Psychoanalysis is a therapeutic approach and theory, founded by Sigmund Freud, that seeks to explore the unconscious mind to uncover repressed feelings and interpret deep-rooted emotional patterns, often using techniques like dream analysis and free association.
The primary assumption of psychoanalysis is the belief that all people possess unconscious thoughts, feelings, desires, and memories.
According to Freud, neurotic problems in later life are a product of the conflicts that arise during the Oedipal phase of development.
These conflicts may be repressed because the immature ego is unable to deal with them at the time.
Basic Assumptions
- Psychoanalytic psychologists see psychological problems as rooted in the unconscious mind.
- Manifest symptoms are caused by latent (hidden) disturbances.
- Typical causes include unresolved issues during development or repressed trauma.
- Freud believed that people could be cured by making conscious their unconscious thoughts and motivations, thus gaining insight.
- Treatment focuses on bringing the repressed conflict to consciousness, where the client can deal with it.
Psychoanalytic therapy aims to create the right sort of conditions so that the patient can bring these conflicts into the conscious mind, where they can be addressed and dealt with.
Only by having a cathartic (i.e., healing) experience is the person helped and “cured.”
How Can We Understand The Unconscious Mind?
Remember, psychoanalysis is a therapy as well as a theory. Psychoanalysis is commonly used to treat depression and anxiety disorders.
In psychoanalysis (therapy), Freud would have a patient lie on a couch to relax, and he would sit behind them taking notes while they told him about their dreams and childhood memories.
Psychoanalysis would be a lengthy process, involving many sessions with the psychoanalyst.
The Process of Psychoanalysis
During psychoanalysis, the analyst interprets the patient’s thoughts, actions, dreams, and defenses, helping them uncover unconscious conflicts that influence behavior.
The analyst often waits until the patient is on the verge of reaching an insight themselves before offering an interpretation – this timing maximizes its emotional and therapeutic impact.
A frequent challenge in analysis is denial, when a patient rejects an interpretation that threatens their ego.
Analysts may view this denial as another form of defensive behavior, revealing the patient’s resistance to confronting anxiety-provoking material.
Modern psychoanalysts, often referred to as ego analysts, place greater emphasis on the role of the ego than Freud originally did (Davison & Neale, 1994).
They argue that defense mechanisms serve as the ego’s unconscious tools for protecting the individual from anxiety and internal conflict.
Resistance, Insight, and Technique
Because defense mechanisms and unconscious processes are difficult to access, classical psychoanalysis is typically a lengthy process, often requiring two to five sessions per week over several years.
Resistance is a key focus of analysis.
Patients may unconsciously resist confronting painful material, by changing the topic, missing appointments, or avoiding discussion of certain themes.
Freud regarded such resistances as valuable clues, revealing areas of deep unconscious conflict.
Importantly, psychoanalysis assumes that reducing surface symptoms is not enough; unless the underlying conflict is resolved, new neurotic symptoms are likely to emerge in their place.
The analyst maintains the role of a blank screen, revealing little about themselves to allow the patient’s unconscious thoughts and feelings, especially those related to transference—to emerge freely.
Common techniques include:
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Free association – encouraging spontaneous verbalization of thoughts.
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Dream analysis – interpreting latent meanings of dreams.
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Resistance analysis – identifying and understanding forms of avoidance.
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Transference analysis – examining how feelings toward significant others are projected onto the analyst.
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Projective techniques such as inkblot tests and parapraxes (Freudian slips), which reveal unconscious material indirectly.
Together, these methods aim to bring unconscious conflicts into conscious awareness, allowing the individual to achieve insight, integration, and psychological growth.
1) Rorschach inkblots
Due to the nature of defense mechanisms and the inaccessibility of the deterministic forces operating in the unconscious,
The Rorschach inkblot itself doesn”t mean anything, it’s ambiguous (i.e., unclear). It is what you read into it that is important. Different people will see different things depending on what unconscious connections they make.
