What is psychoanalysis?
Psychoanalysis is a therapeutic practice that is sometimes used in the treatment of eating disorders. As with other eating disorder therapies, it is best to receive psychoanalysis in addition to getting support from a nutritionist.
What’s the history of psychoanalysis?
Sigmund Freud, an Austrian neurologist, is the founder of psychoanalysis. He coined the term and developed this theory of how the mind works and approach to treating mental health conditions by talking about them in the late 1800s. He believed there were three parts of a person’s personality, the id, superego, and ego. He proposed there are unconscious thoughts, feelings, urges, and memories of childhood experiences that people are unaware of. These primitive instincts and impulses are part of what he called the “id.” He believed these forces drive behavior, sometimes in negative ways, and cause psychological distress, or conflict.
Freud believed this conflict resulted from a clash of the id and what he called the “superego,” or a person’s morals or conscience, which Freud believed came from a person’s parents. He helped patients bring these unconscious drives into conscious awareness. Slips of the tongue–Freudian slips, mannerisms, and dreams are ways the unconscious can manifest. Then he helped his patients address this distress–such as anxiety, depression, and what he called neuroses, and resolve the negative behaviors.
This is where his concept of “ego” comes in. He believed the ego represents a person’s reality and identity and helps resolve conflicts between the id’s impulses and the superego’s morals.
While Freud’s theory and approach are controversial, some concepts have endured and evolved, paving the way for the many modalities of psychotherapy that exist today.
What are sessions like?
Psychoanalysis sessions usually last a little under an hour and can occur up to five times per week. During the session, the patient is usually lying on a couch, and the therapist is not within the view of the patient, although this is not as common today. The patient talks about childhood memories, thoughts, dreams, and fantasies. These may lead to other ideas, called free associations, and talk about them, too. The patient and therapist then discuss how these result in certain emotions, actions, and behaviors, then work toward changing these patterns.
Psychoanalysis practitioners are often medical doctors that specialize in psychiatry, and their rates are higher than other types of psychotherapy practitioners. They may prescribe medications, such as antidepressants or antipsychotics. Traditionally, a minimum of 50 sessions is required.
Treating eating disorders with psychoanalysis
Psychoanalysis is sometimes used as part of a treatment plan for those who have eating disorders when there is a history of disturbances in early relationships, (1) when an individual has a hard time being authentic when others are present, and when there are co-occurring personality disorders.
As with any eating disorder, the objective of therapy for someone with anorexia nervosa is to understand their psychological struggles and gain insight, so change will occur and the person can have a healthy relationship with themselves, eating, and food. (2)
Some questions the therapist may ask include:
- What are the patient’s urges and wishes?
- What modes of defense and adaptation do they use?
- How do they test reality?
- What memories do they have about significant others, both with and without food?
- How do they experience themselves in relation to others and food and do they have boundaries?
Types of psychotherapy
Modern psychotherapy does not generally adhere to classical psychoanalytic methods. For example, sessions may not go on for years and years. Therapists may interact more with their patients and face them directly. They may focus more on what’s happening currently in the patient’s life instead of what happened in early childhood.
Many different “talk therapy” approaches have evolved. They include cognitive behavioral therapy (CBT), cognitive emotional behavioral therapy (CEBT), dialectical behavioral therapy (DBT), emotionally focused therapy (EFT), and internal family systems therapy (IFS).
Cognitive behavioral therapy is one of the more popular approaches used today. (3) CBT analyzes the connection between beliefs, thoughts, and feelings,which often originate from childhood experiences, and how these relate to behavior.
Evaluating psychoanalysis as an effective eating disorder treatment
What are the benefits of psychoanalysis?
There are many benefits of psychoanalysis: (4)
- Psychoanalysis helps people become aware of how their life as a child helped define who they are today.
- People are accepted for who they are and are not compared to others or ‘normal’ standards.
- People aren’t given a diagnosis. Instead, people are seen as individuals with unique challenges and conflicts whose lives are meaningful.
- There is no agenda of what has to be discussed in therapy. . All topics are valid and relevant.
- The session does not rapidly end just because the clock says it’s time.
- The therapist is both an ally and partner.
- The goal is to enhance quality of life and reduce suffering experienced. Symptoms are not the main focus, and symptom reduction is not related to the definition of success. Individuals are treated more holistically than medically.
