Psychoanalysis and psychoanalytic psychotherapy can sound like two different schools of treatment. They are closely related ways of doing the same work. Both try to understand the feelings and conflicts beneath a difficulty, including patterns that keep returning even after a person has recognized them.
The practical difference most people notice is how often sessions take place. At this practice, psychoanalytic psychotherapy usually takes place once or twice a week; psychoanalysis usually involves three or more sessions a week. It is easy to read that as a scale of illness: the more troubled someone is, the more appointments they need. Frequency is not assigned that way. More frequent meetings create continuity between sessions and enough intensity for certain patterns to become visible within the treatment.
To understand why that matters, it helps to know what each form of treatment is like, what they share, and what the different rhythms can make possible.
This article is general information, not medical advice. Speak with a physician or qualified clinician about your own health.
What the two treatments share
Both treatments use a psychoanalytic way of listening. Patients are invited to speak about what is on their minds, including thoughts that seem unimportant, contradictory, embarrassing, or difficult to put into words. The therapist listens for patterns across what a person brings about work, relationships, memories, dreams, and the feelings that develop during sessions. The aim is to understand what may be operating outside awareness, not to fit someone's life into a theory decided in advance.
The present is as important as the past. If a person repeatedly expects criticism from people who have not criticized them, the patient and therapist might wonder when that expectation began. They can also notice when it appears again, perhaps even during a session. Understanding a pattern while it is happening can be different from explaining it later, when it has become a familiar story.
Regular meetings and a relationship in which a person can say more than they usually allow themselves to say are central to both forms. Either can support substantial change and the exploration of deeper questions. The two differ in pace and in what that pace can make possible. At this practice, both take place by secure video.
Online therapy
At this practice, both psychoanalysis and psychoanalytic psychotherapy take place by secure video. A 2021 meta-analysis of 47 studies comparing live video therapy with in-person therapy found negligible differences in outcome, and its authors concluded that therapy is no less effective when delivered by video. Most of those studies tested structured treatments such as CBT.
For psychoanalysis, meeting from home also makes several sessions a week easier to fit into a working life, without a commute to each one.
Psychoanalytic psychotherapy with one or two meetings a week
In psychoanalytic psychotherapy, sessions usually take place at a fixed time once or twice a week. People come with anxiety, depression, self-esteem difficulties, conflict at work or school, and problems in relationships. Treatment begins with what is troubling them now and looks for the feelings and conflicts that give the difficulty its particular force.
A session may start with an argument from the previous evening. The discussion might reveal that the person felt unable to object, then grew angry hours later when the conversation was over. Over time, the same sequence may appear in other relationships: a wish to keep the peace, resentment at the cost, and a fear of what would happen if they spoke directly. The work is to recognize that sequence in enough detail that a different response becomes possible.
Weekly meetings give many people room to think between sessions, notice what happens in daily life, and return with something they could not quite say before. Twice-weekly meetings can make it easier to hold a developing theme across the week. The relationship with the therapist is part of the work at either frequency; a person's familiar expectations may appear there too.
For many difficulties, this rhythm is sufficient. It is also a commitment a person may be able to sustain through work, family, and financial demands. Psychotherapy is not merely a waiting room for analysis. If it is helping address what matters, there is no reason to increase the frequency for its own sake.
Psychoanalysis with several meetings a week
Psychoanalysis uses the same basic method in a more continuous frame. Sessions generally take place three or more times a week, often over years rather than a predetermined number of sessions. Patients are invited to say what comes to mind without first deciding whether it is relevant. A dream, a silence, a fleeting irritation, or a thought nearly kept private may become worth following.
With less time between meetings, a patient does not have to make each session into a report of the week's most important events. Something that emerged yesterday can still feel close at the next session. A feeling toward the analyst can appear, disappear, and return before either person has settled on a quick explanation. Over time, a pattern familiar from other relationships may begin to happen in the treatment itself. The patient and analyst can examine it as it unfolds, instead of relying only on an account of what occurred elsewhere.
Analysis may be worth considering when the same difficulty has returned after previous therapy, when a person understands a pattern but remains caught in it, or when they want to understand themselves beyond relief from a particular symptom. These are reasons to discuss analysis, not rules that determine it. It asks a substantial commitment of time and money, and the schedule needs to be realistic and sustainable. More meetings alone cannot guarantee a better result.
Why frequency changes the experience
The first change is continuity. In weekly work, a feeling that appeared at the end of one meeting may be harder to reach seven days later. It can still be discussed, but the patient may have to reconstruct it after ordinary life has given it a neater shape. When sessions are closer together, the unfinished thought can be picked up while it is still unsettled. The patient and analyst can see what happened to it between meetings rather than starting again from a summary.