The inkblot is known as a projective test as the patient “projects” information from their unconscious mind to interpret the inkblot.
However, behavioral psychologists such as B.F. Skinner have criticized this method as being subjective and unscientific.
2) Freudian Slip
Unconscious thoughts and feelings can transfer to the conscious mind in the form of parapraxes, popularly known as Freudian slips or slips of the tongue.
We reveal what is really on our mind by saying something we didn’t mean to.
Freud believed that these were no accidents but were due entirely to the workings of the unconscious. As such, they were a valuable source of insight into this part of the human mind. These are more technically known as parapraxes.
For example, a nutritionist giving a lecture intended to say we should always demand the best in bread, but instead said bed. Another example is where a person may call a friend’s new partner by the name of a previous one, whom we liked better.
Freud believed that slips of the tongue provided an insight into the unconscious mind and that there were no accidents, every behavior (including slips of the tongue) was significant (i.e., all behavior is determined).
3) Free Association
A key part of learning to conduct psychoanalytic psychotherapy involves developing skills and techniques aimed at accessing and understanding unconscious processes.
This includes facilitating the client’s free association, where the client expresses whatever thoughts or feelings come to mind without censorship.
As unconscious ideas and emotions emerge, the therapist helps the client explore and make meaning of them.
Free association is a psychoanalytic term used to describe the free association of ideas that can give an insight into the unconscious mind of the patient.
In free association, the patient is encouraged to speak freely and to verbalize anything that comes to mind. In this way the patient may be able to bring content to the surface that has previously been censored by the ego.
This technique involves a therapist giving a word or idea, and the patient immediately responds in an unconstrained way with the first word that comes to mind. The analyst then offers an interpretation of the relationship observed.
It is hoped that fragments of repressed memories will emerge in the course of free association, giving an insight into the unconscious mind.
Resistance, Abreaction, and Catharsis
Free association can sometimes be met with resistance – moments when the client hesitates, changes the subject, or refuses to elaborate.
Freud viewed such resistance as a valuable clue that the client was approaching repressed or emotionally charged material.
At times, free association may evoke vivid, emotionally intense recollections in which the client relives a past trauma, a process Freud described as abreaction.
When such emotional release leads to a sense of relief or inner cleansing, it is referred to as catharsis.
Freud found that these deeply emotional experiences often provided powerful insight into the client’s unconscious conflicts, helping them integrate repressed material and move toward greater psychological understanding.
4) Dream Analysis
Freud famously described dream analysis as “the royal road to the unconscious.”
He proposed that the conscious mind acts as a censor, filtering and disguising unacceptable thoughts and desires, yet this censorship weakens during sleep.
Dreams, therefore, offer a unique window into the unconscious mind, allowing repressed thoughts and emotions to surface in symbolic form.
The analyst’s role is to help the patient unravel these symbols and uncover the hidden meanings behind them.
According to Freud, dreams often disguise the dreamer’s true concerns to protect the conscious mind from anxiety or guilt.
Rather than dreaming directly about a distressing issue, the dreamer might instead dream about something that represents it symbolically.
Manifest and Latent Content
Freud distinguished between two levels of dream content:
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Manifest content – the literal storyline or imagery of the dream (what the dreamer consciously remembers).
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Latent content – the hidden psychological meaning of the dream, representing the repressed wishes or conflicts that the manifest content disguises.
Through the process of dream interpretation, the analyst works to decode the latent meaning, revealing the unconscious wishes and motives shaping the patient’s emotional life.
Freud also suggested that many dreams carry sexual symbolism, reflecting the central role of instinctual drives in the psyche.
In his theory of sexual symbolism, he speculated that seemingly ordinary dream elements often represent deeper, unconscious desires.
Dream analysis thus remains one of the most distinctive and enduring features of psychoanalytic therapy, providing a bridge between the hidden world of the unconscious and the conscious self.
5) Transference Analysis
Transference refers to how the client relates to the therapist in ways that unconsciously reflect early important relationships.
