How Does Psychoanalytic Psychotherapy Differ from Psychoanalysis?

How Does Psychoanalytic Psychotherapy Differ from Psychoanalysis?

The answer to this question has occupied many researchers and psychiatrists throughout the last 50 years. Efforts have been made continually not only to elucidate the differences between the two treatments but, more important, to define the underlying princi-ples of psychoanalytic psychotherapy. Whereas some prefer defi-nitions of psychoanalysis and psychotherapy as distinct separate entities, it is more useful to many psychiatrists to conceptualize psychoanalysis and psychoanalytic psychotherapy as residing on a therapeutic continuum. As discussed, there is much in the conduct of psychoanalytic psychotherapy that has been borrowed from psychoanalysis. Free association, clarification and interpre-tation in psychoanalytic psychotherapy are such examples. The centrality of transference is another, although early psychiatrists and researchers advocated that transferences were to be recog-nized and acknowledged in psychoanalytic psychotherapy and “managed” rather than interpreted so that patients were not sub-ject to the intense therapeutic regressions characteristic of psy-choanalysis. Today, such a distinction regarding the approach to transference in psychoanalytic psychotherapy is less rigid.

On the other hand, certain supportive and more directive techniques, such as greater activity of the therapist through fo-cusing the patient on specific current problems and relationships, reassuring and affirming the patient, and the giving of advice, are used much more in psychoanalytic psychotherapy than in

psychoanalysis. Therefore, the adherence to the therapist’s neu-trality is less strict, and as a result, there is often but not always less frustration for the patient in psychoanalytic psychotherapy. The length of treatment may not distinguish the two approaches, but the frequency of sessions (four or five per week) and the use of the couch, however, are characteristic of psychoanalysis (see Table 66.7).

Overall, it is fair to say that psychoanalytic psychotherapy

·              Places greater emphasis on the here and now in terms of the patient’s current interpersonal relationships and experiences outside of the therapy; whereas in psychoanalysis, there is greater emphasis on the experiences within the analysis and the relationship between analyst and analysand;

·              Incorporates,  more  than  does  psychoanalysis,  vari-

·              ous other techniques from other dynamic and behavioral psychotherapies;

·              Emphasizes the usefulness of focusing on current (dynamic) problems and less on genetic issues; and

·              Establishes more modest goals of treatment.

The last point is particularly important in that it facilitated the development of brief dynamic psychotherapies which address focal problems generally in up to 20 sessions.