Psychoanalysis has a reputation for being outdated. However, this psychological technique is making a comeback as research shows it's at least as effective as cognitive behavior therapy—and may be even more so. You probably already have some ideas about what psychotherapists do. Let us correct those for you.
The term "psychoanalysis" conjures the image of a patient crying on a couch as their therapist prompts them to "Tell me how you feel about your mother." It's an archaic cliche perpetuated by bad movies: the actual practice moved on long ago. Sigmund Freud, the founder of psychoanalysis, might not even recognize the discipline he helped to create as it exists today.
So many myths about psychoanalysis are routinely repeated as absolute fact that even clinical psychologists tend not to have an accurate idea of what psychoanalysis (sometimes called psychodynamic psychotherapy) actually is or what the mental health professionals who specialize in it do.
Professor and clinical therapist Jonathan Shedler, PhD, explains that he begins his classes for clinical psychology doctoral students by asking them to write down their beliefs about psychoanalytic therapy. Their misconceptions include the ideas that "psychoanalytic concepts apply only to the privileged and wealthy; that psychoanalytic psychotherapy has been empirically invalidated; that psychoanalysts reduce 'everything' to sex and aggression; that they keep patients in long-term treatment purely for financial gain... and that the terms 'psychoanalytic' and 'Freudian' are synonyms—as if psychoanalytic knowledge has not evolved since the early 1900s."
The idea that psychoanalysis is dead, having been effectively replaced by cognitive behavioral therapy (or CBT) is yet another myth. While it's true that CBT is a much more commonly employed type of therapy, it's also true that many of the core foundational principles of psychoanalysis have become basic, taken-for-granted concepts in psychology. And there's still demand for psychoanalysts because different therapeutic approaches work for different people.
So, let's clear up some misconceptions. In this article about what does a psychoanalyst do, we'll answer the following questions:
Psychoanalysts are therapeutic clinicians who practice modern variants of therapies first developed by Sigmund Freud in the late 1800s. Some psychoanalytic therapists are licensed psychologists, but not all. Others are psychiatrists, social workers, and counselors. Their discipline, psychoanalysis (sometimes called psychotherapy), is defined by an intense form of talk therapy that dives deep into patients' pasts and their unconscious thoughts, fears, and desires.
Psychoanalysts operate under the assumption that people and their problems are much more complex than they appear at first glance. In psychoanalysis, the conscious mind is only a tiny piece of who we are, and the much larger unconscious mind has been shaped in ways—both positive and negative—by our early experiences and relationships. Psychoanalysts help patients work through the process of uncovering and coming to terms with the impact of the unconscious mind on their lives so they can work through their issues. You could reasonably say that psychoanalysts don't solve their patients' problems but rather empower them to tackle those problems head-on.
The stereotypical image of the psychoanalyst sitting just out of sight while a patient, reclining on a couch, free associates about experiences, feelings, and fears isn't too far removed from the truth. Clinical psychoanalysts may sometimes ask questions or offer prompts when they see patients. Still, their primary purpose is to listen thoughtfully (many psychoanalysts don't even stop listening to take notes) and identify connections between the workings of the unconscious and a patient's emotional state, fears, or mental health issues. Their goal is to help the patient tap into their own unconscious mind to discover and understand what internal motivators are driving their thought processes, personality traits, and behaviors.
A psychoanalyst might prompt a patient to talk about their:
In the process, a psychoanalyst develops a bond of trust with that patient that helps create a safe environment for them to dig more deeply into their unconscious self. What they may not do is ask patients to lie on a couch during sessions, because there's no conclusive proof that supineness helps people open up. Freud himself didn't use the couch because it had clinical value but rather because he couldn't bear the persistent gaze of his patients.
There are also career paths in psychoanalysis that don't involve working with patients in a clinical capacity. That's because psychoanalysis is both a clinical method of treating patients and a psychological theory. Many psychoanalysts are researchers trying to increase our understanding of human behavior, development, motivation, emotions, and relationships. You can find psychoanalysts working in academia, education, sports, the arts, and the business world. What these psychoanalysts do is sometimes referred to as "applied psychoanalysis" because it applies psychoanalytic theory in fields other than psychoanalytic therapy.
Psychoanalysts treat the same kinds of patients that other types of psychologists and counselors treat: that is, all kinds. People choose to work with psychoanalysts because they are struggling with:
Most psychoanalysts work with individual patients, but some treat families or oversee group therapy sessions.
