Using the various analytic and psychological techniques to assess mental problems, some believe that there are<unk> rticular constellations of problems that are especially suited for analytic treatment (see below) whereas other problems might respond better to medicines and other interpersonal interventions. To be treated with<unk> , whatever the presenting problem, the person requesting help must demonstrate a desire to start an analysis. The person wishing to start an analysis must have some capacity for speech and communication. As well, they need to be able to have or develop trust and insight within the psychoanalytic session. Potential<unk> tients must undergo a preliminary stage of treatment to assess their amenability to<unk>  at that time, and also to enable the analyst to form a working psychological model, which the analyst will use to direct the treatment.<unk>  mainly work with neurosis and hysteria in<unk> rticular; however, adapted forms of<unk>  are used in working with schizophrenia and other forms of psychosis or mental disorder. Finally, if a prospective<unk> tient is severely suicidal a longer preliminary stage may be employed, sometimes with sessions which have a twenty-minute break in the middle. There are numerous modifications in technique under the heading of<unk>  due to the individualistic nature of personality in both analyst and<unk> tient. The most common problems treatable with<unk>  include: phobias, conversions, compulsions, obsessions, anxiety attacks, depressions, sexual dysfunctions, a wide variety of relationship problems (such as dating and marital strife), and a wide variety of character problems (for example,<unk> inful shyness, meanness, obnoxiousness, workaholism, hyperseductiveness, hyperemotionality, hyperfastidiousness). The fact that many of such<unk> tients also demonstrate deficits above makes diagnosis and treatment selection difficult. Analytical organizations such as the IPA, APsaA and the European Federation for Psychoanalytic Psychotherapy have established procedures and models for the indication and practice of psychoanalytical therapy for trainees in analysis. The match between the analyst and the<unk> tient can be viewed as another contributing factor for the indication and contraindication for psychoanalytic treatment. The analyst decides whether the<unk> tient is suitable for<unk> . This decision made by the analyst, besides made on the usual indications and<unk> thology, is also based to a certain degree by the "fit" between analyst and<unk> tient. A person's suitability for analysis at any<unk> rticular time is based on their desire to know something about where their illness has come from. Someone who is not suitable for analysis expresses no desire to know more about the root causes of their illness. An evaluation may include one or more other analysts' independent opinions and will include discussion of the<unk> tient's financial situation and insurances. Techniques The basic method of<unk>  is interpretation of the<unk> tient's unconscious conflicts that are interfering with current-day functioning – conflicts that are causing<unk> inful symptoms such as phobias, anxiety, depression, and compulsions. Strachey (1936) stressed that figuring out ways the<unk> tient distorted perceptions about the analyst led to understanding what may have been forgotten. In<unk> rticular, unconscious hostile feelings toward the analyst could be found in symbolic, negative reactions to what Robert Langs later called the "frame" of the therapy—the setup that included times of the sessions,<unk> yment of fees, and necessity of talking. In<unk> tients who made mistakes, forgot, or showed other peculiarities regarding time, fees, and talking, the analyst can usually find various unconscious "resistances" to the flow of thoughts (aka free association). When the<unk> tient reclines on a couch with the analyst out of view, the<unk> tient tends to remember more experiences, more resistance and transference, and is able to reorganize thoughts after the development of insight – through the interpretive work of the analyst. Although fantasy life can be understood through the examination of dreams, masturbation fantasies are also important. The analyst is interested in how the<unk> tient reacts to and avoids such fantasies. Various memories of early life are generally distorted—what Freud called screen memories—and in any case, very early experiences (before age two)—cannot be remembered. Variations in technique There is what is known among<unk>  as classical technique, although Freud throughout his writings deviated from this considerably, depending on the problems of any given<unk> tient. Classical technique was summarized by Allan Compton as comprising: * instructions: telling the<unk> tient to try to say what's on their mind, including interferences; * exploration: asking questions; and * clarification: rephrasing and summarizing what the<unk> tient has been describing. As well, the analyst can also use confrontation to bringing an aspect of functioning, usually a defense, to the<unk> tient's attention. The analyst then uses a variety of interpretation methods, such as: * Dynamic interpretation: explaining how being