[PetalPower]

I have had 12 sessions of Psychoanalytical Psychotherapy since September which I have received on a weekly basis via the NHS (UK health service). Unfortunately, I have had difficulties tolerating the therapy; including anxiety; poor appetite and weight loss after some appointments. The therapist said this was resistance. I have found it very different to the supportive type of therapy e.g. Person centred, CBT which I have received in the past.

Does anyone know what the differences are between Psychoanalytical psychotherapy and Psychodynamic psychotherapy? I understand that they are very similar. However, I have read that Psychodynamic Psychotherapy can include supportive interventions as well as uncovering interventions. Therefore, I am wondering whether Psychodynamic psychotherapy might be less intense.

I have some long standing difficulties and would like to have something which goes deeper and is more challenging than what I have had in the past e.g. supportive type but which is less intense and not quite as challenging as the Psychoanalytical psychotherapy I am currently having.

I have discussed the above with my therapist but he does not answer questions directly and it gets turned into the therapy. Unfortunately, If I do not tolerate the Psychoanalytical psychotherapy on the health service I will have to pay to see a therapist as the department do not have any other treatments available in the short term. The department offers Cognitive analytical therapy (CAT) but there is a 2 year waiting list for this.

[feileacan]

I'm in psychoanalysis myself and recently I have thought a lot about what is it that makes the treatment I'm experiencing psychoanalysis or what is it that makes it psychoanalytic at all and most of all, what is it that makes it super useful for me.

I don't have a clear understanding yet but to my understanding psychoanalytic and psychodynamic therapy should be basically synonyms. Also, I think psychoanalytic therapy and contemporary psychoanalysis are to my mind very close to synonyms, the major differences being perhaps only the differences in some parameters - full psychoanalysis occurring usually 4-5 times per week and the patient usually lying on the couch.

What I think differentiates psychoanalytic/psychoanalytic therapy and psychoanalysis from other therapies is the expectance of developing transferences and explicitly working with them. Also the fact that the sessions are patient-lead and without concrete structure, goals and homeworks - but this is also happening in person-centered and possibly other therapies as well.

All other things, I think, should be a parameter that is dependent on a particular patient and therapist. Literature usually characterises psychoanalysis and psychoanalytic therapy as something where the main techniques are free association, interpretation and the passive (blank slate) stance of the therapist. My understanding is that if someone adopts these techniques by the book, not taking into account the patients current situation and how well she tolerates or benefits from these techniques, then this is one helluva bad therapist and the therapy most probably is frustrating to the patient at best and harming at worst.

When I think about what is it that makes my own therapy so useful and satisfying to me (although it is very difficult and also frustrating sometimes) is the fact that my T is very dynamic and I would even say fluid. He is very active in the session, which doesn't mean that he necessarily talks a lot, but i can sense that he is very actively trying to assess and understand the situation at each moment. Depending on what is happening with me he chooses the techniques - whether he talks more (even for me), whether he keeps silent, whether he answers questions, whether he reflects them back to me, whether he encourages exploration or rather attempts to support me, whether he offers an interpretation or avoid interpreting altogether. This kind of dynamic, I think, is not characteristic to psychoanalytic therapy per se - any good therapist should be this active and attentive but this is what makes the therapy tolerable and useful for me. What makes it psychoanalysis specifically, are perhaps only the three things I already mentioned - sessions 4 times per week, lying on the couch and working with transference.

You describe your therapist as someone who seems to apply techniques without assessing your readiness to benefit from using those techniques at such a level. I also find saying that something is resistance quite unprofessional. What would you gain from such a statement? Everybody has their defences and for good reason and saying that something is a defence or a resistance doesn't dissolve it.

I would encourage you to be less compromising with your therapist in that sense that if you feel what the T is doing is not helping you then talk about it out and loud and ask about it until the T gives you a satisfactory answer. It's possible that if it is NHS supported therapy that the therapists there are not that well trained and you might actually be better off without such treatment. Just today someone here wrote about their experience with psychodynamic therapy provided by an inexperienced therapist with very adverse consequences. Sometimes no therapy is much better for your mental health than bad therapy. But in order to find out whether there is something good and useful in this therapy for you or does it have the risk of being harming it would help to confront the therapist more forcefully and explicitly to find out if what the T really has to offer you.

[PetalPower]

Thank you for replying to my post. I really appreciate it. I have also contacted a private therapist whom practices Psychodynamic psychotherapy to ask the same question.

They are basically the same thing.

Therapists who are not analytically trained and who say they practice psychodynamic therapy often use the term in the broadest sense, which sometimes dilutes the whole concept. I find they usually practice a more supportive type of therapy. Sometimes it does not resemble psychodynamic therapy at all.

Therapists with full psychoanalytic training usually practice it in a more traditional way and it is much more intense imo.

