What does a psychoanalyst do?

What is a Psychoanalyst?

Psychoanalysts are practitioners of psychoanalysis. Psychoanalysis is defined as a set of psychological theories and therapeutic methods which have their origin in the work of Sigmund Freud. It is an in-depth form of talk therapy, which aims to bring the content of the unconscious into conscious awareness.

The basic tenets of psychoanalysis are that behavior is influenced by unconscious drives, that emotional and psychological problems are often rooted in conflicts between the conscious and unconscious mind, that personality development is heavily influenced by events that occur by the age of five, and that people use defense mechanisms to protect themselves from information contained in the unconscious.

Before moving on to a more detailed synopsis of the psychoanalyst career, let’s clarify how a psychoanalyst differs from a psychologist and a psychiatrist.

Psychologists are mental health professionals with doctoral degrees in psychology. Those who have completed clinical training work with patients. Research psychologists study how human minds and animal minds work.

Psychiatrists are doctors of medicine with an MD or a DO degree who have chosen to specialize in the treatment of mental health problems. Because they are medical doctors, they are permitted to prescribe medications.

Psychoanalysts are clinicians who practise a particular kind of psychotherapy, as described above.

What does a Psychoanalyst do?

Psychoanalysts examine what lies beneath the surface of human behavior. They are concerned with the unconscious psychological forces and unrecognized wishes and desires within us, outside of everyday awareness.

By listening to patients’ stories, fantasies, and dreams, as well as discerning how patients interact with others, and by analyzing the communication patterns revealed by the patient-analyst relationship, psychoanalysts can discover paths toward emotional freedom necessary to make real, lasting changes, and heal past traumas.

Typically, psychoanalysts see their patients several times a week, with the objective of communicating as openly and freely as possible. Frequency of sessions, however, varies from case to case. More frequent sessions deepen and intensify the treatment.

The responsibilities of the psychoanalyst include:

• Evaluating patients’ mental and emotional health
• Performing psychoanalytic clinical assessments to determine appropriate treatment or course of therapy
• Diagnosing a variety of emotional and mental health disorders
• Encouraging patients to self-identify their emotional states
• Using psychoanalytic techniques to help patients understand and address the unconscious and subconscious influences on their lives
• Keeping detailed notes of each session
• Maintaining strict patient confidentiality, unless legally obligated to disclose information
• Committing patients to a mental health hospital or facility in involuntary, emergency situations in which a patient is a threat to himself / herself or others
• Performing administrative tasks – psychoanalysts in private practice, in particular, may take on administrative or managerial tasks such as billing, payroll, scheduling, and insurance communication
• Conducting research – as scholars of psychology and psychoanalysis, psychoanalysts may conduct research in the form of case studies or experiments, and publish their findings
• Continuing their education to stay updated on new techniques or findings in the scientific community

The psychoanalytic clinical assessment performed by psychoanalysts can take several months and generally consists of two primary components:

The strength assessment includes an assessment of the patient’s motivation, potential for self-observation, potential to withstand the stress of an analysis, potential to work analytically, capacity to resolve internal conflict, capacity to recognize and distinguish between reality and fantasy, and capacity to self-differentiate from others.

The weakness / vulnerability assessment identifies symptoms related to psychiatric diagnoses, unconscious conflicts, defenses, ego functions, and cohesive sense of self (whether the patient feels strong and whole or fragmented, as if things are falling apart).

Psychoanalysts may also use psychological personality tests in combination with their psychoanalytic clinical assessment.

Some of the more popular psychoanalytic techniques employed by psychoanalysts include:

Dream Analysis
This is the recording and interpretation of dreams to reveal unconscious thoughts. Freud believed that repressed ideas and feelings rise to the surface of the mind through dreams. However, because the content of dreams is not always straightforward, the psychoanalyst must help the patient interpret and understand the substance of the dream to uncover its hidden meanings.

Free Association
During free association, the patient is encouraged to freely talk about anything that comes to mind. The psychoanalyst may provide prompts and the patient simply responds with the first associations that occur. The idea behind free association is that, while encouraged to talk before they think, the patient may reveal something important, such as a repressed memory, by exposing the associations their mind makes first. This is sometimes called a Freudian slip, after Sigmund Freud, the founder of psychoanalysis.

Interpretation
The psychoanalyst helps the patient explore memories and personal narratives, and while doing so, analyzes them. The therapist looks for common themes in the patient’s stories, either in recurring feelings or behaviors or how the patient describes things or emphasizes parts of each story. The idea behind interpretation is that the patient may not be aware of how they control their actions or behave in a specific way, or how specific events affect their current lives.

Transference
Patients engage in transference when they transfer feelings they had for someone in their past to the present. Transference sometimes occurs between the patient and the therapist. This can happen when the patient relates information from their past experiences and begins to associate their therapist with the dynamic they lived in the past. This helps the patient react to the feelings that arise in real time with their therapist, allowing the psychoanalyst to gain a more in-depth understanding of the unconscious dynamics influencing the patient’s life.

These are some of the conditions and diseases treated by a psychoanalyst:

• Abuse and neglect including physical, emotional, and sexual abuse, and child or elder neglect
• Addiction including alcohol, drug, sex, gambling, gaming, and internet addictions
• Childhood and adolescent problems including developmental disorders, dysfunctional emerging personality, body image disorders, self-esteem problems, and oppositional defiant disorder (ODD) – a childhood mental health disorder characterized by frequent and persistent anger, irritability, arguing, defiance, or vindictiveness
• Eating disorders including anorexia, bulimia, and binge-eating disorder
• Mental disorders including depression, anxiety, phobias, obsessive-compulsive disorder (OCD), bipolar disorder, and schizophrenia
• Personality disorders including borderline personality disorder (BPD), neurotic personality, paranoid personality, antisocial personality, narcissistic personality, sadistic or masochistic personality, somatic symptom disorder (a disorder in which individuals feel excessively distressed by their health, and also have abnormal, out-of-proportion thoughts, feelings, and behaviors in response to their symptoms), dependent personality, hysterical personality, or dissociative personality
• Relationship problems including family or marital conflict, infidelity, divorce, intimacy, anger issues, stress related to care-giving, stress related to infertility
• Sexual issues and disorders including sexual dysfunction, abnormal sexual desires, sexual orientation, and gender identity
• Sleep disorders including insomnia, nightmares, and sleepwalking
• Trauma and major life issues including post-traumatic stress disorder (PTSD), life transitions, stress from health problems, or grief from death of a loved one

What is the workplace of a Psychoanalyst like?

Psychoanalysts usually work regular office hours. Those in private practice may work some evenings or weekends to accommodate their patients’ schedules. Many psychoanalysts are self-employed, meaning that the amount of hours they work depends on how many clients they have.

While being a psychoanalyst can be very rewarding, it is also very demanding. These practitioners must be prepared for intense and sometimes unpleasant sessions with patients. Psychoanalysts, of course, are bound by counselor-client confidentiality.