Psychoanalytic Psychotherapy
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What is Psychoanalytic Psychotherapy?
If you’ve been researching different styles of therapy (or “modalities” in clinical terms), you may have come across the adage that the relationship between the therapist and client is the most important factor in whether therapy is effective. That fact is actually well-supported by research and Psychoanalytic Psychotherapy (also called psychodynamic therapy) takes this a step further and says that the relationship itself is what creates healing. Psychoanalytic practitioners often refer to their style of treatment as the “talking cure” because of its simple premise that profound psychological growth and change can take place when the therapist cultivates a relationship where the client feels free to say anything and everything that comes to mind.
This doesn’t mean that therapy looks like everyday chitchat or venting—though these things do have their place in a therapy session. Instead of responding in the automatic or habitual ways a close friend, coworker, or family member might, a psychoanalytic therapist strives to guide each therapy session towards continuous, open-ended exploration, where nothing is off-limits or forbidden, there is no agenda for you to think or feel or behave the “right” way, and opportunities to feel truly seen and understood are not cut off prematurely by clichés or overbearing advice.
When the therapist accepts, challenges, or asks questions about what the client says, the objective is always to help the client say more. As the client gradually relaxes into this relationship and puts feelings, thoughts, impulses, and other associations into words, they are able to gain greater awareness of their own minds and begin developing new, creative approaches to the challenges that brought them into therapy. This approach can provide deep, long-lasting healing for psychological suffering.
Healing attachment wounds
Attachment theory and different “attachment styles” have become popular topics of discussion on social media and in pop culture in recent years. What many people don’t realize is that attachment theory was originally developed by psychoanalysts, who were observing the interactions between adult caregivers and infants.
Ideally the caregiver is responsive enough to the child’s needs that, as the child develops and explores their world, the caregiver continues to be a “secure base” that the child can return to when needed. Those early attachment relationships give us our first lessons about what we can expect from our relationships with other people, how we get our needs met, and what kind of response we can hope for when we are in distress.
People often come to therapy with a long history of challenges in their relationships, turning to forms of coping that hurt themselves and their loved ones, or facing bouts of destabilizing anxiety and paralyzing depression. They find that despite their efforts to change their behavior or thinking, they are trapped in patterns that keep them from living life with self-esteem, handling life’s ebbs and flows, or having fulfilling relationships. These patterns were often cultivated through attachment relationships in childhood that were not adequately responsive to their emotional needs, or oppressive messages from their larger society and culture. As these patterns are explored and unraveled through the treatment, new ways of thinking and relating that feel more authentic and like “your own” can also begin to emerge. The therapeutic relationship also can help provide a corrective emotional experience, where the client has the opportunity to experience having their emotional needs understood and learn what a secure and healthy relationship feels like.

While some people may have understandable skepticism that they can address psychological problems simply by talking with a therapist, it’s important to remember that as humans, we are social animals whose brains have evolved to support our exceptionally sophisticated ability to express ourselves through language. The “talking cure” takes advantage of neuroplasticity—our brain’s capacity to change and adapt throughout our lifetimes—through the use of language. As we gain awareness of old patterns, heal attachment wounds, and develop new psychological capacities in the therapeutic relationship, our minds don’t race as quickly down the well-worn paths that led us to more hurt.

Psychoanalytic psychotherapy with an anti-oppressive lens
While psychoanalytic theory is often associated with its earliest theories developed by Sigmund Freud, who by his own admission often failed to fully grasp the experiences of women and sexual minorities, in the past century psychoanalytic theorists and practitioners have developed and corrected his work in a number of directions.
Psychoanalysis was developed in the shadow of the repressive atmospheres of World War I and World War II, and to this day continues to have lively traditions of anti oppressive, radical, and queer thought within its vast body of theory and practice.
Because psychoanalytic theory emphasizes the importance of giving a voice to what is unspoken and unconscious, it can be a helpful framework for exploring subjects that are labeled as “taboo” like sex and sexuality, or how ideas about race, gender, class, ability, and other social forces shape our lives.
Of course, individual therapy cannot eliminate everyday hardship or dismantle global systems of oppression. What it can do is help us to be more in touch with our emotions, have a realistic sense of what is within our control, tolerate uncertainty and ambiguity, cultivate compassion for ourselves, know ourselves better, and develop close, meaningful connections with other people. This can help us step into the world more prepared to address the big and small challenges that face us.
A therapist who works psychoanalytically with an anti-oppressive lens is able to simultaneously understand each client as having a unique mind and experience that must be understood on its own terms, while also holding in awareness how larger social and political forces shape these experiences.
What kind of experience and training do psychoanalytic therapists have?
All licensed therapists are required to complete graduate-level education, gain internship experience while completing their degrees, and then spend their first few postgraduate years talking with an experienced supervisor who provides guidance on their cases. Once the therapist completes their required supervised hours and is fully licensed, it is up to them to decide how much supervision and consultation they seek from their colleagues for the remainder of their career.
Because psychoanalytic work centers o the importance of relationships in promoting continued growth, there is a robust tradition of psychoanalytic therapists being in their own long-term psychoanalytic treatment, and continuing to regularly seek support on their cases with a more experienced psychoanalytically-oriented supervisor long after the requirements for their licensure have been met. This means that just as clients in this type of treatment are continually growing in their therapeutic work, their therapists are also deeply committed to their own personal and professional growth.
Many psychoanalytic psychotherapists additionally pursue postgraduate education through psychoanalytic institutes or other organizations dedicated to providing psychoanalytic education. Some may also pursue further training to provide traditional psychoanalysis, which differs from psychoanalytic psychotherapy primarily in frequency, with sessions taking place at least three times a week, instead of once a week.
Who is psychoanalytic treatment for?
Psychoanalytic treatment can be helpful for just about any client, provided that they feel that their therapist is a good enough fit that they can embark upon therapy together. With younger children, psychoanalytic practitioners use play therapy techniques, as children communicate best through play rather than verbal language. The goal remains the same: to promote the child’s freedom to express themselves, and facilitate the development of the child’s own capabilities through the relationship with the therapist. A psychoanalytic lens can also be powerful for work with couples, groups, and concerns related to relationship challenges in general, as it provides a clear method for exploring and thinking about these challenges.
Psychoanalytic treatment additionally is helpful for a wide range of concerns, from depression and anxiety, to trauma and personality disorders. While many treatments focus on the most outwardly visible symptoms of these conditions, psychoanalytic work aims to uncover and tend to the deeper wounds beneath these symptoms. If more short-term therapies or therapies that are mostly based on teaching specific skills or techniques have felt insufficient for your needs, a psychoanalytically-oriented treatment may be able to take you quite a bit further.
How long will psychoanalytic treatment take?
It depends! The type of concerns you have, the frequency of sessions, and many other highly individual factors will influence how long it takes for sustained psychological change to take place. Many people start to feel some relief within just a few weeks of therapy, but ending treatment at this point usually isn’t enough to break the relational and emotional cycles underlying their pain. To uncover and heal attachment wounds and build a more authentic self, good treatment generally takes place over months or years. Many people find it helpful to continue therapy even after significant progress has taken place, as part of a practice of continued self-exploration, personal growth, and tending to the self, in the same way they might have a regular meditation practice or a regular exercise practice.
How can I get started with Psychoanalytic Psychotherapy?
Flourish provides individual psychoanalytically-oriented psychotherapy for children, teens, and adults, and we offer both in-person and virtual sessions. You can reach us at 828-532-6717 to schedule an intake!