Psychotherapy and psychoanalysis are two terms that are often used interchangeably, but they actually refer to two different forms of talk therapy. Both approaches aim to help individuals overcome emotional and psychological difficulties, but they have different theoretical frameworks,goals, and techniques.
Psychoanalysis is a specific form of psychotherapy that was developed by Sigmund Freud in the late 19th and early 20th centuries, and has continued its developments through authors as Jacques Lacan, Donald Winnnicott, Andre Green, Melanie Klein, among others. Its premise is that there are unconscious conflicts that produce symptoms like compulsions, and inhibitions. Desire, more specifically, unconscious desire and repressed memories are determinants and affect a person’s behaviour and emotions. By making conscious the unconscious, the internal conflicts can be given some form of resolution to what is producing the symptoms. The patient, or better called the analyzand, speaks in the context of the session and is invited to free associate, that is, to say whatever comes to mind at a certain moment, even though what comes to mind may be completely unrelated to what the analizand is talking about at that moment. Also, dreams and slips are part of the material that the analyst would listen to, also in a particular way, through what is called “floating attention”, a specific way of psychoanalytic listening that is not shared by any other form of talk therapy. So, the psychoanalytic dialogue is in a way like any dialogue, but in another way it is like no other form of dialogue: there is one that freely associates, and another who listens with a form of dissolute attention, in order to produce an intervention that can be in the form of interpretation of the unconscious material, clarification, scansion or punctuation, depending of the specific school of the analyst.
On the other hand, psychotherapy is a broad term that refers to a range of treatments that are aimed at improving mental health and emotional well-being. It encompasses various approaches, such as Cognitive-Behavioural Therapy (CBT), Gestalt therapy, Humanistic Therapy, and interpersonal therapy, among others (for “Psychodynamic Psychotherapy”, see below). Psychotherapy focuses on specific problems, such as anxiety, depression, addiction, or relationship issues. In this case, the therapist and the patient work collaboratively to identify and address the patients concerns, using various techniques and interventions to promote change and growth. The therapist’s role in many cases is more directive, and can provide some tasks that would help the patient explore their thoughts, feelings and behaviours. The therapist is more interested in working with coping strategies and developing a new approach to perceived problems, sometimes through meaning change, sometimes through behavioural change.
So, there are differences in the established goals, but also on the theories (the set of propositions about the psyche or mind), and in their techniques. For psychoanalysis, if we consider Freud’s second theoretical formulation, the psyche is composed by different structures like the id, the ego, and the superego, and there are conflicts between these structures, and defence mechanisms play their part in that conflict. This is very different from Cognitive-Behavioural Therapy that derives its formulation from both behavioural psychology and from cognitive psychology. In that sense, as mentioned above, it can focus in changing negative thought patterns or certain maladaptive behaviours, intervening both over the thinking process or over the behavioural outputs, through certain tasks that are provided by the therapist, or through the invitation the therapist does to observe and reflect upon the negative thoughts. Since behaviour, thoughts and feelings are affecting each other, acting on any of these affects or modifies the others.
Psychoanalysis and psychotherapy also differ in their techniques. Psychoanalysis relies primarily on the technique of free association, in which the patient speaks freely about their thoughts and feelings, without censoring or editing them. The therapist makes interpretations about these associations which produces more free associations and/or the retrieving of memories that would contribute to making conscious the unconscious.
Psychotherapy uses a variety of techniques and interventions, such as cognitive restructuring, exposure therapy, mindfulness, or role-playing, depending on the patients needs and goals, but mainly on the therapist frame of work.
A final difference are the goals. Psychoanalysis do not focus on symptoms, but symptoms recede by making conscious those elements of the unconscious life that are involved in symptom formation.
In that process, the capacity of the patient to “love and work”, and create, is increased. Psychotherapy tends to focus mainly on “curing” the symptoms. There is a form psychotherapy that is called “psychodynamic psychotherapy”. For some, it is a way of calling a psychoanalytic treatment in a way that does not use the word psychoanalysis, because this latter word may not have a good press, mainly in the United States, where Cognitive.
Behavioural Psychotherapy is much more popular these days. For others, it is a way of calling a form of psychoanalytic treatment accommodated to social needs and demands of once a week sessions only (psychoanalysis but with a low frequency). In that sense, its techniques, theories and goals are the same.
One final note. There is also a form of psychotherapy called “psychodynamic psychotherapy.” Some use this term as an alternative to “psychoanalysis,” which may have negative connotations, especially in the United States where Cognitive Behavioural Psychotherapy is more widely practiced. For others, “psychodynamic psychotherapy” refers to a version of psychoanalytic treatment that is adapted to meet the social demands and needs of once-a-week sessions only (akin to psychoanalysis but with less frequency). In this regard, its techniques, theories, and objectives remain the same.
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