This is a question I often get from people when they first meet me. "You are a psychoanalyst", they say. "Right..." And then, after a moment of hesitation: "Excuse my ignorance, but I am always confused. A psychoanalyst. What does it mean? You are a doctor, aren't you? Are you a psychiatrist? A psychologist? No? So, what are you? What's the difference?"
You see, all those Greek words, made up by people who were not Greeks at a time when creating "new" Greek words was fashionable, are more or less opaque for whomever does not have much familiarity with the so called Psi world. They are compound terms, sharing the first bit, "psych-" (which comes from Psyche, i.e. Soul.)
So, we have:
- Psychiatrist < Psychiatry < psyche + iatreia, ‘cure’.
- Psychologist < Psychology < psyche + logos, 'discourse, study'
- Psychotherapist < Psychotherapy < psyche + therapeia, 'nursing, cure'
- Psychoanalyst < Psychoanalysis < psyche + analysis, 'separation into components, close examination'
All this is very interesting, but did not answer the question. What's the difference?
People ask me sometimes what I do for a living, and when I tell them, almost invariably I am met with a look of understanding and compassion. I know what this look says. It says: “Poor you, for having to have such a regular contact with those mentally ill people.”
In the early days I tried to challenge this view. (I don’t anymore).
I would explain that people who go to a psychotherapist or a psychoanalyst are not necessarily mentally ill. I would admit that some of them might be, of course, but even they, I would stress, do not go to the therapist because of their illness. They might think so, but what they really do is go to the therapist because they need help and hopefully the therapist can provide this.
This very simple truth was incomprehensible to many of my interlocutors –and, I would expect, to many of the readers of this blog. I can almost hear, loud, the objections: “If you cannot cure people, why do you invite them to come to you? Is this a joke or something?”
In previous posts I have managed, I believe, to cast some doubt on whether Randomized Control Trials are really suitable for measuring the effectiveness of treatments such as psychotherapy or psychoanalysis.
That leaves us with an important question unanswered.
If the effectiveness or the efficacy of many psychotherapies or psychoanalysis cannot be measured with RCTs, how can it be measured? Can it be measured at all?
To attempt at answering the question we first need to think about what we mean by the term effectiveness. It might look self-evident but I am afraid it is not.
(Please note that what follows applies only to psychoanalysis, or psychoanalytic psychotherapy.)
Let’s take the following hypothetical example.
A young woman presents herself to a psychoanalyst. She has a specific problem which she complaints about, severe insomnia; could the analyst please help her?