Psychoanalysis has come a long way since Sigmund Freud proposed that people's issues were caused by vexing unconscious forces—and possibly also by their mothers. This type of therapy is still largely marginalized in a world where CBT rules, but it's making a comeback thanks to a unique approach that resonates with some patients.
The popular image of psychoanalysis looks a lot like a New Yorker cartoon: patient on a couch, uncomfortably dredging up long-ago traumas and repressed fears. The doctor likely has a beard and glasses, is scowling, and looks, not coincidentally, like Sigmund Freud.
Freud is the progenitor of psychoanalysis, and more than a century later still the source of many popular conceptions (and misconceptions) about this form of therapy. A man of his more-inhibited times, Freud had some oddball ideas—especially about sex, the long-term impact of potty training, and women—but he also had plenty of good ones. The latter of which form the basis of modern psychoanalysis.
In a piece on the American Psychological Association’s Monitor On Psychology website, professor and clinical therapist Jonathan Shedler, PhD, put it his way:
“The development of psychoanalytic thought did not end with Freud any more than the development of physics ended with Newton, or the development of the behavioral tradition in psychology ended with Watson.”
Psychoanalysis (sometimes called psychodynamic therapy) is a branch of clinical psychology that has been much-maligned thanks to some of Freud’s wackier beliefs. It’s also one that has markedly changed since he coined the term in 1896.
Are you thinking about pursuing a career in psychological therapy? Considering undergoing therapy? Either way, you need to know the difference between a psychologist and a psychoanalyst. In this article, we’ll answer the following questions:
The shortest and simplest answer is that psychology is a discipline and psychoanalysis is one technique within that discipline, making psychoanalysts a type of psychologist. The problem with this simplistic answer is that not all psychoanalysts are psychologists. Some are psychiatrists or even clinical social workers. Freud would probably tell us to dig deeper to answer this question, so let’s break it down.
The practical approach is actually mostly the same. Both clinical psychologists and psychoanalysts meet with patients, ask them questions, listen to their answers, and offer ways to help them feel better. The most significant differences usually involve the types of questions practitioners ask and the solutions they offer.
Psychologists operate under the assumption that, given the right tools and strategies, people can learn to think about themselves and their lives differently. As a result, they can face fear, overcome depression and anxiety, manage the symptoms of a mental illness or post-traumatic stress disorder, or just enjoy life more. Some psychologists dig into patients’ pasts to look for the root causes of their issues, but in general, most employ a forward-thinking approach to problem-solving commonly known as cognitive behavioral therapy (or CBT). The governing idea is that our thoughts contribute a lot more to our feelings than our circumstances, so a shift in mindset can make us happier or less prone to depression and anxiety.
Psychoanalysts believe that patients (and their issues) are a lot more complicated. Understanding—not eliminating—the feelings underlying depression and anxiety is the better way to help people achieve mental health and emotional wellness. Psychoanalysts operate under the assumption that the conscious mind is only a tiny piece of who we are, and that the unconscious mind (which has been shaped by our early experiences and relationships) contributes a great deal to our issues and sometimes to our resistance to working on them.
CBT, with its practical, science-based, standardized approach, has become the norm in psychotherapy, but some people—especially those resistant to change—respond more readily to psychoanalysis’ deep-dive approach.
Broadly yes, in that practitioners in both fields want to help clients get better. However, when you look at what psychologists and psychoanalysts try to do when they’re working with patients, you’ll see that their session-to-session goals are often very different.
Clinical psychologists want to shape how patients think about their lives and themselves. To that end, they provide:
Psychoanalysts, on the other hand, want to help patients explore how they relate to themselves and why, so they can better understand their thoughts, feelings, and desires to move past psychological distress.