- Individuals learn how to be free from limitations and preconceptions. (5)
What are the limitations of psychoanalysis?
Psychoanalysis does have limitations, including:
- Psychoanalytical theories don’t consider any of the following: (6)
- The patient’s constitution
- The patient’s inborn temperament
- How the family system has affected the patient
- How someone’s nervous system normally develops
- The limits of the child in Piagetian terms, or post-oedipal learning
- The therapist often has a favorite theory that pre-determines the looking glass they use.
- The therapist’s favorite theory may match the patient’s psychological makeup, so it may not fit the patient.
- How well the therapist and the patient interact affects the results. (7)
- Psychoanalysis may not be recommended in any form for children or teens, because children are too open to suggestion and false memories. Because of their age, the unconscious patterns are still being developed.
- Psychoanalysis doesn’t foster personal responsibility for the patient’s current condition. (8) For example, struggling with drug problems is not your fault. It’s because a neighbor touched you when you were very young. It’s his fault.
- The field of psychoanalysis is based on Freud’s theory of personality, which is controversial.Many believe his views and findings are flawed, products of his time and limited observations.
Efficacy of psychoanalysis in healing eating disorders
Nonetheless, psychoanalysis can be effective in treating eating disorders. One major research review on psychoanalysis and eating disorders analyzed 64 studies on psychoanalysis. The review concluded that psychodynamic therapies are effective to help patients suffering from eating disorders and personality disorders. (9) When developing a comprehensive eating disorder treatment plan, it’s essential to tailor the plan to each individual.
Psychoanalysis for eating disorders at Within Health
At this time, Within Health does not use psychoanalysis for the treatment of eating disorders, but our clinicians do apply some psychodynamic ideas when thinking about how they conceptualize cases, clients, and their history. If you’d like to learn more about our treatment practices for eating disorders, or the first steps in starting treatment, call our team now.
Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.
- Bemporad, J. R. (n.d.). A psychoanalytic study of eating disorders: I. A developmental profile of 67 index cases. The Journal of the American Academy of Psychoanalysis. Retrieved November 26, 2021, from https://pubmed.ncbi.nlm.nih.gov/1291541/.
- O-Donnel, Jennifer. Anorexia nervosa from a psychoanalytic perspective: A theoretical conceptualization. The Chicago School of Professional Psychology. ProQuest Dissertations Publishing, 2005 3177433. Retrieved November 26, 2021, from https://www.proquest.com/openview/c255bc9330c8ac1e5777bad2e1fb170a/1?pq-origsite=gscholar&cbl=18750&diss=y.
- Psychoanalysis/Modern Psychoanalysis. GoodTherapy®. Retrieved November 26, 2021, from https://www.goodtherapy.org/learn-about-therapy/types/psychoanalysis.
- Gerson, Michael J., PhD. Seven Benefits of Psychoanalysis. Institute of Advanced Psychological Studies. Retrieved November 26, 2021, from https://www.psychstudies.net/seven-benefits-psychoanalysis/
- Limitations of Psychoanalytic Therapy. Retrieved November 26, 2021, from https://www.ipl.org/essay/Limitations-Of-Psychoanalytic-Therapy-PCJFMV3NFU
- Horner, Althea J. On the limits of psychoanalytic theory: a cautionary perspective. J Am Acad Psychoanal Dyn Psychiatry. Winter 2006;34(4):693-707. Retrieved November 26, 2021, from https://pubmed.ncbi.nlm.nih.gov/17274735/
- Gray, Paul, M.D. Limitations of Psychoanalysis. First published January 1, 1965. Journal of the American Psychoanalytic Association. Retrieved November 26, 2021, from https://pubmed.ncbi.nlm.nih.gov/14267873/
- The Pro’s and Con’s of Psychoanalytic Therapy. Family Recovery & Life Guidance Resources, sponsored by Global Children’s Fund, a Non-Profit Group. Retrieved November 26, 2021, from http://www.keepyourchildsafe.org/therapy/disadvantages-of-psychoanalysis.html.
- Gonon, F, and Keller, P-H. Efficacy of psychodynamic therapies: A systematic review of the recent literature. Encephale. 2021 Feb;47(1):49-57. Epub 2020 Sep 11. Retrieved November 26, 2021, from https://pubmed.ncbi.nlm.nih.gov/32928529/