“Being entirely honest with oneself is a good exercise.”
― Sigmund Freud
Sounds easy, doesn’t it? The truth is, being honest with yourself can be hard. Really hard. Sigmund Freud, the father of psychoanalysis, knew this to be true—and it became foundational to his approach.
What is psychoanalysis, and how is it different from traditional psychotherapy?
One fundamental way in which the two treatment methods differ is their premise: Psychotherapy assumes that people want to change—and that by giving patients the right tools and support, therapy can facilitate that change. Psychoanalysis starts with the acknowledgment that unconscious factors can support an individual’s tendency to remain emotionally stuck. Psychoanalytic treatment, therefore, addresses these unconscious dynamics in an effort to loosen their grip on an individual’s psyche. Freud aptly called it “analysis of resistance.”
For patients who haven’t been successful in traditional psychotherapy, analysis may be a treatment approach worth considering. Unfortunately, psychoanalysis is widely misunderstood.
Psychoanalysis: 8 Common Myths—and Realities
The goal of psychoanalysis is to uncover, address and remove the unconscious thoughts that get in the way of a patient’s ability to make emotional progress. Psychoanalysts are highly trained—first, as psychotherapists, with six to ten years of additional training required to become an analyst—to facilitate this deeper dive into the psyche.
The process is neither fast nor simple. It is, however, laden with common myths, including the following:
Myth #1: It’s all about sex.
Because of generally limited public knowledge of Freud, many people believe that he focused on sex—and only sex. That’s simply not true. Psychoanalysis is really about uncovering the workings of the unconscious mind. Sexuality, while deeply entwined in the human condition, is only one of many, many factors that influence the inner workings of the mind. Can sexuality be discussed in analysis? Yes. Is it all about sex? Hardly.
Myth #2: Psychoanalysis only focuses on the past.
While this is another common misconception around psychoanalysis, the truth is, the unconscious knows no time. The past unquestionably informs—and impacts—the present, but psychoanalysis focuses on the here and now. Analysis considers not only what takes place in a patient’s day-to-day life, but also what transpires in the office between patient and therapist.
Myth #3: You have to lie down on a couch.
Depending on the analyst, there are no “have-to’s.” Does analysis work better if the patient is lying on a couch? That depends on who you ask—and on the patient. Humans are conditioned to read other humans’ facial expressions, monitoring and assessing them as a way to seek nonverbal feedback. A prone position can be very useful in cutting down on this “visual noise.” That said, you don’t have to lie on a couch anymore, especially in instances where sitting is more comfortable for the patient. Children, adolescents, and particularly fragile (or severely psychotic) adults will typically sit up during analysis.
Myth #4: Analysis goes on “forever.”
Because psychoanalysis facilitates a deeper understanding of the unconscious mind, change occurs on a much more profound level than traditional psychotherapy. As such, treatment can take longer. But it doesn’t have to go on forever. While every case is different, patients typically spend anywhere from five to eight years in treatment. This timeline is similar to long-term psychodynamic psychotherapy.
The frequency of analysis is a somewhat controversial subject, and varies by analyst. Usually, analysts meet with patients either three or four days per week.
Myth #5: Research doesn’t support analysis.
Significant research supports the efficacy of psychoanalysis (as well as other types of psychoanalytic treatment). Published in 2010, “The Efficacy of Psychodynamic Therapy,” is perhaps the most well-known modern-day review of psychoanalysis. The evidenced-based paper was written by Jonathan Shedler, PhD., an internationally recognized author, master clinician and former Director of Psychology at the University of Colorado Hospital Outpatient Psychiatry Department. A 2014 Australian meta-analysis also found significant and lasting improvements in patients who had received psychoanalysis, even after termination of therapy.
Because research supports its effectiveness, the healthcare system in many countries—including France, Italy, Finland, Switzerland, Portugal and Argentina, for example—reimburse patients for psychoanalytic treatment.
Myth #6: Psychoanalysis is for the wealthy.
Because of their portrayal in movies and on TV, analysis patients are often mis-stereotyped. In reality, there is no “typical” patient—and psychoanalysis can be an accessible treatment option for everyone. Many psychoanalytic institutes and analysts in private practice allocate resources to make psychoanalysis available to all patients, regardless of socioeconomic level. Most institutes offer clinics that provide services to patients with limited resources. Staffed by (supervised) analysts-in-training, these clinics usually offer low- or no-cost treatment options for patients in need.
Myth #7: Adults only!
Many people believe that psychoanalysis is reserved for adults. In truth, analysis can be a very powerful treatment option for children and adolescents—particularly when traditional psychotherapy isn’t effectively addressing issues that are severely disrupting their lives.
Related: Are your teen’s emotional outbursts “normal,” or is it time to reach out for help? Learn more about psychotherapy for adolescents.
Psychoanalytic treatment for kids and adolescents may look different than it does for adults; children don’t usually lie on a couch and talk about their inner thoughts in the same way that adults can. But they do have unconscious thoughts and feelings that can profoundly impact their emotional wellbeing. Analysis can help address and process these thoughts.
Myth #8: Analysts are silent all the time.
Psychoanalysis often conjures images of an old, Freudian-style analyst who simply nods as the patient talks. This is another outdated stereotype. The analyst and patient both contribute to the process. In my practice, I’m just as verbally interactive with my analysis patients as I am with my traditional psychotherapy patients. The approach is slightly different, but the goal is to reflect back to the patient what they are saying to me, facilitating a greater discovery and understanding of their unconscious thoughts and feelings. I can’t do that if I remain silent.
Despite outdated notions and common misperceptions, psychoanalysis is a powerful, highly effective treatment approach for many patients. In the words of Freud, “Unexpressed emotions will never die. They are buried alive and will come forth later in uglier ways.” Analysis can help unearth—and process—those unconscious emotions, paving the way for psychological growth.
Emotional honesty takes bravery. It can also require support.
Is psychoanalysis right for you or someone close to you? To learn more about this treatment approach, visit our Psychoanalysis page—and feel free reach out to us at 847-729-3034 with any questions you might have.