Whether you are seeking mental health treatment or training to become a mental health provider, you will encounter many different approaches to therapy. It can be confusing to tell the difference between them and to figure out which one is right for you. So, in this post, I’d like to address the question: what is the difference between psychotherapy and psychoanalysis?
Everyone who practices psychotherapy is first trained to be a general practitioner, also called a psychotherapist. We learn the foundational model of Carl Rogers—the “client-centered” approach—which is built on the values and skills of congruence, empathy, and positive regard for the client and his or her struggles, strengths, and weaknesses. It harnesses the power of a genuine relationship to facilitate a client’s natural tendency toward growth and development. We are also trained in the foundational model of cognitive behavioral therapy—CBT—which is a theory and technique for addressing the influence of our thoughts on our behaviors and emotions, and seeks to correct our distorted thinking so that we can solve problems and deal with life in a more practical and effective way.
These models have as an assumption that the client wants to change and to get better. The idea is that if they are given tools and support, and think about their problems in a different way, then therapy will help them. Think of the metaphor of swimming. If you have fallen into a pool or were hit hard by an ocean wave, then you will have to overcome your fear of drowning and learn how to swim. Psychotherapists can help with both. Once you see this fear for what it is (a fear, not a fact) and learn to swim, then you will be more capable of managing your life when you find yourself in water again.
But many psychotherapists have discovered that some clients have conflicting desires and motivations. They want to change and they also don’t want to change. They seem to take the tools offered to them but then reject them, fight them, or ignore them. In other words, the metaphor of swimming has another layer that must be considered. As you have more experience in psychotherapy—either as a therapist or a patient—you inevitably will be confronted with another question. Why do some people remain stuck in the water, even when given support, tools, and different ways of thinking?
This is where psychoanalysis comes in, and where Freud found his starting point. Freud was working with patients who had not been helped by traditional methods of the day. He discovered that listening and talking to these patients was helpful at first, but that their initial improvement faded and they reverted back to their starting point or developed another problem. This is how he discovered the psyche’s unconscious resistance to change. This is the factor that most psychotherapies don’t really address. For some people, the forces that oppose change are stronger than the forces that fuel change. In other words, some people stay stuck in the water on purpose—at least, unconsciously speaking.
But why? Freud believed that people resist being rescued and learning to swim for two reasons. First, because change would mean being aware of and in contact with mental pain. This could involve the fear of the unknown, the pain of loss, and the responsibilities and hard work that come with moving forward, to name a few. Second, Freud believed that people resist change because there is something positive that they get out of staying the same and they may even get something useful out of being ill—at least, unconsciously speaking.
So, to use the swimming metaphor, some people need an approach that helps them face and work with the fact that, at least in part, they don’t want to learn to swim. They may be frightened of moving forward or do not want to do the hard work it would take. Some might even fight to stay where they are because it suits them in some unconscious way to be drowning.
This is where psychoanalysis has something unique to offer. It offers a way to address the unconscious factors that support a person’s tendency to stay stuck in their difficulties. Freud called it the analysis of resistances.
Psychoanalysis, as a theory and treatment model, was developed to address these unconscious factors. Psychoanalysts are trained first as psychotherapists, and then they have a second training to become psychoanalysts. Think of it as training to become a specialist, like a general practitioner of medicine must have additional training to become a cardiologist. Psychoanalytic training, which is a minimum of five years long, is especially designed to help the psychoanalyst address the unconscious levels of a client’s mind so that the resistances to change lose their grip and the forces toward health, growth, and development gain strength. For people who have not been helped by psychotherapy, psychoanalysis is a model that might make a difference.
Copyright 2017 Jennifer Kunst, Ph.D.
John Mcleod, author of An Introduction to Counselling, has identified five key principles of the psychodynamic approach:
- People have troubled relationships because they are repeating a destructive relationship pattern from the past.