Of key importance in psychoanalytic therapy is transference. Freud had originally noticed that his patients sometimes felt and acted toward him as if he were an important person from the patient’s past.
Sometimes, these feelings were positive, but sometimes they were negative and hostile. Freud assumed these were relics of attitudes held toward these important persons in the patient’s past.
Freud felt that this transference was an inevitable aspect of psychoanalysis, and used it to explain to patients the childhood origins of many of the concerns and fears.
In psychoanalysis, transference is seen as essential to a complete cure. Analysts use the fact that transference is developing as a sign that an important repressed conflict is nearing the surface.
Countertransference
The therapist’s own unconscious reactions to the client that can give insight into the therapeutic relationship dynamics.
In psychoanalysis, countertransference refers to the emotional reactions and unconscious biases a therapist might have towards a patient, often influenced by the therapist’s own past experiences or unresolved feelings.
It’s the therapist’s emotional response to the patient’s transference.
So, trainees learn to attend carefully to the emotional interchanges within the therapy relationship as a source of insight into both parties’ unconscious relational patterns stemming from their developmental histories.
Clinical Applications
Psychoanalysis (along with Rogerian humanistic counseling) is an example of a global therapy which has the aim of helping clients bring about a major change in their whole perspective on life.
This approach assumes that maladaptive ways of thinking and behaving stem from unresolved, deep-seated personality conflicts rooted in early experiences.
Global therapies like psychoanalysis differ from problem-based therapies (e.g., cognitive-behavioral therapy) that primarily aim to reduce or manage symptoms rather than explore their origins.
Psychoanalysis has traditionally been applied to neurotic disorders—such as anxiety, depression, and certain eating disorders—rather than psychotic conditions like schizophrenia.
However, its success with depression has been debated due to the inactivity and apathy often associated with depressive states, which can make sustained engagement with therapy difficult.
Depressive clients are also particularly prone to transference, developing deep dependency on their therapist, which can complicate the therapeutic process (Comer, 1995).
Effectiveness and Treatment Considerations
Psychoanalytic therapy has been used to treat anxiety-related disorders, including phobias, panic attacks, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).
The central aim is to help clients recognize how their unconscious conflicts and early childhood relationships contribute to their present-day anxiety, enabling them to integrate these experiences and reduce symptoms.
However, empirical findings on its effectiveness remain mixed and context-dependent.
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Svartberg and Stiles (1991) and Prochaska and DiClemente (1984) report that evidence for psychoanalysis is equivocal.
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Salzman (1980) suggests that psychodynamic therapies are less helpful for specific anxiety disorders (e.g., OCD or phobias), but may benefit clients with generalized anxiety disorder (GAD).
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Some studies even warn that psychoanalysis might worsen symptoms in individuals with OCD due to their tendency to overanalyze thoughts and behaviors (Noonan, 1971).
In the treatment of depression, psychoanalysts often trace the condition to early experiences of loss, particularly the child’s realization of separateness from the caregiver.
Failure to process this early separation may lead to vulnerability to depression later in life.
Therapy, therefore, involves helping clients revisit and process these early experiences, working through fixations and maladaptive coping mechanisms.
Particular care must be taken with transference, as depressed individuals often develop strong dependency needs.
The goal is to help clients develop autonomy, accept loss, and adapt to change in healthier ways.
Still, Shapiro and Emde (1991) note that psychodynamic therapies have achieved only occasional success, partly because some depressive clients lack the motivation to engage actively in long-term analysis.
Others may expect quick results, which psychoanalysis—being a gradual, exploratory process—cannot provide.
Critical Evaluation
Practical Limitations and Ethical Concerns
Psychoanalysis is time-consuming, intensive, and costly, often requiring years of treatment and multiple sessions per week.
Clients must be highly motivated and emotionally prepared to engage with potentially painful repressed memories that surface during therapy.
Because the process can evoke distress before progress occurs, psychoanalysis is not suitable for all individuals or disorders.
Moreover, the inherently unequal power dynamic between therapist and client raises ethical questions, particularly around dependency and transference.