too nice guards against guilt (e.g. defense vs. affect); * Genetic interpretation: explaining how a<unk> st event is influencing the present; * Resistance interpretation: showing the<unk> tient how they are avoiding their problems; * Transference interpretation: showing the<unk> tient ways old conflicts arise in current relationships, including that with the analyst; or * Dream interpretation: obtaining the<unk> tient's thoughts about their dreams and connecting this with their current problems. Analysts can also use reconstruction to estimate what may have happened in the<unk> st that created some current issue. These techniques are primarily based on conflict theory (see above). As object relations theory evolved, supplemented by the work of John Bowlby and Mary Ainsworth, techniques with<unk> tients who had more severe problems with basic trust (Erikson, 1950) and a history of maternal deprivation (see the works of Augusta Alpert) led to new techniques with adults. These have sometimes been called interpersonal, intersubjective (cf. Stolorow), relational, or corrective object relations techniques. These techniques include expressing an empathic attunement to the<unk> tient or warmth; exposing a bit of the analyst's personal life or attitudes to the<unk> tient; allowing the<unk> tient autonomy in the form of disagreement with the analyst (cf. I. H.<unk> ul, Letters to Simon); and explaining the motivations of others which the<unk> tient misperceives. Ego psychological concepts of deficit in functioning led to refinements in supportive therapy. These techniques are<unk> rticularly applicable to psychotic and near-psychotic (cf., Eric Marcus, "Psychosis and Near-psychosis")<unk> tients. These supportive therapy techniques include discussions of reality; encouragement to stay alive (including hospitalization); psychotropic medicines to relieve overwhelming depressive affect or overwhelming fantasies (hallucinations and delusions); and advice about the meanings of things (to counter abstraction failures). The notion of the "silent analyst" has been criticized. Actually, the analyst listens using Arlow's approach as set out in "The Genesis of Interpretation", using active intervention to interpret resistances, defenses creating<unk> thology, and fantasies. Silence is not a technique of<unk>  (see also the studies and opinion<unk> pers of Owen Renik). "Analytic neutrality" is a concept that does not mean the analyst is silent. It refers to the analyst's position of not taking sides in the internal struggles of the<unk> tient. For example, if a<unk> tient feels guilty, the analyst might explore what the<unk> tient has been doing or thinking that causes the guilt, but not reassure the<unk> tient not to feel guilty. The analyst might also explore the identifications with<unk> rents and others that led to the guilt. Interpersonal–relational<unk>  emphasize the notion that it is impossible to be neutral. Sullivan introduced the term<unk> rticipant-observer to indicate the analyst inevitably interacts with the analysand, and suggested the detailed inquiry as an alternative to interpretation. The detailed inquiry involves noting where the analysand is leaving out important elements of an account and noting when the story is obfuscated, and asking careful questions to open up the dialogue. Group therapy and play therapy Although single-client sessions remain the norm, psychoanalytic theory has been used to develop other types of psychological treatment. Psychoanalytic group therapy was pioneered by Trigant Burrow, Joseph Pratt,<unk> ul F. Schilder, Samuel R. Slavson, Harry Stack Sullivan, and Wolfe. Child-centered counseling for<unk> rents was instituted early in analytic history by Freud, and was later further developed by Irwin Marcus, Edith Schulhofer, and Gilbert Kliman. Psychoanalytically based couples therapy has been promulgated and explicated by Fred Sander. Techniques and tools developed in the first decade of the 21st century have made<unk>  available to<unk> tients who were not treatable by earlier techniques. This meant that the analytic situation was modified so that it would be more suitable and more likely to be helpful for these<unk> tients. Eagle (2007) believes that<unk>  cannot be a self-contained discipline but instead must be open to influence from and integration with findings and theory from other disciplines. Psychoanalytic constructs have been adapted for use with children with treatments such as play therapy, art therapy, and storytelling. Throughout her career, from the 1920s through the 1970s, Anna Freud adapted<unk>  for children through play. This is still used today for children, especially those who are preadolescent. Using toys and games, children are able to symbolically demonstrate their fears, fantasies, and defenses; although not identical, this technique, in children, is analogous to the aim of free association in adults. Psychoanalytic play therapy allows the child and analyst to understand children's conflicts,<unk> rticularly defenses such as disobedience and withdrawal, that have been guarding
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Psychoanalytic theory
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