Close your eyes and imagine that you’ve just arrived at your first session of psychotherapy. Picture what the room looks like, where you’re sitting, and the demographics of your psychologist. Now open your eyes. If you pictured a yourself lying down on a leather couch, in front of an older, distinguished gentleman with a white beard, you are not alone—and you have Sigmund Freud, grandfather of psychoanalysis, to thank for the image. While the fields of psychology and psychotherapy have evolved in the century since Freud’s first iteration of the “talking cure,” his psychoanalytic theory remains relevant to this day. The image of the omniscient analyst with the power to see through defenses pervades popular culture.

Goals of Psychoanalysis

Inevitably, when a psychologist meets someone in a social setting, the conversation takes a turn for the awkward when the other person learns what the psychologist does for a living. The other person may clam up and say, “Oh, I better watch what I say! You’re probably analyzing me right now!” Or the person may politely excuse himself and make a beeline for the comfort of the buffet table. In either case, the person seems to be acting out of fear that the psychologist will uncover something he is trying to hide—perhaps something he has kept hidden from himself. This fear is not entirely unfounded, particularly if the psychologist is trained in psychoanalytic or psychodynamic theory. The very goal of psychologists trained in this modality is to use various techniques, such as free association or exploration of dreams and fantasies, to bring the deeply buried subconscious to light.

When is Psychoanalysis Used?

If a psychologist is able to determine that an issue the patient is experiencing is not situational but rather representative of a larger pattern, psychoanalysis is indicated. Through interpretation and facilitated confrontation of immature defense mechanisms, psychologists can help their patients break through the deeply rooted defenses enabling and contributing to symptoms. This is not to say that all defense mechanisms are destructive. For example, sublimation involves channeling an unacceptable impulse into a more acceptable one, such as art. What makes a defense mechanism maladaptive? In an exploration of the relationship between defense mechanisms and pathology, a hierarchy emerged (Vaillant, G.E., Bond, M., & Vaillant, C.O., 1986). The following were found to be immature or maladaptive: projection, passive aggression, acting out, hypochondriasis, and denial.

How Psychoanalysis Works

These terms, while rooted in psychoanalytic theory, are fairly common in the vernacular of mainstream media. In spite of the pervasiveness of images and notions of Freudian psychoanalysis in popular culture, it is actually fairly rare in practice. Psychodynamic therapy, a shorter term version minus the prototypical couch, is far more common. The two terms are often used interchangeably, and are virtually identical, theoretically speaking. According to Gabbard (2004), the distinctive features of this kind of therapy are focus on affect and expression of emotion, exploration of attempts to avoid distressing thoughts and feelings, identification of recurring themes and patterns, developmental focus, focus on interpersonal relations, focus on the therapy relationship, and exploration of wishes and fantasies. These features represent the primary differences between psychoanalysis and other kinds of therapy, which are more solution-focused and / or more directly geared toward the alleviation of symptoms.

Criticisms of Psychoanalysis

In research studies evaluating the relative effectiveness of different kinds of therapy, psychoanalysis typically yields similar effect sizes to comparison groups, including cognitive therapy and interpersonal therapy. This finding, repeated over and over in studies dating back to 1975, is referred to in the field as “The Dodo Bird Effect,” which alludes to an excerpt from Alice in Wonderland in which the Dodo Bird proclaims, “Everyone has won and all must have prizes.” This does not mean that there are not real and important differences in outcome of various kinds of therapy. Rather, it is possible that our outcome measures and / or research methodology are not sensitive enough to detect them.

Psychoanalysis does not appear to offer unique benefits in therapy outcome research. However, Shedler (2010) hypothesized that the focus of outcome measures on symptom reduction overlooks the bulk of what psychoanalysis is designed to do. Psychoanalysis is not simply focused on alleviation of symptoms but also on the development of “the positive presence of inner capacities and resources that allow people to live life with a greater sense of freedom and possibility.” The confrontation of maladaptive or immature defense mechanisms can contribute not only to the reduction of symptoms that are already present but also to the development of the ability to self-soothe when future stressors inevitably emerge. An individual with confidence in his ability to cope with future stressors will be able to take the kind of chances necessary to lead a maximally fulfilling life. While this might not captured in effectiveness research, it is a highly valuable benefit of psychoanalysis or psychodynamic therapy. What can the average person borrow from psychoanalytic theory to improve quality of life? Be on the lookout for potential immature defense mechanisms and try to directly address the issues they may be guarding against through communication—and don’t be afraid to turn to a professional if you need some help. Psychologists are not as a scary or intimidating as they may seem!


Gabbard, G.O. (2004). Long-Term Psychodynamic Psychotherapy: A Basic Text. Arlington, VA: American Psychiatric Publishing.

Shedler, J. (2010). The Efficacy of Psychodynamic Therapy. American Psychologist, 63 (2), 98-109.

Vaillant, G.E., Bond, M., & Vaillant, C.O. (1986). An Empirically Validated Hierarchy of Defense Mechanisms. Archives of General Psychiatry, 43, 786-794.

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