Psychoanalysis
Core Mechanism
Insight into unconscious conflict + interpretation of transference and resistance + working through the repetition reorganizes relational patterns
Ontology
Unconscious conflict between drives, defenses, and internalized relationships
Therapeutic Voice
"What comes to mind when you notice that feeling?"
View of the Person
A divided subject driven by unconscious forces it cannot directly access
Evidence
NICE: does not separately recommend long-term psychoanalysis; NG222 lists short-term psychodynamic psychotherapy (STPP) for depression, not long-term/classical PDT
Limited RCTs (treatment length); naturalistic studies
Leichsenring & Rabung (2008) meta-analysis of LTPP
Difficult to study via RCT. Umbrella review (Leichsenring et al., 2023) found moderate evidence for PDT broadly.
Conditions
Epistemology
Blind Spots
May neglect behavioral activation and symptom stabilization while pursuing insight; long timeframes can delay relief
Contraindications
Active psychosis, acute suicidality, active substance dependence requiring stabilization, severe cognitive impairment, clients needing immediate symptom relief or crisis intervention
Training
Psychoanalytic institute training (4-7 years), personal analysis required
APsaA; IPA member institutes
2,000+ hrs didactic + 300+ supervision + personal analysis
$40K-100K+
Philosophical Roots
Freud; Nietzsche (drives beneath reason); Schopenhauer (will as unconscious force); Ricoeur (hermeneutics of suspicion); Klein, Bion, Winnicott (object relations)
Related Modalities
Psychoanalysis in 7 Comparative Clinical Vignettes
Each vignette presents the same client through multiple theoretical lenses side by side — showing how Psychoanalysis formulates presenting problems, sets treatment focus, and sounds in the consulting room compared with the other modalities working the same 7 cases. This comparative pedagogy is unique to Epoché Clinical; no other clinical reference systematically formulates the same case across traditions.
Test Yourself
What is the fundamental rule of psychoanalysis?
Show answer
Free association: say whatever comes to mind without censoring.