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What Is Psychoanalytic Therapy and How Does It Work?

While the classic image of someone lying on a couch talking to an analyst may come to mind, contemporary psychoanalytic therapy has evolved. Today, it remains one of the most insightful approaches for understanding the deeper layers of the self and the emotional patterns that shape our relationships, motivations, and mental health.

By Taylor Pagniello, RP, M.A.

Nov 01, 2025

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Long before therapy became a familiar concept, there was psychoanalysis — the foundation of modern psychotherapy. Developed by Sigmund Freud in the late 19th century, psychoanalytic therapy explores the unconscious mind — the hidden thoughts, memories, and emotions that influence how we think, feel, and behave.

While the classic image of someone lying on a couch talking to an analyst may come to mind, contemporary psychoanalytic therapy has evolved. Today, it remains one of the most insightful approaches for understanding the deeper layers of the self and the emotional patterns that shape our relationships, motivations, and mental health.

How Psychoanalytic Therapy Works

At its core, psychoanalytic therapy assumes that unresolved conflicts from the past — particularly from early childhood — continue to influence our present life. These experiences often live in the unconscious, subtly guiding how we respond to others, how we perceive ourselves, and how we handle stress or intimacy.

Through open-ended dialogue, a psychoanalytic therapist helps clients bring these unconscious elements into conscious awareness. As insight grows, so does emotional freedom. People often begin to make sense of long-standing patterns, repetitive relationship dynamics, and emotional triggers that once felt automatic or confusing.

Therapy sessions are usually conducted one or more times per week, often in a quiet and reflective setting. Clients are encouraged to say whatever comes to mind — a technique known as free association — while the therapist listens for underlying themes, contradictions, or defences that reveal deeper truths.

Key Concepts in Psychoanalytic Therapy

1. The Unconscious Mind

Much of our mental life happens outside of awareness. The unconscious stores memories, wishes, and feelings that can still affect our everyday thoughts and behaviour. Psychoanalytic therapy aims to bring these hidden elements to light.

2. Defence Mechanisms

Defences are ways we protect ourselves from painful emotions or unwanted truths. These might include denial, repression, rationalization, or projection. Recognizing these patterns allows clients to respond with greater honesty and flexibility rather than avoidance.

3. Transference and Countertransference

In therapy, clients may unconsciously project feelings or expectations from past relationships onto their therapist (transference). The therapist’s emotional responses (countertransference) can also provide valuable insight into the client’s relational world. Exploring these dynamics can lead to deep emotional healing and self-awareness.

4. Insight and Integration

Insight is central to psychoanalytic work. As clients uncover the meaning behind their symptoms or emotional struggles, they gain the ability to integrate those discoveries into everyday life. True change often follows awareness, not force.

What Psychoanalytic Therapy Can Help With

While psychoanalytic therapy was originally used to treat neuroses, today it is used for a wide range of issues, including:

  • Anxiety and depression
  • Relationship difficulties
  • Low self-esteem and identity concerns
  • Personality and attachment challenges
  • Unresolved grief or trauma
  • Repetitive patterns of self-sabotage

Rather than focusing on symptom relief alone, psychoanalytic therapy seeks deeper transformation. It aims to understand the root causes of distress so that healing can be lasting and self-driven.

Modern Adaptations

Psychoanalytic ideas have inspired many newer approaches, including psychodynamic therapy, object relations theory, and attachment-based models. These contemporary forms are often more flexible, collaborative, and time-limited than classical analysis, while still honouring the exploration of the unconscious.

Today’s psychoanalytic therapists may combine insight-oriented work with mindfulness, somatic awareness, or relational techniques — allowing clients to connect emotional understanding with present-moment experience.

Why It Matters

In an age where quick fixes and symptom management are common, psychoanalytic therapy offers something different: depth. It doesn’t rush to quiet the pain but seeks to understand what the pain is trying to say.

By exploring our inner world, we begin to recognize patterns that have shaped our story — and, in doing so, we gain the freedom to rewrite it. This approach invites people to know themselves more fully and live with greater authenticity, self-compassion, and emotional resilience.

  • Freud, S. (1917). Introductory Lectures on Psychoanalysis. Standard Edition.
  • Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98–109.
  • McWilliams, N. (2011). Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process (2nd ed.). Guilford Press.
  • Lemma, A. (2016). Introduction to the Practice of Psychoanalytic Psychotherapy (2nd ed.). Wiley-Blackwell.
  • Kernberg, O. F. (2016). Psychoanalytic perspectives on psychotherapy. American Journal of Psychotherapy, 70(2), 115–130.
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