Psychoanalytic Therapy: Techniques and Effectiveness

This essay explores the techniques and effectiveness of psychoanalytic therapy, based on the case study of a patient undergoing such treatment. It also discusses the limitations of this mode of therapy and suggests alternative treatments.

Running head: PSYCHOANALYTIC THERAPY: TECHNIQUES AND EFFECTIVENESS
Psychoanalytic therapy: Techniques and effectiveness
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1PSYCHOANALYTIC THERAPY: TECHNIQUES AND EFFECTIVENESS
Established by Sigmund Freud, the principles of psychoanalysis continue to impact
contemporary practice even today. According to Freud, psychoanalysis can be used as an
effective means of therapy, where the therapist would gain an in – depth insight into the patient’s
unconscious, in order to let repressed thoughts and emotions surface (Lacan, 2013). These
feelings and experiences which have been buried in the patient’s unconscious, or his id, need to
be examined in order to understand the conflicts and issues affecting an individual’s behavioral
patterns, thinking and relationships (Freud, 2018). It follows Freud’s principles of
psychoanalysis, and several techniques of analysis are used by the therapist in order to examine
repressed emotions and thoughts of the patient. Theories of transference, resistance, attachment
and that of the patient – therapist relationship are instrumental in understanding how
psychoanalytic therapy works.
The following essay takes into account the case study of a patient undergoing
psychoanalytic therapy, in order to assess the success of such a mode of treatment, and also study
its limitations. The patient, Peter, is a forty year old single man, who has been facing severe
interpersonal conflicts, both in his personal and professional lives. After having tried several
mental health care professionals, he decided to opt for psychoanalytic therapy. Psychoanalytic
therapy is usually reserved for patients suffering from emotional trauma, neurotic tendencies,
severe depression, personality disorders, destructive behavior and so on (Zimmerman et al.,
2015). For Peter, presented with social anxiety and inability to find a solution to his problems
both at work and home, I would suggest psychoanalytic therapy, so as to understand his thought
process. I would segregate the therapy into three clear phases, namely early, middle and later
stages.

2PSYCHOANALYTIC THERAPY: TECHNIQUES AND EFFECTIVENESS
In the initial stages of psychoanalytic therapy, I would attempt to understand the
personality traits prevalent in Peter; I would start by asking questions pertaining to childhood,
and his relationships with his family members. Defense mechanism, as the name suggests, refers
to a psychological strategy where a person uses certain behavioral traits in order to protect
himself from recurrent bouts of guilt or anxiety. Since the defense mechanism by nature attempts
to suppress hidden emotions, these can prevent the unconscious from surfacing, making my job
as a psychoanalyst much more complex. This is because in defense mechanisms, the superego or
the id takes the upper hand (Maslow, 2013). Upon speaking with Peter, I realized that he had
severe social and moral anxiety and was unable to open up; moreover, he was unconsciously
using displacement and denial as defense mechanisms. Displacement refers to a situation where a
person takes out his anger or frustration on someone else. In this case, Peter, unable to express
his feelings at his place or work, was invariably lashing out at his family members, thus
disturbing the equilibrium at home. In addition, he was also in denial about the whole thing, and
refused to acknowledge his fault.
The technique of free association is to be used in the middle phase. I would prepare a list
of words that I would repeat to Peter, who would have to utter the first thing that comes to mind
when he hears a particular word. Recollection of a particularly stressful memory, or abreaction,
could point to the reason behind his interpersonal conflicts (Joffe & Elsey, 2014). Initially, Peter
hesitated to share his thoughts, but once I was able to make him feel comfortable, he opened up.
The technique of dream analysis would also be used. According to Freud, it is only when we are
asleep that our conscious mind is overridden by our repressed thoughts and emotions, albeit a
dream may very well be contaminated by our imaginations running wild (Jung, 2014). It is then
the therapist’s duty to grab the essence of the dream, and understand the content. In subsequent

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sessions, Peter shared several dreams he seem to experience over the last few months. Redundant
themes in Peter’s dreams could help me understand the reticent emotions buried within him; they
hinted at the inability to make sense of the world around him, a feeling of being lost in the
wilderness, and a sense of helplessness – these themes reoccurred numerous times in his dreams
(Madsen & Hammond, 2013). In this phase, transference may be observed in the patient, where
he develops an attachment with the therapist. Considering the therapist to be his confidante, he
shares his thoughts with him. The way the patient responds to this relationship would reflect a
pattern of his past behavior, and also demonstrate his level of emotional stability. In the final
stage, a fixed termination date must be established with the consent of the patient, to ensure that
the feeling of transference is resolved and to provide scope for healthy, fruitful attachments in
the future.
Based on my findings, I explained to Peter that he had a case of oral fixation; fixation
referred to a stage in which an individual was stuck on a particular stage of psychosexual
development as explained by Freud. Oral fixation means that the patient, Peter in this case was
stuck in the oral stage and thus resorted to alcohol and cigarettes as a means of oral stimulation
(Claridge & Davis, 2013). The roots of his interpersonal conflict were traced back to his
childhood, and maternal deprivation in the oral stage may have been a key factor in the issues
that he is facing currently.
The goal of psychoanalytic therapy is to bring the unconscious mind to the surface along
with emotions and feelings that the patient had repressed over the years. By doing so, the therapy
strives to strengthen the patient’s ego, to help him stay true to the reality around him and also
alleviate the problems he had been facing. Therapeutic methods involve reminiscing about
childhood events or other difficulties that the patient may have had to face growing up. These

