What is psychoanalysis?
Psychoanalysis (which is sometimes called psychoanalytic therapy) is a form of individual psychotherapy. Psychoanalysis is based on the work of Sigmund Freud. This kind of therapy relies on the idea of the subconscious, or the idea that your mind has unconscious drives and desires that shape your behavior. Because most other forms of psychotherapy have evolved from psychoanalysis, some consider it the most traditional form of therapy.
In psychoanalysis, the therapist serves as a blank slate for the client. The therapist may ask questions or prompt reflection, but they will not offer advice. Instead, the therapist’s job is to reflect your concerns and help you spot patterns in your thoughts and behavior. This is very different from therapy types such as cognitive behavioral therapy, in which your therapist may teach you specific skills or give you homework.
Therapists who are trained in and offer psychoanalysis are often called psychoanalysts.
What psychoanalysis can help with
Psychoanalysis can be a helpful treatment for a number of common mental health conditions, including:
- Identity issues
- Post-traumatic Stress Disorder (PTSD)
- Relationship issues
- Sexual concerns
While other types of therapy can treat these same concerns, psychoanalysis is an especially good choice for people who are interested in gaining deeper insight into themselves and their motivations. Because it is so focused on introspection, psychoanalysis can be helpful if one of your goals is to become more self-aware.
Effectiveness of psychoanalysis
Many studies have found that psychoanalysis can be helpful in treating a range of mental health conditions.
- One review found that psychoanalysis was more effective than other less intensive forms of psychotherapy in treating symptoms of various personality disorders.
- Another study showed that many people who did psychoanalysis continued to see improved relationships with other people. They also experienced reduced symptoms of conditions including depression and anxiety, even after they stopped going to sessions.
- An additional study suggests that psychoanalysis may be especially helpful for treating depression.
How psychoanalysis works
Psychoanalysis works by helping you uncover repressed memories, thoughts, and feelings. It assumes that these emotions are buried in each person’s subconscious and that by confronting these hidden parts of yourself, you can deal with them and resolve the problems they’re causing.
For example, you might find that you unintentionally recreate aspects of your relationship with a parent in your relationship with your therapist. If you felt that your mother never praised you enough, you might start to resent your therapist for the same reason. Your psychoanalyst may also point out that you seem to be recreating old patterns in present-day relationships outside of therapy. This could be with romantic partners, friends, or colleagues. For example, you may describe a frustrating childhood experience with a teacher and then use similar language to talk about a recent fight with your partner.
You may not see the connection between these two events on your own, but with your psychoanalyst’s help, you can begin to understand how they’re emotionally related.
Once you’re aware of these patterns, you can process your feelings around these parts of your past – and keep them from affecting your behavior and emotions in the present.
Frequency of psychoanalysis sessions
Traditional psychoanalysis sessions are at least two or three times a week. However, more modern versions usually include sessions just once a week.
Traditional psychoanalysis is generally more intensive and in-depth. Modern versions may not be as intensive, but they are less expensive and require less of a time commitment.
Length of psychoanalysis treatment
Psychoanalysis is generally long-term and can last several years.
However, short-term versions of it are sometimes used in settings that may not be able to support long-term therapy (like youth resource centers) or when mental health symptoms occur suddenly after a trauma or life change.
How to tell if psychoanalysis is working
As with any kind of therapy, you and your therapist should determine together early in the process how you’ll measure progress toward your treatment goals. If your therapist is a good fit, you should have a shared sense of what you’re working toward, whether it’s behavioral change, reduced anxiety, improved relationships with others, or something else altogether.
No matter your goal, you should experiences some progress within the first month or so of treatment. However, keep in mind that psychoanalysis is a much more long-term model than many kinds of therapy. To see profound change, you may need to stick with the process for a year or longer.
If you’re concerned that your sessions are not helpful, discuss your concerns with your therapists and establish some reasonable goals that you can work toward in the short term.
