Editing Psychoanalysis (section)

===Cost and length of treatment===
The cost to the patient of psychoanalytic treatment ranges widely from place to place and between practitioners.<ref>{{Cite journal |last1=Berghout |first1=Caspar C. |last2=Zevalkink |first2=Jolien |last3=Roijen |first3=Leona Hakkaart-van |date=January 2010 |title=A cost-utility analysis of psychoanalysis versus psychoanalytic psychotherapy |url=https://www.cambridge.org/core/journals/international-journal-of-technology-assessment-in-health-care/article/abs/costutility-analysis-of-psychoanalysis-versus-psychoanalytic-psychotherapy/DEB6C109AAAE748C7295574C591F7046 |journal=International Journal of Technology Assessment in Health Care |language=en |volume=26 |issue=1 |pages=3–10 |doi=10.1017/S0266462309990791 |pmid=20059775 |s2cid=1941768 |issn=1471-6348|hdl=2066/90761 |hdl-access=free }}</ref> Low-fee analysis is often available in a psychoanalytic training clinic and graduate schools.<ref name="academic.oup.com">{{cite book | last=Sharpless | first=Brian A. | editor-first1=Brian A. | editor-last1=Sharpless | title=Psychodynamic Therapy Techniques | chapter=The Process of Interpretation | publisher=Oxford University Press | date=2019 | isbn=978-0-19-067627-8 | doi=10.1093/med-psych/9780190676278.003.0013 | pages=152–176}}</ref> Otherwise, the fee set by each analyst varies with the analyst's training and experience. Since, in most locations in the United States, unlike in Ontario and Germany, classical analysis (which usually requires sessions three to five times per week) is not covered by health insurance, many analysts may negotiate their fees with patients whom they feel they can help, but who have financial difficulties. The modifications of analysis, which include psychodynamic therapy, brief therapies, and certain types of group therapy,<ref group="lower-roman">cf. Slavson, S. R., ''A Textbook in Analytic Group Therapy''</ref> are carried out on a less frequent basis—usually once, twice, or three times a week – and usually the patient sits facing the therapist. As a result of the [[defense mechanism]]s and the lack of access to the unfathomable elements of the unconscious, psychoanalysis can be an expansive process that involves 2 to 5 sessions per week for several years. This type of therapy relies on the belief that reducing the symptoms will not actually help with the root causes or irrational drives. The analyst typically is a 'blank screen', disclosing very little about themselves in order that the client can use the space in the relationship to work on their unconscious without interference from outside.<ref name="Kernberg 287–288">{{Cite journal |last=Kernberg |first=Otto F. |date=October 2016 |title=The four basic components of psychoanalytic technique and derived psychoanalytic psychotherapies |journal=World Psychiatry |volume=15 |issue=3 |pages=287–288 |doi=10.1002/wps.20368 |issn=1723-8617 |pmc=5032492 |pmid=27717255}}</ref>

The psychoanalyst uses various methods to help the patient become more self-aware, insightful and uncover the meanings of symptoms. Firstly, the psychoanalyst attempts to develop a safe and confidential atmosphere where the patient can report feelings, thoughts and fantasies.<ref name="Kernberg 287–288" /> Analysands (as people in analysis are called) are asked to report whatever comes to mind without fear of reprisal. Freud called this the "fundamental rule". Analysands are asked to talk about their lives, including their early life, current life and hopes and aspirations for the future. They are encouraged to report their fantasies, "flash thoughts" and dreams. In fact, Freud believed that dreams were, "the royal road to the unconscious"; he devoted an entire volume to the interpretation of dreams. Freud had his patients lie on a couch in a dimly lit room and would sit out of sight, usually directly behind them, as to not influence the patient's thoughts by his gestures or expressions.<ref>{{cite book|last1=Hergenhahn|first1=Baldwin|title=An Introduction to Theories of Personality|last2=Olson|first2=Matthew|publisher=Pearson Prentice Hall|year=2007|isbn=978-0-13-194228-8|location=Upper Saddle River, New Jersey|pages=45–46}}</ref>

The psychoanalyst's task, in collaboration with the analysand, is to help deepen the analysand's understanding of those factors, outside of his awareness, that drive his behaviors. In the safe environment psychoanalysis offers, the analysand becomes attached to the analyst and pretty soon, he begins to experience the same conflicts with his analyst that he experiences with key figures in his life, such as his parents, his boss, his significant other, etc. It is the psychoanalyst's role to point out these conflicts and to interpret them. The transferring of these internal conflicts onto the analyst is called "[[transference]]".<ref name="Kernberg 287–288" />

Many studies have also been done on briefer "dynamic" treatments; these are more expedient to measure and shed light on the therapeutic process to some extent. Brief Relational Therapy (BRT), Brief Psychodynamic Therapy (BPT), and Time-Limited Dynamic Therapy (TLDP) limit treatment to 20–30 sessions. On average, classical analysis may last 5.7 years, but for phobias and depressions uncomplicated by ego deficits or object relations deficits, analysis may run for a shorter period of time.{{medical citation needed|date=September 2018}} Longer analyses are indicated for those with more serious disturbances in object relations, more symptoms, and more ingrained character pathology.<ref>{{Citation |last=Treatment |first=Center for Substance Abuse |title=Chapter 7—Brief Psychodynamic Therapy |date=1999 |url=https://www.ncbi.nlm.nih.gov/books/NBK64952/ |work=Brief Interventions and Brief Therapies for Substance Abuse |access-date=2023-12-06 |publisher=Substance Abuse and Mental Health Services Administration (US) |language=en}}</ref>