When You Don't Know Where to Turn / A Self-Diagnosing Guide to Counseling and Therapy

by Steven J. Bartlett

In general, psychoanalysis is successful in bringing about what are called broad-spectrum improvements. It is less intended for abatement of specific symptoms. In other words, those with highly specific goals they wish to achieve through therapy tend not to be good candidates for analysis. For example, a person seeking specific and prompt relief from depression, public-speaking anxiety, or shyness may not be appropriate for psychoanalysis. Long-term, intensive psychoanalysis, because it is long-lasting and very detailed, can lead to very broad improvements: a sense of increased satisfaction in daily living; a stronger, more positive sense of self-esteem; a greater capacity to enjoy and be at ease with others. In the process, specific symptoms often do subside or disappear, but the focus is general, and the patient must be willing to embrace a commitment to general improvement.

On the other hand, brief psychoanalysis may begin by focusing on specific problems experienced by a patient, but treatment quickly widens in scope to touch on matters that affect the patient's life in a general way. We saw this in Bobby's case, where recurrent night terrors revealed his general need for the greater emotional stability that comes from feeling settled, having friends, etc.

Psychoanalysis is best suited to problems that fall into two categories:

* Problems that are clearly "neurotic" in nature: they interfere with living to some degree but do not totally impair you so that your life is clearly out of control, as in cases involving psychoses (where you are no longer able to distinguish reality from fantasies and hallucinations), alcoholism, or drug addiction

* Problems that involve sexual difficulties, mood disturbances, and impairment of personal relations, assuming that you are willing to work on these problems within the wider focus that analysis usually requires

Psychoanalysis is not generally considered to be the treatment of choice for severe impairments, such as alcoholism, drug abuse, and psychotic disturbances, when your life is clearly out of control. Analysis is also not generally an appropriate form of treatment for immediate problems arising from sudden environmental changes, such as the loss of a job, or loneliness after a transfer to a new job location, or after a divorce or separation. In some instances, if problems of this kind are not resolved after a reasonable adjustment period, analysis might then be considered. Other approaches to therapy lend themselves better to specific and immediate adjustment problems, as we will see.

We have been describing the appropriateness of psychoanalysis for the treatment of certain kinds of problems, but there is an equally important, and frequently overlooked, question: whether psychoanalysis is appropriate for the kind of person you are. Psychoanalysis is best suited to individuals with these characteristics:

* They are verbally articulate.

* They have a sense of curiosity about themselves.

* They have a good reflective capacity and an interest in achieving insight through a careful analysis of their thoughts, feelings, behavior, and past history.