Psychoanalysis is the diverse body of knowledge and clinical interventions started by Sigmund Freud and continuously modified both by Freud himself and by his various followers. The schools of thought created by these followers can be so different and their approaches so nuanced and refined that analysts with different orientations often disagree on therapeutic action and what is mutative. For this reason, it is difficult to summarize such diverse body of thought in a few lines. For me, what distinguishes psychoanalysis and psychodynamic therapy form other approaches is a strong interest in how the past lives in the present and the belief that we are formed by past experiences and unwittingly repeat the same scenarios. The repetition of unresolved issues is likely to emerge in the session; therefore, addressing these issues in the present therapeutic relationship is mutative, putting the repetition to rest.
One of the earliest concerns of psychoanalysis was the definition of the unconscious, that is, the part of the mind below the threshold of awareness. The unconscious contains both what we are unwilling to face and incapable of facing, and what has been communicated and taught to us over time below the level of awareness; it acts on us and within us, but we are not fully conscious of it. For instance, in the intergenerational transmission of trauma, parents, without being aware or verbally communicating, pass on unspeakable truths about unprocessed traumatic events and thoughts and behaviors deemed shameful and unacceptable. In subtle actions such as gestures and practices, the sharing may be also an unburdening for the parents, who deposit into their children unwanted feelings that are impossible to bear; their children now carry these burdens, passing them on to the next generation or to a targeted group. This unacknowledged hot potato is passed on until someone is able to grasp what is going on and work it through. Understanding these dynamics often helps people to unburden their confusion, fears, and shame; it is beneficial to both individuals and collectively affected groups. Psychoanalysis is helpful in recognizing conflicts in the mind, understanding attachment styles, and determining the type of relationships we are attracted to or avoid; it helps in understanding the meanings and functions of our addictions.
Modern psychoanalysis is not necessarily limited to content analysis and historical reconstruction of disruptive events; rather, it helps develop in real time, during the session, the tools for feeling and thinking when the capacity to experience and tolerate stimulation is underdeveloped or damaged. It helps develop a container for those emotions so that they can be processed.
From a formal point of view, what distinguishes psychoanalysis from psychodynamic psychotherapy is the intensity of treatment. Psychoanalysis proper is often but not always practiced lying on the couch; it involves free association and a frequency of three to five sessions per week. It is a high-intensity practice and its purpose is to reactivate old, unresolved issues to be reworked in the session with the analyst. This re-experiencing in the safe environment, paired with the development of a trusting relationship with the therapist, allows the patient to understand, process, and eventually liquidate the old business. Psychodynamic Psychotherapy is most often practiced sitting up, face-to-face with the therapist, and the frequency is reduced to once or twice per week. The goal of the work is the same, but the diminished intensity may influence the depth of the work. However, plenty can be accomplished once per week, and there are cases in which a less intensive treatment is actually recommended. This is the treatment of choice for people who want to improve their relationships and have attachment problems and trust issues. It is also helpful to people that somatize and have bodily ailments that they or their doctors suspect are due to “stress.” It is a beneficial practice for people who experience negative feelings and depression or numbness and lack of feelings, as well as disruptive conflicting feelings. It is also the treatment of choice for shame and self-esteem issues.