A Guide to Psychoanalytic Therapy

An Important Tool in Addiction Treatment

Psychoanalytic therapy, also known as talk therapy or talking therapy, has long been used as an effective tool in addiction treatment. Since its development in the early 20th century, psychoanalysis has served as both a theoretical foundation for a range of talk therapy methods, and as a hands-on treatment strategy for a number of challenges, including addiction treatment.

Psychoanalysis helps individuals to uncover the roots of the problems they face and helps them take steps to resolve these issues. Unlike many other types of therapy, psychoanalysis is a long-term process that helps participants identify and change complicated and deep-seated emotional issues.

According to the American Psychoanalytic Association, the psychoanalytic framework emphasizes that:

• Each individual is unique
• Certain factors  lie outside of an individual’s awareness and conscious thoughts
• Feelings, experiences, and emotions have a large influence on behavior and thoughts
• The present is shaped by the past
• Individuals continue to develop and grow through each stage of life

Because psychoanalysis recognizes the connection between mental and physical health and the interconnected nature of body and mind, it can serve as a useful tool in the addiction treatment and the recovery process. It’s appropriate for most age groups, a wide range of situations, and a number of issues including drug and alcohol addiction.

What is Psychoanalytic or Talk Therapy?

Sigmund Freud, an Austrian neurologist, developed psychoanalysis in the late 1800’s and early 1900’s. Freud began his career by studying the physiology and nervous systems of the brain. His early career influences led to the development of a hypothesis that would influence much of Freud’s later work: That human behavior and motivation is influenced by many unseen sources, which he described as energy.

Sigmund Freud the Original Practitioner of Psychoanalytic Therapy

As Freud’s interest in the unconscious grew, he began treating patients with what was then known as “hysteria” or nervous disorders. Freud’s books on subjects such as the interpretation of dreams and the causes of neuroses became standards in the field. Freud’s systems were known as psychoanalytic systems.

In the early 1900’s, Freud attracted a number of other psychologists and therapists, forming a group that became known as the Vienna Circle. Several members of the Vienna Circle, such as Carl Jung and Alfred Adler, went on to develop their own well-known theories and treatment methods. After visiting America in 1909, several prominent psychologists adopted his ideas and the practice of psychoanalysis began to spread.

When the Nazi party took power in the 1930’s, Freud left Europe and moved to the U.S., where his influence continued to grow over the next two decades. A number of American theorists, known as neo-Freudians, expanded upon Freud’s ideas about unconscious motivators, but added in a range of social, cultural and interpersonal variables that Freud had largely ignored but that had a lasting influence on psychoanalysis techniques and methods.

While Freud’s theories and techniques focused solely on the individual, others, such as British pediatrician Donald Winnicott, believed that interpersonal relationships played a key role in mental health. Winnicott studied interactions of babies and their mothers, drawing the conclusion that an individual’s sense of self is largely determined by the emotional support he or she receives from caregivers during childhood.

German physician and psychotherapist Edith Jacobs also influenced the field of psychoanalysis. Jacobs integrated Freud’s ideas about human behavioral drivers with her own theories about environmental and social influences. While Freud believed these drivers to be innate in every human, Jacobs saw these behavioral drivers more as potentials or predispositions that could be altered and influenced by a person’s environment and experiences.

Additional Influential Figures

Other influential figures include Harry Stack Sullivan, an American psychiatrist who believed that personality is largely shaped by an individual’s network of personal interactions and relationships. Sullivan’s emphasis on cultural conditioning had a great impact on psychoanalysis. Today, many in the field of psychoanalysis practice what’s known as inter-subjectivity, a theory developed in part by psychoanalyst Robert Stolonow.

Stolonow’s approach builds on the ideas put forth by Freud, Winnicott, Jacobs, Sullivan and others; Stolonow adds in the perspective of inter-subjectivity, or the idea that just as the psychoanalyst influences the individual receiving analysis, that individual also influences the analyst.

This perspective has several implications for therapy, chiefly that the therapist must be careful not to let their own perceptions of reality overshadow those of the individual in analysis. Since Freud initiated psychoanalytic thought, the field has evolved. What was once solely a focus on the individual has shifted to a broader emphasis on the individual within their network of personal relationships, as well as within a framework of social, cultural, and environmental influences.

What are the Theories and Assumptions Underlying Psychoanalysis?

As the father of psychoanalytic theory, Freud’s theories are the most well-known. This is especially true for his theory on the interplay between the three factors within every individual’s mind:

• The id– A set of unconscious energies, such as sexual or aggressive tendencies.
• The ego– A set of organized functions that keep the id in check by moderating between the id, the super ego, and external realities.
• The super ego– A set of internalized rules that derive from cultural influences. The super ego uses guilt or to produce certain culturally acceptable behaviors and moderate the desires of the id.

Together, these factors form what’s known as Freud’s structural model of personality. Freud saw the interaction between these three forces as a struggle between humans’ primitive, animal instincts, and the civilizing forces of society.

