What Is Psychoanalytic Therapy?

The Process, Benefits, and Possible Downsides of Psychoanalytic Therapy

A photography of a man talking to his therapist.

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Psychoanalytic therapy is one of the most well-known treatment modalities, but it is also frequently misunderstood by mental health consumers. The goal of this therapy is to help patients better understand the unconscious forces that can play a role in their current behaviors, thoughts, and emotions. This type of therapy is based upon the theories of Sigmund Freud, who founded the school of thought known as psychoanalysis.

Freud described the unconscious as the reservoir of desires, thoughts, and memories that are below the surface of conscious awareness. He believed that these unconscious influences could often lead to psychological distress and disturbances.

Psychoanalytic therapy looks at how the unconscious mind influences thoughts and behaviors. Psychoanalysis frequently involves looking at early childhood experiences in order to discover how these events might have shaped the individual and how they contribute to current actions.

The History of Psychoanalytic Therapy

Freud began developing his therapeutic techniques in the late 1800s. In 1885, he began to study and work with Jean-Martin Charcot at the Salpêtrière in Paris. Charcot used hypnosis to treat women suffering from what was then known as hysteria. Symptoms of the illness included partial paralysis, hallucinations, and nervousness.

Freud continued to research hypnotism in treatment, but his work and friendship with colleague Josef Breuer led to the development of his most famous therapeutic technique. Breuer described his treatment of a young woman, known in the case history as Anna O., whose symptoms of hysteria were relieved by talking about her traumatic experiences.

Freud and Breuer collaborated on a book called Studies on Hysteria and Freud continued to develop his use of this "talk therapy." This approach proposed that simply talking about problems could help relieve psychological distress.

How Does Psychoanalytic Therapy Work?

Psychoanalytic therapists generally spend time listening to patients talk about their lives, which is why this method is often referred to as "the talking cure." The therapy provider will look for patterns or significant events that may play a role in the client's current difficulties. Psychoanalysts believe that childhood events and unconscious feelings, thoughts, and motivations play a role in mental illness and maladaptive behaviors.

Techniques Used in Psychoanalytic Therapy

Psychoanalytic therapy also makes use of other techniques including free association, exploration of transference, observing defenses and feelings patients may not be aware of, as well as dream interpretation.

The Psychoanalytic Process

People undergoing psychoanalytic therapy often meet with their therapist at least once a week and may remain in therapy for a number of weeks, months, or even years. Through this process, the hope is that people will be able to gain insight and awareness of the unconscious forces that contribute to their current mental state.

Intensive Treatment

Patients may sometimes find that psychoanalysis can be quite intense and personal. It involves talking a great deal about past experiences, relationships, and feelings. This can also lead to feelings of discomfort as unconscious forces are brought to light. While the process can sometimes result in uneasiness, it can also be a great way to gain insight and deal with feelings that are difficult to put into words.

Dealing With Unconscious Forces

This approach to therapy often involves provoking emotional responses and overcoming defense mechanisms. Success often hinges on the ability to confront potentially stressful or triggering past experiences. Gaining insight into your feelings, behaviors, and experiences can help you better understand the unconscious forces that continue to exert an influence on your actions, your relationships, and your sense of self.

Psychoanalytic therapy may also help you learn techniques for coping when future problems arise. Rather than falling back on unhealthy defenses, you may be better able to recognize your feelings and deal with them in a constructive manner.

Benefits of Psychoanalytic Therapy

As with any approach to mental health treatment, psychoanalytic therapy can have its pluses and minuses. The degree to which these potential benefits and pitfalls influence the choice to use this approach depends on a variety of factors, including the individual's preferences and severity of symptoms.

In the last few decades, there has been significant research validating this approach’s benefits. The therapist offers an empathetic and nonjudgmental environment where the client can feel safe in revealing feelings or actions that have led to stress and difficulties in his or her life.

Often, simply sharing these burdens in the context of a therapeutic relationship can be beneficial. Furthermore, it has been shown that this type of self-examination can lead to continued emotional growth over time.

Downsides to Psychoanalytic Therapy

As with all treatment methods, there are also potential downsides that should be considered. The financial costs associated with this treatment modality can be very high. Costs are often cited as the biggest downside of psychoanalytic therapy.

This type of therapy has critics who claim that psychoanalytic therapy is too time-consuming, expensive, and generally ineffective. Some, such as Noam Chomsky and Karl Popper, have suggested that psychoanalysis lacked scientific basis. Misconceptions of this type of treatment are often connected to some of the earlier, more classical Freudian applications of psychoanalytic treatment.

