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.
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 long-standing
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.