What are the indications for psychoanalysis


English: psychoanalysis

1 definition

The Psychoanalysis is one of the psychodynamic therapy methods and was developed by Sigmund Freud. The focus of the therapy is the work on the unconscious conflict, which the psychoanalyst should resolve through interpretation.

Modern models and approaches of psychotherapy based on psychoanalysis are called psychodynamic concepts.

2 theoretical approaches

2.1 trauma theory

The first beginnings of Freud's psychoanalysis can be found in trauma theory. In this Freud describes unconscious trauma in childhood as the etiology of "hysteria". As a student of Charcot, Freud was able to observe the method of hypnosis and its symptom-relieving effect in "hysterical" patients and also used them in his patients. Due to a hypnosis-induced altered state of consciousness, it is possible that patients can now remember the incapable of consciousness events. The moment in which the trauma can be retrieved is called catharsis (cleansing) by Freud, since the symptoms subside and are accompanied by affective impulses. Freud assumed that childhood trauma was not emotionally coped with. The aim of the treatment, the khartatic procedure, should therefore be to relive the trauma (remembering) and to adequately cope with the emotions (reacting off).

Since the symptoms often reappear after hypnosis and the patients cannot remember again after hypnosis, Freud developed psychoanalysis, a therapeutic approach in which the therapy goals can also be achieved without hypnosis. Freud changed his trauma theory to drive theory, since not every trauma is a real event, but in some cases also involves fantasies and unconscious desires.

2.2 Drive theory

The drive theory developed by Freud is based on the knowledge that a large part of the psychological content is hidden from consciousness. The idea of ​​the existence of an unconscious is the foundation of every psychoanalytic theory.

Freud introduced the first topical model (also known as the iceberg model) for better understanding. Freud describes three areas as a topography of mental life:

  • the unconscious,
  • the preconscious and
  • the conscious.

Freud revised the model to the so-called structural model (also known as the second topical model or instance model). Here, too, Freud describes three areas:

Freud also describes instincts as "internal somatic stimulus sources" (in contrast to external stimuli). These drives motivate behavior and, according to Freud, can be divided into life and death drives. Life instincts cause self- or species preservation, while death instincts aim at death and are expressed in aggression.

Freud developed a developmental psychological model of the psychosexual phases to describe the development of human sexuality. In this context, sexuality means the general energy of the vital instinct, the libido. Thus, in psychoanalysis, sexuality relates not only to the genitals, but to a general energy that strives for pleasure or satisfaction. For example, food intake is linked to sexual satisfaction in the psychoanalytic sense. For this reason, the term infantile sexuality is often misunderstood: According to Freud, the development of infantile sexuality can be divided into different phases over the years of childhood, in each of which an erogenous zone dominates the psychosexual development. According to Freud, if the developmental phases are not mastered, disruptions occur.

For the practice of psychoanalytic psychotherapy, the drive theory means that drives from the unconscious, the id, are the focus of the therapy. In order to expose this, psychoanalysts work with methods to weaken the ego. Such methods are e.g .:

  • free association (deliberately turning off self-censorship)
  • Analysis of failures (understood as a compromise between id and ego) or
  • Dream interpretation (while dreaming the ego is weakened).

Psychoanalysts also create conditions in which the ego is weakened. For example, lying on the couch should be conducive to regression.

2.3 Ego Psychology

Anna Freud attached more importance to the ego and super-ego than her father and developed the theories about the ego further. The ego has to integrate the instinctual impulses of the id, the internalized morality of the superego and the demands of reality. Unconscious wishes from the id, which the super-ego does not allow, are experienced by the ego as threatening (and thus unpleasant) and attempts to overcome them through defense mechanisms. The defense mechanisms are not primarily used to defend against instincts, but to reduce the resulting displeasure. If the ego cannot completely ward off the drive, this manifests itself in symptoms. Symptoms therefore always arise when instincts cannot be fully acted out or completely warded off. Disturbances and symptoms thus fulfill a function. The functional aspect of mental disorders is thus also similar to the gain in illness. This knowledge is therefore not only important for psychotherapy but also especially for psychosomatic treatment.

Defense mechanisms can be divided into immature and mature defense mechanisms. The ego of a person with structural pathology (low structural level) uses immature defense mechanisms to defend against instincts. In this type, instinctual defense takes place more in the area of ​​interpersonal relationships, i.e. interpsychic. With a higher structure level, intrapsychic instinctual defense by means of mature defense mechanisms and thus conflict pathology becomes possible.

Ego psychology has changed the practice of psychoanalytic psychotherapy. In contrast to the drive theory, there is no ego weakening, since the focus is not on the id but on the ego. The ego weakening would be counterproductive, since the ego is the object of observation and should be treated.

3 indications

Areas of application for psychoanalysis can include problems with finding identity, interpersonal conflicts, depression or anxiety disorders. The indications also include dissociative disorders and personality disorders.

4 principles of therapy

The personality of the patient and his life story, which has become unconscious, should be comprehensively analyzed. The aim is not to get rid of the symptoms quickly, but to change the patient's existing structures and fixations.

Free association and dream interpretation, which should bring the unconscious to light, are particularly important in therapy. The processing of transference, countertransference and resistance is also of crucial importance.

5 therapy setting

Usually found at one low frequency psychoanalytic therapy 1-2 sessions per week for 2-3 years. It can be performed lying down or sitting.

In the high frequency psychoanalytic therapy (actual psychoanalysis) the sessions take place 3-4 times a week. Complete therapy can take more than 10 years. The therapist usually sits outside of the patient's field of vision while the patient is lying on a couch. The lying position is intended to achieve better relaxation for the patient and direct attention to his soul world. By promoting regression, it is possible to experience and reactivate old mental conflicts.