Should You Consider Psychoanalysis?

by Carol Campbell, MFT

Perhaps you have a thought in the back of your mind: Since I'm thinking of getting therapy, should I consider psychoanalysis? What is psychoanalysis, anyway?

Psychoanalysis is a form of very intensive psychotherapy, meaning that the patient comes to sessions multiple times a week in order to get a great deal of attention from the therapist. While it was first developed systematically over 100 years ago by Sigmund Freud and other analytic pioneers, it is still used today with great effectiveness, especially in sophisticated urban areas of the United States, Europe, and South America. The San Francisco Bay Area is a particularly active area for psychoanalytic thinking and therapy in the United States, with several analytic training institutes and a multitude of psychoanalytically trained therapists.

Psychoanalysis is a way of treating mental and emotional problems that focuses on discovering what is unconscious in the patient's mind, since unconscious thoughts and beliefs are at the root of the sorts of troubles we all have in life that just keep happening over and over. Analytic therapy uses those insights into the unconscious as a roadmap to discovering each patient's own emotional truth — truth that may have been buried for a lifetime and that wants to be found. Where there is truth, there can be authentic growth.

The analytic couple (patient and therapist) can together discover and understand distortions in the patient's reality as it shows up in the very unique and intensely focused relationship with the therapist. The therapist offers a nonjudgmental, deeply caring emotional space that does not reinforce the false assumptions and beliefs that have led to entrenched forms of unhappiness and anxiety. Over time it then becomes possible for the patient to let go of whatever ideas have kept him/her trapped in a painful or dissatisfying life, and to embrace an authentic identity freed from the emotional baggage of past trauma.

Here are some circumstances that in my opinion are cause for considering psychoanalysis as the treatment of choice:

• Your problems have troubled you for a very long time.
   
• Your problems are significantly interfering with your work, relationships, and satisfaction with your life.
   
• You are ready to make a serious commitment to doing the hard work that can lead to having your life be profoundly different and more satisfying.
   
• Other people have suggested to you that you really need therapy.
   
• You have been disappointed by what you have already tried, such as self-help books or other types of psychotherapy.

If the above statements are true for you, you might be a good candidate for psychoanalysis. But you may have some doubts about what you would be getting into. Here are some points of information that might help you determine if psychoanalysis is for you:

• Psychoanalysis is a long-term form of therapy that is centered around developing your relationship with the therapist in a safe, neutral environment. The therapy is designed to promote a very deep emotional connection between you and the therapist, one that will become of central importance in your life for the duration of the therapy. For many people this becomes the first truly intimate relationship they have been able to have with another person, made possible and completely safe by the relative formality and strict boundaries of the treatment model.
   
• The point of analysis is to give you a chance to be completely understood in a way that allows the emergence of your own unique self, without interference from anyone else trying to make you be a certain way. You will experience what it is like to have complete freedom to think, feel, and say whatever you want without judgment and with respect for your uniqueness. This gradually allows for the therapist to help you identify the unconscious beliefs and fantasies that are keeping you from being able to enjoy your life to the fullest and afflicting you with emotional difficulties, or even a mental disorder.
   
• There are two forms of psychoanalytic treatment. In psychoanalytic psychotherapy, the patient sits across from the therapist in a chair, and comes for sessions 2-3 times a week. In psychoanalysis the treatment is 3-5 times a week usually, and the patient lies down. This is in order to help you feel very comfortable and as relaxed as possible, and also to make it easier to access the very young aspects of the psyche that we all have. The therapist generally then will sit in a chair behind you, so that you are not distracted by having to look at the therapist. This may seem a bit odd at first, but most patients come to truly appreciate the arrangement for the freedom to think that it facilitates. This arrangement also facilitates the privacy necessary for the therapist to access his/her own unconscious mind, an essential part of the treatment.
   
• What distinguishes psychoanalysis the most from other forms of therapy is its focus on discovering unconscious thoughts and feelings, which when brought to consciousness can be known, thought about, accepted, rejected, overcome, or otherwise used productively. To be able to know your own mind so completely is to maximize your capacity to deal with the joys and sorrows that life brings. To live without awareness of the unconscious mind, in contrast, is to allow your life to be profoundly shaped and bullied by dangerous, frightening, powerful, out-of-control forces from which you may feel quite unprotected, and which keep you trapped in patterns of thinking and behavior that were once useful but now are problematic.
   
• One way of thinking about psychoanalysis is that it helps you discern the truth in your life, when for many years you have been actually trapped in lies you tell yourself and false assumptions you routinely make.
   
• Analysis is an enormous investment you can make in yourself. Because it ferrets out the root cause of emotional disturbance and creates a new experience of reality grounded in truth, its effects tend to be permanent. Therefore it is often considered the treatment of choice for severe mental and emotional disorders that have not responded well or permanently to other treatments. And it is also an excellent choice for anyone with a very deep interest in wanting to make the most of his/her emotional life.
   
• Because of the frequency of visits, length of treatment, and extensive training required of the therapist, psychoanalysis can be a very expensive undertaking. That fact has led to concerns that analysis might only be possible for wealthy patients. However, my experience is that the vast majority of therapists I know who work analytically are pleased to do some percentage of their work at a reduced fee to accommodate motivated patients who could not otherwise afford treatment. Also, the motivation to have this treatment often has the surprising effect of the patient being far more resourceful than he or she ever could have imagined before in order to provide analysis for him/herself.

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Carol L. Campbell, MFT, is a licensed marriage and family therapist providing psychotherapy and psychoanalysis for individual adults and couples in Palo Alto, California. She has degrees from Brown University and Santa Clara University and has been licensed since 1991. Carol is a graduate of the Palo Alto Psychoanalytic Psychotherapy Training Program sponsored at Stanford by the San Francisco Center for Psychoanalysis and was a candidate at the Psychoanalytic Institute of Northern California in San Francisco from 2010-2011. She is also a clinical member of the California Association of Marriage and Family Therapists and the Northern California Society for Psychoanalytic Psychology.