- The person may seek to control or hide difficult or unacceptable mental desires, memories and feelings by use of ‘defence mechanisms’, such as “transference”, “projection”, “denial”, “repression”, “sublimation”, “splitting” and “projective identification”.
- It is important for helpers, including counsellors, to be aware of their own feelings, fantasies and impulses in relation to the person they are helping.
- The person’s problems can be understood as representing unresolved “developmental tasks” (e.g. separation from the mother/parents).
- People have a need for secure, consistent emotional attachments.
Psychodynamic therapy: A type of psychotherapy that draws on psychoanalytic theory to help people understand the roots of emotional distress, often by exploring unconscious motives, needs, and defenses.
Psychodynamic psychotherapy is a form of depth psychology, the primary focus of which is to reveal the unconscious content of a client’s psyche in an effort to alleviate psychic tension.
In this way, it is similar to psychoanalysis. It also relies on the interpersonal relationship between client and therapist more than other forms of depth psychology. In terms of approach, this form of therapy uses psychoanalysis adapted to a less intensive style of working, usually at a frequency of once or twice per week.
Psychodynamic therapy is a “global therapy”, or form of therapy with a focus on a holistic perspective of the client. The alternative, “problem-based” therapies, such as cognitive behavioural therapy (CBT), aim to reduce or eliminate symptoms instead of exploring the client’s deep-seated needs, urges, and desires (McLeod, 2014).
The global vs. problem-based therapy dichotomy is not the only factor that sets psychodynamic therapy apart from these other, more common forms of therapy. Psychodynamic therapy involves the interpretation of mental and emotional processes rather than focusing on behaviour (Gad, 2017).
Psychodynamic therapists attempt to help clients find patterns in their emotions, thoughts, and beliefs in order to gain insight into their current self. These patterns are often found to begin in the client’s childhood, since psychodynamic theory holds that early life experiences are extremely influential in psychological development and functioning as an adult (Gad, 2017).
Psychodynamic therapy sessions are intense and open-ended, dictated by the client’s free association rather than a set schedule or agenda. They are typically scheduled once a week and last about an hour. While Freud’s psychoanalytic therapy (described in more detail below) demanded a much greater investment of time, current psychodynamic therapy is generally practiced in a less intensive manner (WebMD, 2014). Modern psychodynamic therapy also substitutes a pair of chairs for the stereotypical couch, and usually places the therapist and client face-to-face rather than keeping the therapist hidden from the client’s view.
In these sessions, the therapist will encourage the client to talk freely about whatever is on their (conscious) mind. The thoughts and feelings discussed will be probed for recurring patterns in the client’s unconscious mind.
Goals of Psychodynamic Therapy
The main goals of psychodynamic therapy are to (1) enhance the client’s self-awareness and (2) foster understanding of the client’s thoughts, feelings, and beliefs in relation to their past experiences, especially his or her experiences as a child (Haggerty, 2016). This is accomplished by the therapist guiding the client through the examination of unresolved conflicts and significant events in the client’s past.
The assumption in psychodynamic therapy is that chronic problems are rooted in the unconscious mind and must be brought to light for catharsis to occur. Thus, the client must have the self-awareness to discover these unconscious patterns of thought and an understanding of how these patterns came to be in order to deal with them.
Psychodynamic Theory, Perspective, and Key Concepts
To truly understand psychodynamic therapy, you need to go back to its roots. While this type of therapy has changed over the last century, it is still built on the foundations of some of the earliest work in modern psychology.
In the late 19th century, Signmud Freud was working on his grand idea of the human mind and theory of human development. His theories laid the foundation for decades of psychological research and practice. While many of these theories were eventually found to conflict with hard evidence gained through scientific research, they formed the basis for psychodynamic theory and sparked a bold new school of thought that still exists today, in a modified and updated form.
He proposed that the human mind is composed of three parts:
The id, which consists of instinct and forms the basis of the unconscious mind.
The superego, or moral component that houses our beliefs of right and wrong.
