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Psychoanalysis is a form of psychotherapy used by qualified psychotherapists to treat patients who have a range of mild to moderate chronic life problems. It is related to a specific body of theories about the relationships between conscious and unconscious mental processes, and should not be used as a synonym for psychotherapy in general. Psychoanalysis is done one-on-one with the patient and the analyst; it is not appropriate for group work.


Psychoanalysis is the most intensive form of an approach to treatment called psychodynamic therapy. Psychodynamic refers to a view of human personality that results from interactions between conscious and unconscious factors. The purpose of all forms of psychodynamic treatment is to bring unconscious mental material and processes into full consciousness so that the patient can gain more control over his or her life.
Classical psychoanalysis has become the least commonly practiced form of psychodynamic therapy because of its demands on the patient's time, as well as on his or her emotional and financial resources. It is, however, the oldest form of psychodynamic treatment. The theories that underlie psychoanalysis were worked out by Sigmund Freud (1856–1939), a Viennese physician, during the early years of the twentieth century. Freud's discoveries were made in the context of his research into hypnosis. The goal of psychoanalysis is the uncovering and resolution of the patient's internal conflicts. The treatment focuses on the formation of an intense relationship between the therapist and patient, which is analyzed and discussed in order to deepen the patient's insight into his or her problems.
Psychoanalytic psychotherapy is a modified form of psychoanalysis that is much more widely practiced. It is based on the same theoretical principles as psychoanalysis, but is less intense and less concerned with major changes in the patient's character structure. The focus in treatment is usually the patient's current life situation and the way problems relate to early conflicts and feelings, rather than an exploration of the unconscious aspects of the relationship that has been formed with the therapist.
Not all patients benefit from psychoanalytic treatment. Potential patients should meet the following prerequisites:
  • The capacity to relate well enough to form an effective working relationship with the analyst. This relationship is called a therapeutic alliance.
  • At least average intelligence and a basic understanding of psychological theory.
  • The ability to tolerate frustration, sadness, and other painful emotions.
  • The capacity to distinguish between reality and fantasy.
People considered best suited to psychoanalytic treatment include those with depression, character disorders, neurotic conflicts, and chronic relationship problems. When the patient's conflicts are long-standing and deeply entrenched in his or her personality, psychoanalysis may be preferable to psychoanalytic psychotherapy, because of its greater depth.


Psychoanalysis is not usually considered suitable for patients suffering from severe depression or such psychotic disorders as schizophrenia, although some analysts have successfully treated patients with psychoses. It is also not appropriate for people with addictions or substance dependency, disorders of aggression or impulse control, or acute crises; some of these people may benefit from psychoanalysis after the crisis has been resolved.


In both psychoanalysis and psychoanalytic psychotherapy, the therapist does not tell the patient how to solve problems or offer moral judgments. The focus of treatment is exploration of the patient's mind and habitual thought patterns. Such therapy is termed "non-directed." It is also "insight-oriented," meaning that the goal of treatment is increased understanding of the sources of one's inner conflicts and emotional problems. The basic techniques of psychoanalytical treatment include:

Therapist neutrality

Neutrality means that the analyst does not take sides in the patient's conflicts, express feelings about the patient, or talk about his or her own life. Therapist neutrality is intended to help the patient stay focused on issues rather than be concerned with the therapist's reactions. In psychoanalysis, the patient lies on a couch facing away from the therapist. In psychodynamic psychotherapy, however, the patient and therapist usually sit in comfortable chairs facing each other.

Free association

Free association means that the patient talks about whatever comes into mind without censoring or editing the flow of ideas or memories. Free association allows the patient to return to earlier or more childlike emotional states ("regress"). Regression is sometimes necessary in the formation of the therapeutic alliance. It also helps the analyst to understand the recurrent patterns of conflict in the patient's life.

Therapeutic alliance and transference

Transference is the name that psychoanalysts use for the patient's repetition of childlike ways of relating that were learned in early life. If the therapeutic alliance has been well established, the patient will begin to transfer thoughts and feelings connected with siblings, parents, or other influential figures to the therapist. Discussing the transference helps the patient gain insight into the ways in which he or she misreads or misperceives other people in present life.


In psychoanalytic treatment, the analyst is silent as much as possible, in order to encourage the patient's free association. However, the analyst offers judiciously timed interpretations, in the form of verbal comments about the material that emerges in the sessions. The therapist uses interpretations in order to uncover the patient's resistance to treatment, to discuss the patient's transference feelings, or to confront the patient with inconsistencies. Interpretations may be either focused on present issues ("dynamic") or intended to draw connections between the patient's past and the present ("genetic"). The patient is also often encouraged to describe dreams and fantasies as sources of material for interpretation.

