What is Psychoanalytic Therapy?

When people hear the word “psychoanalytic therapy,” they usually picture the classic image of a patient lying down on a couch, talking nonstop, while the therapist sits quietly behind them, just nodding or taking notes. And that’s not entirely incorrect, because that’s pretty much how Sigmund Freud, the founder of psychoanalysis, set things up.

In its original form, what we call psychoanalysis was an intense therapeutic approach. Patients came to sessions four to six times a week, at least for several months, sometimes for years. They would lie down on a couch, face away from the therapist, and say whatever popped into their minds. This process—called free association—is believed to be a very effective way to dig below the surface and to uncover hidden conflicts and desires.

Now, this method of psychoanalysis is still alive, still practiced by some therapists; it’s very effective, and for certain people, it’s even the therapy of choice. But psychoanalysis has evolved a lot since then, both because in practice it’s not affordable (many of us don’t have the time, money, or motivation for such intensive work), and also because this format isn’t ideal for some people with certain types of problems, or it could even be counterproductive for them.

Over the decades, newer versions have been developed. These are often called psychoanalytic therapy or psychodynamic therapy. So psychoanalytic approaches try to keep the spirit and depth of Freud’s method but adjust the frequency and format of the sessions to better fit the needs and lifestyle of modern patients.

So today, you may find a therapist who’s trained in psychoanalysis, might have gone through years of their own intensive therapy, but when they see patients, it might be just once or twice a week, sitting face-to-face, and sometimes without a couch at all. The essence is still there—it’s just more flexible, more affordable, and easier to fit into a busy lifestyle.

What Makes Psychoanalytic Therapy Really “Analytic”?

Now, what makes psychoanalytic therapy different from other therapies, like cognitive-behavioral therapy or solution-focused approaches?

There are a few core ideas (most analysts and authors believe there are at least three of them) that give psychoanalytic therapy its unique flavor.

The first one is the concept of the unconscious mind. The idea is that a huge part of what goes on in our minds isn’t conscious. Think about the times you’ve said, “I don’t know why I did that” or “Why do I keep ending up in this same situation?” Those are clues that there are some unconscious processes at play.

For example, maybe you keep choosing partners who are emotionally distant. Consciously, you might tell yourself, “This time I’m going to find someone different.” But somehow, you end up in the same place. In psychoanalytic therapy, we’d ask: what unconscious pattern is being repeated here? Maybe it goes back to childhood—maybe, in your early years of life, closeness felt unsafe, so part of you unconsciously keeps recreating scenarios of distance and detachment, even if you’re unhappy about it.

And that brings us to the second idea, the developmental perspective. Psychoanalytic therapists pay a lot of attention to childhood and early relationships. That doesn’t mean they’re obsessed with the past and you’re going to get stuck in old memories forever, but because those early years often create the blueprint for how we think, feel, and relate as adults.

Let’s say you grew up in a family where you had to be the “responsible one,” always taking care of others or making compromises possible between them. As an adult, you might notice you struggle to ask for help or feel guilty when you put your own needs first. Those patterns didn’t just appear out of nowhere—they started early, you’ve practiced them hundreds if not thousands of times in different situations, and what therapy does is to help you trace them back, understand them fully (and not just at a cognitive level, we know that’s not enough, but also at an emotional and bodily level), and find new ways of responding.

The third core idea of psychoanalytic therapy is that the therapy relationship itself is extremely important. In many other therapies, the therapist tries to stay focused on your presenting problem, your emotional or behavioral symptoms, and your complaints. But in psychoanalytic therapy, the relationship between you and your therapist becomes part of the work, because the therapy situation can serve as a microcosm that reflects how things are really going in your life outside the sessions.

Imagine you start feeling like your therapist doesn’t really care, or maybe you feel angry with them, or you find them attractive, or you get disappointed at them. In most other types of therapy, you’d probably keep those feelings to yourself. But here, you’re encouraged to talk about them. Those reactions may come from your objective evaluation of the sessions, but very often, they can also reflect older patterns from past relationships. By bringing them into the open and exploring them with your therapist, you can better understand them and eventually change how you respond.

Everyday Examples of How It Works

Imagine you get into arguments with your partner about tiny things—like who forgot to buy milk. On the surface, it’s about groceries. But underneath, maybe it touches on old feelings of being neglected, unseen, or dismissed. Therapy helps you connect the dots between the small fight and the bigger emotional story.

Or let’s say you often feel like your achievements never measure up, no matter how hard you try. That feeling might link back to a childhood where love or approval was tied to performance. Therapy can help you loosen that knot so you’re not endlessly chasing validation.

These examples show how psychoanalytic therapy goes deeper than symptoms. It asks: what’s underneath? What story is being replayed?

Why Consider Psychoanalytic Therapy?

And finally, why choose psychoanalytic therapy when there are many other types of usually shorter-term therapy out there?

One big reason is that psychoanalytic therapy focuses on depth and lasting change. Many therapies are great at helping reduce symptoms like anxiety or depression, and that’s incredibly valuable. But psychoanalytic therapy also helps you understand the roots of those struggles. Say you suffer from social anxiety symptoms, and you constantly feel nervous in situations that require social interaction. In therapy, instead of just learning exposure or relaxation techniques (which are, again, very useful and necessary skills to learn), we’d also ask why. What’s the deal with this anxiety? Where does it come from? What memories does it bring up? Are there any other emotions (like anger, sadness, resentment) that feed your anxiety? When you get to the bottom of the pattern—when you understand why you feel and act the way you do—you’re less likely to fall back into the same cycle later.

Another reason is that it gives you something you may not easily find in other therapy approaches: a time and a space to really reflect. In our daily lives, we’re usually rushing—we’re so impatient to check off tasks and get rid of our problems as soon as possible. And we naturally bring this expectation with us to the therapy room. Psychoanalytic therapy is one of the few places where you can slow down and take a close look at yourself. Unlike some solution-focused therapies, it’s not about quick fixes—it’s about creating a more solid sense of who you are, and it’s not shy to acknowledge that any meaningful change takes time; it requires commitment, patience, and intentional dedication. For many people, this process is not just healing but transformative. It can lead to healthier relationships, more self-confidence, and the freedom to live in ways that feel more mature and more authentic.