Psychoanalysis is the most in-depth and intensive of any psychotherapy. Its goal is to help you gain a deeper understanding of yourself. Many patients that enter psychoanalysis have first tried other types of therapies, have tried medications to relieve their difficulties, and used other strategies towards self-awareness without adequate success. Traditional psychoanalysis is generally conducted at a frequency of 3-5 times per week with sessions that are 45 minutes in length. Psychoanalyts believe that through intensive work and  a deeply introspective process, most people will begin to realize that their previous experiences have greatly influenced who they are today—the positive and satisfying aspects, but also the problematic parts that they wish to change. Being aware of your problems is only the first step. Psychological change sometimes requires breaking patterns of being that are often repetitive, pervasive, and unconscious. People often think they know their issues, but find themselves unable to change. Psychoanalysis and psychoanalytically oriented psychotherapy can offer more than just insight: it works towards real change. Because there is so much confusion and misinformation surrounding people’s perceptions of psychoanalysis, Dr. Jain, a psychoanalytically trained physician, has prepared this following list of FAQs about this powerful treatment model.

What typically happens in a session?
Patients are encouraged to speak freely about whatever comes to their mind (free-associate) and refrain from censure or editing (even things people may feel are inappropriate, offensive, silly, embarrassing or crazy). They talk about important daily events, significant interactions with others, feelings about themselves and what troubles them, memories, dreams, etc. Psychoanalysts believe that our defenses, inhibitions, anxieties and capacity for self-deception are impressive and create invisible barriers that keep us from seeing things about ourselves, others and reality that we don’t want to see – but need to see. Dreams, fantasies and reverie are also important tools in psychoanalysis and they can sometimes reveal deeper preoccupations, internal struggles, desires and conflicts that our mind is trying to keep from our consciousness.

What is the relationship between patient and therapist?
The popular media caricature of an old bearded man asking you about your mother is just that, caricature. Analysts as ‘blank screen’ sounds like a scary movie where you are pouring your heart out in front of what is made to look like an un-empathic, cold and unfeeling stranger. That is absolutely not true. Your analyst may take on different roles during the course of your treatment: as a mentor, a life coach, a parent, a confidante. Remember, focus of treatment is YOU. Contemporary psychoanalysts are interactive and are focused on using the therapeutic relationship in the service of your recovery.

Analysts attempt to keep their personal information in the background, which can often be confusing for patients. They wonder if the analyst does not trust them, or if they are just being withholding. I always tell patients that in therapy they get to know me very well even without knowing the sorts of things that they are accustomed to knowing about people they are close to. We explore if they feel insecure with me and why they wish to know the specific details they are inquiring about. Sometimes personal information about your analyst can interfere in our deeper exploration of your psyche. For e.g. if you knew that your analyst’s political or religious beliefs, you might feel somewhat inhibited in discussing opposing viewpoints, concerned about hurting his/her feelings.

Patients are also often taken aback when analysts ask them about their thoughts and feelings about them (the analyst). They wonder if the therapist is asking out of vanity, a need to be reassured, or insecurity. Psychoanalytic thinking considers therapy to be a microcosm for the outside world. Our past and present experiences influence how we relate to people in our everyday lives in both beneficial and problematic ways, and that includes how we interact with our therapists. You may find yourself feeling towards your analyst the way you feel or may have felt towards other people in your life. Reactions, especially negative ones are usually not appropriate to express if we were in a social setting, but in the safety of a professional office we can have a close look at them and possibly get a glimpse of how you relate with others. I ask people to be vigilant of their reactions to what I might say or do, and encourage them to not withhold back from talking about those thoughts and feelings. This is the basic principle of transference, a central feature of a psychoanalytic treatment. Transference occurs in all relationships; therefore a deeper understanding of how this influences the way we relate to others can bring about significant changes in how we view ourself and others.

Do I have to lie on a couch?
The couch is not mandatory. It is, however, a useful "tool" for some patients. In traditional psychoanalysis patients recline on the couch and the analyst sits slightly behind them just out of view. Lying down is a more relaxing position, and can often allow a more open, free-flowing and less intellectual stance. With the analyst out of sight, they can often have a clearer image of what they imagine or fear their analyst is thinking/feeling. This can give us a lot of information about what kind of expectations you carry around all the time without notice, because looking at other people’s faces and body language can often disconfirm and keep these thoughts out of our conscious mind. Patients that are not comfortable are welcome to move back to the chair and to face-to face therapy.

Does therapy have to happen 4-5times/week?
No, though frequent sessions can help deepen the process and address core issues. Whereas a 45-minute session held once in a few weeks can be rapidly filled with updating the analyst about events that have transpired since the patient was last seen, more frequent sessions allow conversation to expand further. For example, important daily events, significant interactions with others, feelings about themselves and what troubles them, the past, dreams, etc. In time, the analyst begins to notice patterns in the patient's behavior and notices feelings that seem prominent or completely missing in important situations. A deeper understanding of what situations a person avoids, how the past is influencing the present develops.

Does psychoanalysis take the place of medications?
Many patients in psychoanalysis are on medications as well. Medications can expediate therapy by make painful feelings less overwhelming – thus easier to feel and talk about.  

Does treatment go on forever?
No. The basic goal is to resolve as soon as possible the problematic emotional issues that bring a patient to therapy. At the same time, emotional difficulties that have a long history and have led to dysfunctional and repetitive patterns of behavior can sometimes take time to change in meaningful ways.

Are Psychoanalysts obsessed with Freud and the past?
Contemporary analysts draw from a multitude of psychoanalytic theories (yes, Freudian school of thought is just one of many) and can fluidly change gears and modes to best suit what technique and intervention would be best suited to you in any given situation.
And while psychoanalysts believe that an understanding of the past can help identify problems in the here-and-now, they view the past as a path to the present (and future).

Will I become dependent on psychoanalysis?
Dependence and intimacy are issues that are universal and often evoke anxiety, concerns and questions in people. Some people cannot allow themselves to feel that they need anyone and often have difficulties forming close, intimate relationships. Others feel that they need someone upon whom to be totally or largely dependant in order to function in life. They panic if threatened with the loss of that someone. Psychoanalysts are acutely aware of these issues and try to help people overcome these problems, not take advantage of them. If an individual becomes overly dependent on the analyst, it becomes an issue to be resolved within analysis. Likewise, if an individual needs to keep a "wall" up in their relationships, that too, becomes an issue to be worked on.

While I hope that these questions and answers have provided you with a better understanding of what psychoanalysis and psychoanalytically oriented psychotherapy is and isn’t, I fully understand that this form of treatment is a large undertaking and I would be happy to speak with you individually to discuss whether it is right for you.