One of the principal techniques is free association. The patient is made to feel relaxed and comfortable—one reason a couch is sometimes used. He is encouraged to talk in an uninhibited way about his concerns and feelings. During this process, the analyst usually remains detached and restrained so as not to interfere with the patient's free expression. From time to time, the analyst shares with the patient certain of the interpretations he has developed on the basis of the patient's reports and behavior. The analyst's objective is to help the patient recover lost and painful memories that are responsible for the conflicts, weaknesses, or inabilities that cause the patient to suffer.
This process can be very hard on the patient: he or she must revisit experiences that may be very painful. Analysis requires perseverance, endurance, and courage. It is not, as we will see, for everyone or every problem.
One of the most important developments in psychoanalysis has to do with the increasing popularity of psychoanalytic psychotherapy (also called dynamic psychotherapy), meaning psychoanalysis that is extremely brief (12 to 20 sessions, for example). Considerably more patients are now treated with psychoanalytic psychotherapy than with traditional, intensive psychoanalysis.
TWO EXAMPLES OF PSYCHOANALYSIS
Other than the length and intensity of treatment, the main difference between Freudian psychoanalysis and brief analysis has to do with the amount of emphasis that is placed on sexual matters. Freud believed that an infant's relationship to his environment and parents is predominantly sensual: a baby seeks oral gratification; his attention is absorbed by what he puts into his mouth. Later, attention is focused on excretory processes; toilet-training requires the child to exercise self-regulation for the first time. Later, genital sexuality becomes the dominant interest. These sexual phases of development identify the dominant areas of attention that influence the infant, the child, and then the adult in their behavior toward others.
Brief psychoanalysis generally does not affirm Freud's sexually based (libido) theory of motivation. The second example that follows illustrates this shift of emphasis. The first example was described by Freud himself[[1]]; the second illustrates brief psychoanalysis.
[[1]] Sigmund Freud, "Lecture 17," General Introduction to Psychoanalysis (New York: Garden City Pub. Co., 1943).
A CASE FROM FREUD
Freud describes the analysis of a girl who has repressed a strong desire for sexual intercourse with her father and has, as a result, developed a bizarre pattern of behavior.
Unconsciously, the dread of actually making love with him has generalized to a dread of sexual activity of any kind. Without any conscious intent on her part, an association is formed between sexual intercourse and breaking a vase. She is not aware of the unconscious symbolic connection she has established between these acts. Similarly, she begins to associate the bolster at the head of her bed with her father and identifies her mother with the headboard.