Frequently Asked Questions

1. What is the difference between psychoanalysis and psychotherapy?
2. Who can benefit from psychoanalysis?
3. Who is a psychoanalyst?
4. What is transference?
5. What is the purpose of the couch?
6. Is it true that psychoanalysts are silent?
7. Is psychoanalytic treatment all about sex?
8. What is the purpose of four- or five-day-a-week treatment?
9. How long does psychoanalysis take?
10. Will insurance pay for psychoanalysis?
11. What is the evidence that psychoanalysis is effective?

1. What is the difference between psychoanalysis and psychotherapy?

Psychoanalysis and psychoanalytic psychotherapy share many goals and methods. Both approach each person as an individual with a unique history and personal experience. Both work to reduce symptoms and help people to progress in their lives. Both involve an intensive effort to listen and understand the uniqueness of each person. In psychoanalytic psychotherapy meetings are less frequent, and the work may focus more on current situations and problem solving than on deeper understanding and reworking of unconscious conflicts.

What distinguishes psychoanalysis is the opportunity for deeper exploration of unconscious processes. Psychoanalysis gives patients the fullest opportunity to examine their assumptions about themselves and the world, understand their origins, modify them, and make better and freer choices for themselves. The aim of psychoanalysis is a fuller examination of personal development and character in order to resolve central underlying difficulties. The greater intensity of psychoanalysis, meeting four or five times a week, typically using a psychoanalytic couch, facilitates these deeper therapeutic gains.

2. Who can benefit from psychoanalysis?

Psychoanalysis is particularly useful with problems which have been enduring or repetitive. Some individuals seek psychoanalysis after having tried other forms of treatment without lasting relief. Others may wish to understand the sources of their difficulties in a deeper way. Many people may function satisfactorily at work or home but are troubled inside. Being worried or persistently unhappy, feeling blocked, having troubles in intimate relationships or jobs, or being puzzled about yourself and your behavior are valid reasons for speaking with a psychoanalyst. Typical issues include:

  • trouble in work situations such as conflicts with employers or co-workers or failure to advance
  • repetitive patterns of disappointment or conflicts in personal relationships
  • making self-defeating choices
  • difficulty in achieving life goals
  • feeling lethargic and disconnected from friends and colleagues
  • physical complaints which might be manifestations of underlying emotional conflict
  • coping with depression, anxiety, or anger
3. Who is a psychoanalyst?

A psychoanalyst is a licensed mental health clinician (generally a psychiatrist, psychologist, or social worker) who has completed psychoanalytic training. The PINE Psychoanalytic Center is a member of the American Psychoanalytic Association (APsaA). The training through the PINE Institute conforms to the standards of the APsaA, and psychoanalysts trained under their auspices must meet high ethical, psychological, and professional standards.  PINE is also accredited nationally by the Accreditation Council for Psychoanalytic Education (ACPE).

Psychoanalytic training takes a minimum of five years as a "psychoanalytic candidate." It is a rigorous and extensive program consisting of seminars in psychoanalytic theory and technique, a personal psychoanalysis, and conducting multiple psychoanalyses under close supervision by experienced training analysts. Candidates who plan to treat children attend further classes and, under supervision, conduct analyses of boys and girls ranging in age from toddlerhood to late adolescence.

Because psychoanalysts are provided with the most thorough education available in normal and pathological development, their training enhances the quality of all their therapeutic work. In addition to conducting psychoanalysis, psychoanalysts also see individuals in psychotherapy and provide supervision to other mental health professionals. Some see couples; some conduct family or group therapy sessions. They may also conduct research, write for professional journals, and teach mental health trainees in various settings such as hospitals, clinics, medical schools, colleges, and daycare centers. They consult in the community, in schools, in businesses, and with professional groups such as teachers, judges, and religious leaders.

The designation "psychoanalyst" is not protected by federal or state law: anyone, even an untrained person, may use the title "psychoanalyst." It is therefore important to know the practitioner's credentials before beginning treatment.

