Psychoanalytic psychotherapy is a form of therapy that aims to help people to develop deeper self-understanding and lead a more fulfilling life.

We have all had different experiences early in life, and these experiences shape who we become. Psychoanalytic psychotherapists consider these early experiences to be extremely important, as not only do they shape our understanding of ourselves and others, but what we have learned from our experiences can lead to repetition of problematic patterns in relationships with others, without necessarily even realising this is occurring. Furthermore, throughout our lives, we develop ways of coping with our underlying and often hidden feelings, and these ways of coping can in themselves cause us further problems or distress. 

Often, people come to therapy for help with a particular problem, such as an episode of depression, or coping with a relationship breakdown. Sometimes, people can have multiple episodes of therapy, all for seemingly different problems such as these. They might obtain some strategies for managing symptoms, and the symptoms may ease, but for many people, different problems and issues can keep arising, or there is a sense of still having underlying issues.

In psychoanalytic psychotherapy, problems such as depression, anxiety, relationship difficulties, and other mental health issues are not typically seen in isolation, as issues to be treated separately. Instead, this therapy helps people to understand how these seemingly separate problems and symptoms, all of which can create a great deal of distress, may in fact arise from underlying, unresolved issues.

For instance, a person who has had negative experiences of caregivers throughout childhood might grow up to have a sense of others as being critical and emotionally unavailable, and find it difficult to form close, connected relationships. This might also contribute to developing problems such as depression or anxiety. Therapy that focuses on managing the symptoms of depression or anxiety may end up not exploring and working through the underlying themes and issues that have contributed to the development and maintenance of depression and anxiety.

In contrast, psychoanalytic/psychodynamic psychotherapy helps you with your current problems that are bringing you to therapy, through helping you to have better understanding of how and why these problems developed, and helping you to work through the underlying issues or conflicts that have been leading to these problems developing and continuing. As a result of this form of treatment, you can develop more insight, feel more connected with yourself, and have a more fulfilling and engaging experience of life.  

Psychoanalytic psychotherapy can feel quite different to other psychological treatments. Because there is a focus on exploration and uncovering, this form of therapy is non-directive, and you, as the patient, start the session by initiating discussions about whatever comes to mind. Unlike many other treatments, strategies and skill-building techniques do not occur in this treatment. This is because the problems that are bringing you to therapy are often linked to underlying issues, which are gradually uncovered and worked through in therapy, and are not seen as something to be managed or treated in isolation, as this is believed to only lead to short-term relief rather than lasting change. The therapist will help you to make sense of what is coming out in sessions, and may at times be encouraging you to notice experiences, and make connections, that previously had not been within your awareness.

Another way in which psychoanalytic psychotherapy can differ from other treatments is that there is a strong focus on the therapy relationship as a part of self-understanding and change. Your therapist is likely to discuss your relationship with them and how you feel in this relationship, so that you can gain increased understanding of how your relationship experiences affect you in the present moment.

Psychoanalytic psychotherapy can be beneficial for people experiencing a range of problems and challenges. This form of treatment can be particularly helpful for:

• Relational and interpersonal challenges, particularly when there are repeating patterns occurring in relationship experiences

• Attachment patterns that cause distress or issues, such as struggling to form and maintain fulfilling and positive relationships

• Mental health conditions such as depression and anxiety, particularly where these problems do not appear to respond well to other treatments

• Working through experiences of trauma

• Personality disorders or personality traits that can impact on relationships and emotions

• Difficulties with emotional regulation and emotional connection

• Physical symptoms that do not have an underlying medical cause

• Working through experiences of separation, loss, and grief

• Developing better self-understanding and self-awareness, even if there is not a mental health concern bringing you to therapy

If you would like to develop a deeper understanding of yourself, increase your self-awareness, work through past experiences that continue to have an impact on your life now, and/or work towards having a more fulfilling experience of life, this is likely to be a good approach for you. If you have issues or challenges that do not appear to have responded well to past treatments, such as long-standing issues with depression, anxiety, problem behaviours, or the impact of traumatic experiences, psychoanalytic psychotherapy may be able to offer you a different, more in-depth way of assisting you than other psychological therapies. It may also be a good treatment if you have experienced different mental health issues at different points in your life, and you are wondering if there is an underlying connection between these issues.

You also need to be able to commit to sessions occurring at least once per week, at a set time per week, over an extended period of time as part of this journey. These sessions can occur via Telehealth, face-to-face, or a combination of both modalities.

If you are looking for short-term therapy with a focus on practical strategies, or you want help with a current crisis, this approach may not be a good fit for you, as it tends to be longer-term and exploratory, without direct guidance or strategies. However, this still might be a useful approach to consider at a later stage. Many people find that after completing a different form of therapy, they have gained useful skills, and feel more equipped to be able to engage in a more exploratory therapeutic process to work on underlying issues. If this is the case, psychoanalytic psychotherapy may be a good next step for you.

When you see a psychoanalytic psychotherapist, the first session will typically involve assessment, where you may be asked questions about what brings you to therapy, along with other questions about your background and history. From there, subsequent sessions will involve you initiating the session, discussing whatever it is that comes to mind. The therapist will not ask you questions at the start of the session, or provide a direction about what you should say, as it is important in this approach that you feel free to discuss whatever it is that comes to mind in the moment, no matter how trivial or insignificant it might feel. This way of starting the session can feel unusual at first, but is an important part of feeling that you can discuss whatever you need to discuss.

The therapist will help you from there to better understand what is going on for you and develop increased self-awareness and connection with yourself. You are also encouraged to discuss your dreams, daydreams, and fantasies, even if these feel insignificant, uncomfortable, or shameful. You do not need to prepare in any way for the sessions, as we are trying to get beyond the surface to what it is that might be unsaid, or outside of your awareness. 

Sessions will occur at regular set times, go for 50 minutes, and start and end on time. They will occur at least once a week, and commonly occur two or three times per week. This stability and consistency provides a containing and holding environment, so that you can feel comfortable to express yourself freely while having a sense of containment.

Another way in which this therapy can differ from other treatments is that there is a focus on what is going on between the patient and therapist, so the therapist is likely to discuss what is occurring in your relationship with them, and to help you to better notice your emotions in the moment while you are in the session. This is a way to help you to make connections between how you are relating to others now, and your patterns in relationships throughout your life.

You may hear the terms “psychoanalytic” and “psychodynamic” used interchangeably. Both therapies have the same underlying principles and ways of working, but typically refer to different types of intensity and length of treatment. Generally, psychodynamic psychotherapy usually refers to therapy that is shorter-term and less intensive in nature, where it occurs once per week or less, typically for a period of several months to a year or more. Psychoanalytic psychotherapy is generally a more intensive process, where sessions generally occur between once and three times per week, over a longer period of time. It sometimes occurs with the patient lying on the couch, as this can allow them to more freely express themselves without feeling the need to look at the therapist; however, this is optional. The level of intensity and frequency of psychoanalytic psychotherapy sessions is required to provide a containing space where you can freely discuss whatever comes to mind.

At Aurora Psychology, we have both psychodynamically and psychoanalytically oriented practitioners, as well as practitioners who use other approaches.