Psychoanalysis or psychotherapy: when to resort to one therapy or the other?

When choosing psychological help, doubts may arise about the difference between a psychologist, a psychotherapist or a psychoanalyst. In the following article, psychologist Álvarez Sicilia explains the differences.

First, it is necessary to clarify what a psychologist is.

Psychologist: what is he and how does he help the patient?

The psychologist has studied psychology. During his studies he becomes familiar with different theories that help him to understand human behavior and acquires notions about his behaviors and thoughts. In Spain, however, a psychologist cannot see patients if he or she has not completed a master’s degree in General Health Psychology or training as a Psychologist in Residence (PIR). However, this has been the case since 2014. Hence, there are psychologists without a higher specialty but with many years of experience treating patients.

The psychotherapist

A psychotherapist is trained specifically in psychotherapy, something that can be done by psychiatrists, medical doctors and psychologists. There are also psychotherapists without a university degree but who have completed a master’s degree in psychotherapy. Here the patient’s opinion comes into play and it is up to the patient to decide whether he or she wants to see someone with more or less training.

On the other hand, there are many approaches to psychotherapy: humanistic, Gestalt, psychoanalytical, cognitive-behavioral, etc. All of them seek to alleviate the patient’s discomfort, but each therapy will do so with its conception of the human being.

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Thus, two very different types of psychotherapy would be:

  • Cognitive-behavioral psychotherapy (CBT). This is the most commonly applied in Spain, due to the great influence of the United States. It is a type of therapy that detects inappropriate thoughts and behaviors and applies re-education techniques to modify them. The aim is to replace erroneous thoughts and behaviors with correct ones. The specialist will carry out a functional analysis of the patient to identify the problematic behavior, paying special attention to what the patient does, thinks and feels during the erroneous behavior. He or she must also identify what triggers the behavior and the consequences it may have in the future. The therapist is directive, deciding what to change and how.
  • Psychoanalytic psychotherapy. It employs the tools of psychoanalysis. The specialist who does this therapy never makes judgments about what is right or wrong. It may give some guidelines when it has to do with the subjectivity of the patient, but it is based on the fact that each person is unique and that it is unthinkable to apply standardized techniques, as CBT does. Thus, the specialist will guide the patient to find in himself the reasons for what is happening to him. The objective is not to learn new behaviors or to make the patient change his thinking, but to reduce his suffering.

The psychoanalyst: importance and influence of childhood

Psychoanalysis is the only therapy that gives a leading role to childhood and the unconscious. The psychoanalyst will ask the patient about his childhood, taking for granted that it has been key in his life, since childhood experiences leave unconscious traces.

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The patient’s present is also studied in psychoanalysis, and day-to-day challenges and difficulties are also examined.

It should be noted that psychoanalysis is not studied at the university, but its learning is based more on experiential learning than on what is learned through academic teaching. Some psychoanalysts are trained in non-university institutions and others outside the institutional setting. There are 3 factors that all psychoanalysts go through:

  • They have made a deep personal inquiry. That is to say, they have been patients and have been psychoanalyzed.
  • They have studied the work of other psychoanalysts and the different currents of thought within psychoanalysis: Fredian, Kleinian, Lacanian, Jungian, among others.
  • You supervise cases in your practice with more experienced psychoanalysts.

What do they have in common and what are the differences between psychoanalytic psychotherapy and psychoanalysis?

What they have in common is that they are both therapeutic methods based on attentive listening to the patient and interventions that help guide the patient to understand what is happening to him/her. The aim of both methods is to alleviate discomfort and remove the obstacles that prevent the patient from developing his or her capacities.

They differ in the sense that psychoanalysis allows to reach a deeper self-knowledge that increases the consolidation of improvement. It is necessary constancy and commitment on the part of the patient, since he/she has to go into his/her mind, explore it and discover its contents, which takes time.

Psychoanalytic psychotherapy also helps a lot. It is recommended for patients who have to solve specific problems, without delving into deeper contents of the mind.