Importance of Meaning in Psychoanalytic Psychotherapy

Importance of meaning in psychoanalytic psychotherapyThe importance of meaning in psychoanalytic psychotherapy is core to the field. Psychoanalytic psychotherapy recognizes that the meaning of behavior is important. Unlike most behavioral therapies where behavior is explained in terms of learning and contingencies, psychoanalytic theories support the idea that our behavior is purposeful and meaningful.

While there is no argument that we are influenced by rewards and punishments that encourage or discourage our actions, we also persist in actions regardless of consequences and against our better judgment. Some of these actions can be called addictions or habits, but these terms only address one aspect of their explanation.

Psychoanalytic presuppositions about purposefulness of behavior recognizes that, as humans, we are more than reflexive creatures at the mercy of external cues and internal biochemistry. We are active and creative authors of our life experience, continuously trying to make sense out of our circumstances. We think in stories while imbuing meaning into all that occurs within and around us. The importance of meaning in psychoanalytic psychotherapy cannot be overstated.

Whereas much of that meaning is conscious and readily describable in words, there is also a deeper, more personal meaning that constitutes our private truths. Such truths are not always easily verifiable or empirically validated, but they remain rooted in our subjective experience of living and being.

A person molested as a child may remain in a subjective state of guilt and shame for a lifetime, regardless of any objective facts to the contrary. Likewise, growing up in a home that is emotionally cold and rejecting may forge an expectation for betrayal and mistrust in all subsequent close relationships. These types of truths are known viscerally and emotionally without conscious awareness. The importance of meaning in psychoanalytic psychotherapy allows the patient to process their history.

Through the exploration of meaning, the psychoanalytic patient is helped to discover their fundamental beliefs, values, and desires in the context of a therapeutic relationship, where transference reveals the dynamics of their personal history as they knew it to be. In turn, they come to know themselves as a unique being beyond the definition ascribed to them by others.

The patient’s truth is respected and witnessed by a therapist dedicated to enhancing the patient’s potential. Only the patient themselves can effectively re-define who they are and who they strive to become. Whereas the therapist may help illuminate unconscious meaning through interpretation of statements and actions, these interpretations are, at best, approximations of alternative truths and examples of empathic acceptance of the person.

Since the truths were constructed in a particular time and context, their meaning may become changed through reflection and discussion. Thought patterns, descriptive narratives, slips of the tongue, non-verbal gestures, and other subtle cues may lead to insights that are emancipating from the past.

Similarly, in current conflicts and issues, a patient may come to understand how symptoms belie an unconscious wish or fear. For example, a patient developed a sudden attack of hiccups for several days that prevented him from speaking freely with his girlfriend. Upon exploration it was discovered that the attack began after she brought up her desire to get married. The patient left our session discounting my interpretation of his hiccups as a defense against speaking with her. He denied any possible meaning to his symptoms and was convinced that his physician’s prescription for an anti-seizure medication was his best option. A few hours later, he left me a message that the hiccups had stopped once he got to his car in the parking lot outside my office. While he was relieved from his symptom distress, he was angry that he had to continue the discussion with his girlfriend.

Finally, I think it is important to note that meaning is not found or discovered, but rather created. Psychoanalytic therapy is a collaborative process of inquiry, exploration, and creativity that is uniquely tailored for every patient.

Thus, the use of “canned” or generic meanings or symbolism often does a disservice to our patients by ignoring the significance of their histories. When a patient asks, “what does it mean when…”, they are subordinating themselves to a position of ignorance and elevating the therapist to an idealized other who is supposed to know what they cannot know. The unequal power dynamic undermines the patient’s growth and fosters an undesired dependency.

The therapeutic relationship is, potentially, a mutually enriching process of meaning for both the patient and the therapist

If you would like to learn more about the psychoanalytic process, you may find the following articles to be of interest: 7 Reasons Why Psychoanalysis is Still Relevant Today; Value of Psychoanalysis; and Psychoanalysis, Resilience, and Meaning-Making.

Interested in earning a Certificate of Advanced Study in Psychoanalytic Psychotherapy?  Simply complete 48 CE credits with our psychoanalytic courses, including at least three course courses. Entirely online, accessible 24/7, and paced at your convenience.


APA Approved CE Online CoursesThe Institute of Advanced Psychological Studies is approved by the American Psychological Association to sponsor continuing education for psychologists. The Institute of Advanced Psychological Studies maintains responsibility for this program and its content.



Is Psychoanalytic Psychotherapy Empirically Validated?

Psychoanalytic Psychotherapy Empirically ValidateIs psychoanalytic psychotherapy empirically validated?

Is psychoanalytic psychotherapy empirically validated? The short answer is, yes. And empirical support for this long-established approach is rapidly growing.

Why do some people assume that it isn’t evidence-based? Probably because empirical research on psychoanalytic psychotherapy has been slower in coming than for some other clinical approaches.

There are a number of reasons why empirical validation of psychoanalytic psychotherapy has lagged behind other therapeutic approaches.

First, psychoanalytic psychotherapy is relatively difficult to assess with standard empirical techniques. Empirical research typically relies on quantitative data, observable outcomes, unvarying procedures applied across cases, large sample sizes, and replication of findings. Experiments with random assignment to discrete conditions with a control group (i.e., randomized-controlled studies) are considered the “gold standard” in research because they are highest in internal validity (i.e., determining cause-effect relationships). Each of these elements is problematic for psychoanalytic psychotherapy.

