Psychoanalysis as treatment

The picture of the development of psychoanalysis as a therapeutic approach is rather different. Broadly speaking, it may be argued that psychoanalysis and other long-term psychodynamic therapies are predominantly verbal interpretive insight-oriented approaches which aim at the modification or restructuring of maladaptive relationship representations. As these infantile or child-like relationship representations are considered to lie at the root of psychological disturbance, it is believed that their modification, primarily but not exclusively through the use of insight, leads to improved adjustment to the demands of the social world.

Psychoanalysis is the most intensive form of these long-term therapies. The analysand attends treatment three or more times a week over a period of years. The use of the couch and the instruction to the analysand to free associate have been considered hallmarks. There is considerable controversy in most Western countries concerning the number of sessions per week which unequivocally define psychoanalytic treatment. In France three sessions per week is considered standard, in the United States four, and in the United Kingdom five. Notwithstanding these variations across countries, the distinction between psychoanalysis and other forms of psychotherapy is normally made in terms of the frequency of sessions rather than in terms of the therapeutic stance of the analyst. It is difficult to avoid the conclusion that in the absence of plausible, theoretically based criteria for what is or is not psychoanalytic, against the background of an overwhelming diversity of theoretical frameworks, psychoanalysts have attempted to find common ground in readily identifiable treatment parameters. This problem arises as a consequence of an extremely loose relationship between psychoanalytic theory and clinical practice. (16) It is an indisputable fact that, whereas theory has evolved extremely rapidly in the last half of the twentieth century, psychoanalytic practice has changed surprisingly little and continues to provide the core of the psychoanalytic identity.

In this chapter we will not consider the theoretical richness of this field but instead will focus on the clinical constructs which run across the diverse intellectual approaches. The intersection of the two is perhaps clearest in one area which we shall consider in some detail, namely the therapeutic action of long-term psychoanalytically oriented psychotherapeutic treatment.

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