4. What is transference?

In the course of a psychoanalytic treatment, patient and analyst create an intimate relationship, built on trust and shared curiosity about the mind of the patient. It is inevitable that the patient develops strong feelings about the analyst, often repeating important aspects of early formative relationships. These emotional experiences, referred to as transferences, reflect unconscious needs which are powerfully recreated in the treatment. Understanding them in this context produces important insight and frees the person to move beyond problematic repetitions.

5. What is the purpose of the couch?

In psychoanalysis, the analyst usually sits behind the patient who lies on the couch. This arrangement minimizes distractions and increases the patient’s relaxed introspection. When facing the psychoanalyst, it is easy, without realizing it, for the patient to scan the analyst's face for reactions. Facing away from the analyst enables the patient to more easily access thoughts, feelings, and fantasies, and to have associations emerge more freely, giving the patient and analyst more access to the workings of the patient's mind.

6. Is it true that psychoanalysts are silent?

Psychoanalysts are generally non-directive listeners in order to give patients the opportunity to develop their own direction. However, psychoanalysis is fundamentally a conversation in which both patient and analyst contribute to the rich and intimate dialogue.

Psychoanalytic treatment explores both conscious and unconscious mental processes as these are revealed when we allow our minds to associate freely to our spontaneous thoughts, memories, and feelings. A psychoanalyst often listens quietly to the patient's associations, avoiding intrusions or efforts to direct the patient's thoughts. This form of quiet listening alternates with verbal exchanges which assist the patient to understand his/her inner world and clarify the hidden conflicts and fantasies that have limited the patient's life choices and personal freedom.

7. Is psychoanalytic treatment all about sex?

In psychoanalytic theory, libido or "sexuality" is not limited to the meanings in common use. Psychoanalysts understand libido as the source of all pleasurable thoughts and behaviors. In psychoanalysis, much attention is given to "sexuality" and its various non-sexual transformations so that a person may have free access to desire and the capacity to experience pleasure in intimate relationships, friendships, parenting, creative endeavors, work, and so forth.

8. What is the purpose of four or five day a week treatment?

The frequency of psychoanalysis keeps the deeper topics of exploration close to the surface where they can be discussed and worked through more consistently and thoroughly with less intrusion from “current events.” The frequency also deepens the working relationship with the analyst through which the patient begins to resolve difficulties in other close relationships.

9. How long does psychoanalysis take?

Although most psychoanalytic treatments have a definite beginning and ending, there is no pre-set time for patients to resolve longstanding difficulties. Patients generally find it useful to think in terms of years rather than months. This is because deeply entrenched inner conflicts take some time to understand and work through in a lasting way. As part of the treatment, the patient's capacity for self-analysis is enhanced. Therapeutic gains achieved during the analysis are often continued and consolidated following termination of the treatment.

10. Will insurance pay for psychoanalysis?

In this age of tightly managed care, some insurance companies might not pay for psychoanalysis. In some cases, however, your policy may cover one or two sessions per week, at least for 24 sessions per calendar year. You should inquire about the “outpatient mental health benefits” of your particular health insurance policy. It is also appropriate to ask whether your analyst is able to reduce your fee so that psychoanalysis is affordable for you. In addition, if you are not already in treatment with an analyst, you can ask to be referred through the PINE Institute for a low fee analysis with a psychoanalyst in training (psychoanalytic candidate). Candidates are experienced clinicians who conduct psychoanalyses under close supervision.

11. What is the evidence that psychoanalysis is effective?

There is a large body of empirical data supporting the benefits of psychoanalytic therapy and psychoanalysis. These studies demonstrate positive changes in subjective symptoms, life functioning, and psychological flexibility. Another important outcome of psychoanalysis is the understanding the patient gains about how his/her mind functions, allowing the individual to continue to explore, gain insight, and grow emotionally after the treatment is ended.

To learn more about specific studies, please go to the research site of the American Psychoanalytic Association.