Psychoanalysis is a form of talk therapy focused on uncovering unconscious thoughts, emotions, and past experiences to address mental health issues. While it can be effective for some mental health conditions, it is not recommended for obsessive-compulsive disorder (OCD), as it can cause you to assign meaning to your intrusive thoughts, obsess over false memories, and or become more attached to your compulsions.
Obsessive-compulsive disorder (OCD) is a chronic mental health condition that requires specialized treatment to disrupt the cycle of obsessions and compulsions. While you may already be familiar with effective OCD treatments like exposure and response prevention (ERP) therapy, you may be curious about whether other therapies can also help manage your symptoms.
Psychoanalysis has sometimes been recommended as treatment for OCD, but it does more harm than good. Keep reading to learn more about psychoanalysis, how it works, and whether it’s an effective treatment for OCD.
What is psychoanalysis?
Psychoanalysis, also known as psychodynamic therapy or psychoanalytic therapy, is a set of psychological theories and therapeutic approaches created by neurologist Sigmund Freud between 1885 and 1939. This therapeutic approach is based on the idea that the unconscious mind—including thoughts, feelings, and memories that often stem from early childhood experiences—influences human behavior. By bringing these unconscious elements to the forefront, psychoanalysts believe you can gain insights into your current behaviors and relieve psychological distress.
Other core beliefs or theories within psychoanalysis include the following:
- Mental health conditions develop due to conflicts, or competing desires, values, or demands between the subconscious mind (the part you aren’t aware of) and your conscious beliefs (the part you are aware of). In response, your mind tries to find a compromise—a way to deal with these conflicts. This results in emotions, behaviors, or thought patterns that reduce internal stress. Sometimes, these responses are helpful, but other times they cause anxiety or avoidance.
- People use defense mechanisms (e.g., repression, denial, destructive thinking patterns, etc.) to protect themselves from internal stress.
Types of psychoanalytic therapy techniques
During a typical psychoanalytic therapy session, patients talk about their experiences, dreams, and early childhood experiences with a trained therapist known as a psychoanalyst. The most common techniques psychoanalysts use in these sessions include:
- Interpretation: Your therapist helps to unveil your unconscious mind and bring it to the present to resolve those internal conflicts.
- Free association: Your therapist asks you to say anything that comes to mind, no matter how strange it may sound. This can help you and your therapist gain deeper insights into your feelings, thoughts, or experiences that may influence your current behavior.
- Transference analysis: Your therapist tries to understand how you might project your feelings about someone else onto them, and aims to gain insights into how your past experiences influence your current ones.
- Countertransference analysis: Your therapist explores how they might project their unconscious and conscious feelings and thoughts onto you, and tries to improve treatment outcomes.
- Technical neutrality: Your therapist remains neutral and nonjudgmental throughout therapy, and doesn’t attempt to influence you with their values.
How does psychoanalysis work?
Psychoanalytic therapy can occur once or several times a week and can even be a long-term treatment for some people, lasting for years. In a typical session, you’ll lie down on a couch while a certified psychoanalyst works through the previously mentioned techniques to address your mental health concerns.
Benefits
Psychoanalytic therapy has been used to address a variety of emotional and mental health problems, such as:
- Anxiety
- Depression
- Eating disorders
- Fears and panic
- Self-esteem issues
- Relationship issues
- Lack of direction and purpose
- Identity issues
The other benefits of psychoanalysis therapy include:
- Exploration of past experiences: While most therapies focus more on the present, psychoanalysis helps people revisit their past to understand how it affects their current psychological distress.
- A positive therapeutic relationship: Psychoanalytic therapy is a very personal experience, as it is a collaborative effort between a therapist and a patient to work through repressed thoughts, emotions, and experiences.
- Free-flowing conversations: Unlike many other therapies that can be very structured and goal-oriented, psychoanalysis allows the patient to freely discuss their fears, desires, dreams, and fantasies without interruption or judgment.
- Reductions in symptoms: A review of studies discovered that short-term psychoanalysis led to long-lasting improvements in anxiety, depressive, and somatic symptoms.
Psychoanalysis critiques
Despite its potential benefits, psychoanalysis has received considerable criticism from mental health professionals and the public. The main critique is that many of the central concepts of psychoanalysis, such as the unconscious mind and early childhood experiences, are challenging to observe and measure.
