What is psychoanalysis?
When people ask what psychoanalysis is, they usually want to know about treatment. As a therapy, psychoanalysis is based on the observation that individuals are often unaware of many of the factors that determine their emotions and behavior. These unconscious factors may create unhappiness, sometimes in the form of recognizable symptoms and at other times as troubling personality traits, difficulties in work or in love relationships, or disturbances in mood and self-esteem. Because these forces are unconscious, the advice of friends and family, the reading of self-help books, or even the most determined efforts of will, often fail to provide relief.

Psychoanalytic treatment demonstrates how these unconscious factors affect current relationships and patterns of behavior, traces them back to their historical origins, shows how they have changed and developed over time, and helps the individual to deal better with the realities of adult life.

Analysis is an intimate partnership, in the course of which the patient becomes aware of the underlying sources of his or her difficulties not simply intellectually, but emotionally - by re-experiencing them with the analyst. Typically, the patient comes four or five times a week, lies on a couch, and attempts to say everything that comes to mind. These conditions create the analytic setting, which permits the emergence of aspects of the mind not accessible to other methods of observation. As the patient speaks, hints of the unconscious sources of current difficulties gradually begin to appear - in certain repetitive patterns of behavior, in the subjects which the patient finds hard to talk about, in the ways the patient relates to the analyst.

The analyst helps elucidate these for the patient, who refines, corrects, rejects, and adds further thoughts and feelings. During the years that an analysis takes place, the patient wrestles with these insights, going over them again and again with the analyst and experiencing them in daily life, in fantasies, and in dreams. Patient and analyst join in efforts not only to modify crippling life patterns and remove incapacitating symptoms, but also to expand the freedom to work and to love. Eventually the patient's life - his or her behavior, relationships, sense of self - changes in deep and abiding ways.

Why psychoanalysis?
The purpose of psychoanalytic treatment is to help people change and progress in their lives. The development of self-awareness/insight is a step in achieving that progress. 

People make the best choices they can, given the limitations of their assumptions about themselves and their circumstances. 

Psychoanalytic treatment gives patients the opportunity to examine these assumptions, understand their origins in their lives, modify them if necessary, and make better choices for themselves.

When to seek psychoanalytic advice?
People often wonder when it's time to seek advice from a psychoanalyst.

All of the usual reasons someone might consult with any mental health professional are good reasons for seeing a psychoanalyst, to get the most comprehensive assessment of one’s problems. This includes symptoms and feelings of anxiety, depression, panic attacks, obsessions and compulsions. Personality traits that keep getting in your way, in your private or professional life, are also very amenable to being understood and helped by a trained psychoanalyst.

Perhaps you're having trouble in work situations—repetitive patterns of disappointment in personal relationships, not getting along with your boss or co-workers, seeming lethargic and not connected with friends or colleagues, physical complaints that might be manifestations of underlying emotional conflict, or coping with personal losses and transitions. These are examples of times when consultation with a psychoanalyst can be extremely helpful.

Problems don’t necessarily have to be severe to justify making the first call. You probably have heard the term "worried well" and may even apply that to yourself at times when you are at a loss to describe a general malaise you are feeling. Many people, for example, may be highly functioning at work and home, but troubled inside. While the term “worried well” has sometimes been used pejoratively, being worried, having long-standing internal conflicts, or even just curious about yourself and how your mind works, are valid reasons for speaking with a psychoanalyst. People who have concerns that interfere with the way they want to live their lives benefit from therapy. Psychoanalysis helps people address mental disorders and internal conflicts, and increase self-understanding and freedom.

Much as we like to fantasize that life is easy and that we can create a perfect world around us, the reality is that living is fraught with ups and downs. Just as there are times in life when we need the expertise of a certain kind of accountant or financial planner when we're tackling how to secure our economic future-- or we need a specialist for a certain type of home improvement project-- so at times, some professional advice about personal issues can be invaluable in confronting seeming road blocks that are deterring our ability to experience a sense of emotional freedom about our lives and feeling unencumbered by events of the past.

It is important to understand that it's alright to need some assistance in making our way along life's path. The insight, understanding, and perspectives that can be gained through therapy can be invaluable to our sense of personal autonomy and fulfillment.

Psychoanalytic Treatment Approaches
There are a variety of treatment approaches within psychoanalysis. The central common ground shared by all psychoanalysts is the concept of the unconscious determinants of behavior, psychic determinism, and the influence of the past on the present. The intensity and duration of psychoanalytically-based treatment varies, but many clinicians and patients find that more frequent visits to a psychoanalyst can best arrive at and address core problems. Less intensive work, such as psychodynamic psychotherapy, may also effectively address patients’ problems.