Who Benefits Most?
Critics argue that psychoanalysis primarily benefits a narrow demographic.
The acronym YAVIS – standing for Young, Attractive, Verbal, Intelligent, and Successful – is often used to describe the clients most likely to benefit from this form of therapy.
While few studies confirm all these traits, there is consistent evidence that psychoanalysis is most effective for clients who are highly motivated, self-aware, and open to introspection.
Those seeking rapid relief or struggling with severe mental illness may not find it suitable.
Effectiveness and Conflicting Evidence
The effectiveness of psychoanalysis has long been debated.
Eysenck (1952) delivered one of the harshest critiques, claiming that roughly half of neurotic patients recovered within two years , but that two-thirds of untreated patients improved without any therapy at all.
However, later analyses challenged Eysenck’s conclusions.
Bergin (1971) found that by applying different outcome criteria, 83% of psychoanalytically treated clients showed improvement compared with only 30% of untreated controls.
Similarly, Fisher and Greenberg (1977) concluded that psychoanalytic theory should not be accepted or rejected as a whole, noting that some components are empirically supported while others require revision or reinterpretation.
Methodological Challenges
Evaluating psychoanalysis is notoriously difficult due to individual differences between clients and therapists, as well as the subjective nature of change.
Unlike behavioral therapies, which can measure outcomes through observable symptom reduction, psychoanalysis often aims for deep personality restructuring, which is harder to quantify.
Corsini and Wedding (1995, 2013) estimate cure rates between 30% and 60%, depending on how “improvement” is defined.
Additionally, the case study method—central to Freud’s work—has been criticized for lacking objectivity and generalizability.
Famous cases like Little Hans provide valuable insights but are open to observer bias and cannot establish universal principles.
Science and Subjectivity
Attempts to validate Freud’s theory through experimental methods have also been questioned.
Fonagy (1981) argues that such efforts may miss the point entirely, as Freud’s framework can be seen as a critique of scientific rationalism, rather than a theory meant to conform to it.
Psychoanalysis, therefore, may occupy a unique position—straddling the line between clinical art and psychological science.
While its subjective nature limits scientific validation, it continues to offer profound insights into human motivation, emotion, and interpersonal dynamics.
As Anthony Storr (1987) observed, many psychoanalysts draw from rich clinical experience, but these interpretations are inevitably shaped by personal bias and theoretical orientation, making psychoanalysis more interpretive than empirical.
Neo Freudians
Subsequent psychoanalytic theorists built upon but also challenged Freud’s drive theory.
Object relations theory shifted focus to relationships and attachment, with key figures like Melanie Klein, Donald Winnicott, and John Bowlby emphasizing how internal working models of self/other based on early caretaker relationships shape personality and relational patterns.
Harry Stack Sullivan and interpersonal psychoanalysis highlighted social and cultural factors influencing mental health.
Heinz Kohut’s self-psychology focused on empathy, attunement, and disorders of the self like narcissism.
Intersubjective and relational psychoanalysis theories view the client’s and therapist’s subjectivities as co-created in an intersubjective field, with attention to enactments and dissociated self states, especially for trauma survivors.
Attachment Theory vs Psychoanalysis
Attachment theory, developed by John Bowlby, and psychoanalytic theory, developed by Sigmund Freud, offer complementary perspectives on human development and relationships.
While attachment theory reacted against some psychoanalytic views, like drive theory, the two approaches converge on many topics.
Both see early childhood experiences as shaping internal models that influence adult relationships and behavior.
Attachment research provides empirical evidence that unresolved issues from childhood perpetuate across generations, a key psychoanalytic claim.
Concepts like internal working models and secure base align with psychoanalytic ideas like transference and the therapeutic relationship fostering insight.
However, attachment theory more strongly emphasizes the impact of actual childhood events, whereas psychoanalysis highlights inner reality and fantasy.
Both offer useful frameworks for understanding how relational patterns persist or change across the lifespan.
Their differences can spark productive dialogue on the roles of inner and outer reality in development.