The therapeutic technique that defines traditional psychoanalysis is free association. Unlike other types of therapists, psychoanalysts don't typically engage their patients in back-and-forth conversation (as a psychologist specializing in CBT might). The patient can talk about whatever is on their mind, and their analyst may purposefully choose not to respond for some time, so the patient has time to reveal what's happening in their unconscious. The psychoanalyst listens for patterns, themes, contradictions, or connections in the patient's monologue and uses these to help the patient see how they may be affecting their current patterns of behavior and relationships.
Psychoanalysis can sometimes succeed where CBT and other forms of therapy fail. Some patients fare best in treatment that places more of the onus of discovery and problem-solving on them, as psychoanalysis does.
Anyone can become a psychoanalyst, but the educational requirements are rigorous. Psychoanalytic institutes and programs at colleges and universities accredited by the American Psychoanalytic Association (APsaA) accept students with the following qualifications:
Aspiring psychoanalysts typically opt for psychology degrees or social work degrees at the undergraduate level, though your bachelor's degree major will matter less than the master's degree or doctoral program you choose.
Psychologists and social workers who want to become psychoanalysts also need to meet high ethical, psychological, and professional standards—and have extensive clinical experience.
Yes, psychoanalysts receive professional-level specialist training, and that's part of what sets them apart from other types of psychologists. Psychoanalytic training programs are intensive and can last for years. Some of these are offered by universities (the Columbia University Center for Psychoanalytic Training and Research has a psychoanalysis certificate programs and New York University has a psychoanalysis postdoc program), but most are offered by private organizations like the American Institute of Psychoanalysis (AIP). The APsaA website maintains a full list of APsaA-accredited psychoanalysis programs. The Society for Psychoanalysis and Psychoanalytic Psychology also has a list of schools that offer psychoanalytic-friendly graduate programs.
The curriculum in most psychoanalytic training programs touches on:
In some programs, students specialize further in psychoanalysis for adults or psychoanalysis for children. Much like psychology and counseling degree programs, psychoanalytic training programs include supervised, hands-on psychoanalytic clinical training. Your training will include supervised work with at least three patients. Students must also undergo an in-depth personal analysis during their training—which not all therapeutic specialties require—so they have a better understanding of what it's like on the other side of the couch.
Most training programs for psychoanalysts take four or five years to complete, and most students in them have completed a four-year bachelor's degree and a two- or three-year master's degree or doctoral degree program. That's ten years of schooling, but you also need to consider that most psychoanalytic training programs require applicants to have significant clinical experience. It can take 14 to 16 years to become a psychoanalyst, which may be part of why so few psychologists and clinical social workers choose this specialty.
Some people perceive psychoanalysts as colder and less reassuring than other psychotherapists. You can probably chalk that up to the fact that a big part of the psychoanalytic technique involves merely listening. In other forms of psychotherapy, a therapist serves as a trainer or teacher and a source of reassurance; in psychoanalysis, therapists are very much focused on a patient's words and their delivery during sessions. They may not interrupt with words of comfort when a session gets intense because they don't want to break the patient's focus or mental processes. That doesn't mean that psychoanalysts aren't caring or empathetic, just that they are giving patients space to communicate without interruption.
Psychoanalysts may also see patients more frequently and for longer than therapists who specialize in CBT or other therapeutic techniques. That's not because psychoanalysts are in it for the money, but rather because the goal is to delve deeper into the patient's personality. That can take a long time, unlike CBT, which has a more limited set of strategies and techniques that are presented to patients based on their issues. Some patients see an analyst four or five times a week for years—if that's what they need. Others may only see their analysts once a week. In both cases, creating a plan for termination and ending is part of the process, just as in other forms of therapy.
The short answer is yes, psychoanalysis can be an effective mental health treatment. For a long time, researchers didn't treat psychoanalysis—aka talk therapy—as a scientific form of psychotherapy and so didn't bother to study its efficacy. It's only fairly recently that researchers have begun looking at how effective psychoanalysis is and how it stacks up against CBT and other therapeutic techniques. We may never know definitively which form of therapy is "the best," but plenty of studies have shown that psychoanalysis can be an effective treatment for depression, maternal mental health issues, and anxiety disorders. Psychoanalysis may be even more effective than CBT in some cases, and the results of treatment may actually last longer.
That's good news for anyone who has thought about becoming a psychoanalyst but didn't want to get involved in what is sometimes regarded as a soon-to-be irrelevant specialty. It's pretty clear that the modern psychoanalytic approach to therapy works. For those patients who've tried CBT and other brief behavioral therapies without finding relief, it may be a lifesaver.
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