Freud also created two other models of personality. The topographical model consisted of a map of the human psyche that includes three areas:

• The unconscious – This contains emotions and thoughts that can’t be directly accessed.
• The preconscious – This stores emotions, experiences, and ideas that have the potential to be actively accessed at some later time.
• The conscious – This stores accessible experiences and feelings.

Freud believed that mental problems and symptoms arise when unacceptable thoughts and feelings are trapped within the subconscious. Psychoanalytic therapy attempts to move these problematic thoughts and emotions from the subconscious into the conscious. Freud’s third personality model, the genetic, focuses on the interplay between human biology and personality.

In essence, the genetic model suggests that an individual’s sexual instincts or drives affect their psychological functioning. Freud viewed these drives as internal forces that result in an external expression at various points in a child’s development.

Freud believed that each child progressed through various stages related to different erogenous zones in the body, such as oral, anal, phallic, and genital. If a child becomes stuck at a certain stage, problems may develop later in life.

Freud developed the practice of psychotherapy to address all three of these personality models, essentially “unlocking” the past issues that cause an individual’s suffering. Now known as classical analysis, the goal is to alleviate the tensions between conscious and subconscious, id and super ego.

Under a Freudian model, therapy follows what’s known as the free association method, where individuals attempt to bring the contents of the subconscious to the surface of their conscious mind. Classic analysis also involves transference, in which an individual transfers fantasies about past relationships, such as with a parent, to the therapist in order to gain insight and resolve old conflicts.

Modern psychotherapy involves other schools of thought. These include:

• Ego psychology
• Object relations psychology
• Self psychology

Ego psychology has strong links to Freudian methods, but emphasizes enhancing an individual’s resilience, adaptation, and defense. This type of therapy operates with the overall goal of enhancing the abilities of the ego and super ego.

Object relation focuses on how relationships to the “significant others” influence and shape an individual. This type of therapy may emphasize the struggle between differentiating the self from others, while at the same time attempting to maintain relationships. Object relation theory recognizes that individuals may need to “re-enact” old relationships in order to release themselves from them.

Self psychology was created in the U.S. in the 1960’s and has been used to treat substance abuse and addiction. This type of psychotherapy emphasizes an individual’s perception of a sense of self, as defined through experiences. Areas of focus include self-esteem and boundaries between the self and others.

The founder of self psychology, Dr. Heinz Kohut, felt that those suffering from substance abuse and addiction were attempting to fill gaps in self-esteem through substance use. Kohut felt that these people were abusing drugs in an attempt to build the self-confidence and feelings of acceptance they were lacking. Kohut also believed that substance abuse allowed individuals to “merge with a source of power that gives them the feeling of being strong and worthwhile.”

Today, psychoanalytic therapy may follow one or a combination of these schools of thought. While all are based in Freud’s original ideas to some extent, modern psychoanalysis may blend multiple techniques and methods from several different approaches.

What is Psychoanalytic Therapy Used For?

Psychoanalytic therapy has been used to treat a number of issues, from substance abuse and addiction to depression and anxiety. Essentially, talk therapy can be helpful to almost anyone, no matter what age, social class, ethnicity, religion, or sexual orientation they may be a part of.

Historically, psychoanalysis has been used to help those experiencing:

• Depression
• Anxiety and panic attacks
• Phobias
• Eating disorders
• Sleeping disorders
• Substance abuse and addiction problems
• Sexual problems
• Schizophrenia
• Bi-polar disorder
• Difficult life events, such as divorce, death of a loved one, infertility or job loss
• Chronic, serious or long-term illnesses, such as cancer, heart disease, stroke, diabetes, multiple sclerosis, or lupus
• Depression related to aging
• Sexual, physical, or emotional abuse
• Post traumatic stress (PTSD)
• Discrimination or racism
• Family problems
• Inability to have satisfying relationships with others
• Social isolation or shyness
• Anger
• Attention deficit disorders and difficulties with concentration
• Autism in children

Essentially, talk therapy can be an effective choice for anyone who’s experiencing psychological issues or feeling like they can’t deal with problems all by themselves. When individuals feel overwhelmed, talking about the issues with someone who’s trained to listen, without judgment and to provide healthy ways to deal with negative feelings, can be extremely helpful.

Psychoanalytic therapy provides the chance to explore thoughts, feelings, and ideas, as well as the effects they may have on mood, behavior, and emotional state. This, in turn, makes it easier to notice destructive patterns or habits and take positive steps toward change. At its core, psychoanalysis involves two people working closely together to uncover the roots of emotional, psychological, physical pain and suffering, then identifying ways to cope and heal.

Benefits of Psychoanalytic Therapy

Since psychoanalysis has been used for more than a century, a great body of research exists as to its benefits. Study after study points to talk therapy’s effectiveness, and while not every individual responds in the same way to the same type of the therapy, overall the results are positive. And, while each therapist may have their own methods, research indicates several common factors in talk therapy:

• Expressing a full range of emotions, even those that may feel threatening or contradictory
• Recognizing attempts to avoid dealing with distressing emotions and negative feelings
• Identifying recurring patterns and themes in life, especially those that individuals follow without awareness
• Focusing on interpersonal relationships
• Emphasizing the therapeutic relationship between one and their therapist; this relationship provides the opportunity to “re-do” past relationships in a positive way
• Examining inner fantasy lives, including all of the dreams, desires, wishes, goals, and fears that make up an individual’s mental landscape

Supporting Statistics:

Studies indicate that when these common factors are present, individuals undergoing psychotherapy tend to have positive outcomes. The first major meta-analysis (or a study of the results of many other studies) of psychotherapy outcomes, performed in 1993, looked at almost 500 other research studies that had been completed over the past few decades.

