So What is Psychoanalysis? And How Does it Differ From Other Approaches?

So what is psychoanalysis? And how does it differ to other forms of mental health treatment?

In this piece I'm going to briefly clarify what Talk Therapies are, what is specific to different approaches, and what psychoanalysis is in comparison. I'll highlight key terms in bold that you may wish to research further.

Note: Always make sure that anyone you work with is trained to a high standard, registered with a professional body that will have a code of ethics and regulate their work, and be fully insured. Professional organisations will have lists of qualified members, and you can check a person's credentials with them. My own professional organisations are the A.P.P.I. (Ireland) and the B.A.C.P. (UK).

Psychoanalysis is one approach to mental health treatment that falls under the broad term Talk Therapy, an umbrella term referring to approaches where the person seeking help speaks about what they are going through, on an ongoing basis, with a trained professional. Talk therapies contrast with the approach of medicine, which uses prescribed drugs to treat mental health concerns, and where someone may be prescribed such medicines after speaking with a doctor once. With talking therapies, talking is the medicine – alongside whatever changes someone chooses to make in their life based on their work within treatment. What is essential to all forms of talk therapy, before you look at any specific approach, is that simply having such space in your life where you can speak to another person in privacy about difficult things can lessen the burden of whatever it is you're dealing with.

Lots of people, including mental health professionals themselves, will use the terms counselling, therapy and psychotherapy interchangeably to refer to the same thing, and refer to mental health professionals as a counsellor, therapist or psychotherapist. All of these terms fall within talking therapy, but different professionals will work in specific areas (such as addiction counselling), or with specific modalities (such as C.B.T.) and use specific terms to refer to themselves. Approaches to treatment will differ in terms of their focus ( i.e. on past and continuing behaviours or on specific current issues), the techniques that are used, and the academic theories that underpin them.

Counselling usually refers to a more informal approach to treatment, centred around specific issues that are often in the present. It tends to have a conversational flow between the counsellor and client. Some counsellors may work with specific issues, or find that they prefer to work in specific areas, more usually the term 'counsellor' refers to someone who works on a wide range of issues.

Psychotherapy is generally more in-depth than counselling, and a lot of psychotherapists will specify the particular approach that they take (such as Integrative, or Systemic etc.). Traditionally a distinction has been made between counselling and psychotherapy based on the amount of extra time that psychotherapists spent in training, or the specificity of their approaches – psychotherapists have tended to train for longer, and may have to train to degree standard. However, increasingly in Ireland, and as a consequence of changes in law coming from the European Union, newly qualified counsellors now spend as long in training as psychotherapists – a minimum of four years continuous study and training – to bring all new professionals up to a similar level of training. This has been part of a broader undertaking to regulate the sector in Ireland over the past 10 years or so.

There are many approaches to psychotherapy, and you may wish to do some research into different approaches before deciding how you want to work with someone. A lot of people don't know exactly what they want from treatment before they begin – they just know that they want to begin, and you can clarify what it is that you want as you go. You can also always make contact with any mental health professional and ask them about their approach before making an appointment to meet them. You also need to be prepared for the possibility that you may not want to work with someone after meeting them. You may feel that you don't 'click' with them personally, or you don't feel comfortable with the approach that they use. It's important not to be disheartened by this – for something as important as your mental health, you need to find your right fit.

Psychoanalysis is a very in-depth approach to mental health treatment as it pays particular attention to the unconscious part of our minds – the part of ourselves where we keep all the stuff we feel so overwhelmed by that we block it out. This repressing of thoughts and experiences begins in earliest childhood, and it's not a bad thing in and of itself – it's just a defence mechanism that's part of being a human. The difficulty arises when the thoughts we're repressing are too significant to be kept hidden, and keep pushing back to the front of our minds. The effort to keep those bigger issues blocked out produces symptoms on the surface of our lives – insomnia, over-eating, depressed mood, anxiety, poor focus etc.. These are the stress points in our lives, like fault lines or volcanoes on the surface of the earth – when pressure builds up, it has to come out somewhere. The idea of psychoanalysis is that putting things into words, as fully as we can, reduces this pressure and free up our energy to get on with life.

We can keep certain thoughts repressed for so long, and so completely, that we no longer see the connection between what's going on on the surface of our lives and where those difficulties originate. It's often not until we hear ourselves say something out loud that we realise what we actually think about it. Psychoanalysis is a good approach when we can't explain why we get caught up in destructive patterns of behaviour, caught in repetitive cycles, feeling anxious or depressed without knowing why, or when we feel ourselves divided and pulled in different directions, tripping ourselves up, self-sabotaging. It's a particularly good approach if you find yourself asking “why do I keep doing this? Why can't I stop?”