Psychoanalysis is alive and well and has undergone many changes over the past century. It remains one of the most effective treatments for certain types of psychological or emotional problems.  Psychoanalysis is more of a commitment than psychotherapy because it requires a commitment to meet several times per week. Taking the time and using the intensity of more frequent sessions allow for a more comprehensive understanding of the self.  This intensive treatment may make it more likely that a person will undergo lasting change and resolve problems in self esteem, relationships, sexuality and mood. 

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The American Psychoanalytic Association has a good description of what psychoanalysis is:

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Psychoanalysis is a comprehensive theory about human nature, motivation, behavior, development and experience. And it is a method of treatment for psychological problems and difficulties in living a successful life.

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The psychoanalytic framework stresses the importance of understanding that:

• each individual is unique,

• there are factors outside of a person's awareness (unconscious thoughts, feelings and experiences) which influence his or her thoughts and actions,

• the past shapes the present

• human beings are always engaged in the process of development throughout their lives.

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Psychoanalysis is based on the observation that individuals are often unaware of the factors that determine their emotions and behavior. Because these factors are unconscious, the advice of friends and family, the reading of self-help books, or even the most determined efforts will often fail to provide enough relief. Psychoanalytic treatment explores how these unconscious factors affect current relationships and patterns of thought, emotion and behavior. Treatment traces theses patterns back to their historical origins, considers how they have changed and developed over time, and helps the individual to cope better with the realities of their current life situation. Analysis can be viewed as an intimate partnership, in the course of which the patient becomes aware of the underlying sources of his or her difficulties, not simply intellectually but emotionally as well – in part by re-experiencing them with the analyst. From the beginning of therapy, patient and analyst work together to build up a safe and trusting relationship that enables the patient to experience aspects of his or her inner life that have been hidden because they are painful, embarrassing, or guilt-provoking.

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http://www.apsa.org/About_Psychoanalysis.aspx

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Transference

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Transference refers to feelings you have toward important people in your life that come up in the relationship with your therapist. These include both positive and negative feelings. Transference gives you the opportunity to understand feelings you had growing up and how these still influence you today. One type of transference you may have heard about is called erotic transference, which is often described as "falling in love" with your therapist. This is one of the many feelings that some people experience and is a route to understanding yourself and your loving and sexual feelings better.

 

Regression

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Regression refers to feelings from early childhood that are re-experienced in the therapy. This does not mean that you literally turn into an infant or a two year-old, only that you get in touch with how you may have felt at that age. If these feeling become too overwhelming, your therapist will help you find ways to manage them.

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Equally important to the old feelings that are re-awakened in therapy is the chance to have new feelings with your therapist and to discover new ways of being in a close relationship. Over time, you and your therapist will get to know each other well and to share intimate experiences. Your therapist, at different times, may feel like a parent, a lover, a sibling, or a close friend to you. Your therapist, by becoming an important part of your life, can help you to let go of patterns based in the past and to learn that there are new and better ways to be yourself.

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Depersonalization can hit like a clap of thunder; in a split second all tilts towards the surreal and the trusted sense of reality evaporates. It can seep in insidiously, settling in for relentless decades of profound estrangement and detachment.  Some are propelled in and out of transient episodes in response to triggering events, and some actually willfully induce states of depersonalization to avoid the claws of unacceptable reality (Guralnik, 2008).

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Phenomenologically people describe witnessing their lives as if it were a movie or “from the ceiling”, an experience often accompanied by a bitter deadening of affect: “The emotional part of my brain is dead… My laugh is automatic; there just doesn’t seem to be anything there…” (Patient reports, Mt Sinai - PRMS). The integrity of time, space, mind and body falls apart: “The times have gone… Everything around me is very far away and tiny…” (Shovron, 1946), “I enter the house I lived in for the past 7 years and feel like I’ve never seen it before… I look at my hand and it does not belong to me, it looks large and foreign…” (PRMS). The unity of intention and action fragments: “I can hear my voice talking, but it does not seem to be coming from me…“ (PRMS). The result of these various fragmentations is that for the depersonalized what used to be implicitly relied on as “me” and “reality” is pulled from under, leaving one de-clothed of a familiar self, in an alienated landscape.

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Although prevalent[2], depersonalization is poorly studied and unfamiliar to even seasoned clinicians. It is a subjectively felt altered state of consciousness, not an affect or a disturbance of thought, yet the actual ‘symptoms’ are terribly difficult to describe. It infects a rather abstract psychological register in which one draws conclusions, grounds and narrates what their Self, and ultimately Reality, mean to them[3] (we will return to this register in later sections).  When mentioned in the literature, depersonalization typically gets incorporated into existing categories and misattributed as an epiphenomenon of more familiar disorders of affect such as depression and anxiety. The implication is that depersonalization cannot be engaged with directly but will somehow lift when other problems clear. Indeed, people with relentless depersonalization typically grow increasingly alienated and hopeless after migrating from one mental health professional to the next, misdiagnosed, misunderstood and treated with no success.  

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As far as definitions, depersonalization should be distinguished from the concepts of dissociation and repression. As a diagnostic category depersonalization is classified by the DSM-IV-TR (2000) as one of four primary dissociative disorders. All four come under the roof of dissociation because they share the mental operation of splitting apart and excluding from consciousness psychic materials that are typically integrated into one experience (self-states or ‘identities’ in Dissociative Identity Disorder, a renounced self in Fugue, auto-biographical memories in Amnesia, personhood and real-hood in Depersonalization and Derealization). Thus, depersonalization is a sub-type of dissociation. Often when clinicians refer to their patients’ dissociation they are actually describing the very specific experience of depersonalization.

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As dynamic psychic mechanisms both dissociation and repression are ways to banish mental contents from consciousness. They have different implications regarding psychic structure and dynamics. In repression the hidden elements are thing-representations of particular contents. In dissociation they are structures, potential ways of being a person in the world. Repression disallows conscious representation of once-known, anxiety provoking “things” like memories, wishes and fantasies. Under the supervision of the ego’s censor, neurotic distortion renders these thing-representations unavailable to the conscious mind. Dissociation, in contrast, segregates or de-links “states” rather than things, matrixes of self-other-relationships and their related affects[4]. The parallel operator to the repressive censor in the case of dissociation would be avoidance of attending-to and formulating into meaning (Stern, 2007). As a sub-category of the ability ‘to dissociate’ one also has the capacity ‘to depersonalize’, whereby one becomes detached and certain aspects of self become inarticulate or unavailable, instigating the subjective dis-ease of depersonalization.

 

Much of the thinking collected here is based on a series of NIH and NARSAD-funded studies of the phenomenology, etiology, cognitive processes, biological correlates and treatment of depersonalization. These were conducted over eight years by a research group we founded at the Mount Sinai School of Medicine in New York City (Director: DS) with more than 350 patients for whom depersonalization was the primary symptom.  Our main findings are summarized in a selection of our papers: Simeon et al., 1997, 1998, 2000, 2001a , 2001 b, 2002, 2003a, 2003 b; Guralnik et al., 2000, 2007).