For a long time psychoanalysis was the only formalized psychotherapy practiced in Western society. It was this type of therapy that gave rise to the classic picture of a bearded Viennese doctor seated behind a patient who is lying on a couch.
Psychoanalysis is based on the theories of Sigmund Freud. (46) According to Freud’s views, psychological disturbances are due to anxiety about hidden conflicts in the unconscious parts of one’s personality; therefore, one of the psychoanalysts job is to help make the patients aware of the unconscious impulses, desires, and fears that are causing the anxiety. Psychoanalysts believe that if patients can understand their unconscious motives, they have taken, the first step toward gaining control of their problems. Such understanding is called insight.
Psychoanalysis is a slow procedure. It may take years of fifty-minute sessions several times a week before the patient is able to make fundamental changes in her life. (47) Throughout this time, the analyst assists his patient in a complete examination of the unconscious motives behind her behavior. This task begins with the analyst telling the patient to relax and talk about everything that comes into her mind. This method is called free association.
As the patient lies on the couch, she may describe her dreams, discuss private thoughts, or recall long-forgotten experiences. The psychoanalyst often says nothing for long periods of time. (48) The psycho-analyst also occasionally makes remarks or asks questions that guide the patient, or he may suggest an unconscious motive or factor that explains something the patient has been talking about, but most of the work is done by the patient herself.
Psychoanalysis has sometimes been criticized for being" all talk and no action." In behavior therapy there is much more emphasis on action. (49) Rather than spending a large amount of time going into the patient’s past history or the details of his or her dreams, the behavior therapist concentrates on finding out what is specifically wrong with the patient’s current life and takes steps to change it. The idea behind behavior therapy is that a disturbed person is one who has learned to behave in the wrong way. The therapist’s job, therefore, is to "reeducate" the patient. (50) The reasons for the patient’s undesirable behavior are not important; what is important is to change the patient’s behavior which is formed and reinforced in stressed environment and to establish new patterns of behavior for the patient.
One technique used by behavior therapists is systematic recovery. This method is used to overcome irrational fears and anxieties the patient has learned. The goal of systematic recovery therapy is to encourage people to imagine the feared situation while relaxing. Having been taught how to relax, the patient learns to think about the past experience without being afraid. During this process, the therapist attempts to replace anxiety with its opposite, relaxation.
(50) The reasons for the patient’s undesirable behavior are not important; what is important is to change the patient’s behavior which is formed and reinforced in stressed environment and to establish new patterns of behavior for the patient.