The second change is intensity, meaning sustained attention rather than emotional drama. Frequent meetings leave room for small, unplanned reactions to appear more than once. A person who is afraid of disappointing others may begin to worry about disappointing the analyst. Someone who tends to hide anger may notice it during a session and then find it has not vanished by the next one. This creates an opportunity to understand the feeling as it develops.
Higher frequency does not require a person to arrive with a new insight each time, and it does not oblige them to disclose something before they are ready. A quiet session may simply be quiet. At other times, the worry that there is nothing worthwhile to say is itself familiar and worth discussing. The point is to make room for what appears, rather than to produce a breakthrough on schedule.
The American Psychoanalytic Association describes more frequent sessions as deepening and intensifying treatment while emphasizing that frequency is worked out between the patient and analyst. That is a description of a clinical possibility, not a promise that the highest number is best for everyone.
One difficulty, two possible rhythms
Consider a hypothetical example. Someone is angry that a friend canceled dinner. In weekly psychotherapy, treatment might begin with that anger, then return to the friendship over several meetings. The person may gradually notice that they had also felt relieved: they had been dreading the dinner. Later, they may recognize a worry that asking this friend for anything would leave them owing something in return. The same worry has made it hard to ask for closeness in other relationships. Weekly work can follow all of this, including how the discovery affects the person's life outside therapy.
In analysis, the same feelings might be available across several meetings in one week. Anger on Monday is followed by relief on Tuesday. On Thursday, the person worries that the analyst will judge them for having mixed feelings. The patient and analyst can consider whether that expectation resembles what happens with the friend. No single meeting has to settle which feeling is the “real” one. The sequence can be observed as it changes.
This example does not show that one treatment finds the truth and the other misses it. The psychoanalytic method is present in both. The closer rhythm may make it easier to notice the movement between conflicting feelings, and the way those feelings enter the treatment relationship, before they have been smoothed into one account. That is one way a closer rhythm can allow more depth.
More sessions do not mean a more serious problem
The number of sessions is easily mistaken for a verdict on how unwell someone is. In some ways, it is the opposite. A person in considerable distress may do good work in weekly psychotherapy. Someone whose daily life looks stable may choose analysis because a painful pattern keeps returning and they want to understand it thoroughly. The number of appointments does not, by itself, reveal who is struggling more.
Severity still matters when deciding what kind of help a person needs. It simply does not convert into a fixed number of analytic appointments. The question is what treatment fits the problem, what the person hopes to change, and whether the proposed rhythm supports that work.
Choosing a form of treatment together
Choosing a frequency begins with understanding what brings a person to treatment, how long the difficulty has been present, and what they have tried. A treatment that helped for a while and then stopped helping offers different information from one that never felt useful. The person's goals matter too: relief from a particular symptom, a better understanding of a repeating conflict, or both.
Practical circumstances belong in the decision. A schedule of several meetings a week has to fit with work, family, money, and the rest of a life. If it creates constant strain, that strain will affect the treatment. A once- or twice-weekly rhythm that a person can keep may serve them better. The right frequency is one that can be sustained reliably, not a number chosen to prove seriousness.
The decision can be reviewed as the work develops. If weekly meetings provide enough continuity, that rhythm can continue. If important feelings keep becoming distant before they can be examined, meeting more often can be discussed. If a higher frequency becomes difficult to sustain, that also deserves discussion. Changing the rhythm is an adjustment to the work, not a judgment about the person doing it.
Patients can ask why a particular frequency is being recommended and expect a clear answer. A free 15-minute consultation gives the patient and clinician time to consider the difficulty and decide together which form of work fits. To arrange one, contact the practice.
About Dr. John J. Hartman
John J. Hartman, Ph.D. is a board-certified psychoanalyst (FABP) with over 50 years of clinical experience. He holds a B.A. from Harvard College and a Ph.D. in clinical psychology from the University of Michigan, with psychoanalytic training at the Michigan Psychoanalytic Institute. A former tenured Associate Professor of Psychiatry at the University of Michigan, he is a training and supervising analyst and has published six books and numerous peer-reviewed papers. He practices online and is licensed in DC, Florida and Michigan, with PsyPACT authorization across more than 40 states.
References and further reading
- American Psychoanalytic Association. "About Psychoanalysis." apsa.org/about-psychoanalysis
- Fernandez, E., Woldgabreal, Y., Day, A., et al. (2021). Live psychotherapy by video versus in-person: A meta-analysis of efficacy and its relationship to types and targets of treatment. Clinical Psychology & Psychotherapy, 28(6), 1535-1549. doi.org/10.1002/cpp.2594