Another criticism of psychoanalytic therapy is how subjective interpretation can be. One technique in particular, free association, has received criticism because it relies heavily on the therapist’s ability to interpret your unconscious thoughts and feelings. This can be very subjective, as different therapists can interpret words or phrases differently.
The concept of repressed memories also presents some issues. Most psychoanalysts believe that people who have traumatic experiences—typically childhood sexual abuse—repress those memories as a defense mechanism. However, some psychoanalysts may unintentionally implant false memories through suggestive techniques, leading to what is known as false memory syndrome.
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Psychoanalysis for OCD: does it work?
Obsessive-compulsive disorder (OCD) is a complex mental health condition characterized by a cycle of obsessions and compulsions that can be difficult to escape without the proper treatment.
When it comes to using psychoanalysis for OCD treatment, Taylor Newendorp, LCPC, NOCD’s Chief Network Clinical Director, advises against it, as this type of talk therapy makes OCD symptoms worse. It’s crucial to note that OCD intrusive thoughts are ego-dystonic, meaning they don’t align with your personal values. Analyzing distressing thoughts like, “Why do I think about harming my kid?” or “Do I really want to cheat on my partner?” can make your OCD symptoms worse, by convincing you these obsessions have real meaning, and heightening the distress you feel.
Mental compulsions—such as mental reviewing or rumination—are also a common response to the distress you experience from OCD obsessions. And psychoanalysis can mirror these behaviors, unintentionally reinforcing these compulsions. Doing compulsions keeps you stuck in the OCD cycle, so this is another reason why talk therapy can be so problematic for OCD. It doesn’t address the behaviors that reinforce OCD obsessions.
“If someone is seeing a psychoanalyst or doing any type of talk therapy, there’s a good chance they’re bringing up the same issues they’re ruminating on in session over and over again,” says Newendorp. “Ultimately, it’s unproductive.”
How is behavioral therapy different from psychoanalysis?
Instead of focusing on behavioral interventions, psychoanalysis centers on revealing repressed thoughts, feelings, and memories from your past experiences that may be influencing your current behavior. Unlike other forms of behavioral therapy, psychoanalysis doesn’t try to change your behaviors—like helping you learn to resist the compulsions that continue the OCD cycle, says Newendorp.
In contrast, behavioral therapies, such as exposure and response prevention (ERP) therapy and cognitive behavioral therapy (CBT), change those behaviors. These therapies involve techniques to identify and change potentially harmful or self-destructive behaviors by teaching you healthier coping mechanisms and skills to improve your quality of life.
What is the preferred treatment for OCD?
While experts don’t recommend psychoanalysis for OCD, ERP therapy is highly effective for OCD, with 80% of people seeing a significant reduction in their symptoms. ERP is a specialized form of CBT that is designed to treat OCD. A therapist specializing in ERP will guide you through exposures, which are situations where you confront your fears head-on. You’ll also learn response prevention techniques, which are exercises that help you resist engaging in compulsions.
“Compulsions are the problem in OCD, and ERP effectively targets them,” says Newendorp. “Over time, people learn they can resist compulsive urges and that their anxiety associated with their obsessions does fade away without them doing anything about them.”
Bottom line
As you seek help to manage your OCD symptoms, it’s important to know which treatments can be the most beneficial and which can be harmful—especially since OCD is sometimes misunderstood and misdiagnosed. Psychoanalysis is not the best treatment for OCD, as it doesn’t address the behavioral aspect of the condition, and can actually worsen your symptoms over time.
If you want to escape the OCD cycle, your best bet is to work with an ERP therapist who can identify your triggers, obsessions, and compulsions and develop a customized treatment plan so you can start the journey to recovery.
Key takeaways
- Psychoanalysis is a theory and therapy that explores the unconscious mind to address psychological distress.
- Psychoanalytic therapy may help with some mental health conditions, but there are also widespread criticisms of the approach.
- Psychoanalytic therapy is not recommended for OCD, as it can encourage you to assign meaning to your intrusive thoughts and ruminate on them, thus reinforcing compulsions rather than helping you break them.
- Exposure and response prevention (ERP) therapy is the preferred treatment for OCD as it has behavioral interventions that directly target compulsions.
