Elena, a 41-year-old literature professor in Chicago, had cycled through three rounds of brief CBT for what her doctors called recurrent major depression. Each round produced a few months of relief and then the same heavy weight returned. After her third relapse her psychiatrist suggested something different. He referred her to a candidate at the Chicago Institute for Psychoanalysis who was finishing analytic training and offered low-fee analytic sessions four times weekly. Elena was skeptical — she had read the standard caricatures of psychoanalysis as outdated — but she made the appointment. Eighteen months later, lying on the couch four mornings a week and following her associations wherever they led, she had begun to understand a pattern she had repeated in three relationships and two academic departments: a rigid identification with her father’s standards and a buried rage at her mother’s emotional unavailability that she had spent thirty-five years protecting them from. The depression did not disappear overnight. The way she carried it changed completely. The work she needed was not faster, more structured, or more techniques. The work she needed was a different kind of attention to a different kind of question.
The search for a psychodynamic therapist in the United States has become harder as graduate programs deemphasize depth-oriented training and insurance plans favor brief, manualized care. A skilled psychodynamic therapist still exists, particularly near the analytic institutes that have trained American clinicians for a century. This guide explains how to distinguish psychoanalysis from psychodynamic psychotherapy, how to find candidates and graduates of credentialed institutes, what insurance will and will not cover, and when this work is the right choice.
Psychoanalysis versus psychodynamic psychotherapy
The two are related but not identical. Psychoanalysis proper involves three to five sessions per week, typically with the patient on a couch and the analyst out of view, sustained over years. The frequency is not arbitrary — it is what allows transference, the patient’s projection of early-relationship patterns onto the analyst, to develop with enough intensity to be analyzed. Psychodynamic psychotherapy uses the same theoretical foundation but at lower frequency, usually once or twice weekly face-to-face. The work is still about the unconscious, defenses, transference, and characterological patterns, but adapted to the practical constraints of contemporary life.
The American Psychoanalytic Association (APsaA) certifies analysts after a multi-year training that includes a personal training analysis (the candidate’s own four-times-weekly analysis), didactic coursework in theory and clinical technique, and supervised analytic cases. Psychodynamic psychotherapists may have completed full analytic training or shorter psychodynamic certificate programs offered by the same institutes. Either route produces clinicians who think in terms of meaning, history, and relational patterns rather than just symptoms and skills.
The major American training institutes
Most American psychoanalysts trained at one of roughly thirty APsaA-affiliated institutes or at non-APsaA programs that grew out of the interpersonal and relational traditions. The most prominent include:
- Columbia University Center for Psychoanalytic Training and Research — affiliated with Columbia’s Department of Psychiatry, classical Freudian and ego psychology orientation.
- NYU Psychoanalytic Institute — long-established, emphasis on contemporary Freudian thinking.
- The Psychoanalytic Association of New York (PANY) — affiliated with NYU School of Medicine.
- William Alanson White Institute — Sullivan-derived interpersonal tradition, NYC.
- The New York Psychoanalytic Society and Institute — the oldest in the country, founded in 1911.
- San Francisco Center for Psychoanalysis and the San Francisco Psychoanalytic Institute — strong on contemporary Freudian and relational integration.
- The Boston Psychoanalytic Society and Institute — close ties to Harvard Medical School faculty.
- Chicago Institute for Psychoanalysis — historically Kohutian, the home of self psychology.
- The Washington Baltimore Center for Psychoanalysis — broad theoretical range.
Most of these institutes operate low-fee clinics where candidates in training see patients under supervision at sliding-scale fees, often $30 to $100 per session. The clinical work is supervised weekly by senior analysts, which means the quality control is unusually high for the cost. Our guide to verifying mental health credentials covers how to confirm institute affiliation when a clinician lists it.
