanalytic approach. 

  • Length of sessions – Psychoanalysis insists on two or more sessions in a week which can continue for many years.  In the modern world, many people do not have the time or finances to commit to this. 

  • Misinterpretation – The therapist is at risk of misinterpreting words, thoughts and images from the client and not only could this potentially damage the therapeutic relationship, but it could also cause a delay in effective treatment by investigating the wrong avenues. 

  • Lack of relationship – With the therapist providing a blank slate, patients may feel that they cannot connect with the therapist and so find it difficult to work through the issues which they uncover.

There are many therapists who use a psychoanalytic approach with high levels of success; however the popularity of this approach has been waning for many years.  In the next post, we will be looking at the Person Centred Approach.