Psychoanalysis as a treatment

Aims

Distress comes from unconscious conflicts, often from childhood. Therapy aims for insight (understanding the hidden causes of feelings and behaviour) and catharsis (emotional release when repressed material is recalled).

Classically, the patient lies on a couch with the analyst out of sight, acting as a 'blank screen', for several sessions a week over years.

Free association and dream analysis

• Free association: the patient says whatever comes into their mind without censoring it. Hesitations or changing the subject are seen as resistance, a sign that painful material is near.
• Dream analysis: Freud called dreams 'the royal road to the unconscious'. The manifest content is the story remembered; the latent content is the hidden meaning (repressed wishes) that the analyst interprets through symbols.

Transference and counter-transference

• Transference: the patient unconsciously redirects feelings about important people (often parents) onto the analyst, such as anger or dependence. Analysts see it as central to treatment because it shows the conflict in action.
• Counter-transference: the analyst's own emotional reactions to the patient. Analysts are trained (including through their own therapy) to notice these as clues to the patient's relationship patterns, without acting on them.

The object relations school uses these relationship patterns in therapy (see the object relations lesson).

Evaluation

• Strengths: aims to treat underlying causes rather than symptoms; Fonagy et al. (2015), with 129 patients with treatment-resistant depression, found adding 18 months of weekly psychoanalytic therapy to usual care made partial remission more likely during follow-up (30.0% versus 4.4% at 42 months), though complete remission was uncommon in both groups (14.9% versus 4.4% at 42 months).
• Weaknesses: very long and expensive; interpretations are subjective and hard to test; Eysenck (1952) argued many patients improved without therapy; not suitable for everyone (needs insight and verbal skills); may be distressing to recall repressed memories.

Worked example

During therapy a patient becomes angry with the analyst for being late, in the same way she used to feel about her father. What is happening and why does it matter?

1. She is redirecting feelings about her father onto the analyst.
2. This is transference.
3. It lets the analyst see and interpret the conflict as it happens, helping the patient gain insight.

Answer: Transference: it brings the unconscious conflict into the therapy room where it can be interpreted.

Check yourself

1. A patient says whatever comes into their head without censoring it. This technique is
   • dream analysis
   • systematic desensitisation
   • counter-transference
   • free association
   Show answer

   free association. Free association lets unconscious material surface.

2. The hidden meaning of a dream is its
   • manifest content
   • latent content
   • transference
   • catharsis
   Show answer

   latent content. Latent = hidden; manifest = remembered story.

3. A patient changes the subject when talking about their mother. A psychoanalyst would see this as
   • reciprocal inhibition
   • vicarious reinforcement
   • spontaneous recovery
   • resistance
   Show answer

   resistance. Avoidance suggests painful material.

4. Counter-transference refers to
   • the analyst's emotional reactions to the patient
   • the patient's feelings towards their parents
   • the patient remembering a dream
   • the end of therapy
   Show answer

   the analyst's emotional reactions to the patient. It is the analyst's side.

5. Which is a weakness of psychoanalysis?
   • It only treats symptoms
   • It is based on classical conditioning
   • It is time-consuming, expensive and its interpretations are subjective
   • It needs no trained therapist
   Show answer

   It is time-consuming, expensive and its interpretations are subjective. Years of sessions and subjective interpretation.

6. Fonagy et al. (2015): at 42 months, partial remission was 30.0% with added psychoanalytic therapy and 4.4% with usual care alone. What is the difference in percentage points?
   Show answer

   25.6 percentage points. 30.0 - 4.4 = 25.6 percentage points.

7. Explain what transference is and why it is useful in psychoanalysis.
   Show answer

   Transference is when the patient unconsciously redirects feelings about important people, such as parents, onto the analyst; it is useful because it brings the unconscious conflict into the therapy so the analyst can interpret it and the patient gains insight.. Define, then say how it helps.

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Sources

• Pearson Edexcel International Advanced Subsidiary/Advanced Level in Psychology specification, Issue 5 (February 2021)
• Pearson IAL Psychology component guide: WPS02 (Issue 2, November 2024)
• Simply Psychology: Psychoanalysis
• Fonagy et al. (2015), Pragmatic randomized controlled trial of long-term psychoanalytic psychotherapy for treatment-resistant depression, World Psychiatry 14

Last updated 8 November 2026. Spotted a mistake? Tell us.