This meta-study found that 80 percent of people who had been treated with psychotherapy were better off, a significant statistic. The study also looked at results from non-psychotherapeutic research and found that less than 70 percent of people treated by other methods were better off after therapy than before.

Of special note is that many studies indicate that the benefits of psychoanalytic therapy tend to not only last for a long time, but also increase over time. Five separate meta-analyses, performed from 1995 to 2009, found that the benefits of talk therapy continue to grow over time, as compared to many other therapeutic approaches, which may offer short-term results but tend to decay over time.

In 2010, the American Psychological Association — the “gold standard” of professional organizations in the field of mental health — released a study with similar results. The study reviewed 160 studies and 16 meta-studies of talk therapy’s effectiveness; together, these studies encompassed the experiences of tens of thousands of individuals who’d undergone psychoanalysis. The study found that not only did 90 percent of people experience benefits, but that those benefits also grew over time, long after the therapy was complete.

What to Expect in Psychoanalytic Therapy

Although each therapist may follow an individual approach, certain factors tend to be similar across psychotherapy experiences and follow a framework as defined by the American Psychoanalytic Association.

The therapist and the individual undergoing analysis work together to create a relationship based on trust, in which the individual can feel safe expressing themselves, and to experience inner feelings that may seem threatening, painful, wrapped in guilt, or embarrassing. In most cases, an individual attends talk therapy several times per week. Usually, the individual will sit or lie on a couch, facing away from the therapist.

The therapist will record and observe what the individual says. Therapists may guide the conversation, but the individual in therapy will always be encouraged to speak freely, make associations and connections, explore feelings, and essentially talk about whatever comes to mind.

At first, this may feel strange. Most of the time, a therapist will spend less time speaking as analysis progresses. Therapists often let the individual in treatment control the pace, agenda and topics of discussion, rather than following a rigid program the therapist develops. The goal is for the individuals in therapy to learn how to recognize their own thought processes and take control. The therapist takes notes to create a complete picture in order to determine patterns in the individuals’ thought, behavior, and emotion.

The therapist then helps the individual to recognize these patterns, understand where they come from, recognize their influence, and develop new and more productive ways to think, behave, and feel. Over time, the individual will work through these deep-seated patterns, learning different ways to cope and overcome. As a result, behavior, attitudes, actions, thoughts, and emotions will shift and change, taking a positive direction.

Psychoanalytic Therapy and Addiction Treatment

Talk therapy has long been used as an important and effective tool in addiction treatment and recovery. As traditional psychotherapy methods usually take place over years, it’s often used in conjunction with other, more immediate, treatment methodologies.

However, certain forms of psychoanalysis have been found to be especially effective for those experiencing substance abuse and addiction. One such approach, supportive-expressive psychotherapy, is what is known as a brief psychodynamic therapy and has been used extensively on individuals with opiate dependence in conjunction with methadone treatment.

Supportive-expressive Framework

Under the supportive-expressive framework, the substances that individuals abuse take the place of life experiences, essentially replacing real-life events with chemically induced feelings. Substance abuse also provides a buffer against potentially painful or uncomfortable experiences, blocking the impact of external events. Individuals undergoing this type of therapy learn to focus on rebuilding their ability to experience emotions and events without the effects of chemicals.

This type of talk therapy also helps individuals deal with what’s known as Core Conflictual Relationships Theme (CCRT), or a theme that lies within a person’s subconscious. The CCRT has its roots in childhood experiences, but it develops outside of an individual’s awareness. The CCRT is created in response to relationships with others, including one’s ideas about others’ reactions to them. When left unresolved, the CCRT can lead to a host of problems, including substance abuse.

According to psychotherapeutic thought, individuals who abused a substance tended to have CCRTs that are dominated by negative thoughts about others’ attitudes toward them, leading to low self-esteem and feelings of emptiness. Substance use and abuse offers a way to push these feelings of low self-worth and low self-confidence aside, at least for a while.

Psychoanalytic Therapy Works for Addiction Treatment

Through psychoanalytic therapy, individuals are able to uncover the roots of negative thoughts, feelings and beliefs that lead to addiction. The process involves identifying these issues, creating a framework for change, and working through the process with a therapist.

It also provides individuals with coping tools to help them deal with the potential for relapse after recovery and treatment. The therapeutic alliance that forms between the client and their therapists during talk therapy is an especially important piece of the puzzle. Studies indicate that a strong relationship of trust is leads to higher long-term rates of sobriety. Given psychoanalytic therapy’s long history and record of effectiveness, it’s not hard to see its benefits for addiction treatment and therapy.

If you or someone you know can benefit from psychoanalytic therapy, contact us for a free and confidential consultation.