Working through

"Working through" occupies most of the work in psychoanalytic treatment after the transference has been formed and the patient has begun to acquire insights into his or her problems. Working through is a process in which the new awareness is repeatedly tested and "tried on for size" in other areas of the patient's life. It allows the patient to understand the influence of the past on his or her present situation, to accept it emotionally as well as intellectually, and to use the new understanding to make changes in present life. Working through thus helps the patient to gain some measure of control over inner conflicts and to resolve them or minimize their power.
Although psychoanalytic treatment is primarily verbal, medications are sometimes used to stabilize patients with severe anxiety, depression, or other mood disorders during the analysis.
The cost of either psychoanalysis or psychoanalytic psychotherapy is prohibitive for most patients without insurance coverage. A full course of psychoanalysis usually requires three to five weekly sessions with a psychoanalyst over a period of three to five years. A course of psychoanalytic psychotherapy involves one to three meetings per week with the therapist for two to five years. Each session or meeting typically costs between $80 and $200, depending on the locale and the experience of the therapist. The increasing reluctance of most HMOs and other managed care organizations to pay for long-term psychotherapy is one reason that these forms of treatment are losing ground to short-term methods of treatment and the use of medications to control the patient's emotional symptoms. It is also not clear as of 2003 that long-term psychoanalytically oriented approaches are more beneficial than briefer therapy methods for many patients. On the other hand, patients who can benefit from a psychoanalytic approach but cannot afford private fees may wish to contact the American Psychoanalytic Association, which maintains a list of analysts in training who offer treatment for reduced fees.


Some patients may need evaluation for possible medical problems before entering psychoanalysis because numerous diseases—including virus infections and certain vitamin deficiencies—have emotional side effects or symptoms. The therapist will also want to know whether the patient is taking any prescription medications that may affect the patient's feelings or ability to concentrate. In addition, it is important to make sure that the patient is not abusing drugs or alcohol.


The primary risk to the patient is related to the emotional pain resulting from new insights and changes in long-standing behavior patterns. In some patients, psychoanalysis produces so much anxiety that they cannot continue with this treatment method. In other cases, the therapist's lack of skill or differences in cultural background may prevent the formation of a solid therapeutic alliance.

Normal results

Psychoanalysis and psychoanalytic psychotherapy both have the goal of basic changes in the patient's personality structure and level of functioning, although psychoanalysis typically aims at more extensive and more profound change. In general, this approach to treatment is considered successful if the patient has shown:
  • reduction in intensity or number of symptoms
  • some resolution of basic emotional conflicts
  • increased independence and self-esteem
  • improved functioning and adaptation to life
Attempts to compare the effectiveness of psychoanalytical treatment to other modes of therapy are difficult to evaluate. Some aspects of Freudian theory have been questioned since the 1970s on the grounds of their limited applicability to women and to people from non-Western cultures. In particular, some psychiatrists with cross-cultural experience maintain that psychoanalysis presupposes a highly individualistic Western concept of human personhood that is alien to traditional Asian and African societies. There is, however, general agreement that psychoanalytic approaches work well for certain types of patients, specifically those with neurotic conflicts.



Blass, R. B. "On Ethical Issues at the Foundation of the Debate Over the Goals of Psychoanalysis." International Journal of Psychoanalysis 84 (August 2003): 929-943.
Gabbard, G. O., and D. Westen. "Rethinking Therapeutic Action." International Journal of Psychoanalysis 84 (August 2003): 823-841.
Lombardi, R. "Mental Models and Language Registers in the Psychoanalysis of Psychosis: An Overview of a Thirteen-Year Analysis." International Journal of Psychoanalysis 84 (August 2003): 843-863.
Roland, A. "Psychoanalysis Across Civilizations: A Personal Journey." Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry 31 (Summer 2003): 275-295.


American Psychoanalytic Association. 309 East 49th Street, New York, NY 10017. (212) 752-0450.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.


a system of theoretical psychology and psychotherapy formulated by Sigmund freud to analyze mental processes and mental disorders, based on recognition of unconscious mental processes such as resistance, repression, and transference, and of the importance of infantile experience as a determinant of adult behavior; techniques used include free association, interpretation, and dream analysis. This theory has increased our understanding of the causes of many different mental phenomena, such as neuroses and personality disorders. Called also psychoanalytic psychotherapy. adj., adj psychoanalyt´ic.

