Psychoanalytic Therapy and Psychoanalysis

What is psychoanalytic therapy?

Psychoanalytic therapy is a talking therapy. Your therapist is trained to listen for what may be going on in your mind at a deeper level.

It rests on the idea that early life and the unconscious shape how you feel and relate now. The aim is to bring what is unconscious into view, so that you know yourself better.

You lead, and your therapist follows. Over time, the two of you notice the patterns that keep coming back.

The name covers a family of approaches. It includes Freudian and Jungian work, object relations and relational therapy.

Sources: BPC: psychoanalytic therapy, UKCP: approaches

Where it comes from

Sigmund Freud founded psychoanalysis. He grew up in Vienna, where he developed a new kind of treatment. His patients talked about whatever came to mind, and he later called this free association.

Freud's first psychoanalytic work came out in 1895. By 1896, he was calling his method psychoanalysis.

In London, Ernest Jones set up a psychoanalytical society in 1913. It was formed again as the British Psychoanalytical Society in 1919.

Freud left Vienna with his family in June 1938. He settled in Hampstead, where he went on writing and seeing patients.

He died in 1939. His last home is now the Freud Museum.

Sources: Freud Museum: overview, BPAS: Sigmund Freud, BPAS: archives history, Freud Museum: Freuds in exile

How it works

In your sessions you may be encouraged to talk freely and honestly, without censoring what you say. Your therapist may work with your dreams, and with whatever comes to mind as you talk.

Your therapist listens for hidden patterns in what you say and in how you respond to other people. They help you make links between the past and the present.

Feelings from past relationships can come to rest on your therapist. This is called transference, and it is part of the work.

Some of these therapists may seem slower to reassure you than others. They stay closely tuned in to you, but they keep their own feelings and reactions private.

Your therapist will often let you lead, and that can mean silences. An NHS guide says a silence is not a sign that the therapy is unhelpful.

You do not need a plan for what to say. You bring whatever is on your mind that day.

Sources: BPC: psychoanalytic therapy, UKCP: approaches, BPC: starting therapy, RCPsych: psychotherapies, BACP: types of therapy, NHS Waiting Room: psychoanalysis

What sessions look like

Sessions usually last 50 minutes. This therapy often means one to three sessions a week. Many therapists also work online or by phone.

You might sit in a chair, or lie on a couch with your therapist behind or beside you. The couch is your choice, and some people find it easier to talk lying down.

Therapy usually begins with a consultation, where you decide together whether and how to go on. It can last from many months to several years.

Private fees vary with experience, place and time of day, and you agree them before you start. Some NHS mental health services offer this therapy, and your GP can refer you.

What you talk about is up to you, and it can change from week to week.

Sources: BPC: psychoanalytic therapy, BPAS: before booking, UKCP: approaches, NHS Waiting Room: psychoanalysis, BPC: starting therapy

Psychoanalysis, the intensive form

Psychoanalysis is the most intensive form of this work. You see your analyst four or five times a week, and you lie on a couch.

An analysis normally takes years, not months, and it is common for it to last more than four years. The British Psychoanalytical Society calls it a big commitment of time and money.

The society says psychoanalysis can help, but it does not provide a cure. It says the work can go deep enough to change a life, and it can also disappoint.

Training takes at least four years. Each trainee has their own analysis five times a week, and analyses two patients under supervision.

The society puts an average private fee at sixty to a hundred pounds a session. A lower-fee route exists.

The London Clinic of Psychoanalysis offers low-fee analysis with experienced trainees near the end of training. After a consultation, the fee can be as low as five pounds a session. Places are limited.

The British Psychoanalytic Association runs a second low-fee service, for people on low incomes. You would come at least four times a week, for at least two years.

Most psychoanalysts also offer less intensive therapy, with fewer sessions each week.

Sources: BPC: psychoanalytic therapy, BPAS: psychoanalysis overview, BPAS: training, BPAS: clinic, BPA: low fee service, BPAS: before booking

How it differs from psychodynamic therapy

Psychodynamic therapy grew out of psychoanalysis. It works with similar ideas, but it is less intensive and usually briefer. Psychodynamic therapists train to work once or twice a week, usually with you in a chair.

The British Psychoanalytic Council says how often you go is not the whole difference. It sees how often you go as a sign of how deep the work goes.

In everyday use the two words overlap. The NHS uses the two names for one therapy.

Sources: BACP: types of therapy, BPAS: before booking, UKCP: approaches, BPC: psychoanalytic therapy, NHS: depression treatment

Who it may suit

Psychoanalytic therapy may suit you if you:

• Notice the same patterns coming back in your relationships or your work
• Want to understand yourself, not only change a habit
• Feel ready to talk about your close and family relationships
• Would rather lead the conversation than follow a set programme
• Have the time and the money for work that may last years

It may suit you less if you want quick help with one problem. Shorter therapies such as cognitive behavioural therapy may focus more on managing problems and feelings.

An NHS guide to this therapy notes that some people feel worse before they feel better. The same guide says it is not recommended during a psychotic illness.

Sources: BPC: starting therapy, BPAS: before booking, NHS Waiting Room: psychoanalysis

Finding a psychoanalytic therapist

Anyone in the UK can call themselves a psychotherapist or a counsellor. The NHS advises checking that a private therapist is on a register accredited by the Professional Standards Authority.

The British Psychoanalytic Council keeps one such register, accredited since 2014. It includes psychoanalysts, among other roles. Its registrants have had their own therapy before and during training.

The Authority checks how a register is run. It cannot act against a single therapist.

Sources: Lally & Naulls 2025, NHS: talking therapies, PSA: BPC renewal 2025, BPC: psychoanalytic therapy

The evidence

NICE does not name psychoanalytic therapy or psychoanalysis in its guidance on depression or generalised anxiety. In its depression guidance, it names a briefer relative, short-term psychodynamic psychotherapy.

For less severe depression, that therapy usually runs for eight to sixteen sessions. NICE lists it last of eleven options, though it says any of them can be used first.

NICE says this therapy may be less suitable for people who do not want to focus on their own feelings.

NHS Talking Therapies offers a short psychodynamic therapy, for depression only. Its manual does not list psychoanalytic therapy.

The Tavistock Adult Depression Study tested weekly psychoanalytic therapy for depression that other treatments had not eased. Its 129 adults had each tried at least two treatments.

One group had 18 months of weekly sessions on top of their usual care. The other group had usual care alone. At the end, few people in either group were fully free of depression.

Differences appeared later. After three and a half years, 30% of the therapy group had partly recovered. In the usual care group, the figure was 4%.

The trial's authors name its limits. The team that developed the therapy also ran the trial, and one organisation delivered it.

A 2019 study compared long-term psychoanalytic therapy with long-term CBT for chronic depression. It found no significant difference between them. The psychoanalytic group had about four times as many sessions.

Psychoanalysis itself has only a limited number of studies. A 2013 review found 14 studies of psychoanalysis, and all but one had no comparison group. Its authors call that a serious limitation.

Reviews of the long-term form also disagree. One review of 11 trials found the evidence limited and at best conflicting. A later review of 14 trials found small gains over other therapies, and urged caution.

If you are weighing up a few options, our guide to the different approaches sets them side by side.

Sources: NICE NG222, NICE CG113, NHS England: talking therapies manual, Fonagy et al. 2015, Leuzinger-Bohleber et al. 2019, de Maat et al. 2013, Woll & Schönbrodt 2020, Smit et al. 2012