Psychoanalysis is an intensive version of psychotherapy in which issues are addressed deeply and comprehensively. The frequency of meetings and continuity of the process allows people to make profound changes. Both children and adults can engage in psychoanalysis. For younger children, the process involves play as the medium of the work. For a clear and comprehensive description of psychoanalysis, take a look at this essay from the American Psychoanalytic Association (APsaA).


Adult Psychoanalysis

Psychoanalysis as a type of treatment

What is psychoanalysis about? What sort of help does the analyst offer, and what will be expected of me? How does treatment work, and how will I know if it is working for me?

Psychoanalysis is based on the observation that individuals are often unaware of the factors that determine their emotions and behavior. Because these factors are unconscious, the advice of friends and family, the reading of self-help books, or even the most determined efforts will often fail to provide enough relief. Psychoanalytic treatment explores how these unconscious factors affect current relationships and patterns of thought, emotion and behavior. Treatment traces theses patterns back to their historical origins, considers how they have changed and developed over time, and helps the individual to cope better with the realities of their current life situation. Analysis can be viewed as an intimate partnership, in the course of which the patient becomes aware of the underlying sources of his or her difficulties, not simply intellectually but emotionally as well – in part by re-experiencing them with the analyst. From the beginning of therapy, patient and analyst work together to build up a safe and trusting relationship that enables the patient to experience aspects of his or her inner life that have been hidden because they are painful, embarrassing, or guilt-provoking.

In psychoanalysis, the patient typically comes four times a week, lies on a couch, and attempts to communicate as openly and freely as possible, saying whatever comes to mind. These conditions create the analytic setting, which enables you to become more aware of aspects of your internal experience previously hidden. As you speak, hints of the roots of current difficulties that have been out of your awareness gradually begin to appear – in certain repetitive patterns of behavior, thought and emotion, in the subjects which you find hard to talk about, in the ways you relate to the analyst. The analyst helps to identify these patterns, and together you and the analyst refine your understanding of the patterns that limit you or cause you pain, and help you elaborate new and more productive ways of feeling, thinking and behaving. During the years that an analysis takes place, you wrestle with these insights, going over them again and again with the analyst and experiencing them in your daily life, fantasies, and dreams. You and the analyst join in efforts not only to modify crippling life patterns and remove incapacitating symptoms, but also to expand your freedom to enjoy intimate relationships and professional and personal pursuits. Gradually, you will change in deep and meaningful ways; you may notice changes in your behavior, relationships and sense of self.

Before beginning psychoanalytic treatment, many people find it helpful to learn about some of the specific kinds of experiences that people often have when they start in analysis. You may find that your analyst will talk less once the treatment begins. He or she will listen carefully to what you have to say, let you structure the sessions and set an agenda, allowing you to take the lead.  He or she will speak when he or she has something to add to what you are saying. This may feel strange at first – people quite naturally expect their analyst to tell them what to talk about or to give them advice about how to solve their problems. But learning to watch where your thoughts and associations take you, without undue interference, is a vital part of the analytic process. Also, psychoanalysts understand that even the best direction and advice is limited in its potential to help you make meaningful and lasting changes in ingrained patterns of behavior and emotion. Instead of providing more advice, your analyst will help you develop a greater understanding of the internal forces that are behind the difficulties that lead you to seek help, to help you understand why you think and feel and do things the way you do. In the end, this will enable you to change patterns that no longer work for you. One of the key goals of analysis is freedom, including the freedom of your mind to range freely in thought and feeling.

It is very likely that problems in relationships are a part of the reason why you originally sought treatment. Relationships are often a source of conflict, and they are an important source of information in psychotherapy. It will be important to discuss your intimate thoughts and feelings about significant people in your life, both negative and positive, with your analyst—including any thoughts and feelings you have about your analyst. In contrast to a friend, a relative or a boss, your analyst is prepared to help you understand your experience – even if what you have to say is uncomfortable or seems inappropriate or rude. For example, if you think your analyst is condescending, clueless, intelligent, overprotective, attractive or unkind – whatever you are thinking or feeling at the moment – it is wise to share it with him or her. You will find that with your analyst you will be able to talk about anything that comes to your mind. Your analyst won't have any preconceived notions about what is right or what is wrong for you or what the best solution would be, and rather than repeating with you the sort of patterns you may encounter in life, he or she will help provide you with a new understanding.

At first, you may find it difficult to talk about how you are experiencing your analyst. So, just like the important issues that brought you into treatment, your analyst will encourage you to share your thoughts and feelings regarding your relationship with him or her. One way the analyst does this is by encouraging you to speak as openly and freely as possible, sharing everything in your experience – whatever thoughts and feelings come to mind at the moment in session. Ordinarily, people edit many of their thoughts and feelings, or may have never even put them into words before, because they feel what they have to say is too personal, or trivial, may hurt other people's feelings, or is simply absurd. Whatever the concern – it doesn't matter – it is important to share it with your analyst. What you think is too personal, trivial, hurtful, or absurd is often the key to something very important.

Your analyst will facilitate the therapeutic process by offering you use of the couch. Analysis is the only treatment in which the patient lies on a couch and does not look at the analyst. Lying on the couch and not looking at the analyst may seem strange at first but in most cases enables patients to think and feel more freely and spontaneously about their internal experience – and to express themselves without excessive concern about the analyst’s reaction. Most patients actually prefer to work this way and become quite comfortable once they get accustomed to lying down. Before long, you will find that you are able to talk freely and openly and you and your analyst will be able to collaborate in useful and unexpected ways that will help you grow.

While analysis is productive and useful in a number of ways, you will encounter apparent roadblocks along the way. Real lasting change does not come easy and is often accompanied by unexpected discomforts, diversions, and delays.  For some, this means feelings of anxiety or depression or crying episodes which may make you worry that you are getting worse. Or the opposite may be true. You may feel all your difficulties have vanished and you are ready to move on. For some, it means periods of silence, or spinning ones wheels, or boredom, or excitement, or a sense that nothing therapeutic is being accomplished. Sometimes you may even not want to come to sessions. You can be assured that such negative thoughts are completely to be expected, and they are typically a good indication that you are working on important issues.

To promote the kind of growth and change that analysis aims to accomplish requires time and energy, therefore, analytic treatment is open-ended. The treatment typically lasts for a number of years, a period to be mutually determined over the course of time by you and your analyst. Together, you and your analyst will decide when to end your treatment, and will spend some time processing the decision. It is important for you to talk about leaving treatment with your analyst before you stop coming. This period can be a most productive period of work, when you and your analyst review and organize your understanding of the work you have done together, and when you process your experience of ending this period of working together.

[Adapted from a piece written by Eve Caligor, M.D. and Lisa Piazza, M.D., Columbia University Center for Psychoanalytic Training and Research.]

Psychoanalysis as a “Theory of the Mind”

In addition to being a specialized type of therapy, psychoanalysis is also a comprehensive, in-depth theory of the mind. It has many applications. Using the uniquely psychoanalytic explanatory tools of the unconscious, transference and development, among others, psychoanalytic insight can enrich the understanding of human beings, their behaviors and motivations in a wide range of arenas from business to politics to sports, the arts, education, advertising, the law, literature, family relations, and popular culture.

While always acknowledging the uniqueness of the individual, and the infinite variation of human experience, psychoanalysis has, over the decades, developed a set of useful understandings about common human psychological experiences. For example, we know that human beings often have a powerful, unconscious need to idealize their leaders and others in authority, and that they can become angry and vengeful when idealized figures disappoint them. This psychoanalytic concept, one of many hundreds, can be extremely valuable in understanding certain political phenomena.

The themes of psychoanalysis are those found in great literature – power, ambition, insecurity, ideals, attachment, isolation, longing, and so on. The careful studies of psychoanalysts have enabled us to develop an explanatory theory that puts these great passions in context and allows us to predict the course they may take.

Essentially, psychoanalysis is about the story of human beings, what motivates, inspires and sometimes cripples them, but it looks at these phenomena and tells a story from a unique perspective – “what lies beneath” the surface.

Is Psychoanalysis only a Therapy?

Although psychoanalysis began as a tool for ameliorating emotional suffering, it is not only a therapy. It is, in addition, a method for learning about the mind, and also a theory, a way of understanding the processes of normal everyday mental functioning and the stages of normal development from infancy to old age. Furthermore, since psychoanalysis seeks to explain how the human mind works, it contributes insight into whatever the human mind produces. In so doing, it has had a profound influence on many aspects of 21st century culture.

As a general theory of individual human behavior and experience, psychoanalytic ideas enrich and are enriched by the study of the biological and social sciences, group behavior, history, philosophy, art, and literature. As a developmental theory, psychoanalysis contributes to child psychology, education, law, and family studies. Through its examination of the complex relationship between body and mind, psychoanalysis also furthers our understanding of the role of emotions in health as well as in medical illness.

In addition, psychoanalytic knowledge is the basis of all other dynamic approaches to therapy. Whatever the modifications, the insights of psychoanalysis form the underpinnings of much of the psychotherapy employed in most other individual, family, and group therapies.

The Psychoanalytic Tradition

Sigmund Freud was the first psychoanalyst. Many of his insights into the human mind, which seemed so revolutionary at the turn of the century, are now widely accepted by most schools of psychological thought. Although others before and during his time had begun to recognize the role of unconscious mental activity, Freud was the preeminent pioneer in understanding its importance. Through his extensive work with patients and through his theory building, he showed that factors which influence thought and action exist outside of awareness, that unconscious conflict plays a part in determining both normal and abnormal behavior, and that the past shapes the present.

Although his ideas met with antagonism and resistance, Freud believed deeply in the value of his discoveries and rarely simplified or exaggerated them for the sake of popular acceptance. He saw that those who sought to change themselves or others must face realistic difficulties. But he also showed us that, while the dark and blind forces in human nature sometimes seem overwhelming, psychological understanding, by enlarging the realm of reason and responsibility, can make a substantial difference to troubled individuals and even to civilization as a whole.

Like any other field of inquiry, the ideas of psychoanalysis did not "freeze" with the work of the field's founder a century ago.

Building on the foundational ideas and ideals of Freud and his contemporaries, psychoanalysis has continued to grow and develop as a general theory of human mental functioning, while always maintaining a profound respect for the uniqueness of each individual life. Ferment, change, and new ideas have enriched the field, and psychoanalytic practice has adapted and expanded. But psychoanalysts today still appreciate the persistent power of the irrational in shaping or limiting human lives, and they therefore remain skeptical of the quick cure, the deceptively easy answer, the trendy or sensationalistic.

Like Freud, they believe that psychoanalysis is the strongest and most sophisticated tool for obtaining further knowledge of the mind, and that by using this knowledge for greater self-awareness, patients free themselves from incapacitating suffering, and improve and deepen human relationships.


In the late nineteenth century, Freud formulated a theory of the human mind, psychoanalysis, which had at its basis the discovery of the unconscious. He pursued a theory of treatment to help patients bring traumatic memories and their accompanying affect into consciousness in ways that would allow them to form associative connection with other conscious thoughts and achieve expression.

There are currently diverse approaches to treatment within psychoanalysis, yet these approaches all share the aim of helping patients bring to their consciousness what is unconscious or difficult to acknowledge. Unconscious occurrences may include, for example, an individual's vulnerabilities, motives, tensions, impulses, guilt, fantasies, or urges. One of the goals of psychoanalysis is to help the patient develop insight into his/her unconscious processes. Psychoanalysis encourages us to search for personal truthfulness and focuses specifically on the irrational dimensions of our mental life, as it applies rational procedures to achieve its goals.

Who can benefit from psychoanalysis?

Psychoanalysis is an effective treatment for many people with moderate to severe difficulties and who have had unsuccessful attempts with briefer therapies. 

Because analysis is a highly individualized treatment, people who wish to know if they would benefit from it should seek consultation with an experienced psychoanalyst. Still, some generalizations can be made. The person best able to undergo psychoanalysis is someone who, no matter how incapacitated at the time, is basically, or potentially, a sturdy individual. This person may have already achieved important satisfactions - with friends, in marriage, in work, or through special interests and hobbies - but is nonetheless significantly impaired by longstanding symptoms: depression or anxiety, sexual incapacities, or physical symptoms without any demonstrable underlying physical cause.

Many people come to analysis because of a pattern of repeated failures in work or in love. Others recognize self destructive patterns of behavior they are unable to change. Others need analysis because the way they are - their character - substantially limits their choices and their pleasures. Some feel a painful but vague sense of unease and emptiness. And still others seek analysis definitively to resolve psychological problems that were only temporarily or partially resolved by other approaches.

Whatever the problem - and each is different - that a person brings to the analyst, it can be properly understood only within the context of that person's strengths and life situation. Hence, the need for a thorough evaluation to determine who will benefit - and who will not - from psychoanalysis.

Who is a Psychoanalyst?

The designation "psychoanalyst" is not protected by federal or state law: anyone, even an untrained person, may use the title. It is therefore important to know the practitioner's credentials before beginning treatment.

Graduate psychoanalysts trained under the auspices of the American Psychoanalytic Association have had very rigorous and extensive clinical education. Candidates accepted for training at an accredited training institute must meet high ethical, psychological, and professional standards. These candidates are either physicians who have completed a four-year residency program in psychiatry, psychologists or social workers who have completed a doctoral program in their fields or hold a clinical masters degree in a mental health field where such a degree is generally recognized as the highest clinical degree; all must have had extensive clinical experience. Outstandingly qualified scholars,researchers, educators, and selected other professionals may also be approved for psychoanalytic training. All accepted candidates, whatever their background, then begin at least four years of psychoanalytic training.

This training consists of three parts. Candidates attend classes in psychoanalytic theory and technique. They undergo a personal analysis. And they conduct the psychoanalysis of at least three patients under the close and extended supervision of experienced analysts. Candidates who plan to treat children attend further classes and, with supervision, analyze boys and girls ranging in age from toddlers to late adolescents.

Besides conducting psychoanalysis, most graduate analysts also practice intensive and brief psychotherapy. Those who are psychiatrists sometimes prescribing medication. Many treat couples, conduct family or group therapy sessions, and work with the aging.

Because psychoanalysts are provided with the most thorough education available in normal and pathological development, their training enhances the quality of all their therapeutic work. It also informs their community activities as teachers, supervisors, consultants, and researchers, in the many different settings - hospitals, medical schools, colleges, daycare centers - where analysts are found.

Child and Adolescent Psychoanalysis

Child and Adolescent Psychoanalysis

In addition to treating adults, some psychoanalysts also treat adolescents and children after receiving special training. APsaA's publication on child and adolescent psychoanalysis tells how treatment can be beneficial.

Child and adolescent psychoanalysis, offshoots of adult psychoanalysis, share with it a common theoretical framework for understanding psychological life, while also using additional techniques and measures to deal with the special capacities and vulnerabilities of children. For instance, the young patient is helped to reveal his or her inner feelings and worries not only through words, but also through drawings and fantasy play. In the treatment of all but late adolescents, parents are usually consulted to round out the picture of the child's life. The goal of child and adolescent analysis is the removal of symptoms and of the psychological roadblocks that interfere with normal development.

What kinds of problems or symptoms can psychoanalysts help with?





-night terrors or sleepwalking

-excessive sadness or depression

-physical symptoms without physical cause

-extreme aggression

-cruelty to animals or people

-disturbances in conduct or behavior

-excessive sibling rivalry

-bullying, or being a scapegoat or a class clown


-compulsive thinking or rituals

-learning disorders

-inattentiveness and disinterest in learning

-excessive shyness and separation problems

-lag in emotional and social development

-eating disorders

-loneliness or isolation

-preoccupation with death

-suicidal thinking or behavior

-sexual confusion

-sexual conflicts

A guide for parents, teachers and healthcare professionals.

Children and adolescents often behave in ways that puzzle and worry their parents, teachers and friends. Sometimes their behavior reflects passing problems that arise in reaction to temporary stresses. But sometimes the troubles do not go away by themselves.

Children and parents may feel guilt, shame, and anger as they struggle to understand these problems, why they are happening, and what to do. Families and schools can get stuck in a confused cycle of blaming and helplessness.


Psychoanalysts can help:

-Evaluate a troubling situation

-Understand different treatment options

-Find the best treatment for each individual child

Psychoanalysts are highly trained mental health professionals who may suggest an array of techniques to help children with mental health treatment needs. For example, some children may benefit from medication, some may benefit from in-depth psychodynamic therapy, some from both. Every child and every problem are unique.

Child and adolescent psychoanalysts approach each child individually

-They respect each child and adolescent as a unique individual within a family and a community.

-They understand that unconscious factors outside a person's awareness influence feelings, thoughts and actions.

-They help children, adolescents and parents understand how the past shapes the present, and can influence the future.

-They help children and adolescents become happier, and more caring, productive and creative.

The goal of child and adolescent analysis is the removal of symptoms and psychological roadblocks that interfere with normal development.

Psychoanalysis is the best treatment when

-Other therapies and attempted solutions have failed to deliver deep, long-lasting change.

-The emotional or psychological difficulties are primarily the result of unconscious conflicts. When children or adolescents are not aware of the underlying issues that affect their feelings, behavior, and relationships to family, friends, or teachers, and these troubles interfere with the development of their personality, they may need intensive help to explore and master them.

-Children or adolescents have several and/or complex emotional disturbances. Such children may have intense and dramatic emotional states, may hunger for positive or negative social responses, may be clingy, hyperactive, or have temper tantrums. Sometimes these children also have been diagnosed with attention deficit/hyperactivity disorder, conduct disorder, separation anxiety disorder, or mood disorder.

-Psychoanalysis is often the best treatment because the intense relationship formed between the child/adolescent and analyst enables children, either through play, action, or words, to express and exhibit their problems to the psychoanalyst. The psychoanalyst then can help the child or teen understand and solve the problems.

-Two children or adolescents can have similar symptoms, but their underlying difficulties may be very different and require different treatments. A thorough evaluation usually includes a series of interviews with parents and with the child or adolescent in order to learn about the current problems, how the parents have been responding, the child and family's history, possible precipitating events and potential genetic and physical contributing factors. At times, educational, medical or neurological examinations may be needed.





Kim Foehl, MD     Cambridge MA    Therapist

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