Psychoanalytic psychotherapy is often misunderstood and thought as outdated or even extinct. Some of the original psychoanalytic ideas are outdated and extinct, but like any good theory it evolves as new research is conducted and as the world changes. Psychoanalytic psychotherapy is rarely (if ever) practiced in the way that was originally created. Of course, it still has more to grow, but there are some central ideas that have remained.
However, many people teach the theories (particularly in undergraduate psychology classes) as outlandish and inaccessible, in part to taking the theory literally. If you read any psychoanalytic literature and take it literally, it does sound quite incomprehensible or even absurd! But when you read it thinking symbolically, it transforms into something much more powerful that can provide insight into the complexity of the human experience.
Psychoanalytic psychotherapy is a therapeutic modality that focuses on depth and growth.
As a result, it takes longer and is a larger investment than other modalities that focus on behaviors (like cognitive behavioral therapy or CBT) or skill building. These other modalities can be very valuable for particular kinds of clients, but can leave those seeking greater understanding and personal growth wanting more. It has distinctive features as compared to other schools of thought in psychology.
Psychoanalysis, psychoanalytic psychotherapy, and psychodynamic therapy are all related and utilize the same fundamental ideas. They are distinct in terms of the amount of training for the psychotherapist, time investment from the patient, and utilization of theoretical concepts.
Regardless of whether it is psychoanalytic psychotherapy or psychoanalysis, these modalities take far more training and education in order to practice than other theories, such as CBT. For example, a certification in psychoanalytic therapy takes 1-2 years, which involves reading and regular classroom work. A certification in psychoanalysis takes a minimum of 5 years, which includes dyadic work, supervised clinical work, and a dissertation or clinical case write up. In contrast, a certification in CBT takes anywhere from 29 hours to 55 hours depending on the institute providing the certification.
What is Psychoanalytic Psychotherapy good for?
Psychoanalytic psychotherapy isn’t just about symptom reduction, but about personal growth. It is about building resilience through fostering greater psychological capacity during stressful times. It can be helpful with:
- Identity development
- Chronic depression or anxiety
- Chronic suicidality
- Trauma, particularly early childhood trauma
- Recurrent ‘unhelpful’ patterns
- Personality disorders, like Borderline Personality Disorder or Narcissistic Personality Disorder
- Eating disorders
- Somatic disorders
- Dissociative disorders
Not every psychoanalytic psychotherapist works with all these as they may specialize with a particular population or condition. Even particular psychoanalytic theories (like Klein’s object relations or Kohut’s self psychology) work better with particular types of patients.
For example, Cadyn Cathers , PsyD specializes in identity development with LGBTQIA+ communities, with a strong emphasis on working with transgender and nonbinary communities. Due to oppression and lack of acceptance, the negative messages from society can become internalized into negative views of the self. As a result, LGBTQIA+ clients often struggle with depression, anxiety, chronic suicidality, trauma, and other mental health concerns. Psychoanalytic psychotherapy is helpful to unlearn these messages to help people grow into healthier, authentic human beings.
What is Psychoanalytic Psychotherapy not good for?
As with any modality, it has strengths and weaknesses. It isn’t the right fit for everyone! In general, it is best for clients who want to grow. It doesn’t work well for clients who just want to get some skills and move on. In addition, most psychoanalytic psychotherapy isn’t ideal for:
- Addiction when it is in the active/crisis stage
- As psychoanalytic psychotherapy can bring up difficult emotions, it can sometimes make addictive behaviors worse. Once someone is stabilized, it can work well to address the intrapsychic patterns that led someone to addiction in the first place, which can be helpful for maintaining long term sobriety.
- Schizophrenia & other psychotic disorders
- Some psychoanalytic theorists have developed specialized theories to work with psychotic disorders, but most psychoanalytic psychotherapists don’t have this training.
- Bipolar disorder
- It cannot treat the manic/depressive cycles as they are more biochemical, but can help with building resilience, gaining insight, and personal growth.