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events are chronologically arranged, studied and analyzed to offer the patient an understanding
of the self. Psychoanalytic therapy may be considered successful when the above mentioned
techniques enhance and positively affect a person’s character and personality development.
One of the main reasons why psychoanalytic therapy is practiced is because it involves
the unconscious (Lacan, 2013). The unconscious may be defined as the storehouse of the brain,
where every little detail gets stored deep within. To understand the intricate issues a person
might be facing, it is important to decipher his unconscious. In Peter’s case, it is derived that
conflicts in childhood were the root cause of his behavioral problems as an adult. Psychoanalytic
therapy provides a nourishing environment for the patient to delve deep into his troubles, and
promotes self development (Sanville, 2013). Childhood experiences and memories play an
integral role in gaining insight into an individual; before I try to decipher the cause behind
Peter’s conflicts at home and work, I would need to understand the events that shaped his
childhood. Also, psychoanalytic therapy helps with personality development by helping the
patient understand himself better (Hurry, 2018). According to Freud, the human personality is
shaped by the id, ego and superego. While the id, the unconscious refers to the instinctive drives
that we experience, the ego and the superego act as moderators of these drives. Man’s instinctive
drives are curbed by strict notions of morality and social codes (Fairbairn, 2013). This conflict
gives rise to defense mechanisms. In Peter’s case, he was unable to find a balance between his id,
or his instincts and his moral code of conduct, that society prescribes. This gave rise to the
defense mechanisms of guilt and denial mentioned above. As this therapist, I worked with him to
eradicate the guilt as far as possible so as to help him control his personality.
However, psychoanalytic therapy also has certain limitations (Dreher & Sandler, 2013).
For instance, therapy requires the patient to invest both money and time. If a patient is under

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intense stress, he or she might require immediate care, which includes hospitalization and
intervention (Rüsch et al., 2014). Psychoanalytic care in that case would simply delay such
treatment. Similarly, some patients might not have the financial resources to continue therapy,
causing them to abruptly stop. While Peter had the monetary resources required for prolonged
treatment, he did express his concern about the limited number of sessions offered; as a result, he
could not trust the reliability of the process as well. For many, psychoanalysis, which relies
entirely on a person’s perspective or a subjective view, this method is unscientific. Current
positioning on psychoanalysis is neutral; while psychoanalytic therapy certainly forms the
foundation for any kind of psychiatric treatment, it must be remembered that in this kind of
therapy, the patient tends to feel disempowered; he might feel helpless since the power resides in
the hands of the therapist entirely. It would be better if the stringent rules could be relaxed, so
that the patient can feel more at ease.
However, for better results, a person centered therapy or PCT may be used. The
foundations for this approach were laid by Carl Rogers in 1940 (Elliott, 2013). This kind of
treatment focuses on the human aspect of the patient; the therapist is no longer the authoritative
expert but instead creates an aura of empathy that motivates and enables the patient to grow.
Cognitive behavioral therapy or CBT is another contemporary treatment method that can be used
in Peter’s case. Clinical trials have demonstrated how CBT can be very effective while treating
anxiety and depression (Driessen et al., 2014). It is short term, and the course of the treatment is
chalked out keeping certain goals in mind. The main aim of cognitive behavioral therapy is to
alter the pattern of emotions that could be the cause behind the patient’s emotional disturbances.
CBT is founded on the principle that negative thoughts do not arise out of a particular event that

6PSYCHOANALYTIC THERAPY: TECHNIQUES AND EFFECTIVENESS
occurs to us, but because of how we interpret it. Peter’s pessimistic attitude towards his
professional and personal lives arose out of the negative connotations he associated with them.
As a matter of fact, psychoanalytic therapy in Peter’s case may also be replaced by IPT or
interpersonal therapy (Lipsitz & Markowitz, 2013). Such a mode of treatment would take into
consideration the nature of the individual’s interpersonal relationships. The therapy would first
seek to identify the emotion the person is experiencing and the origin. Next, the person would be
encouraged to express these suppressed emotions so as to provide an outlet. Also, the preexisting
causes of such emotions and unresolved issues of the past would be examined to provide a
wholesome solution to the person’s problems.
To conclude, psychoanalytic therapy, one of the most commonly used methods of
counseling and therapy, is based on the principles of psychoanalysis established by Sigmund
Freud. Freud considered this method to be the most effective in gaining insight into the mind of
an individual; some of the techniques used in psychoanalytic therapy directly target the id or
unconscious of a person, and allow it to surface. An analysis of these hidden thoughts and
feelings can be cathartic, and lead to a release of excess emotion, which might have been causing
emotional imbalance. In the case of Peter, interpersonal conflicts with other people at home or at
his place of work might have roots in certain childhood events which have since then been
suppressed. Recollection of these memories could point towards a solution for his problems.
Dream analysis, the Rorschach inkblot test, free association and transference are some of the
other methods that have been utilized in the therapy; these have been segregated into initial,
middle and final stages to get optimum results. However, it must also be stated that
psychoanalytic therapy, being one of the most primitive methods of psychological treatment, can
be outdated in some cases; moreover, such treatment is mainly to be reserved for people who are

7PSYCHOANALYTIC THERAPY: TECHNIQUES AND EFFECTIVENESS
wealthy and have a lot of free time on their hands. To compensate for these limitations or
shortcomings, other modes of treatment like interpersonal therapy, cognitive behavioral therapy
or person centered therapy may be used.

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