Training
Psychoanalytic education also involves the trainee undergoing extensive personal therapy, where through experiencing the therapy process directly they gain firsthand insight into their own psychological conflicts, attachment history, unconscious reactions, and clinical blind spots.
This helps develop self-awareness and attunement needed to understand and respond helpfully to clients’ unconscious communications.
Finally, cultural competence requires analysts to engage in ongoing self-examination around differences and power dynamics related to their own and their clients’ sociocultural identities and experiences.
Unconscious assumptions, biases, stereotypes etc. rooted in culture and privilege/oppression influence clinical perceptions and relationships, so their ongoing reflection upon is considered imperative.
The multiple layers of self-exploration around unconscious processes in one’s personal therapy, clinical work, supervision, and sociocultural context form the bedrock of psychoanalytic clinical education and skill development.
Learning Check: You are the Therapist
Read through the notes below. Identify the methods the therapist is using. What do you think Albert’s problem is?
A young man, 18 years old, is referred to a psychoanalyst by his family doctor. It seems that, for the past year, the young man (Albert) has been experiencing a variety of symptoms such as headaches, dizziness, palpitations, sleep disturbances – all associated with extreme anxiety.
The symptoms are accompanied by a constant, but periodically overwhelming fear of death. He believes that he has a brain tumor and is, therefore, going to die.
However, in spite of exhaustive medical tests, no physical basis for the symptoms can be identified. The doctor finally concludes that Albert’s symptoms are probably psychologically based.
Albert arrives at the analyst’s office accompanied by his parents. He describes his problems and depicts his relationship with his parents as “rosy” – though admitting that his father may be “a little on the strict side.”
It emerges that his father will not permit Albert to go out during the week, and he must be home by 11 pm at weekends.
Additionally, he successfully broke up a relationship between Albert and a girlfriend because he thought they were getting “too close.” In describing this, Albert shows no conscious resentment, recounting the events in an emotional, matter of fact manner.
During one session, in which Albert is encouraged to free associate, he demonstrated a degree of resistance in the following example:
“I remember one day when I was a little kid, and my mother and I were planning to go out shopping together. My father came home early, and instead of my mother taking me out, the two of them went out together leaving me with a neighbor. I felt……for some reason my mind has gone completely blank.”
This passage is fairly typical of Albert’s recollections.
Occasionally, Albert is late for his appointments with the therapist, and less often he misses an appointment, claiming to have forgotten.
ALBERT’S DREAM
During one session, Albert reports a dream in which his father is leaving on a train, while Albert remains on the platform holding hands with both his mother and his girlfriend. He feels both happy and guilty at the same time.
Sometime later, after the therapy sessions have been going on for several months, the analyst takes a two weeks holiday. During a session soon afterward Albert speaks angrily to the therapist.
“Why the hell did you decide to take a holiday with your damned wife just as we were beginning to get somewhere with my analysis.”
Frequently Asked Questions
What is the difference between psychoanalysis and other forms of talk therapy?
Psychoanalysis differs from other forms of talk therapy in its emphasis on unconscious processes and childhood experiences.
Unlike shorter-term therapies, psychoanalysis typically involves several sessions per week and continues for an extended duration. Other talk therapies, such as cognitive-behavioral therapy (CBT) or humanistic therapy, focus more on conscious thoughts, present problems, and symptom relief.
While psychoanalysis delves into the unconscious mind and explores long-standing patterns, other therapies may prioritize practical strategies and immediate symptom management.
Are the concepts and techniques of psychoanalysis still relevant today?
Freud’s ideas about the unconscious mind, defense mechanisms, and the influence of early experiences continue to shape modern psychology.
While some aspects of Freud’s work have been refined or challenged, psychoanalysis remains valuable for understanding human behavior, emotions, and relationships.
The emphasis on self-reflection, insight, and uncovering hidden motivations can help individuals gain a deeper understanding of themselves.
However, it’s important to note that other therapeutic approaches have also emerged, offering alternative perspectives and methods for addressing mental health concerns.
