How Does Psychoanalytic Psychotherapy Work?
Psychoanalytic psychotherapy helps by permitting the patient to become increasingly conscious of troublesome feelings, conflicts and wishes that heretofore had remained out of awareness and that produced unhappiness by promoting repetitive self-defeat-ing behaviors, that is to gain “insight”.
Whereas insight has always been valued as a goal, insight by itself is insufficient. The process whereby insight is acquired is a lengthy and arduous one that is inextricably linked with the recall of painful affects, memories and traumatic experiences. For treatment to be effective, there must be both cognitive and affective experiences for the patient. Neither a purely intellectual nor a purely cathartic experience is likely to result in relief or be-havioral change. The support provided by the treatment relation-ship, which includes commitment, respect, reliability, honesty and care, is a powerful factor in the curative process. It is this atmosphere that makes bearable the emotional pain that accom-panies the healing of the wounds first experienced in isolation, so often inflicted by the first objects of the patient’s love, need and trust. All of these considerations are central to psychoanalytic psychotherapy as well.
The concept of “working through” is helpful in appreciat-ing the often lengthy and complex psychotherapeutic processes. Working through is that stage or aspect of treatment characterized by repeated identification of reenactment and reliving of earlier experiences through confrontation, clarification, and interpreta-tion of resistance and transference that ultimately promotes the patient’s self-awareness. In effect, the working through process frees the patient from the position of being at the mercy of uncon-scious conflicts and fears that have compromised interpersonal relationships and achievement. This is accomplished not only through the analysis of the transference but also of current inter-personal relationships outside of the psychotherapy. Ultimately, a thorough understanding of the transference and of current re-lationships can permit the patient to appreciate their relationship to important early experiences and ultimately to ameliorate the influence of the past on the present.