Psychoanalysis—or rather, the stereotypical caricature of psychoanalysis—strikes many people as old-fashioned and silly. It’s essential to recognize that psychoanalysis didn’t fall out of favor because it was ineffective or less effective than other forms of therapy. There are lots of different therapeutic approaches—e.g., humanistic, behavioral, and integrative—and they go in and out of fashion. There’s a growing body of research showing that psychoanalysis works at least as well as other therapeutic approaches. That means that there’s definitely a place for psychoanalysis in today’s therapeutic landscape.
This may be the most common and the most persistent myth about psychoanalysis, thanks to Freud’s psychosexual theory of personality. He was definitely fascinated by the role sexuality plays in the human experience and human behavior. Modern psychoanalysis is more interested in holistic human experience.
Many, but not all, psychoanalysts still do invite patients to lounge on the couch while they sit out of sight. That may be because people are more open to sharing when in a supine position or less likely to engage in banter when not sitting eye-to-eye with a therapist. However, it’s worth pointing out that Freud didn’t use the couch because it had clinical value. He came up with the idea because he couldn’t bear to be stared at all day long.
When Woody Allen’s character is awakened from a 200-year state of suspended animation in the movie Sleeper, he observes: “I haven’t seen my analyst in 200 years. If I’d been going all this time, I’d probably almost be cured by now.” Psychoanalysis can indeed be more involved and take longer than cognitive behavioral therapy because psychoanalysts are working to help patients understand themselves. Like all therapeutic approaches, however, the frequency of appointments depends on the needs of the patient. Termination of therapy is part of the process.
Psychoanalysts are actually obsessed with the unconscious. People working with psychoanalysts often talk about their pasts quite a bit as part of talk therapy, but primarily as a way of understanding the present.
Yes and no. To practice independently in a clinical capacity, psychologists need to earn either a PhD in psychology (a research-focused degree) or a Doctor of Psychology (PsyD), a degree that follows a practice-based educational model explicitly designed for aspiring clinicians. The typical psychology curriculum teaches a relationship-based client-centered approach to therapy and the foundational principles of cognitive-behavioral therapy.
The right degree plus the requisite number of supervised clinical hours and a license is all you technically need to practice as a psychologist. However, many psychologists decide to pursue board certification or specialty certifications in addition to their education and training.
To become a psychoanalyst, practitioners must complete an intensive psychoanalytic training program approved by the American Psychoanalytic Association (APsaA). Students in these programs are usually psychiatrists with MD or DO degrees and therapists who’ve earned a PhD in either psychology or social work. Some programs also accept students who have earned a master’s degree in social work or a master’s degree in psychology. Most programs require that students previously train and work providing therapy as a clinical therapist, clinical counselor, or clinical social worker.
There are psychoanalytic training programs offered by universities (like the Columbia University Center for Psychoanalytic Training and Research’s certificate programs in psychoanalysis and New York University postdoc program) and private organizations like the William Alanson Institute. The curriculum in psychoanalytic training programs typically touches on:
Much like psychology and counseling degree programs, psychoanalytic training programs include supervised, hands-on psychoanalytic clinical training. They also typically require students to undergo their own period of in-depth analysis with a psychoanalyst as part of their training. You can think of the education psychoanalysts receive as professional-level specialist training.
Current research does not have a definitive answer to this question, but the results of many studies suggest that neither is better nor worse than the other. There are pros and cons to both approaches, and a patient’s needs or personality can have a big impact on which works better in any given situation. While some research indicates that psychodynamic or psychoanalytic therapies may be even more effective than cognitive-behavioral therapy for treating depression, improving maternal mental health, and reducing anxiety, you can find other studies that suggest that the type of therapy someone receives is less important because all legitimate treatments for conditions like depression are equally effective.
If you decide to become a psychoanalyst or to become a psychologist, you’ll probably find that the “therapy wars, as Oliver Burkeman called them in the Guardian, haven’t had much of an impact on the field. Every practitioner (not to mention every patient) has a preferred approach, but all of them want to help people live their best lives.
As psychoanalyst and clinical psychologist Peter Fonagy put it in the APA piece linked above, “The important thing is finding the psychological therapies that work best for particular patient groups.”
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