Is psychoanalysis only effective for specific types of mental disorders?
Psychoanalysis is not necessarily limited to specific types of mental disorders. While it was originally developed for treating neurotic disorders, its principles can be applied to a wide range of mental health concerns.
Psychoanalysis focuses on understanding the underlying emotional conflicts and unconscious processes that contribute to psychological distress. It can be helpful for various conditions, including anxiety, depression, personality disorders, and relationship difficulties.
Additionally, psychoanalysis can also be beneficial for personal growth and self-exploration, even if someone doesn’t have a specific mental disorder. The approach aims to enhance self-awareness and foster a deeper understanding of one’s emotions, thoughts, and behaviors.
What are some of the defence mechanisms Freud described?
Freud described several defense mechanisms that people unconsciously use to cope with anxiety or distress. Some of these mechanisms include:
1. Repression: Pushing distressing thoughts or memories out of awareness.
2. Denial: Refusing to acknowledge or accept a painful reality.
3. Projection: Attributing one’s own unacceptable thoughts or feelings to someone else.
4. Displacement: Redirecting emotions from their original source to a less threatening target.
5. Rationalization: Creating logical explanations or justifications to make unacceptable behaviors or thoughts seem more acceptable.
6. Sublimation: Channeling unacceptable impulses into socially acceptable activities or outlets.
7. Regression: Reverting to an earlier stage of development in the face of stress or conflict.
8. Reaction Formation: Expressing the opposite of one’s true feelings or desires.
These defense mechanisms serve to protect the ego from overwhelming anxiety, but they can also distort reality and hinder personal growth and self-awareness.
Is transactional analysis a psychoanalytic theory?
Transactional analysis (TA) is a psychotherapeutic approach developed by Eric Berne.
While it incorporates certain elements of psychoanalytic theory, especially regarding early childhood experiences, it distinctively emphasizes the “transactions” or interactions between people and introduces concepts like the Parent, Adult, and Child ego states.
So, while influenced by psychoanalysis, TA stands as its unique approach.
References
Comer, R. J. (1995). Abnormal psychology (2nd ed.). New York: W. H. Freeman.
Davison, G. C., & Neale, J. M. (1994). Abnormal Psychology. New York: John Willey and Sons.
Eysenck, H. J. (1952). The effects of psychotherapy: an evaluation. Journal of Consulting Psychology, 16(5), 319.
Fisher, S., & Greenberg, R. P. (1977). The scientific credibility of Freud’s theories and therapy. Columbia University Press.
Fonagy, P. (1981). Several entries in the area of psycho-analysis and clinical psychology.
Freud, S. (1916-1917). Introductory lectures on psychoanalysis. SE, 22: 1-182.
Freud, A. (1937). The Ego and the mechanisms of defense. London: Hogarth Press and Institute of Psycho-Analysis.
Garfield, S. L., Prager, R. A., & Bergin, A. E. (1971). Evaluating outcome in psychotherapy: A hardy perennial.
Noonan, J. R. (1971). An obsessive-compulsive reaction treated by induced anxiety. American Journal of Psychotherapy, 25(2), 293.
Prochaska, J., & C. DiClemente (1984). The transtheoretical approach: Crossing traditional boundaries of therapy. Homewood, Ill., Dow Jones-Irwin.
Salzman, L. (1980). Treatment of the obsessive personality. Jason Aronson Inc. Publishers.
Shapiro, T., & Emde, R. N. (1991). Introduction: Some Empirical Approaches To Psychoanalysis. Journal of the American Psychoanalytic Association, 39, 1-3.
Storr, A. (1987). Why psychoanalysis is not a science. Mind-waves.
Svartberg, M., & Stiles, T. C. (1991). Comparative effects of short-term psychodynamic psychotherapy: a meta-analysis. Journal of consulting and clinical psychology, 59(5), 704.
Wedding, D., & Corsini, R. J. (2013). Current psychotherapies. Cengage Learning.
