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Psychoanalysis Gets to the Root of the Problem

How unconscious factors or “blind spots” influence our emotions and behavior.

By Alexandra Sacks, M.D.

Source: wavebreakmedia/Shutterstock

Patients come to me with frustrating conundrums such as “My last three boyfriends cheated on me. Why do I keep falling for the wrong guys?” or “I keep yelling at my boss when I’m frustrated and now I’m afraid of getting fired.” They also come to me with distressing thoughts and feelings. For example “Every time I look in the mirror, I feel ugly”.

Often, they have already spent hours thinking about these issues, usually seeking advice from friends and family. Perhaps they have even spent money in the self-help section of the bookstore. Many have even tried other briefer, more targeted talk therapies, but still haven't found relief. So now they have decided to invest more energy into a deeper process with the hope that it may help get to the underlying causes of their problems.

What does psychoanalysis look like?

Most of us conjure images we’ve seen of Freud and his office: a leather couch, some funky dusty rugs, and an old white man, bearded and piped, peering over his spectacles. Maybe you imagine a caricature from a cartoon in The New Yorker of someone who is mystical, out-of-touch, and holier-than-thou. Maybe you remember a psychoanalyst from a movie who supposedly could read your mind and see into all of your hopes, fears, demons, and secrets.

Well, here’s the good news—today’s psychoanalysis is ready for a makeover. Psychoanalysis is becoming more and more an endeavor in which both the patient and analyst have a voice. Gone are the days of analysts looking down on patients with the implication that they know better. Today it’s more of a conversation with the therapist functioning more like a guide than a god. And then there’s the identity crisis of who becomes psychoanalysts. Today’s analysts include women, people of color, LGBTQ, and from cultures all around the world.

Different Types of Talk Therapies

Other forms of talk therapy are designed to be targeted, efficient, and helpful within a few weeks or months. Sounds pretty good, right? I agree. Brief treatments that are designed to bring people relief from their suffering and symptoms have advanced our field and helped millions worldwide. Here's a list of some helpful, short-term forms of therapy that are related to but also different from psychoanalysis:

Psychoanalytic or psychodynamic therapies are also designed to help you better understand yourself and, ultimately, feel better. The therapy is based on the concept that unconscious factors or “blind spots” influence our emotions and behaviors. The goal is to help you understand how these blind spots prevent you from seeing things clearly, leading to painful emotions or repeated unsatisfying or unpleasant experiences. There is often a focus on talking about your childhood and past to understand how memories and experiences relate to your current problems.

The analyst is a partner who helps you to become more self-aware by helping you appreciate how patterns of behavior play out in the therapy sessions themselves. This process, transference, helps you to better understand your behavior both with the analyst and with people and patterns in your real life. It is designed to help you discover your own answers with your therapist’s skilled facilitation.

Psychoanalysis tends to be a slower treatment that takes more time, and often involves meeting with your therapist more than once per week. And in today’s workforce which barely encourages workers to take sick days when they’re shivering with the flu, fitting a regular mental health appointment into your schedule can be very difficult .A lot more work needs to be done to change policies with government as well as insurance companies to make talk therapies of all forms accessible to everyone who needs it. In the meantime a number psychoanalytic training institutes offer low-cost clinics and referrals with reduced fee options for individuals with limited financial means.

Like Working with a Gardener

The American Psychoanalytic Association decided it was time to retell our story, complete with a new picture of what psychoanalysis looks like today. Our first venture is our newest video, Getting at the Root of the Problem, where we use the analogy of a gardener and a tree to capture the essence of a modern relationship between a psychoanalyst and his/her patient.

Psychoanalysts are curious about the roots of problems. And, like gardeners, we work with patients to dig deep, clearing out the weeds and nourishing the soil until the trees and plants can once again thrive. We encourage patients to take their time to tell their stories, to talk freely, letting their minds and memories wander. Together, slowly but surely, psychoanalysis is a process that can help you better understand yourself, get relief from painful emotional symptoms, and improve your personal relationships.

Please enjoy our video and visit us at to learn more. And send us feedback and questions because we’re ready to grow too!

About the Author: Alexandra Sacks, MD is a Reproductive Psychiatrist, advanced candidate at The Columbia University Psychoanalytic Center for Training and Research, New York Times Contributor, and Spring 2018 TED Resident. Her article “The Birth of a Mother” was the #1 most read article of 2017 for the New York Times Well-Family Section and has been featured in Time Magazine, Elle, Slate, and NPR. She has specialty Fellowship training in Reproductive Psychiatry from New York Presbyterian/Columbia.

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