Conditions Treated by Psychoanalysis

Psychoanalysis may be used to treat a number of different psychological conditions, including:

  • Obsessive-compulsive disorder
  • Depression
  • Psychosomatic disorders
  • Phobias
  • Anxiety
  • Identity problems
  • Emotion struggles or trauma
  • Self-destructive behavior
  • Relationship issues
  • Sexual problems

People who are likely to benefit from this form of therapy are often those who have been experiencing symptoms for some time. People might choose psychoanalytic therapy when they have long-term symptoms of anxiety, depressed mood, and behaviors that have a negative impact on functioning and enjoyment of life.

Psychoanalysis Success Rates

While some critics have derided the success rates of psychoanalytic therapy, recent research suggests that this treatment modality can be an effective treatment for a range of issues.

Effective for Symptom Reduction

One review of the effectiveness of long-term psychoanalytic therapies found moderate to large success rates for reducing symptoms of a variety of psychopathologies.

Another large-scale study found that short-term psychoanalytic therapy was effective for general symptom improvement. In addition to these general improvements, the review also found that psychoanalytic treatment led to lasting improvements in somatic symptoms, depressive symptoms, and anxiety symptoms.

Leads to Lasting Improvements

Patients who receive psychoanalytic treatment retain these gains and may continue to improve even after treatment ends.

A 2010 review published in American Psychologist found that the scientific evidence supports that psychodynamic therapy was as effective as other evidence-based treatments.

How Psychoanalysis Differs From Other Treatments

What makes psychoanalytic therapy different from other forms of treatment? A review of the research comparing psychodynamic approaches to cognitive-behavioral therapy (CBT) identified seven features that set the psychoanalytic approach apart.

  1. The focus on emotions and how they are expressed. Where CBT is centered on cognitions and behaviors, psychoanalytic therapy explores the full range of emotions that a patient is experiencing.
  2. The exploration of avoidance. People often avoid certain feelings, thoughts, and situations that they find distressing. Understanding what patients are avoiding can help the therapist and client better explore why such avoidance comes into play.
  3. The identification of recurring patterns and themes in thoughts, feelings, and behaviors. In some cases, people are aware of such repetitious actions but may be unable to break out of unhealthy or destructive patterns. At other times, patients are not aware of how such patterns influence their behaviors.
  4. The emphasis on talking about past experiences. Other therapies often focus more on the here-and-now, or how current thoughts and behaviors influence how a patient functions. The psychoanalytic approach helps the patient explore their past and understand how it affects both the present and future.
  5. The exploration of interpersonal relationships. Through the therapy process, patients are able to explore their relations with others, both current and past.
  6. The focus on the therapy relationship itself. Because psychoanalytic therapy is so personal, the relationship between the therapist and the patient is an important part of the treatment process.
  7. Exploring the patient's fantasy life. Where other therapies are often highly structured and goal-oriented, psychoanalytic therapy allows the patient to explore freely. Patients are free to give voice to fears, desires, dreams, and other urges that they have never spoken of before.

How to Find a Psychoanalytic Therapist

If psychoanalytic therapy sounds like it might be right for you, the first step is to begin looking for a therapist who specializes in this form of treatment. To find a qualified psychoanalytic therapist, start by asking your primary care physician for recommendations. Your doctor can also put you in touch with a referral service if needed.

Friends who have had a good experience with psychoanalytic treatment can also be another good source of recommendations. If you do not have a good referral from someone you know, there are a number of online therapist networks and directories that can point you in the right direction.

Once you have identified a potential therapist, make a call to set up an initial consultation. During this consultation, you can further explore if psychoanalytic therapy is the right approach for you.

A Word From Verywell

Psychoanalytic therapy is just one mental health treatment approach that you may want to consider. This approach may provide benefits that might be well suited to your particular situation, but always talk to your doctor or therapist to determine which psychotherapy method might be the most effective for your individual needs.

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  1. Eysenk HJ. The Effects of Psychotherapy: An Evaluation. J Consult Psychol. 1952;16:319-324. doi:10.1016/b978-1-4832-0087-3.50019-x

  2. De Maat S, de Jonghe F, Schoevers R, Dekker J. The effectiveness of long-term psychoanalytic therapy: a systematic review of empirical studies. Harv Rev Psychiatry. 2009;17(1):1-23. doi:10.1080/10673220902742476

  3. Shedler J. The efficacy of psychodynamic psychotherapy. Am Psychol. 2010;65(2):98-109. doi:10.1037/a0018378