ADULTS, CHILDREN, GROUPS
Psychoanalysis is applied in various forms. The classical psychoanalytic treatment (see above) was designed to best accommodate the capacities of an adult neurotic patient who is reasonably well adapted to the demands of life and work. Meanwhile high frequency psychoanalytic treatment is also applied to a broader range of psychopathology (widening scope), eg, severe narcissistic and borderline personality disorders.
- Psychoanalytic or psychodynamic psychotherapy with adults is usually applied with lower frequency (one or two sessions per week) and in a face to-face, seated arrangement. Often its goals are more focused on the resolution of a particular kind of problem (eg, difficulties in relationships or at work), depression or anxiety disorders. Even though transferences and counter-transferences occur, as in psychoanalysis, they often stay in the background and remain un interpreted, giving room to address and resolve more directly the problems in the patient’s life. Sometimes both participants in a psychoanalytic psychotherapy decide at a later point of treatment to deepen their work and embark on psychoanalysis at higher frequency.
- Children (from infancy onwards) and adolescents can experience lasting problems (depression, anxieties, sleeplessness, extreme aggression and cruelty, obsessive thinking, compulsive behaviour, learning difficulties, eating disorders, etc) that may jeopardize their psychic development and raise concerns in their parents, teachers and friends. For them, modified age-specific psychoanalytic treatment methods have been developed (including playing with figurines, toys, and painting) that allow a child or adolescent to express what is troubling them. Child-analysts are specialists in noticing the unconscious portions of their patient’s communications and responding to them appropriately, thus helping the child to solve emotional conflicts and problems that lie beneath their manifest symptoms and interfere with further mental growth.
- Psychoanalytic Psychodrama was developed (mostly in the US and in France) for patients with massive inhibitions, who need support in representing, expressing, and elaborating their difficulties in order to structure their inner world. The setting includes a play leader or director, who helps the patient to suggest, enter and develop a scene (eg, a memory, a feeling, the actual situation), which is the material of the therapeutic work. The patient plays with several co-therapists or actors who assume the roles assigned to them by the patient. The co-therapists’ function is to empathically understand these roles as parts of the patient (eg, different sides of a conflict) or their significant objects, and translate the latent meaning of these roles by representing their underlying unconscious (mostly defensive) processes. The play leader may interrupt and interpret the play at any point. The play allows the unfolding of difficult issues before the patient and facilitates their integration and internalization. The goal is to develop the patient’s insight into their inner life (thoughts, feelings, fantasies, dreams, and conflicts), and to foster its activation, thus expanding the psychic (intermediate) space (inner theatre), in which its various components can be considered and understood.
- Psychoanalytic Couples- and Family-Psychotherapy applies the insights of psychoanalysis to the dynamics to be found between the partners of couples and families, who are stuck in recurrent conflicts. With the help of a psychoanalyst, aspects of incompatible positions and transferences, mutual projections, and the repeated enactment of unconscious fantasies can be interpreted and analyzed with regard to prevailing unconscious ideas of what marriage and family life might or ought to mean, thus easing the tensions and opening ways for new self-determined choices.
- Psychoanalytic Groups (usually 6-9 members) make use of the universal tendency that unstructured assemblies of individuals in small or big groups without a defined task experience regressions to primitive levels of psychic functioning, eg, dependency on, and submission under, an idealized or frustrating group leader, aggressive flight-fight reactions, pairing and splitting into subgroups, as well as defences against these processes. While some groups focus on the individual’s participation and interaction in the here and now of the group dynamics, others address the overall group processes and the particular culture that emerges through free-floating discussions (the equivalent to free association). Psychoanalytic group work can serve various purposes: there are psychotherapeutic groups, groups that foster personal development, clinical discussion groups for the medical professions (Balint Groups, Tavistock-conference), as well as groups that encourage self-reflection and problem-solving in larger organizations.
Susana L. Ruiz