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If you heard about a form of treatment that provides “substantial” improvement for 75 to 90% of those pursuing care in four years, would you consider it? 

            Psychoanalysis differs from psychotherapy.  Psychotherapy supports the psychic structure that is already present.  Psychoanalysis permeates deeply into the core of the psyche and facilitates remodeling of the self.  Analysis usually takes place on the couch at a frequency of 3-5 times per week and encourages free association.  Although strange to the uninitiated, the use of the couch provides both analyst and patient with a private space free of the necessity of social reciprocity to facilitate increased depth and unconscious process.  The patient is then free to focus inward on dreams, fantasies, thoughts, and ideas without the necessity of maintaining eye contact or monitoring facial expression.  There is less therapeutic structure and greater fluidity of thought.  Although techniques in psychotherapy and analysis are not mutually exclusive, there is a difference in emphasis. The analyst utilizes more interpretation, marks process rather than content, and focuses carefully on the transference/countertransference. Analytic listening involves more neutrality.  No specific goals or intentions are kept in mind by the analyst with the primary purpose being to understand the patient rather than make them feel better.  The patient focuses on self understanding rather than a cure.  Although this may seem counterintuitive, feeling deeply understood and becoming more connected to the unconscious provides an enhanced sense of well-being. 

Another essential difference between therapy and analysis is that the analyst avoids introducing or imposing their own expertise, explanations, and authority which assists the patient in developing increased inner strength and creativity.  In psychotherapy, use of support, suggestion, reassurance, and education can potentially restrict dialogue and curtail exploration of deeper issues.

A distinct contrast in time and rhythm exists between psychotherapeutic and analytic forms of treatment.  With the necessity of social exchange removed in analysis, the pace slows and there is no compelling rush or pressure for answers or solutions.  This allows the patient the time they need to discover themselves more completely.

Analysis travels to the core of personality structure, facilitating a sort of psychic supergluing process.  Internal levels are reworked and rebuilt, providing increased emotional strength, resiliency, and sturdiness.

Although this method has been used for a variety of symptoms and problem severity, increased effectiveness is noted for those who are healthier and more stable.  A large number of persons eventually seeking psychoanalysis have failed some form of psychotherapy or have not made the gains they desired.  This treatment requires an enduring commitment and a capacity to bear the journey into one’s own form of personal madness. Intellectual curiosity and the toleration of uncertainty and ambiguity are important personal variables.  The process does not work quickly with the average length of treatment being between 3 and 7 years to reach maximum improvement.  However, the benefits of living without lifelong internal restrictions, entrenched defenses, persistent symptoms, and limited psychological resiliency are worth a substantial investment.


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