Psychoanalyst: Your Expert in the Subconscious and Unconscious Mind

Medically Reviewed By William C. Lloyd III, MD, FACS

What is a psychoanalyst?

A psychoanalyst is a healthcare provider who specializes in the mental health needs of adults, and children in some cases. Psychoanalysts use psychoanalysis, an in-depth form of talk therapy, to help people overcome difficulties and make lasting changes in their lives. Many types of providers practice psychoanalysis, including psychiatrists, psychologists, nurse practitioners, clinical social workers, counselors, and marriage and family therapists.

A psychoanalyst typically: 

  • Evaluates a patient’s mental and emotional health

  • Performs a psychoanalytic clinical assessment

  • Diagnoses and treats a variety of emotional and mental health disorders

  • Uses psychoanalysis to help people understand and address the unconscious and subconscious influences on their lives

  • Maintains strict patient confidentiality, unless legally obligated to disclose information

  • Commits patients in involuntary, emergency situations in which a patient is a threat to himself or herself or others

A psychoanalyst may also be known by the following names: analyst, counselor, psychotherapist, social worker, psychologist, and psychiatrist.

Who should see a psychoanalyst?

Anyone with personal challenges, possible mental disorders, or problems with unhealthy thoughts, feelings or behaviors might benefit from seeing a psychoanalyst. People often seek psychoanalysis in order to gain self-awareness or insight into themselves and their circumstances. A psychoanalyst can help you work through difficult or failed relationships, grief and loss, sexual identity concerns, trauma, decision-making dilemmas, and self-defeating thoughts and behaviors.

When should you see a psychoanalyst?

Consider seeking care from an experienced psychoanalyst if you develop any of the following symptoms or conditions including but not limited to:   

  • Dependence on food, alcohol or drugs

  • Difficulty functioning at home, work or school

  • Difficulty establishing or maintaining relationships

  • Difficulty sleeping or changes in sleep patterns

  • Disturbing or concerning sexual feelings or attractions, or problems with sex

  • Overeating or undereating

  • Overwhelming anxiety, panic or stress

  • Unusual anger or hostility towards others or yourself

  • Unusual sadness, excessive crying, or depressed feelings that will not go away

You may also benefit from seeing a psychoanalyst under the following situations:

  • You have tried other, less intensive forms of psychotherapy that have failed to help.

  • You have repetitive patterns of difficulties in personal, social and professional relationships.

  • You have personality traits that bother you or are constant obstacles in your life.

  • You want professional help moving past an event, dealing with past experiences, or resolving chronic internal conflicts.

  • You desire the insight and understanding that psychoanalysis can provide to help you feel more fulfilled and self-assured.

You should seek immediate help from a mental health provider (counselor, social worker, therapist, psychologist or psychiatrist) or call 911 if you have thoughts of hurting yourself or others, or if you or someone you know is considering suicide.

What conditions and diseases does a psychoanalyst treat?

Psychoanalysis can be a useful part of an overall treatment plan for emotional and mental health. A psychoanalyst treats conditions including:

  • 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

  • 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, somatizing personality, dependent personality, hysterical personality, and dissociative personality

  • Relationship problems including family or marital conflict, infidelity, divorce, intimacy, anger issues, and the stress related to caregiving or infertility

  • Sexual issues and disorders including sexual dysfunction, abnormal sexual desires (paraphilias), 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 tests does a psychoanalyst perform or order?

A psychoanalyst relies primarily on a psychoanalytic clinical assessment to reach a diagnosis and offer treatment recommendations. A psychoanalytic clinical assessment can take several months and generally consists of two main components:

  • Strength assessment including an assessment of the patient’s motivation, potential for self-observation, potential to withstand the stress of an analysis, potential to work analytically, ability to resolve internal conflict, ability to recognize and distinguish between reality and fantasy, and ability to self-differentiate from others

  • Weakness or vulnerability assessment including symptoms related to psychiatric diagnoses, unconscious conflicts, defenses, ego functions, and cohesive sense of self (whether you feel strong and whole or fragmented, as if things are falling apart)

Psychoanalysts may also use assessment processes or tests from their background in a mental health field. For example, a psychoanalyst with a background in psychology may use psychological personality tests with his or her psychoanalytic clinical assessment.

What procedures and treatments does a psychoanalyst perform or order?

Psychoanalysts specialize in using psychoanalysis to help people overcome mental or emotional problems and make lasting changes in their lives. Psychoanalysis is an in-depth form of talk therapy pioneered by Sigmund Freud in the late 19th century and further developed in the 20th century.

How psychoanalysis works

Psychoanalysis is based on the idea that the subconscious mind influences human relationships and patterns of thought, emotion and behavior. By uncovering and investigating these unconscious influences, psychoanalysts help people understand their motivations and cope with or change their ingrained thought or behavior patterns.

