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What is psychoanalytic psychotherapy?

It is one of many different types of psychotherapy. What they have in common is that they are all treatments involving talking to another person who is trained to listen and to think in a sensitive way. The aim of psychotherapy is to understand better how we behave and what motivates us, which can enable change to take place in our lives. The type of psychotherapy practised by BAP psychotherapists and taught in its training uses psychoanalytic or Jungian analytic approaches. Child psychotherapy also involves play.

How does it work?

Psychotherapy involves a process of exploration undertaken by the therapist and patient together in order to gain an understanding of the unconscious processes which take place in our minds and get expressed in all our relationships. Our early experiences are important in shaping the way our minds work and a large part of our mind operates outside of our conscious awareness.

In the psychotherapy sessions the patient is encouraged to reflect on whatever is uppermost in his/her mind during regular 50 minute sessions. Feelings, thoughts, wishes, fears, memories and dreams can be explored within the relationship between the therapist and patient. The patient is helped to understand the unconscious processes which affect their conscious thinking and behaviour. In this way, psychotherapy can gradually bring about a degree of self understanding, particularly how past experiences can affect current behaviour, and this enables the patient to find more appropriate ways of being, and of coping with difficulties. No-one can know much about their unconscious mind without specialist help.

Who can be helped by this type of psychotherapy?

In over a century since psychoanalytic psychotherapy and psychoanalysis were first developed, thousands of people in many countries have sought help through this treatment and have found it helpful in making more sense of and feeling better about their lives.

Psychotherapy may be helpful to those who suspect that difficulties in their lives have an emotional or psychological origin. Everyone experiences emotional problems at some stage in life and they are often resolved without outside help. However, sometimes they persist and are repeated in various aspects of our lives, because current issues stir up feelings from the past of which we are not consciously aware, and which get in the way of us living fulfilled lives. Emotional problems can be experienced in a variety of ways:

• Feelings of anxiety and an inability to concentrate or cope
• Feelings of emptiness, sadness or depression
• Extreme mood swings or frequent anger, like road rage
• Low self esteem or lack of confidence resulting in low achievement
• Difficulty in making or sustaining relationships, or repeatedly becoming involved in unsatisfying or destructive or violent relationships.
• Sexual problems
• Social shyness and isolation
• Addictive or obsessional behaviour which may be related to alcohol, drugs, sex, internet use or gambling
• Long term difficulties following losses such as bereavement, divorce, or job loss
• Sleep problems which may include nightmares
• Phobias
• Panic attacks
• Eating disorders
• Physical symptoms and psychosomatic illnesses

As regards children, referrals can arise due to conduct disorder, out of control behaviour and autism.

If I ask to see a psychotherapist, does it mean I am really ill?

Sometimes, people are afraid that it could be painfully obvious to the whole world that they are very unhappy or in need of “professional help”. In fact, seeking psychotherapy is a very private matter, which requires courage and is usually a sign that someone really wants to get to grips with whatever is troubling them.

Would the treatment be confidential?

In psychotherapy we aim to offer a consistent, safe and private space in which the patient feels able to talk about whatever is on his/her mind. Strict confidentiality is an essential prerequisite to this, and so we attach the highest importance to maintaining privacy with respect to all aspects of the therapy. Generally, disclosure of confidential information is resisted, even when a patient consents to this, in order to maintain a secure boundary for the very private work of psychotherapy to take place. The only circumstance in which disclosure of information to a third party would be considered without the express permission of the patient, is where the patient or another person is thought to be at severe risk. However, in such instances, this would first be discussed with the patient. Even then, the information disclosed would be limited to the absolute minimum necessary for the safety of the patient or other person. In the case of child patients, confidentiality is observed as with adult patients. It is understandable that parents may wish to know about their child’s progress during treatment and this can be discussed in general terms without breaching the child’s confidentiality.

What is the time commitment for psychotherapy?

Continuity is important in psychotherapy to allow the therapeutic process to take place. The minimum frequency of sessions is therefore weekly. However, more frequent sessions allow the patient and therapist to work at greater depth and patients are quite often seen more frequently, if this is possible. It is difficult to say how long treatment will take; it can vary from months to several years. The process is gradual and open ended. The timing of the ending of the therapy is usually agreed by discussion between the patient and therapist, although the patient is free to end at any time. Psychotherapy does require a regular commitment of time.

It is often helpful to discuss such matters in an initial exploratory consultation, in which your individual needs can be discussed with an experienced psychotherapist, who can then refer you on to a suitable psychotherapist if it is thought that psychotherapy could be helpful to you. See Find a Therapist

Is psychotherapy better than prescription drugs?

People who have been prescribed medication may also be helped by psychoanalytic psychotherapy. Medication is prescribed to help alleviate the symptoms of mood disturbances, such as anxiety or depression, whereas psychotherapy seeks to address the emotional roots of these symptoms. Some patients may need to be sufficiently stabilised by medication in order to be able to undertake psychotherapy, which can in itself be an emotionally disturbing and sometimes painful process. Occasionally psychotherapists suggest that their patients seek a consultation with their GP if they consider that medication might help them for a time.

