What Is Psychoanalytic Therapy?
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Medically reviewed by Stephanie Hartselle, MD
Psychoanalytic therapy is a form of psychotherapy (talk therapy) rooted in the idea that all people are motivated by unconscious desires, thoughts, emotions, and memories. Also known as psychodynamic psychotherapy, psychoanalytic therapy is based on the theory of psychoanalysis, which the Austrian neurologist Sigmund Freud developed in the late 19th century.
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Today, psychoanalytic therapists help people uncover their unconscious feelings and memories, identify negative patterns of thinking and behavior, and overcome past traumas. They use techniques like transference analysis, dream analysis, interpretation, and free association to help patients identify these self-defeating patterns.
In this article, learn about psychoanalytic therapy, including history, techniques, and benefits.
Psychotherapy, also known as talk therapy, is a method of helping people manage emotional distress, stress, conflicts, and mental health disorders. Psychotherapy is conducted by a therapist in individual, family, or group settings.
Psychoanalytic Theory
Psychoanalytic therapy evolved out of the theory of psychoanalysis, which Freud developed in the 1890s. Some of the core beliefs within psychoanalysis include:
All people are influenced in their thinking and behavior by their "dynamic unconscious," or the collection of thoughts, memories, and feelings of which they are not aware.
People develop defense mechanisms in response to unconscious thoughts, desires, or emotions that would make them feel anxiety or shame if they came to the surface. Defense mechanisms could include denial, destructive thinking patterns, repression, and more.
Mental health conditions result from a conflict between the subconscious mind and a person's conscious beliefs. The mind often seeks to develop a "compromise" for these competing desires and goals.
Many of Freud's ideas about mental health have since been widely debated, disputed, and refuted. However, the core tenets of psychoanalysis remain highly influential in the fields of psychology and psychiatry.
Related:Types of Psychotherapists: Differences and How to Choose
How It Works
According to the American Psychoanalytic Association (APsaA), the goal of psychoanalytic therapy is to identify patterns of thinking and behavior that cause emotional distress.
Usually, this involves working with a therapist one on one multiple times per week to make unconscious drives and defenses conscious and to reconcile these.
Through in-depth conversations and other therapeutic techniques, psychodynamic psychotherapists help their patients to analyze, confront, and heal from the past in order to achieve greater well-being in the future.
You might associate psychoanalysis with the stereotype of someone lying on the couch while an analyst scribbles notes. While the couch has mostly gone by the wayside, there’s some truth to this image.
Because psychoanalytic therapy is focused on uncovering your subconscious, the first goal in therapy is to make you feel comfortable enough to explore memories and thoughts that you usually don’t like to confront.
What It Can Help With
Psychoanalytic therapy can help with anything in your life that causes emotional distress or impairs your daily functioning. It can also be used to treat certain mental health conditions, such as depression and some anxiety disorders.
By gaining a greater understanding of your underlying motivations and fears, you may be able to address conflicts in your relationships and resolve problems at work or school. Confronting the thoughts and emotions you normally avoid under the guidance of a psychotherapist may help you to address your issues head-on.
Psychoanalytic Therapy Techniques
Psychoanalytic therapy usually involves free-flowing, in-depth conversations in one-on-one sessions with a trained therapist. Typical techniques used in these sessions include the following.
Transference Analysis
The therapist-patient relationship is highly important in psychoanalytic therapy.
Transference refers to the idea that the patient’s feelings and behaviors toward their therapist can provide insight into their childhood experiences with caregivers and authority figures. In turn, countertransference refers to the therapist’s unconscious feelings and thoughts about the patient.
Psychoanalytic therapists analyze these patterns to gain insight into their patient’s past experiences and unconscious mind.
Dream Analysis
Psychoanalytic theory holds that many thoughts, memories, drives, and emotions that remain outside of conscious awareness show up in dreams and fantasies. Psychoanalytic therapists often analyze recurring symbols and imagery from their patients’ dreams to discover key themes and patterns that may emerge.
Interpretation
Interpretation refers to the process through which a psychoanalytic therapist pieces various observations about their patient’s conscious and unconscious behavior into a cohesive narrative. This may include interpretations of body language, emotional expressions, and other forms of verbal and nonverbal communication.
Free Association
While other forms of psychotherapy often involve controlled, targeted discussions with clear goals in mind, psychoanalytic therapy is deliberately more free flowing.
Developed by Freud, free association is a psychoanalytic technique that involves encouraging the patient to talk openly about whatever is on their mind in a stream-of-consciousness fashion. This open-ended approach is believed to help unconscious thoughts, fears, shame, and motivations come to light.
Benefits
Psychoanalytic therapy is effective in helping people gain insight into the repetitive, self-destructive patterns that hold them back in relationships, work, school, and other aspects of everyday life. Research suggests that psychodynamic psychotherapy may be useful in treating the following medical conditions:
Depression
Anxiety
Some eating disorders
Personality disorders, such as borderline personality disorder (BPD)
Functional somatic disorders (FSDs), such as fibromyalgia and chronic fatigue syndrome (CFS)
Functional somatic disorders (FSDs) are chronic, complex disorders with persistent physical symptoms that may have no known explanation. Researchers believe they may involve interactions among physical, neurological, and psychological symptoms.