When to end psychoanalysis
There is no set end point for psychoanalysis. It is not goal-oriented, and so it will not necessarily end based on external factors like symptom reduction.
Generally, it comes to a close when you and your psychoanalyst agree that you have worked through the issues that brought you to therapy and you feel satisfied with the insight you have gained.
However, because the subconscious can be such a rich source of insight, some people choose to continue psychoanalysis for many years, even when they’re not experiencing any particular challenges.
Ultimately, it’s up to you when to end psychoanalysis. The short answer is that it can conclude whenever you no longer feel that it is a helpful part of your life.
How psychoanalysis sessions are structured
During your first few sessions of psychoanalysis, you’ll focus on building a bond with your therapist, also known as the therapeutic alliance. Your therapist will ask questions to learn more about you and your current concerns, and you’ll also identify your goals for therapy.
After the second or third session, you’ll move into an open-ended discussion. You may talk about your presenting problems, but you’ll also talk about your life more generally. Often, this discussion will cover your childhood and family of origin.
Your therapist will encourage you to discuss whatever comes to mind. As your sessions go on, they will help you notice patterns and trends that might lead you to uncover repressed memories or feelings, and eventually, resolve the challenges you came into therapy to address.
What happens in a typical psychoanalysis session
Psychotherapy sessions usually include one or more of the following basic therapeutic techniques:
- Open-ended conversation. Much of the time, you’ll just be talking! Your therapist will be an active listener and encourage you to explore your thoughts freely. This might even include fantasies or thoughts you don’t fully understand. These fantasies can be anything: sexual fantasies, abstract wishes for the future, desires for things that don’t otherwise fit into your life plans, or any number of other things. For example, you may find yourself thinking often of leaving your family and living alone on a mountain, even though you also love your life at home and don’t actually want to leave. Some more traditional therapists may have you lie on a couch with the therapist behind you, so that the therapist is out of your line of sight and you’re able to free-associate, rather than feeling that you must carry on a conversation with the therapist.
- Transference. Transference is the idea that you might unconsciously act out an important relationship from your past with a different person in the present. For example, you might discover that you’re treating your partner the same way you used to treat a sibling. Your therapist will help you become conscious of these patterns and work toward changing them.
- Interpretation. As you talk through your thoughts, feelings, and experiences, your therapist might point out patterns that you haven’t noticed. Sometimes, they may also provide a word or image and ask you to say the first thing that comes to mind in response. Helping you understand these responses is called interpretation.
- Dream analysis. Some therapists include dream analysis in psychoanalysis. You’ll tell your therapist about your dreams, and the therapist will help you find symbols that may be clues to your subconscious.
Do I have to lie down on a couch in psychoanalysis?
No. Though some psychoanalysts may require this, many do not. The rationale behind lying on a couch during psychoanalysis is that it keeps you from looking directly at the psychoanalyst. In this arrangement, you may feel more able to speak freely instead of trying to carry on the kinds of polite conversations that people typically have face-to-face.
If you’re not comfortable lying down during psychoanalysis, check with potential therapists about their usual practices and find one who can accommodate your preference.
What to look for in a psychoanalyst
There are several things you should look for in a therapist for psychoanalysis:
- Advanced education. Therapists for psychoanalysis should have a Master’s degree, PhD, or other advanced degree. They are often psychologists, psychiatrists, or social workers.
- Mental health license. You’ll want to find a therapist who is licensed to practice mental health treatment in your state.
- Training in psychoanalysis. Therapists who practice psychoanalysis need advanced training in this specialty. Most get certification through a psychoanalytic institute. You can ask potential therapists where they got their training and how they stay up-to-date in the field.
- A good fit. Psychoanalysis often requires you to open up even more than many kinds of psychotherapy. Make sure you find a therapist with whom you feel comfortable discussing emotional, intimate matters.
New to therapy? Learn about how to find a therapist here.