Neurotic patterns of behavior have their origin in conflicts, feelings, and attitudes that arise in childhood. Children have many desires, impulses, and thoughts that are in conflict with the expectations of their parents. In order to avoid the unbearable anxiety of direct conflict with their parents, which they fear would result in loss of affection or other forms of punishment, these conflicts are repressed; the anxiety-producing thoughts or feelings are excluded from conscious awareness. Normally, the conflict is resolved unconsciously by acting out the repressed wish in a disguised form in play, fantasy, or dreams in order to come to terms with it.

When unconscious conflicts are not resolved, the repressed wishes and fantasies may continue to be acted out in daily life, producing neurotic symptoms. A neurotic adult will tend to respond to people in terms of childhood feelings toward members of the family, even though these responses are not appropriate to the situation. Without realizing it, the person is going through adult life still acting out fantasies of childhood. The unresolved conflicts prevent the person from seeing others as they are and reacting to them in an appropriate way.
Psychoanalytic Psychotherapy. Psychoanalysis is an insight-oriented type of psychotherapy. Its goal is to uncover unconscious psychologic patterns and enable the patient to discover the influence of these patterns in daily life. As the patient acquires self-knowledge, the unconscious patterns are undone and areas of behavior come under conscious control. For a person who has the required maturity and intelligence and who is motivated to accomplish a thorough reconstruction of the personality, psychoanalysis is the psychotherapy of choice. The treatment is usually prolonged, such as with four or five analytic sessions a week, lasting 45 minutes to an hour, for two to five years. Many analysts also conduct less intensive treatment with two or three sessions a week with patients who might not be suitable for the more intensive treatment, such as those with severe personality disorders, or those unable to afford the time or expense for the more extensive treatment.

Key techniques include free association and description of dreams by the patient and periodic interpretation by the psychoanalyst. Other concepts in psychoanalytic theory include resistance and transference on the part of the patient.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.


1. A method of psychotherapy, originated by Freud, designed to bring preconscious and unconscious material to consciousness primarily through the analysis of transference and resistance.
See also: freudian psychoanalysis. Synonym(s): psychoanalytic therapy
2. A method of investigating the human mind and psychological functioning, interpretations of resistances, and the patient's emotional reactions to the analyst plus use of free association and dream analysis in the psychoanalytic situation.
3. An integrated body of observations and theories on personality development, motivation, and behavior.
4. An institutionalized school of psychotherapy, as in jungian or freudian psychoanalysis.
[psycho- + analysis]
Farlex Partner Medical Dictionary © Farlex 2012


n. pl. psychoanaly·ses (-sēz′)
a. The method of psychological therapy originated by Sigmund Freud in which free association, dream interpretation, and analysis of resistance and transference are used to explore repressed or unconscious impulses, anxieties, and internal conflicts, in order to free psychic energy for mature love and work.
b. The theory of personality developed by Freud that focuses on repression and unconscious forces and includes the concepts of infantile sexuality, resistance, transference, and division of the psyche into the id, ego, and superego.
2. Psychotherapy incorporating this method and theory.

psy′cho·an′a·lyst (-ăn′ə-lĭst) n.
psy′cho·an′a·lyt′ic (-ăn′ə-lĭt′ĭk), psy′cho·an′a·lyt′i·cal (-ĭ-kəl) adj.
psy′cho·an′a·lyt′i·cal·ly adv.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.


Psychiatry A branch of psychology concerned with issues of emotional conflict and repression attributed to formative childhood experiences; through analysis of free associations and interpretation of dreams, emotions and behavior are traced to the influence of repressed instinctual drives and defenses against them in the unconscious; psychoanalysis seeks to eliminate or diminish the undesirable effects of unconscious conflicts by making the analysand aware of their existence, origin, and inappropriate expression in current emotions and behavior. See Freudian analysis, Jungian psychoanalysis. Cf Psychotherapy.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.


1. A method of psychotherapy, originated by Sigmund Freud, designed to bring preconscious and unconscious material to consciousness primarily through the analysis of transference and resistance.
Synonym(s): psychoanalytic therapy.
2. A method of investigating the total mental life, conscious and unconscious, of a person with a mental disorder, employing interpretation of resistance and transference, free association, and dream analysis.
3. An integrated body of observations and theories on personality development, motivation, and behavior.
4. A school of psychotherapy, as in jungian or freudian psychoanalysis.
See also: freudian psychoanalysis
Medical Dictionary for the Health Professions and Nursing © Farlex 2012


1. A purported treatment for psychiatric disorders in which the patient is encouraged to reminisce freely about his or her past life while the analyst silently interprets these free associations in the light of FREUDIAN THEORY. Success is said to be unlikely unless the subject falls in love with the analyst (transference). Classical psychoanalysis involves sessions of about an hour, up to six times a week, for several years.
2. A dogmatic theory of human behaviour.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005
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