Method of Treatment in Psychoanalysis

A person who goes to a psychoanalyst for consultation usually meets with the
analyst at least three times face-to-face before the analyst recommends psychoanalysis. Sometimes the patient and analyst meet for several weeks,
months, or years in psychoanalytic psychotherapy; they decide upon psychoanalysis
if they identify problems that are unlikely to be solved by less intensive
treatment.
Once they begin psychoanalysis, the analyst and patient usually meet four
or five times per week for fifty-minute sessions, as this creates the intensive
personal relationship that plays an important role in the therapeutic process.
The frequent sessions do not mean that the patient is very sick; they are
necessary to help the patient reach deeper levels of awareness. (People with
the severest forms of mental illness, such as schizophrenia, are not usually
treated with psychoanalysis.) Often the adult patient lies on a couch, as this
may make it easier to speak freely. The couch is not essential, and some patients
feel more comfortable sitting up.

By working together to diminish obstacles to free expression in the treatment
sessions, the analyst and patient come to understand the patient’s worries
and learn how the patient’s mind works. The patient learns about
thoughts and feelings he or she has kept out of awareness or isolated from
one another. Through the intensity that comes from frequent meetings with
the analyst, the patient often experiences the analyst as if the analyst were a
parent or other important person from the past. This is called transference.
Eventually, the patient has a chance to see these feelings from a more mature
point of view. Although the patient may experience intense emotions within
the analytic sessions, the anxieties and behaviors that brought him or her to
treatment gradually diminish and feel more under control. The patient
feels freer and less restricted by worries and patterns that belong to the past.
For example, a patient may be very fearful of angry feelings and avoid
telling the analyst about them, expecting punishment or rejection. As a result,
the patient may turn the anger on himself or herself in a form of selfsabotage.
Often this is the way the patient dealt with angry feelings toward
significant people while growing up. Over time, as the patient and analyst
understand this behavior, the patient feels freer to express angry feelings directly
and eventually feels less need to sabotage or self-punish.

Gradually, in the course of the intensive analytic relationship, the patient
learns more about his or her maladaptive ways of dealing with distressing
thoughts and feelings that have developed during childhood. By understanding
them in adulthood or (for a child) at a later age, the patient gains a
different perspective and is able to react in a more adaptive way. Rigid personality
traits that had been used to keep the childhood feelings at a distance
are no longer necessary, and the patient is able to react to people and
situations in a more flexible way.

During the course of the treatment, the analyst will often have strong feelings
toward the patient, called countertransference. Well-trained analysts
are required to undergo psychoanalysis themselves before treating patients.
In their own analysis, they learn how to cope with their countertransference
feelings in ways that will not hurt the patient. For example, they learn not to
take the patient’s expressions of anger personally but to help the patient express
the emotion more fully and understand where it originates.

Children and adolescents can be treated with psychoanalysis or psychoanalytic
psychotherapy by using methods suitable for their ages. Most children
play with toys, draw, or explore the room, in addition to talking, during
their sessions with the analyst, and these activities provide ways to explore inner
thoughts and feelings. The analyst meets with the parents before the
treatment starts and continues to do so regularly during the course of the
child’s therapy or analysis. Adolescents usually sit face-to-face or draw or
write about their feelings and worries. Occasionally, older adolescents want
to lie on the couch. Adolescents often prefer that the analyst not meet with
the parents on a regular basis. Instead, the analyst and adolescent usually develop
some way to keep the parents informed about what they might need to
know about the treatment. 642