So I think it largely depends on whether the T is a psychoanalyst.

This article explains more about this topic: http://www.jonathanshedler.com/PDFs/...20now%20R9.pdf

I think if you are just starting and already experiencing problems, then I would question if it's a good idea to continue. It could get much worse and even be very damaging.

My current therapist is a psychoanalyst, and he does not recognize a relationship outside of transference, which sounds similar to what you described. Instead, any discussion or requests for modification of the therapy become about my childhood wishes, etc., and become part of the therapy. From my experience and understanding, many, but not all, who are psychoanalytic do this. It's one of the downsides.

I saw a therapist who was analytical, and I experienced something similar to you when I tried to discuss the therapy with her. She would never accept what I said about my therapy at face value and actually discuss what I said. I think that her style was undermining and disrespectful and totally untherapeutic. Her style made her into the 'expert', and also gave her the power. I kind of feel that her training and time as a therapist, and her own experience of analysis herself sort of brain washed her into believing that what she was doing was therapeutic. I'm now seeing a different T who I think had quite similar training, but who works very differently and who discusses and respects the things I bring up. I'm in the UK too, I know that it is possible to find T's who will offer low cost therapy to those on low incomes, most of the T's I tried out offer this.

[MRT6211]

From my understanding, psychoanalytical and psychodynamic are used pretty much interchangeably.

I came here to say that I’m the one who posted about how wrong psychodynamic can go. I would say if you’re feeling like the therapy is hard to tolerate and you’re getting worse, it might be time to look elsewhere. I understand that’s complicated by the NHS situation, but as stated above, no therapy for a period of time might be better than bad therapy. Maybe you could also consider switching to another psychoanalytical provider that might be more skilled/equipped to help you.

[PetalPower]

Thank you to all those that have replied to my post. I have found your comments helpful and supportive.

[Carmina]

They are not synonyms - psychoanalysis is a specific form of psychodynamic therapy (and even then there are variations - from traditional Freudian analysis to object relations, Kleinian, Feminist etc flavours). Psychodynamic therapy (therapies really) is a broader and looser group of approaches, all of which have their origins in psychoanalysis but some have moved far away from those origins (eg embodied relational therapy would be one modern example of a psychodynamic theory approach that would not be classed as psychoanalysis).

[missbella]

I found them to be different techniques. In Horneyan analysis, I eventually used a couch, did 99 percent of stream of consciousness talking and eventually went three times a week. The therapist was a faint presence in the process. I began at only twice weekly and was not supposed to do more than I could "handle."

The therapists were much more participatory and somewhat more directive and prescriptive in psychodynamic therapy and were more of a presence in the process.

I'd think a therapist should respect adverse effects and not just explain them away as "material." I believe the psychoanalytical therapist was on the lookout for that.

[Nix]

Originally Posted by feileacan

I also find saying that something is resistance quite unprofessional. What would you gain from such a statement? Everybody has their defences and for good reason and saying that something is a defence or a resistance doesn't dissolve it.

Couldn't it be useful to recognize that resistance is there? Maybe the first step in working through it comes with recognizing it.

[starfishing]

Originally Posted by Nix

Couldn't it be useful to recognize that resistance is there? Maybe the first step in working through it comes with recognizing it.

The thing is that just because something is (or could be) resistance doesn't mean it's a good idea to point it out. Part of being an even halfway decent therapist hinges on only looking at resistance when the client is ready to hear that and can use it productively. And a lot of lazy/crappy therapists misuse the idea of "resistance" to encompass any disagreement with or questioning of the therapist's approach. Impossible to say how/whether that relates to the OP's situation, but it does happen.

[PetalPower]

Update: I have had 3 further sessions since my original post; a total of 15 sessions in total. I appear to have turned a corner since the new year and have been tolerating the therapy a lot better. I am really pleased and am planning to continue with it. My mental health has improved since September 2017 when I started the therapy and it is definitely doing something.

I did contact three private Psychodynamic Psychotherapists in early January. Two of them encouraged me to continue with the Psychoanalytical Psychotherapy; as they said it was rare to get this on the NHS and re-assured me that it can take time to trust the therapist.

Originally Posted by PetalPower

Update: I have had 3 further sessions since my original post; a total of 15 sessions in total. I appear to have turned a corner since the new year and have been tolerating the therapy a lot better. I am really pleased and am planning to continue with it. My mental health has improved since September 2017 when I started the therapy and it is definitely doing something.

I did contact three private Psychodynamic Psychotherapists in early January. Two of them encouraged me to continue with the Psychoanalytical Psychotherapy; as they said it was rare to get this on the NHS and re-assured me that it can take time to trust the therapist.

Excellent. Therapy is a tough journey. But so much can be gained from it.