About Psychoanalytic Psychotherapy

What is Psychoanalytic Psychotherapy?

Psychoanalytic psychotherapy is one of the many descendants of psychoanalysis, the famous ‘talking cure’ that was invented and promulgated by Sigmund Freud about a century ago. Psychoanalytic therapy (also sometimes referred to as Psychodynamic therapy) aims to help people who want to delve deeper into their psyche and gain valuable understandings about their lives but, for one reason or another, would not best benefit from intensive psychoanalysis (i.e., four or five sessions per week, with the patient lying on a couch).

What is unique about Psychoanalytic Psychotherapy?

Some premises and positions of psychoanalytic therapy that distinguish it from other types of therapy are as follows:

  • Alongside our everyday, conscious awareness, our mind has a parallel life of its own that is normally out of our conscious reach. We may have some explanations for what we want or don’t want, whom we like or dislike, and why we do what we do, but most of the time we are unaware of the real, unconscious forces that affect our feelings, thoughts, decisions, and actions.

  • The early years of our lives play a crucial role in shaping our unconscious minds. This doesn't mean that we are solely defined by what we have been through in the past. Abundant empirical evidence on the effectiveness of psychoanalytic psychotherapy indicates that we are more than just helpless victims of our childhood. However, during our development, we form cognitive, emotional, interpersonal, and behavioral patterns that continue to influence our lives today. These patterns are often the root cause of our difficulties and may need to be changed.

  • Because all of us have unconscious minds and have formed unconscious patterns in life, we need a companion (in the case of psychotherapy, a therapist) who can observe and bring to our awareness what we most frequently miss (our ‘blind spots’).

  • Since our emotional and behavioral patterns are formed through many years and in response to a myriad of interpersonal experiences, it takes time to become aware of them and grasp the full range of their influence. That is one reason why psychoanalytic therapy doesn't have a set number of sessions; it is usually long-term and open-ended.

  • However hard it may be, curiosity about our psychological suffering could prove useful. It may sound odd, but oftentimes what urges us to seek help is not the most important issue we need to address. This is not to say that our symptoms are not important. Depression, anxiety, obsessions, relational conflicts, identity confusion, and substance-related problems are among the most common psychic ailments that afflict many of us at some point or other in our lives. It's only natural to want them gone. However, most of the time they are just the tip of an iceberg, worthy of closer examination. This spirit of constant curiosity, of not readily taking symptoms and issues at face value, is the hallmark of psychoanalytic psychotherapy.

Some people prefer to acquaint themselves with a therapy before embarking on it.  If you're one of them, welcome to this page! As someone who is considering psychotherapy, it's your right to have a general idea about what you're about to experience. To honor this right, I aim to outline psychoanalytic therapy and highlight its main distinctions from other therapies.

At the same time, I believe nothing compares to experiencing therapy firsthand to fully understand what it's like and decide whether or not it's for you. If you've never been in psychoanalytic therapy, you may want not to bias yourself too much with preconceptions but to approach it with the openness and curiosity of a debutant. Remember that each course of therapy is, first and foremost, a unique human encounter. In this encounter, you and your therapist will embark on and navigate your journey toward understanding and healing in a way no one has ever done.

Psychoanalytic Therapy Vs. Other Therapies

There are many, many types and brands of psychotherapy out there. It's not my aim -let alone that it's impossible- to compare psychoanalytic therapy with every other therapeutic approach. However, I've found that sketching a rough schema of two major categories of psychotherapy can help patients choose the ones that would probably fit them best. 

The first category comprises therapies that are derived from psychoanalysis, but each is modified to address the needs of a different group of patients (or the same patient at different points in time). These include psychoanalysis, psychoanalytic therapy, psychodynamic therapy, transference-focused psychotherapy (TFP), mentalization-based therapy (MBT), interpersonal psychodynamic therapy (IPT), etc.

In the second category, you can find therapies mainly related to the cognitive and behavioral traditions in psychology. Some of the most popular are cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), emotion-focused psychotherapy (EFT), acceptance and commitment therapy (ACT), mindfulness-based therapy, etc.

Now, it's not the question of which therapy is superior or inferior. In terms of effectiveness, all of them are quite effective in helping patients better manage their lives. However, none of them is suited for everyone. It's more the question of which one is best for your current "self" in the current constellation of your needs, concerns, and preferences. I hope the following distinctions (again very rudimentary and not necessarily precise) can help you decide what's more interesting to you:

  • In the first category, therapy aims to gain a deeper understanding of who you are and what you want to be as a human being, while in the second category, the aim is more to resolve the specific issues with which you come to therapy. In other words, the first one is more 'insight-oriented' and less concerned with alleviating your immediate symptoms, while the second one is more 'problem-focused' and usually makes reducing your symptoms its priority.

  • In the first category, usually (not always) no prior agenda is set for the therapy sessions. You go to each session and express your thoughts and feelings that seem the most pertinent to that particular moment (i.e., you free associate). It's only after some time that you will notice a convergence of seemingly unrelated themes that had been brought up in different sessions. In contrast, in the second category, the agenda for each session is more or less set beforehand. You know what you're going to discuss in the next session, and there's a sense of continuity in the activities you and your therapist do together to tackle your problems.

  • In the first category, the therapist is less directive. They usually refrain from telling you what they think is correct/incorrect or what you should do or not do in a certain situation. Instead, they try to give you more space to express yourself as freely as possible, to find your own voice. They also try to listen attentively to your concerns and pose pertinent questions and comments. In the second category, the therapist is more active and directive. They may give you advice on some issues or provide what we call 'psychoeducation' to orient you to the basics of a matter in a professional way.

  • In the first category, you'll most probably not have any specific tasks to focus on or assignments to do between sessions. In the second category, it's very common for the therapist to give you assignments and ask you to practice specific skills and discuss their results in the next session.

  • The therapies in the first category are, by nature, usually long-term, taking at least several months and, not infrequently, many years. On the other hand, the course of the therapies in the second category is often shorter, usually taking less than a year to complete. However, it's not uncommon for people to continue their cognitive-behavioral therapies for years, as it's not uncommon for psychodynamic therapists to adjust their treatment for patients who can benefit more from shorter-term therapies.