Freudian psychoanalysis

Domain I · Psychodynamic & depth psychology · Sigmund Freud · 1911

What it is

Classical psychoanalysis is a high-frequency (traditionally 4–6 sessions/week), open-ended treatment in which the patient lies on a couch and says whatever comes to mind (the fundamental rule) while the analyst listens with evenly suspended attention and interprets. Change is held to happen when…

Format

• Freud explicitly declined to give a full schema; he likened analysis to chess, where only openings and end-games can be systematised. The stages below combine Freud's opening and end-game advice with Greenson's description of the mid-phase. Session counts are approximate.
• Format (whole treatment). 45–50-minute sessions (Freud used a full hour; 50 minutes became standard later). Freud saw patients daily except Sundays and public holidays; for mild cases or established treatments, three sessions a week sufficed. Contemporary IPA standard for "psychoanalysis" is…

Evidence status, as the guide reports it

• Move on when: core transference patterns have been repeatedly recognised and worked through; symptoms have diminished; the patient increasingly self-analyses; reconstructions have been confirmed by memories or indirect evidence.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• The patient adding further examples himself = alliance working.
• Over-reading trivia (patient becomes self-conscious or compliant).
• Suggestibility; constructions of abuse or trauma imposed by the analyst.
• Rigid refusals felt as cruelty (Greenson criticises coldness) → balance with warmth.
• Dangerous acting out (self-harm, ruinous decisions) → prioritise safety; see section 5.

Problems the guide addresses

• Silence and "nothing comes to mind"
• Stuck analysis / stalemate
• Intellectualisation / compliance
• Overwhelm, excessive regression, flooding
• Non-adherence to the frame (lateness, missed sessions, non-payment)
• Acting out and threats to the treatment
• Erotic transference turning into demands
• Hostile transference / threats to quit (ruptures)
• Negative therapeutic reaction
• Symptom aggravation early in treatment

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.