How does psychoanalytic psychotherapy compare with CBT or other short term talking treatments?

In psychoanalytic psychotherapy, the therapist is not directive and will not usually give advice. The process involves the therapist following and paying attention to whatever the patient presents and offering their understanding of this, including possible unconscious influences, the aim being to enable the patient to think in new ways about his/her life and thereby to find his/her own solutions to problems. Also, the relationship between the therapist and patient is a key element in the treatment. People seeking psychotherapy are usually those who are interested in gaining a deeper understanding of their symptoms and behaviour and whose symptoms are more pervasive, less specific and more longstanding. This motivation is an important prerequisite of psychotherapy.

CBT (Cognitive Behaviour Therapy) concentrates on how the patient’s thoughts and beliefs affect their feelings and behaviour. The therapist devises strategies for the patient to practise in their day to day lives, aimed at helping the patient deal with difficult or problematic emotional states, symptoms and behaviours. It focuses on treating specific symptoms and can be very helpful in this respect. It is not concerned with understanding the deeper meanings of symptoms and what motivates the patient, such as the unconscious factors referred to above. In CBT, the therapist would be quite directive in recommending strategies to change thought patterns and behaviour and would tend to focus on the present and future and be less concerned with the past.

What is the difference between counselling, psychotherapy and psychoanalysis?

Sometimes these terms are used loosely and interchangeably. Much of the difference can lie in the intensity and frequency of sessions. Also, not all counselling or psychotherapy is “psychoanalytic” in orientation.

Counselling aims to offer a neutral space for the patient or client to talk about problems. The act of talking about these with the counsellor often provides relief for the patient and can help them to look at things in a different way and to make decisions for change. Counselling tends to be supportive rather than challenging.

In psychotherapy and psychoanalysis the therapist will listen carefully to what the patient presents, at the same time paying attention to what is being communicated unconsciously, both verbally and in other ways, particularly in the relationship that develops between the patient and therapist. The term psychoanalysis is usually used to describe an intensive process in which the patient is seen four and five times a week.

Is psychoanalytic psychotherapy suitable for everyone?

Psychotherapy is unlikely to help those people who are interested only in ridding themselves of their symptoms, rather than understanding what has lead to their development, and discussing their lives more generally. For someone to benefit from psychotherapy they need to have some degree of curiosity about how their mind works. Also, psychotherapy can be a painful and disturbing process because it involves giving attention to aspects of our lives which we would rather forget or not know about. For some patients this process can be too disturbing to embark on whilst maintaining their normal day to day lives. This can vary over time, depending on the patient’s particular situation and stage in life. In some cases, psychotherapy would need to be undertaken in the context of psychiatric support.

Patients who habitually use alcohol excessively, or other substances to modify their mood, are unlikely to be able to benefit from psychotherapy sessions, or to tolerate the process.

Matters concerning the suitability of psychotherapy for you can be discussed in an initial exploratory consultation with one of our consultants, at the end of which a considered recommendation can be made about future treatment, taking into account your particular difficulties and circumstances. See Find a Therapist.

Are people ever too old for psychotherapy?

In a word, no. Even people of an advanced age have reported great benefits from undertaking psychoanalytic psychotherapy.

Who regulates psychoanalytic psychotherapists?

Most BAP psychotherapists have had extensive experience as mental health professionals in medicine, clinical psychology, psychiatry, social work or counselling before undertaking a rigorous psychotherapy training lasting a minimum of four years.

The BAP was a founder member of the British Psychoanalytic Council (BPC), which exists to protect the interests of the public by promoting standards in the selection, training, continuous professional development and conduct of psychotherapists. BAP psychotherapists working with adults are under a professional obligation to observe the BPC Code of Ethics. BAP psychotherapists working with children and adolescents observe the Code of Ethics of the Association of Child Psychotherapists (ACP). In 2009 all psychotherapists will be also be regulated by the Health Professions Council.

Is there any research evidence that psychoanalytic
psychotherapy really works?

Numbers of studies have been completed and published showing the effectiveness of psychoanalytic psychotherapy in the UK and overseas and more are under way. People who are interested can look up Anthony Roth and Peter Fonagy’s book entitled ‘What works for whom? – A Critical Review of Psychotherapy Research’, First published by the Guilford Press in 1996.

The following books may help you to think further about psychotherapy:

‘An Intelligent Person’s Guide to Psychotherapy’

by Anthony Stevens, Duckworth 1998

‘Introduction to Psychotherapy: An outline of psychodynamic principles and practice’

by D. Brown and J.Pedder, Routledge 2000

‘A Short Introduction to Psychoanalysis’

by J. Milton, C. Polmear and J. Fabricius, Sage Publications 2004

‘An Introduction to Psychoanalysis: Contemporary theory and practice’

by A. Bateman and J. Holmes, Routledge 1995

’The Handbook of Jungian Psychology’

by R. Papadopoulos ed., Routledge 2006.

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