Let’s first consider the type of data involved. The aim of psychoanalytic psychotherapy is not merely to reduce problem behaviors; rather, it is to help deepen self-understanding and to achieve some outcomes that are important for an individual’s quality of life but difficult to measure. Psychoanalysis and psychoanalytic psychotherapy provide a setting where an individual’s personal truths can become known, understood, and shared. Some outcomes may be assessable through self-report, rating scales, or behavioral outcomes. Patient self-reports, however, may not reflect the deeper, sometimes ineffable changes that lead to greater health. Their validity can also be undermined by fabrications and/or a patient’s wish to validate (or invalidate) a treatment process. Even observable behavior change does not always accompany or reflect growth and improved well-being attained in psychoanalytic psychotherapy.

As we are complex creatures, psychoanalytic theories are also inherently complex, providing models for appreciating the uniqueness of the human experience. These models are difficult to understand, let alone to operationalize, by a researcher who is not an experienced psychoanalytic psychotherapist. And most researchers are not experienced psychoanalytic psychotherapists.

Then, there are procedures that must be standardized across cases in research studies. Psychoanalytic psychotherapy considers such constructs as the changing phenomenology of the patient and the transference relationship with the clinician—both difficult, if even possible, to replicate in a meaningful way, as each case is unique. The gold standard of research involves random assignment to condition. Random assignment requires that discrete conditions be pre-determined, which may be difficult, if even feasible, when the clinician’s focus is on responding to the changing, unconscious needs of an individual. Is psychoanalytic psychotherapy empirically validated? Because research involving psychoanalytic psychotherapy has tended to involve observational or case studies, the studies have not always been “counted” as evidence. Hence, the approach is often assumed not to be evidence-based.

Furthermore, psychoanalytic psychotherapy often deals with issues that cannot be resolved quickly. This factor has several implications. First, many researchers depend on number of publications for tenure, academic promotion, etc., making long-term studies less desirable. No wonder there are so many more outcome studies on cognitive-behavior therapy (CBT). And, statistical power relies on having a large enough sample size to reveal subtle differences. When therapy is individualized and longer term, gathering a large sample is impractical.

Finally, psychoanalytic psychotherapy occurs through the relationship with the therapist—a vehicle that is viewed as sacred and to be protected from contamination by outside factors. As such, psychoanalytic psychotherapists have tended to be suspicious of and protective against incorporating empirical assessments that could influence the therapeutic process.

In contrast, cognitive-behavior therapy focuses on modifying observable behaviors and/or conscious cognitions, with protocols that are brief, relatively simple to manualize, and conducive to randomized controlled studies. Consequently, many research studies have been published on this approach, leading some to assume that it is the only valid type of therapy for many conditions. A self-fulfilling prophecy is then also engaged, with greater recognition leading to greater access to further research funding, for even more outcome studies and confidence in the approach.

Is psychoanalytic psychotherapy empirically validated? Despite the many challenges, the quality and quantity of research testing psychoanalytic psychotherapy is increasing. More proponents of the approach are becoming convinced of the importance of providing research evidence and becoming creative in ways to test its complex features. Midgley et al. (2021) recently published a narrative synthesis of such outcome studies, including a growing number of randomized-controlled studies involving psychodynamic techniques.

There are future challenges, however. More funding is needed for studies that are complex and difficult to operationalize. Randomized-controlled studies have routinely been favored by the scientific community; hopefully, observational studies will also come to “count” as empirical evidence. As noted by Midgley et al. (2021), “Whilst the findings of these studies cannot be considered as ‘rigorous’ as those of experimental studies, such studies may be more representative of a ‘real-world’ context, where treatments are not often delivered according to a specific manual, treatment length is not predetermined, and patients often present with a mixed picture of mental health issues” (p. 12).

I value the words of Eric Kandel, neuroscientist and Nobel Laureate: “Psychoanalysis still represents the most coherent and intellectually satisfying view of the mind” (1999, p. 505). 

To learn more about Midgley et al.’s (2021) narrative synthesis of outcome studies on psychodynamic psychotherapy, please see their open-access article: Midgley, N., Mortimer, R., Cirasola, A., Batra, P., & Kennedy, E. [2021]. The evidence-base for psychodynamic psychotherapy with children and adolescents: A narrative synthesis. Frontiers in Psychology12, 1-18. doi: 10.3389/psyg.2021.662671.

You may also earn 2 CE credits for reviewing the article by registering for the online course, Evidence Base for Psychodynamic Psychotherapy With Children and Adolescents.

You may also enjoy our blog, Is Psychodynamic Psychotherapy Evidence-Based?

Interested in earning a Certificate of Advanced Study in Psychoanalytic Psychotherapy?  Simply complete 48 CE credits with our psychoanalytic courses, including at least three course courses. Entirely online, accessible 24/7, and paced at your convenience.


APA Approved SponsorThe Institute of Advanced Psychological Studies is approved by the American Psychological Association to sponsor continuing education for psychologists. The Institute of Advanced Psychological Studies maintains responsibility for this program and its content.

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