Psychotherapy and Psychoanalysis

The field of psychodynamic psychotherapies, which refers exclusively to psychoanalysis, also includes “psychoanalytically oriented psychotherapy”. The term psychotherapy is used solely for practical reasons. There is a complete palette of types of psychotherapy which extend all the way from only smaller changes made to classic analytic psychotherapy, through shorter, “focal” psychotherapy, to psychoanalytic psychotherapy of psychoses, through child psychoanalytic psychotherapy, to psychoanalytic treatment of families, etc. Group analysis represents its own field.¹

Today, each of these psychotherapies has its own literature, its own special technique, and the trainings are also starting to differentiate more and more.

These days, it is difficult to imagine a psychotherapist who engages in all these fields without being frivolous in some of them. Respectively, they need to be properly specialized and qualified in order to perform in more fields. As well as in any profession, there is a lot of researching, various positions and manners in psychoanalysis and psychotherapy, but we need to distinctly separate the differences which are a consequence of serious and in-depth research from the varieties which are simply a result of superficiality and ignorance.

Namely, every psychotherapy needs a working model, which needs to have certain consistency and which should explain what its theoretically-technical basis is, which goals it sets and which means it intends to use in order to reach them. Psychotherapy is being dealt with by psychoanalysts as well as psychotherapists, who have undergone proper training, under proper standards in competent institutions. There are sometimes conflicts between psychoanalytic institutions and psychotherapists which occur for different reasons: often based on competitiveness and competence, but there are also many other reasons.

The boundary between psychoanalysis and individual psychoanalytic psychotherapy is anything but strictly defined, which also affects the boundary in the psychotherapist’s and analyst’s work.

While psychoanalysis is unlimited in duration and open to all subjects a patient brings up, psychotherapy is either at the very beginning limited in duration or its goal is a shorter, more direct processing of some, but not all of the patient’s topics, problems, symptoms. In psychotherapy, both parties are perhaps more actively present, which is always a matter of happening during the meeting and not a rule. We could say that in psychotherapy there are different possible and recommended interferences and interventions in the process of therapy and they can vary from those in psychoanalysis. In psychotherapy the relationship is bound to the reality of the situations and solving concrete, already conscious problems and/or symptoms, but it does not so much focus on solicitation and “researching the deeper unconscious content”. In psychotherapy, we try to approach the unconscious emotional happening, but we could say that we are “moving in a psychotherapeutic relationship in less deep layers of the psyche”.

The goal of psychotherapy is removing the symptoms, especially through the patient’s self-recognition of their own reactions to the outer world and people in the present and past. These assumptions should also be supported by concrete differences in the setting. Psychotherapy should take place once or twice a week vis-a-vis. The setting of psychoanalytic psychotherapy also “sticks” to certain frame which define psychoanalysis and the psychoanalytic process which is described in more detail in the section Psychoanalysis.

Psychoanalysis is:

• The process of researching the unconscious mental processes, which are almost unreachable in any other way.
• A method of healing neurotic and non-neurotic disorders (which is based on research of the the unconscious processes).
• Collecting psychological data, which is slowly included in the scientific discipline of psychoanalysis, through this method (EPF definition, Torino, 2014).

Process (processus, lat.) is an event or happening, a set of phenomena, which are working or are organized in a certain time frame, in the development and sequence of work phases. In medicine or therapy, the process is the course of an illness (problem) or the course of its treatment.

Psychoanalytic process is framed or limited by a psychoanalytic setting which represents a necessary pre-condition in order for the process of psychoanalysis to be performed.

Setting includes an outer and inner view. The outer frame includes the use of a couch, a minimum number of meetings, and the frequency of meetings, the permanency of the time and place of the meetings, the frame of payment of the analyst’s work. The inner frame includes the so-called basic rule, which includes free associations of the analysant and the free-floating attention (reverie) of the analyst and the therapeutic alliance of the couple as well as the analyst’s knowledge of the analytic procedure. Through this, the setting becomes an empty screen, a space, a field, where all the transference-countertransference matrixes or the interweavements of the intersubjective happening between the two parties (the analytic couple) of the analytic process are being projected.²

The analysant’s job is to indulge in the process which means that through constant and gradual overcoming and processing of resistances, they can enter to the inner and interpersonal-intersubjective happenings which take place in the process. The psychoanalyst’s job is to co-help with the development of the psychoanalytic process with his knowledge, skill, experience and involvement: silence, abstinence from counter-transference reactions, interpretation of unconscious content, and other analytic interventions which encourage the expression and experience of the analysant. Psychoanalyst also uses his intuition and especially his emphatic-sympathetic approach and containment of the analysant’s unconscious content and affects, up until the moment when they can be mentalized, dreamed, thought and articulated.

The goal of psychoanalytic process is the change of a subject of psychoanalysis. In the old psychoanalytic paradigm (psychoanalysis as psychology of one psyche/person) the analysant was the “object” of analysis by a professional, while in the new, transitional field and space-relation between the analyst and analysant oriented psychoanalysis, the analysant is the subject of psychoanalysis as well as the analyst. The process is reciprocal and mutual but not symmetrical. The change of analysant being the main goal makes her/him more in focus, but still the process of development and maturation of both participants in the analysis is happening in the interpersonal relationship between them.

When psychoanalysis starts it does not have an expiration date. It goes on until the end of the analysant’s life. That which has and ending is the setting. After a certain time, when the meetings end, the analysant continues their life path by themselves with the internalized analyst (transformative object) and the relationship with the analyst in her/his own inner world. The analysant is qualified and prepared enough to be her/his own analyst. At the end of the process of psychoanalysis the subject has changed (awoken, developed) and better knows herself/himself, her/his identity, good and bad sides, her/his potential, creativity and talents, better understands her/his problems, traumas, life and surroundings. To express ourselves metaphorically, psychoanalysis is a “common writing of a novel about the analysant’s life” in which the analysant as the main character brings her/his life experience, fragment and material from her/his life, which together with the analyst she/he assembles and shapes into a coherent story on the basis of which one can live a more fulfilled life. Psychoanalysis is a long-lasting process, demanding emotionally as well as in time and money. But the effects are long-term and permanent.

1. The description is partially summarized and changed with the author’s permission from the text by dr. Paolo Fonda, a psychoanalyst and psychotherapist from Trieste, titled The Problems with Education in Psychoanalytically Oriented Psychotherapy and Psychoanalysis (published in Psihološka obzorja, nr. 1, September 1992, p. 67–72) ↩︎
2. The text is an extract and translation of the text titled Psihoanalitički proces (2019) by Stanko Matačić, former president of the Croatian Psychoanalytic Society and is published with his consent and permission. ↩︎