Psychoanalysis
What Is Psychoanalytic Therapy (and How Is It Different)?
Most people who search for a therapist encounter a list of acronyms — CBT, DBT, ACT, EMDR — and are not quite sure what they mean or which one applies to them. Psychoanalytic therapy tends to sit apart from that list, often described in ways that make it sound either archaic or inaccessible.
It is neither. This article explains what psychoanalytic therapy actually is, how it differs from other approaches, and who tends to find it useful.
The Basic Idea
Psychoanalytic therapy is based on the premise that a significant part of what drives human behaviour, emotional responses, and relationship patterns operates outside conscious awareness. The things that trouble us most — chronic anxiety, repeating the same relationship dynamics, a persistent sense of dissatisfaction, difficulty understanding our own reactions — often have roots that are not immediately visible.
The aim of psychoanalytic therapy is not primarily to teach skills or restructure thoughts. It is to help you develop a deeper understanding of yourself: what you want, what you fear, how your history has shaped you, and what gets in the way of living more fully.
This happens primarily through conversation. You talk, and the therapist listens carefully — not just to what you say, but to how you say it, what you avoid, what keeps coming up, and what connections emerge over time.
How It Differs from CBT
Cognitive Behavioural Therapy (CBT) is the most widely known structured therapy approach. It focuses on identifying negative or distorted thought patterns and replacing them with more helpful ones. Sessions are typically structured, time-limited, and goal-oriented. CBT is well-supported by research and is an effective approach for many people, particularly for specific, defined problems.
The differences with psychoanalytic therapy come down to a few key things:
Depth versus surface. CBT works primarily at the level of thoughts and behaviours. Psychoanalytic therapy is more interested in what is underneath — the beliefs, conflicts, and emotional patterns that produce those thoughts and behaviours in the first place.
Structure versus openness. CBT sessions tend to follow a clear format with tasks and homework. Psychoanalytic sessions are less structured. The client leads, and what matters is often what emerges from an open conversation rather than from a pre-set agenda.
Duration. CBT is generally time-limited, often 8 to 20 sessions. Psychoanalytic therapy tends to be longer-term, because the work being done is more fundamental. This does not mean indefinite — but if you are dealing with longstanding patterns rather than a specific short-term problem, a brief intervention is unlikely to change them in any lasting way.
The relationship itself. In psychoanalytic therapy, the therapeutic relationship is not just a delivery mechanism — it is part of the work. How the relationship between client and therapist unfolds can reveal patterns that are present in the client's other relationships, and working with those patterns is a central part of what happens.
Neither approach is categorically superior. They are suited to different kinds of problems and different kinds of people.
Who Does Psychoanalytic Therapy Suit?
Psychoanalytic therapy tends to suit people who:
- Feel that previous structured approaches got them so far but did not address the underlying issue
- Find themselves repeating the same patterns in relationships and cannot understand why
- Are dealing with something that does not fit neatly into a specific diagnosis or problem category
- Want to understand themselves more deeply, not just manage symptoms
- Are willing to engage in open-ended conversation and sit with uncertainty
- Are dealing with long-standing difficulties rather than an acute crisis
It is not for everyone. People who want a clear, structured plan and measurable short-term outcomes may find a skills-based approach more suited to their needs. There is nothing wrong with that. The goal is to find the right fit for what you are actually dealing with.
What Sessions Look Like
Sessions are typically 50 minutes. You sit and talk — usually by video call in an online setting. The therapist does not direct you to a specific topic. You bring what is on your mind, and the work develops from there.
People sometimes find this format uncomfortable at first, particularly if they are expecting more direct guidance. The open structure is intentional: what you choose to talk about, what you avoid, what comes up unexpectedly — all of that is part of the material.
Over time, patterns tend to become clearer. Not in a dramatic way, but through the gradual accumulation of understanding that comes from having a consistent space to think.
A Note on Lacanian Psychoanalysis
Within psychoanalytic therapy, there are different traditions. The work at Paul Reid Counselling & Psychotherapy draws on a Lacanian orientation — an approach developed from the work of French psychoanalyst Jacques Lacan, which emphasises language, the unconscious, and the structure of subjectivity.
You do not need to know anything about Lacan to engage in this work. The theoretical framework informs how the therapist listens and what they attend to, but the sessions themselves are conversations — not lectures. If you are curious about what a Lacanian approach means in practice, you can read more at /lacanian-psychoanalysis-melbourne/.
Is It Evidence-Based?
Psychoanalytic and psychodynamic therapies have a substantial and growing evidence base. Long-term psychodynamic therapy in particular shows strong outcomes for complex presentations, with evidence of continued improvement even after treatment ends — sometimes referred to as a "sleeper effect." The evidence base is not as large as for CBT (which has been more extensively studied), but it is robust for the populations it is designed to serve.
Getting Started
If any of this resonates with what you are looking for, the best way to find out more is to have an initial conversation. Psychoanalytic therapy is not something you need to fully understand before you start — it tends to make more sense as you experience it.
Paul Reid is a PACFA-registered psychotherapist with 15+ years of clinical experience, offering psychoanalytic therapy online across Australia. Find out more at counsellingtherapymelbourne.com.au.