The ego, the mediator between the animal instinct of the id and the enlightened moral thought of the superego (Haggerty, 2016).
Freud hypothesized that these components grew out of certain stages in childhood development. He believed humans are born with the id, develop the ego as a toddler, and add the superego around the age of five. Freud’s hypothesis led him to the logical conclusion (based on his theory) that one’s personality is firmly rooted in their childhood experiences.
While Freud believed that each component formed in each human, the development of each component could be significantly influenced by one’s environment and family relationships. These factors could contribute to the development of a healthy sense of self and effective functioning, or they could trigger the development of neuroses and dysfunctional or distressing patterns of thought.
Whether the development led to positive or negative patterns of thought and belief, Freud held that that which truly drives human behavior is buried deep within the human mind, in what he termed the unconscious mind.
Freud theorized three levels of the mind:
The Unconscious: this level is where our instincts, deeply held beliefs, and many patterns of thought and behavior reside; we are not consciously aware of anything at this level, but Freud believed the contents of the unconscious mind make up the vast majority of who we are, what we want, and how we behave in order to get what we want.
The Subconscious or Preconscious: this level is between the conscious and unconscious, and can be called up to consciousness with purposeful effort from the individual; the contents of this level are just below the surface of consciousness.
The Conscious: this is the level at which we are fully aware; Freud believed this was the level with the least defining content, the level that makes up only a tiny sliver of who we are.
Based on this theory, Freud insisted that to truly address our issues and solve our problems, we must dig deep into the unconscious level. This is where we store our unspoken values, the beliefs we do not even realize we have, and the patterns of thought and behaviour developed in our childhood.
The unconscious mind is one of the most powerful drivers of human behaviour and emotion
No behaviour is without cause; all behaviour is determined
Childhood experiences exert a significant influence on thoughts, emotions, and behavior as an adult.
Important conflicts during childhood development shape our overall personality as adults (Freud, 1899).
Freud’s theories directly support the methods of psychoanalysis, but also help form the basis of psychodynamic theory and inform the methods and techniques used in today’s psychodynamic therapy.
Psychoanalysis: The Freudian Approach
While psychoanalysis and modern psychodynamic therapy grew from the same source, there are several important differences between the two forms of therapy.
First, the timeline and duration of psychoanalysis is far more intensive than modern psychodynamic therapy. Psychoanalysis is generally conducted in two to five sessions per week, lasting several years (McLeod, 2014).
Second, the physical layout of the office or therapy room is significant – in psychoanalysis, the client (or patient, as they are usually called) lies on his or her back on a couch while the therapist sits behind them, out of their line of sight. In modern psychodynamic therapy, it is much more common for therapist and client to face one another, or at least remain in the other’s field of vision.
Role of the Psychodynamic Therapist
The role of the therapist in psychodynamic therapy is to work with the client to discover the bases for their symptoms.
The therapist plays this role by encouraging the client to talk about the emotions they are feeling and helping the client to identify recurring patterns in their thoughts, emotions, and behaviours. He or she will aid the client in finding the significance of these patterns and discovering the effects they exert upon the client.
One of the most important roles of the therapist is to probe the client’s past. Discussion of the client’s childhood and early life experiences will likely take up a large portion of psychodynamic sessions, as this form of therapy assumes these experiences have a significant impact on the client’s current issues.
The therapist may also observe how the client interacts within the therapeutic relationship and add their own insight on the client’s relationship habits to the discussion. Psychodynamic theory holds that how the client acts in the relationship with the therapist usually mirrors how they act in other relationships, such as with a parent or other important adult from their childhood (WebMD, 2014).
In general, the therapist’s role is to aid the client in connecting the dots between their past experiences and their current problems, and leveraging their internal resources to address these problems.
Accessing the Unconscious
People tend to develop defense mechanisms. Defense mechanisms may keep painful feelings, memories, and experiences in the unconscious. A few common defense mechanisms include: