Psychoanalysis is a talking therapy, arguably the most in-depth talking therapy, which engages with the unconscious parts of ourselves that lie at the root of the psychic pain and internal conflicts we experience as human beings. The patient’s feelings, thoughts, memories, fantasies and dreams are explored within analysis, in order to help the individual work through and resolve present and past emotional difficulties.
Within regular and frequent sessions, the patient is invited to say whatever comes to their mind without restriction and, with the help of the analyst’s interventions, new understanding of the patient’s internal world gradually begins to emerge. The process of exploring and working through the unconscious patterns which emerge in the analysis helps the patient to become capable of recognizing the thought processes that stir their conflicts.
Recognising, understanding and resolving these familiar conflicts can free the patient’s mind from old inhibitions and make room for new, more adaptive, choices. This is what the analyst Hans Loewald meant when he said that through analysis “ghosts of the unconscious are laid and led to rest as ancestors, whose power is taken over and transformed into the newer intensity of present life.”
The setting and structure of treatment
The patient is invited to lie comfortably on the couch, saying whatever comes to mind, without being distracted by seeing the analyst, who sits out of the way behind the couch. This allows both partners in the analysis to fully listen to and reflect on what transpires in the session. The patient is free to immerse themselves in their inner world, to revive memories, revisit important experiences, talk about dreams or fantasies. This is all part of a process which sheds new light on the patient’s life, history and the workings of their mind.
Each session lasts for 50 minutes, and sessions take place frequently, usually four days a week. Unlike a medical model of treatment, in which a high-intensity of sessions might reflect severe illness, in psychoanalysis meeting regularly and frequently is designed to facilitate a process of supportive exploration, understanding and containment of human experience.
Psychoanalysis recognises that the process of in-depth personal change takes time to occur and cannot be hurried. So, while a time-frame for completing an analysis is hard to predict, it is better to think in terms of years rather than months.
There are now a significant number of well-designed studies and random control trials (e.g., Leichsenring, F. and Klein, S., 2014; Shedler, J., 2010; Tavistock Adult Depression Study, 2015) which demonstrate the efficacy of the psychoanalytic approach. These studies show that psychoanalytic therapy yields good change outcomes which typically increase at long-term follow up, suggesting that patients who receive psychoanalytic treatment experience continuing psychological benefits long after therapy has ended.