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Psychotherapy is a method for the treatment of psychological problems, which are often expressed somatically.

Therapies can be classified following various models. In the cathartic model, the patient is urged to speak, in order to expel or get rid of his suffering. The therapist favors the act of communication over the content of what is expressed. In the reparative model, the therapist tries to help the patient by bringing love and understanding to cancel out the prejudice he has been victim of or to make up for some internal deficit. With the educational model, the therapist guides the patient in the "right" direction, advising him as to his life choices. He "corrects" the mistakes of nature, parental education, or social environment.

Freud demarcated himself dramatically from hypnosis and cathartic post-traumatic abreaction in developing an original psychotherapeutic dimension, centered on the exploration of the unconscious, the study of psychic functioning and intrapsychic conflicts, and transference-counter-transference relation (Ellenberger, 1970). He emphasized psychic reality understood through the reality of narrative. Accordingly, the psychotherapy to be discussed here is psychoanalytic psychotherapy, situated within the context of the theory, technique, and framework of psychoanalysis.

The term psychotherapy surfaced for the first time in 1872, while the term psychoanalysis came to be known only in 1896. But it wasn't until 1905, in his article "On Psychotherapy" (1905a [1904]) that Freud clearly distanced himself from hypnosis by opposing the cathartic method to the analytic method. For a number of decades, he had used the terms psychoanalysis and psychotherapy interchangeably, but shortly before 1920 he abandoned the term psychotherapy definitively, qualifying his method from then on as psychoanalysis. This abandonment occurred after the defections of Alfred Adler, Wilhelm Steckel, and Carl G. Jung and, in a second stage, his differences with Otto Rank and Sàndor Ferenczi. In effect, some of those in Freud's circle were advocating a more active attitude on the part of the psychoanalyst to accelerate the psychoanalytic process as well as to shorten its duration. A reaction was not long in coming: Ernest Jones and Edward Glover emphatically denounced any deviation from a traditional treatment, and any psychotherapeutic approach, such as a return to pure suggestion of the preanalytic period (Robert Wallerstein). This traditional position was the "official" one of the psychoanalytic movement for a very long time. Nevertheless, in the 1950s the term psychoanalytic psychotherapy gained currency among psychoanalysts themselves, who came to believe that certain changes had to be made in the framework of the classical psychoanalytic model, which was not appropriate for the psychopathology of some patients.

As of 2005, questions about the differences between psychoanalytic psychotherapy and psychoanalysis are still posed in terms of process: how, for example, could the psychoanalytical process be influenced by reworking the framework? The face-to-face position implies seeing the analyst, being able to observe his gestures and unconscious corporal reactions, to hang onto his every word and look into his eyes. Likewise, not being seen by the analyst can result in the patient's feeling lost, cast into the abyss, or on the contrary allow him to feel emotions that would be blocked by a face-to-face expression. However, these differences in formal framework (frequency of sessions, face-to-face or couch-armchair, more or less active position of the psychoanalyst, etc.) are insufficient, in themselves, to characterize the type of process underway. In any event, according to René Roussillon (1986), a psychoanalytic approach can only explore certain portions of the psyche. Even where the choice of the framework (psychotherapy or psychoanalysis) favors a psychoanalytical approach, this is not always necessarily the same one. Finally, the psychotherapeutic process is characterized by a transference of partial objects to the psychoanalyst while, in the psychoanalytical process, these partial transferences would be worked through until there was a full development of the transference neurosis.

Other authors have brought out differences in therapeutic aims. Ideally, in psychoanalysis the framework should allow exploration of the patient's unconscious with the psychoanalyst following the patient as far as he is able to go. According to this very strict definition, psychoanalysis does not, a priori, aim at a therapeutic goal. Instead, the therapeutic result emerges from the psychoanalytic process. By contrast, psychotherapy does imply a goal: to diminish the suffering of the patient, allowing him to return to work, and so on. However, these differences are not always so clear-cut in the reality of practice among psychoanalysts and psychotherapists. Whatever technique is chosen, standard treatment or face-to-face, the psychoanalyst has a "psychoanalytic function," so that any psychotherapeutic approach undertaken by the psychoanalyst involves psychoanalytical work.

Psychotherapy cannot be isolated from its social context. After the Second World War, the development of social health care programs allowed compensation for psychiatric care and the establishment of a variety of facilities for the treatment of specific pathologies. Many of the professionals practicing in these institutional settings were trained in psychoanalytic psychotherapy by psychoanalysts working in the field, or else were educated in teaching institutes that structured their curricula in accordance with psychoanalytic psychotherapy. These professionals engaged in personal psychoanalytic work without, necessarily, matriculating in the training courses of psychoanalytic societies; but very often a veritable analytical process developed with patients that they were treating in their institutions.

Accordingly, the wish of Freud (1919a [1918]) has been fulfilled, "to alloy the pure gold of analysis freely with the copper of direct suggestion" (p. 168) to create "a psychotherapy for the people" (p. 168), and to alleviate a greater portion of "the vast amount of neurotic misery which there is in the world" (p. 166), which the small number of psychoanalysts cannot greatly affect. Clearly Freud wanted to see the traditional treatment adapted to treat a greater number of patients as soon as "the conscience of society will awake" (p. 167). The concern to preserve psychoanalytic thought in some institutional form has led national societies of psychoanalytic therapy to create organizations like the European Federation for Psychoanalytic Psychotherapy (EFPP).

Psychoanalysis and psychoanalytic psychotherapy, and their particular adaptations (child psychoanalysis, group psychoanalysis, analytical psychodrama, psychoanalytical couple or family therapy, etc.) constitute a "psychoanalytic field," very different in nature from therapeutic techniques. The latter, basically anti-analytic, may be considered as "an ensemble of ready-made counter-transference approaches meant to function as institutional defenses, as a system of alleviating anxieties prompted by the relation to the other," representing "group-oriented ideologies" (Roussillon, 1986).

The psychoanalytical approach often requires much time since it favors the process rather than the suppression of symptoms, which is the case with non-analytical therapeutic techniques. In the interest of budgetary considerations, social agencies that reimburse psychic treatment try to limit its duration or the amount of compensated sessions, or else to favor approaches that aim to eliminate symptoms very quickly, without taking account of their function in the overall psychic economy of the patient. The psychoanalytical approach runs the risk of losing its liberty and revolutionary quality in submitting overly to social constraints. Countries that seek to integrate the psychoanalytic approach in the master plan of their treatment policies risk making it shed its special and irreverent identity, becoming increasingly therapeutic, in the sense of "suppressing symptoms" (Frisch, 1998). The notion of conflict, central in psychoanalysis, has consequently been introduced in the psychoanalytic movement on issues relating to its future and its identity: it must either evolve toward isolation to maintain its purity (psychoanalysis), or adapt to social constraints to survive (psychoanalytical psychotherapy), but at the risk of losing its soul.

SERGE FRISCH

See also: Analyzability; Cathartic method; Deutsches Institut für Psychologische Forschung und Psychotherapie (Institut Göring); Directed daydream (R. Desoille); Face-to-face situation; Group psychotherapies; Hypnosis; Initial interview(s); "Lines of Advance in Psycho-Analytic Therapy"; Narco-analysis; Psychodrama; Psychoanalytic family therapy; Relaxation psychotherapy; Suggestion; Symbolic realization.