Psychoanalytic theory tends to focus on bringing what is unconscious (out of awareness) to the conscious mind. This is often done by the act of talking on a consistent basis (as articulated above), by exploring dreams and fantasies, and by making connections between how past experiences have helped to shape one’s behavior, thoughts, and emotional reactions as well as one’s relationships and career.

How does it work?

Symptoms such as depression, anxiety, phobias, obsessions, and compulsions, to name just a few, often arise when we repress feelings, thoughts, and aspects of ourselves that, if we were to become aware of, might be anxiety provoking, intolerable, or hard to manage. Sometimes repression occurs because our thoughts and feelings conflict with one another. I often find that one does not become aware of these different aspects of experience until the process of psychoanalysis has gone underway. As one talks, puts words to feelings, and makes sense of his or her life in a more adaptive way, the symptoms will no longer have “to carry” what has been repressed and as a result, will eventually lessen and/or disappear over time.

In other words, if we repress our experiences, especially those we have had of ourselves during traumatic or difficult times, they will ultimately find another way of expression. This is essentially the way our minds/psyches operate. Over time if feelings, thoughts, and experiences of our selves get repressed (i.e., get consciously or unconsiously get pushed out of awareness), the mind/psyche will find another way of release. This may be through some of the symptoms I mentioned before or via others such as: somatically (in the body, for example, headaches or dizziness), feelings of emptiness, difficulties concentrating, drug abuse/addiction, self-mutilation, eating disorders, and many more.

Sessions

Psychoanalysis is conducted in a safe and confidential atmosphere where the therapist and patient form a relationship at a pace that feels comfortable to the person seeking help. One may lie on the couch or sit face to face with the therapist. Sessions can occur once to as many as four times a week. Again, this is according to the pace the person seeking help wants to establish. Sometimes coming in more expedites the process, and sometimes it does not. It depends on the individual. This is something that also can be discussed and explored during session.

Freud was known for calling dreams ”the royal road to the unconscious”. Although not the only road, dreams are certainly an effective way of reaching what lies beyond our conscious thoughts. During the day, since we are alert and more guarded, logic and reason reign more often than not.  Essentially, we are more equipped and able to ward off anxiety provoking thoughts and feelings while awake.  On the contrary, when we are asleep, logic and reason recede into the background.  Although disguised and distorted, the unconscious, which logic and reason are often experts at protecting from emerging,  is able to seep through into our dreams giving us important information about where we are stuck, what core conflicts are hampering our development, and what issues need working through.  I find dreams are a great supplement to the psychoanalytic process, as they often help to piece together the puzzles of a picture slowly emerging by talking alone.  In addition, dreams are sometimes ahead of the game, in the sense that they lend information one might not be privy to through conscious awareness and analysis.  Although, I find dreams to be helpful, I do not require patients to bring them into session and think a successful analysis can be conducted without them, as there are many “royal roads” to the unconscious.   

Some patients prefer to lie on the couch while others prefer to sit face to face with the therapist. There is no “right” way and what works best for each person varies.

One advantage of using the couch is it can decrease the anxiety one may be experiencing associated with seeing and being judged by the therapist’s reactions. This decrease in anxiety most often enhances the ability to express whatever is on one’s mind. For example, some patients have stated that they have held back on disclosing important experiences that were too shameful to articulate because they were too focused on looking out for how I might respond non-verbally.  When these same patients switched to using the couch, they stated it was easier for them to focus on their internal world thereby, not only increasing their ability to talk about things that were humiliating, but to also get in touch with their thoughts and feelings on a deeper level.  In essence, these patients thought using the couch expedited the analytic process.

On the contrary, some patients prefer sitting face to face with the therapist. These patients have stated being able to see me was important for them due to their fears around not being listened or paid attention to. Using the couch created more anxiety and in effect, served as a source of distraction and hindered them from accessing important experiences. 

Either way, I encourage discussion around both avenues of “being” in the room an as mentioned earlier, think both modes are equally as effective depending on the individual.