Is psychoanalysis only a therapy?
Although psychoanalysis began as a tool for ameliorating emotional suffering, it is not only a therapy. It is, in addition, a method for learning about the mind, and also a theory, a way of understanding the processes of normal everyday mental functioning and the stages of normal development from infancy to old age. Furthermore, since psychoanalysis seeks to explain how the human mind works, it contributes insight into whatever the human mind produces. In so doing, it has had a profound influence on many aspects of 21st century culture.

As a general theory of individual human behavior and experience, psychoanalytic ideas enrich and are enriched by the study of the biological and social sciences, group behavior, history, philosophy, art, and literature. As a developmental theory, psychoanalysis contributes to child psychology, education, law, and family studies. Through its examination of the complex relationship between body and mind, psychoanalysis also furthers our understanding of the role of emotions in health as well as in medical illness.

In addition, psychoanalytic knowledge is the basis of all other dynamic approaches to therapy. Whatever the modifications, the insights of psychoanalysis form the underpinnings of much of the psychotherapy employed in general psychiatric practice, in child psychiatry, and in most other individual, family, and group therapies.

Who can benefit from psychoanalysis?
Psychoanalysis is an effective treatment for many people with moderate to severe difficulties and who have had unsuccessful attempts with briefer therapies. 

Because analysis is a highly individualized treatment, people who wish to know if they would benefit from it should seek consultation with an experienced psychoanalyst. Still, some generalizations can be made. The person best able to undergo psychoanalysis is someone who, no matter how incapacitated at the time, is basically, or potentially, a sturdy individual. This person may have already achieved important satisfactions - with friends, in marriage, in work, or through special interests and hobbies - but is nonetheless significantly impaired by longstanding symptoms: depression or anxiety, sexual incapacities, or physical symptoms without any demonstrable underlying physical cause. One person may be plagued by private rituals or compulsions or repetitive thoughts of which no one else is aware. 

Another may live a constricted life of isolation and loneliness, incapable of feeling close to anyone. A victim of childhood sexual abuse might suffer from an inability to trust others. Some people come to analysis because of repeated failures in work or in love, brought about not by chance but by self- destructive patterns of behavior. Others need analysis because the way they are - their character - substantially limits their choices and their pleasures. And still others seek analysis definitively to resolve psychological problems that were only temporarily or partially resolved by other approaches.
Whatever the problem - and each is different - that a person brings to the analyst, it can be properly understood only within the context of that person's strengths and life situation. Hence, the need for a thorough evaluation to determine who will benefit - and who will not - from psychoanalysis.

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

Graduate psychoanalysts trained under the auspices of the American Psychoanalytic Association have had very rigorous and extensive clinical education. Candidates accepted for training at an accredited training institute must meet high ethical, psychological, and professional standards. These candidates are either physicians who have completed a four-year residency program in psychiatry, psychologists or social workers who have completed a doctoral program in their fields or hold a clinical masters degree in a mental health field where such a degree is generally recognized as the highest clinical degree; all must have had extensive clinical experience. Outstandingly qualified scholars, researchers, educators, and selected other professionals may also be approved for psychoanalytic training. All accepted candidates, whatever their background, then begin at least four years of psychoanalytic training..

This training consists of three parts. Candidates attend classes in psychoanalytic theory and technique. They undergo a personal analysis. And they conduct the psychoanalysis of at least three patients under the close and extended supervision of experienced analysts. Candidates who plan to treat children attend further classes and, with supervision, analyze boys and girls ranging in age from toddlers to late adolescents.

Besides conducting psychoanalysis, most graduate analysts also practice intensive and brief psychotherapy, sometimes prescribing medication. Many treat couples, conduct family or group therapy sessions, and work with the aging.

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. It also informs their community activities as teachers, supervisors, consultants, and researchers, in the many different settings - hospitals, medical schools, colleges, daycare centers - where analysts are found.

What about the couch?
In psychoanalysis, the patient sometimes lies on the couch so (s)he can allow his or her mind to wander freely. It’s often easier to talk about thoughts and feelings if you’re not face to face with the psychoanalyst – hence the use of a couch. At other times, a patient may feel too uncomfortable not looking at the analyst, so he or she may sit face to face with the analyst.

How to find a psychoanalyst or psychoanalytic psychotherapist?
The Oregon Psychoanalytic Center website offers biographical and specialty information about each faculty member, candidate, and student, together with contact information. Many of these mental health specialists offer reduced-fee psychoanalysis or psychotherapy.

The American Psychoanalytic Association helps individuals find a qualified psychoanalyst or psychotherapist through its institutes, affiliates, and informational literature. APsaA's Find an Analyst feature provides a way to locate a psychoanalyst. Low-cost psychoanalysis is available in many areas.