Authored by Saeed Shoja Shafti*
Short Communication
Psychoanalysis and its modified versions like psychodynamic psychotherapy constitute important components of modern psychotherapy. Psychodynamic theories stress that early childhood experiences are crucial in shaping the personality. In psychodynamic approaches unconscious conflicts are explored and the insight gained aims to change patients’ maladaptive behavior. The main goals of such kind of psychotherapies are symptom relief and personality modification through exploration of the unconscious. So, the relationship between the therapist and patient is crucially important. Therapies can be offered on an individual, couple, group and therapeutic residential community basis. Psychodynamic psychotherapy has been shown to be a highly efficacious treatment in a range of psychological disorders but patient selection for therapy is important, with consideration of psychological mindedness and a concern with the antecedents as well as the relational contexts of the presenting problem being key [1].Generally, for trainees in psychiatry, an understanding of psychological therapies is important for many reasons. Early exposure to psychotherapy is important for trainees to decide whether they want to specialize in this field. For psychiatrists who do not go on to specialize in psychotherapy, experience of this area also represents an essential part of their training. For all psychiatrists there is likely to be a psychological component to the presentations of most patients seen in mental health services, and for some there will be significant transference and countertransference reactions. To care for these patients, doctors will need to be able to understand and deal with these factors appropriately. Psychodynamic factors are also important in many interactions within mental health teams, both community- and ward-based. Doctors who can perceive these, and adapt to them, will make better leaders within these teams. Another relevant factor relates to appropriate referrals for psychological therapies. One model of psychological therapy does not fit every problem, or every patient. Psychiatrists will frequently be responsible for assessing and diagnosing a patient, and deciding on a course of treatment, which may be biological, psychological or both. To assess and refer appropriately the treating psychiatrist must understand the indications for a particular therapy and be able to have an idea of its likely success in a particular patient. But training in psychotherapy is likely to be more consuming of resources than other areas of postgraduate study in psychiatry. For example, an area such as psychopharmacology can be learnt in a more self-directed way, relying mainly on written information, whereas the main activity of psychotherapy training is seeing patients, and being supervised in their treatment. With the financial challenges of recent times, mental health services as a whole are likely to be asked to make significant cuts to services. Psychotherapy, particularly longer models, may be a target for reduced services, leading to a further restriction in the availability of training [2].
Psychoanalysis, as second historical revolution in psychiatry, first systematic psychotherapeutic approach, and an essential exploratory tool for study of deeply rooted unconscious mental processes plays a key role. But in spite of its central position among different styles of psychotherapy, its situation as training curriculum is not the same in developed and developing societies, due to a number of clashes between its various theoretical aspects and usual cultural ideals. Some aspects of this topic have been discussed previously in another article regarding process of appearance and progression of psychoanalysis in Iran, as a prototypical developing society in the region [3]. For sure, such a historical process could have more or less similar characteristics and /or problems around the world, particularly with respect to conservative societies. The aforesaid clashes are based on a mixture of valid and non-valid believes, hold by superintendents and/or psychotherapists.
The justifiable part of this challenge involves the necessity of special kind of setting, lack of suitable supervision or qualified supervisors, troubles regarding monetary issues and financial assistance or coverage by insurance companies, and above all, lack of qualified institutes for training skillful analysts. The mistaken part of that clash is based mainly on misinterpretation or distorted inference of psychoanalytic theories or overindulgence in them without any experimental or practical proof or perspective. The end result of such a disturbing circle could be nothing except than general ignorance of this deeply investigative method and replacing it with more superficial individual psychotherapeutic methods like Cognitive therapy, behavior therapy and etc., which basically never penetrate so deep into the mental strata and act only at conscious and subconscious levels. While psychoanalysis probe absolutely in the district of unconsciousness, with numerous swinging in the midst of conscious and subconscious levels, all of the other methods starting from conscious layer and reside constantly there or operate maximally at the subconscious level of mind. For a therapist who believes in unconscious processes this means nothing than obvious shortcoming of therapeutic intervention in instances where deep analytical method is mandatory. Although some believe that long-established cultural values or slow psycho-social stage of development may play an important role against progression of psychoanalysis in developing societies, it cannot be ignored that wrong or distorted understanding of the matter is not an unimportant subject (Table 1). Why such a wrong comprehension is common among psychotherapists of developing societies? It seems to be rather due to deviation from fundamental literature and particularly circumnavigating Freud’s basic and pragmatic writings. Psychoanalysis had been introduced to the world by ‘studies on hysteria ‘, valuable work of Freud S & Breuer J [4], and then in around two decades extended overseas up to America. The aforesaid book with a clear medical aspect for treatment of psychoneuroses (hysteria, phobia and obsession), though apparently dated, is still the opening point of teaching and practicing analysis, and this is the same as regards other practical works of Freud as well [5-12].
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