Psychodynamic psychotherapy is unique in its intense focus on patients’ emotions, childhood experiences, interpersonal relationships, avoidance tactics, and fantasy lives.
You may prefer it to other forms of therapy if you want to build a strong relationship with a single therapist, if you have long-standing problems in relationships, or if you feel “stuck” in a self-limiting cycle of thoughts and memories.
Related:Relationship Trauma: Signs, Causes, How to Heal
Efficacy
Psychoanalytic therapy has a somewhat controversial history as a clinical approach. Some researchers have expressed skepticism about the long-term efficacy of psychoanalytic therapy in treating mental health conditions.
However, recent evidence suggests that both short-term (fewer than 40 sessions) and long-term psychoanalytic therapy are effective in treating mental health symptoms and preventing them from returning.
Recent results about the potential efficacy of psychoanalytic techniques include:
A 2018 review in the Brazilian Journal of Psychiatry showed that psychodynamic psychotherapy was an effective and often less expensive than short- and long-term treatment for major depressive disorder (MDD).
A 2019 randomized controlled trial (a study that randomly assigns participants into a control group or an experimental group) in Psychiatry Research found that patients who underwent psychoanalysis experienced ongoing improvements in social functioning, personality, and self-concept 10 years after they began treatment.
A 2021 systematic review (study of evidence that answers a defined research question) and meta-analysis (using statistical methods to summarize study results) in the Journal of Psychodynamic Research suggested that short-term psychodynamic psychotherapy significantly reduced somatic symptoms in patients with FSDs, such as chronic pain and irritable bowel syndrome (IBS).
Cost
Effective long-term psychoanalytic therapy may take multiple weekly sessions across several years to complete, so many patients are concerned about cost.
The cost of psychoanalytic therapy varies widely based on your location, provider, and insurance plan. It may range from as little as $10 per session from an analyst-in-training to over $250 per session with a highly qualified senior analyst. Some clinicians offer sliding-scale fees based on your annual income.
APsaA offers a list of low-fee clinics and other resources to help you find affordable psychoanalytic therapy in your area.
Who Should Avoid It?
While there is no agreed-upon group of people who should avoid psychoanalytic therapy, it may not be effective for everyone. There is limited evidence to suggest that psychoanalysis is effective in treating the following mental health conditions:
Psychosis (difficulty discerning what is real and what isn't)
Bulimia nervosa (BN)
Also, most psychodynamic psychotherapists are not able to prescribe medicines. Talk to your healthcare provider about getting a referral to a psychiatrist if you think you may need medication.
Summary
Psychoanalytic therapy, sometimes called psychodynamic psychotherapy, is a type of talk therapy that grew out of Sigmund Freud’s theory of psychoanalysis. Psychoanalysis is rooted in the idea that much of our behavior is motivated by unconscious thoughts, feelings, and memories that remain outside of our everyday awareness.
The goal of psychoanalytic therapy is to help the patient identify self-limiting patterns, heal from past experiences, and gain insight into how their unconscious mind influences their behavior. Psychoanalytic therapists use free-flowing conversation, usually in at least one session per week, to accomplish this goal.
Other psychoanalytic techniques include dream analysis, free association, interpretation, and transference analysis.
A Word From Verywell
If you’d like help with mental health symptoms, relationship problems, or emotional distress, you might want to consider psychoanalytic therapy. Reach out to therapists who are trained in psychoanalytic techniques to see if their approach might be right for you.
Frequently Asked Questions
How is behavior therapy different from psychoanalysis?
Psychoanalysis differs from other forms of psychotherapy, such as cognitive behavioral therapy (CBT), in its heavy focus on uncovering repressed memories, thoughts, and emotions from the past that may influence current behavior.
Behavioral therapy techniques aim to change maladaptive behaviors. It does this with various techniques to support desired behaviors and extinguish problematic ones.
Psychoanalytic therapy also places more emphasis on the therapist-patient relationship, including the unconscious feelings and motives that both parties bring to the table.
Other unique characteristics include the focus on exploring fantasies and dreams, frequent discussion of formative memories from childhood, and the goal of identifying recurring self-destructive patterns in thinking, emotions, and behavior.
What is the role of the therapist in psychoanalytic therapy?
The role of the therapist in psychoanalytic therapy is to help the patient achieve greater emotional freedom, bring unconscious thoughts into conscious awareness, and identify self-defeating patterns of thinking and behavior.
They do this through techniques such as dream analysis, free-flowing conversations, transference analysis, interpretation, and free association. With these techniques, psychoanalytic therapists attempt to help their patients gain insight into how their past experiences inform their present behavior.
How long does psychoanalysis usually take?
Short-term psychoanalysis for a specific purpose may take just 20–30 sessions. Long-term psychoanalytic therapy may take up to seven years. In some cases, full-fledged psychoanalytic therapy requires multiple weekly sessions.
Who founded psychoanalysis?
As a theory, psychoanalysis was founded by Austrian neurologist Sigmund Freud in the late 19th century. His 1899 book, The Interpretation of Dreams, is considered one of the most significant texts in the discipline.
Some of the most important ideas in his initial theory involved the dynamic unconscious (the thoughts, feelings, and memories that remain outside of our conscious awareness) and the belief that unconscious drives motivate our everyday behavior.
