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How Does Psychoanalysis Work?

Someone recently told me that before coming to see me they thought that people laid on the couch when they go to therapy. “That’s psychoanalysis,” I replied. “Some people still do that.

How does psychoanalysis work exactly? In the last week, a few people asked me that same question: “How did we get here? What changed that things are going so much better now? What did we do that’s different?” Almost as if there was this magical transformation that happened out of nowhere. Trust me, there is a lot that goes on behind the scenes. Let me speak from my personal experience:

My first experience in therapy was on the couch. My analyst at the time, a self-identified Freudian with Lacanian nuances to her technique, had me lay down on the couch after a few preliminary sessions sitting up, during which I think she was gathering some basic information about my main presenting concern.

One day, I showed up for my regular appointment and she had a pillow on the left side of the couch and a small rug on the right, where my feet would go. She made a gesture pointing to the couch. “Shall I lay down?” I asked. She nodded so I did. It was awkward at first but I quickly got used to it and found a sense of relief not having to face her anymore or see her facial expressions. The only thing I had to face now were my own words, and occasionally, hers.

So how does it work? I speak… the analyst listens… then she says something. Because she doesn’t say much (this is not always true for psychoanalysts; some say more than others), I listen carefully to what she says. It’s interesting, out of the three or four years that I spoke to her, I can count my most vivid memories on my ten fingers. Two of them involve dreams, one is about an interpretation to my dream, the others revolve around my relationships and past experiences, and the last one is around the ending.

There is indeed a TRANSFORMATION that happens in the therapeutic relationship that is not magical but that has to do with the creation of MEANING through words, the expression of EMOTION and the VALIDATION of feelings past and present. What’s different about psychoanalysis from other forms of psychotherapy is the focus on the UNCONSCIOUS, on SEXUALITY and on the SYMPTOM as a way to reach the unconscious.

That symptom can be depression, anxiety, alcoholism, self-injury, hair-pulling, promiscuous behavior, an eating disorder, cheating, inability to maintain relationships, angry outbursts, obsessive-compulsive behaviors, you name it. In psychoanalysis, we try to understand WHY we do what we do and we do this TOGETHER with our analyst, who has gone through the process themselves and can guide us through it.

These are lessons I have learned in my own analyses through speaking but also through my experiences helping others. There is a great deal of learning about myself, about people and about the way the human mind works that is life-long and never-ending. So, if I had to sum this up in one sentence, I would probably say that it is through KNOWLEDGE and SELF-AWARENESS that psychoanalysis works.


Do you have other questions about psychoanalysis? Please, ask them in the comment section below.

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How Does Psychoanalysis Work?

Mihaela Bernard, MA, LCPC

Mihaela Bernard, MA, LCPC is a licensed clinical professional counselor and founder of Inside Family Counseling, LLC in Chicago. She is a Professional Member of the American Counseling Association and a member of Chicago Psychoanalytic Circle of the Freudian School of Quebec, Canada. She is the author of Mental Health Digest electronic magazine, your free, easy-to-read electronic resource on common mental health issues affecting you and your family, plus some suggestions on how to address them. She specializes in psychoanalytic psychotherapy for troubled children and adolescents, who face behavioral and emotional challenges at home and at school. Her mission is to empower, support and guide children, adolescents and their parents to a happy and healthy family. Mihaela also writes a Parenting Blog, where parents find helpful resources and practical tips on how to support their child and adolescent's behavioral and emotional development. You may find out more about her at

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APA Reference
, . (2017). How Does Psychoanalysis Work?. Psych Central. Retrieved on April 1, 2020, from


Last updated: 29 Mar 2017
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