HOW PSYCHOANALYSIS AND PSYCHOTHERAPY WORK

by Fonya Lord Helm, PhD, ABPP

Psychoanalysis pioneered our modern treatment of emotional suffering and now includes psychodynamic psychotherapy.   The person who comes for treatment can come as often as he or she wishes, ranging from once a week to five times a week, and can choose whether to use a couch, work face-to-face in person or by videoconferencing.  Some psychoanalyses have even been conducted by telephone.  The conversations are broad and focus on the individual needs and preferences of the person who is coming to discuss the issues important to them.  The analyst or therapist is active and engaged in the conversation.

Psychoanalytic work is special: it involves two people deeply involved in talking about life, surfacing patterns leading to discoveries of powerful emotional meanings that are part of thinking and behavior that formerly existed and operated beneath or outside conscious awareness.  Even some of the patterns that emerge between the two people who are talking and discovering are part of what eventually comes into conscious awareness.  Most of what happens, though, takes place through unconscious communication between the two people, and that fact makes it difficult to describe how psychoanalysis works.

Nonetheless, it does work, and it works very well, compared to other treatment modalities.  In Jonathan Shedler’s metaanalysis of studies of psychoanalysis and psychodynamic psychotherapy, his summary shows that emotional growth continues even after the psychoanalytic work has been completed.  The relationship between the two people continues to have a good effect, even when they no longer meet on a regular basis.  Most analysts and therapists now are willing to end the treatment gradually and meet occasionally to discuss important issues if the person would like to do so.  The important point is that the discussions and when they meet is tailored to needs of each individual person.

Mark Solms and others have shown, through imaging techniques such as PET scans and MRI, durable physical changes in the brain.  Recent studies also have found correlations with increased longevity and improved cognitive function.