In psychoanalysis, patients typically lie on a couch, not directly facing the psychoanalyst. This encourages patients to speak freely without worrying about the psychoanalyst’s reaction. The psychoanalyst acts as a guide or facilitator during the sessions, often remaining quiet and letting the patient talk about whatever comes to mind. The psychoanalyst does not act as an authority figure, give advice, or have preconceived notions of what is best for you.

While this may seem odd, it lets the psychoanalyst observe where your thoughts and associations take you and what subjects you find difficult to address. It also allows the psychoanalyst to identify patterns in the way you think, feel, behave and interact. All of these observations provide clues to the subconscious influences that are contributing to your problems or difficulties. The psychoanalyst helps you understand these patterns and influences, and find more productive approaches.

Psychoanalysis relies on a close, trusting relationship between the patient and the psychoanalyst. Patients often explore extremely intimate topics, some of which may carry significant guilt or be disturbing, embarrassing or painful. A patient’s feelings about the psychoanalyst may even be a topic of exploration.

Psychoanalysts may lead a patient to re-live an experience that has been subconsciously influencing the patient’s life. Therefore, the patient must feel that his or her relationship with the psychoanalyst is a safe place to talk about absolutely anything. The psychoanalyst is bound by strict confidentiality unless the patient authorizes release of information or the psychoanalyst is legally obligated to release information.

Other considerations

Psychoanalysis is not a short-term treatment method and often takes years to reach completion. It is a commitment to frequent (typically four times a week) sessions with a psychoanalyst. Because of this level of dedication and the need for mutual trust and confidence, a psychoanalyst may use a trial period to determine if psychoanalysis is suitable and if the necessary relationship can be established with the patient.

Psychoanalyst training and certification

Education, training, experience, licensure and certification are key elements in establishing a psychoanalyst’s level of competence. While licensure is the legal ability to practice a mental health profession, certification is a voluntary process that recognizes a practitioner’s expertise. Board certification verifies that a provider has completed training and has passed competency examinations. Each mental health profession, such as psychology or counseling, has its own certifying board or boards

In the United States, the practice of psychoanalysis is regulated by individual states. In most states, the term “psychoanalyst” is not regulated, and anyone can use it. Instead, states regulate and license various professions practicing psychoanalysis, such as psychologists. For this reason, it’s important to familiarize yourself with the types of providers who practice psychoanalysis and verify a psychoanalyst’s education, experience, and licensure if needed.

The American Psychoanalysis Association accredits training institutes that offer psychoanalysis programs. A graduate of an accredited psychoanalysis training institute has:

  • Completed four to five years of coursework in psychoanalytic theory and technique

  • Undergone a personal analysis

  • Conducted supervised psychoanalysis of at least three patients

  • Completed additional coursework and supervised analysis of children if his or her practice will include treatment of children

 Eligible candidates for psychoanalysis programs include:

  • Psychiatrists: A board-certified psychiatrist is a licensed medical doctor (MD) or doctor of osteopathic medicine (DO) who has completed specialized residency training in psychiatry following medical school, and has passed a certification exam that validates the doctor’s specialized knowledge and skills in psychiatry. To maintain board certification in psychiatry, a doctor must participate in the American Board of Psychiatry and Neurology’s Maintenance of Certification program.

  • Mental health providers with a doctoral level degree: These candidates include psychologists and other mental health providers with doctorates in their mental health field. In addition, these candidates have completed at least two years of postdoctoral training in mental health and passed a licensing exam.

  • Mental health providers with a clinical master’s degree: These candidates include mental health providers with a clinical master’s degree that is recognized as being the highest clinical degree in the field. In addition, these candidates have completed at least two years of post-degree training in mental health and passed a licensing exam.

  • Other qualified candidates: Qualified scholars, researchers, educators, and other professionals may be accepted as candidates on an individual basis.

Examples of mental health providers who practice psychoanalysis include licensed nurse practitioners (NPs), licensed professional counselors (LPCs), licensed clinical social workers (LCSWs), and licensed marriage and family therapists (LMFTs). When considering psychoanalysis, be sure to ask a provider about the details of his or her training, education, licensure and certification.

Was this helpful?
  1. About Psychoanalysis. North American Psychoanalytic Confederation.  
  2. Common Mental Health Diagnoses. American Psychoanalytic Association.  
  3. Psychoanalytic Terms & Concepts Defined. American Psychoanalytic Association.  
  4. Education Standards. American Psychoanalytic Association.  
  5. What Is Psychoanalysis? What Is Child Psychoanalysis? Psychology Today.  
  6. About Psychoanalysis. American Psychoanalytic Association.

Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2017 Nov 27
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.