Finding analysts and psychodynamic therapists
The American Psychoanalytic Association maintains a Find an Analyst directory at apsa.org searchable by city and state. The National Association for the Advancement of Psychoanalysis (NAAP) lists non-medical psychoanalysts including those trained at institutes outside the APsaA system. The American Academy of Psychoanalysis and Dynamic Psychiatry, an organization within the American Psychiatric Association, lists psychiatrists with analytic training who can prescribe medication and conduct dynamic therapy in the same relationship.
For psychodynamic psychotherapy without full analytic credentialing, look for clinicians who completed institute-based psychodynamic certificate programs, completed postdoctoral fellowships at psychodynamic-oriented academic departments (the Menninger fellowship at Baylor, the Austen Riggs fellowship in Stockbridge, the Yale Department of Psychiatry’s psychodynamic track), or trained at clinical psychology programs with analytic faculty (the Derner Institute at Adelphi, the City University of New York’s clinical psychology program, the Wright Institute in Berkeley).
How long does psychodynamic treatment take
Honest answer: longer than CBT. Once-weekly psychodynamic psychotherapy commonly runs two to four years for symptomatic and characterological change. Twice-weekly treatment may be slightly faster on a per-month basis but accumulates similar total session counts. Full analysis typically runs four to seven years at three to five sessions per week.
Brief psychodynamic protocols exist and have been studied. Habib Davanloo’s intensive short-term dynamic psychotherapy, Hans Strupp’s time-limited dynamic psychotherapy, and the panic-focused psychodynamic psychotherapy developed at Cornell run sixteen to thirty sessions and have randomized trial support for specific presentations. These are the right choice when the goal is symptom remission and the patient does not have the time or resources for open-ended work. The longer treatments aim at characterological change — how a person organizes attachments, manages internal conflict, and tolerates affect — rather than symptom relief alone.
Object relations, self psychology, and relational analysis
The theoretical traditions within psychoanalysis matter because they shape how a clinician listens. Classical Freudian analysis focuses on drive, defense, and the structural conflict among id, ego, and superego. Ego psychology, developed by Heinz Hartmann and Anna Freud, emphasizes adaptation and ego strength. Object relations theory, with British Independent and Kleinian roots, focuses on internalized representations of self and other. Self psychology, developed by Heinz Kohut in Chicago, emphasizes the development of a cohesive self through empathic responsiveness from caregivers, with implications for narcissistic disorders. Relational psychoanalysis, developed in New York by Stephen Mitchell and others, sees the analytic relationship itself as the primary therapeutic medium.
Most contemporary American analysts work integratively across these traditions. Asking a prospective analyst about their orientation reveals how they conceptualize cases and what kinds of patients they have done well with. Patients with primary attachment trauma often benefit from relational and object relations approaches. Patients with narcissistic vulnerability may benefit from self psychology. Patients with neurotic-level conflicts may do well with classical and ego psychological work. Our piece on choosing a therapist’s theoretical orientation goes deeper into these distinctions.
Insurance reality for analytic and dynamic work
American insurance coverage of full psychoanalysis is rare. Plans typically authorize twelve to thirty sessions per year and require utilization review for additional sessions. Four-times-weekly analysis exceeds these limits within the first month. Most analytic patients pay out of pocket or use out-of-network benefits that reimburse a fraction of the fee after a deductible. Analytic fees in major American cities range from $250 to $500 per session for senior analysts, with significant lower options through institute clinics.
Once-weekly psychodynamic psychotherapy is more often covered. The CPT code is the same as any psychotherapy — 90834 or 90837 — and insurance does not distinguish between modalities. The practical issue is finding psychodynamic clinicians who accept insurance; many do not because reimbursement rates do not support the indirect time the work requires (case formulation, clinical writing, supervision). The National Institute of Mental Health summarizes evidence on long-term psychotherapy at nimh.nih.gov.
Low-fee clinics and how they work
The institute-based low-fee clinic is the historic American mechanism for making analytic treatment available beyond the wealthy. Candidates in analytic training are required to conduct supervised cases — typically three to four cases at four sessions weekly — to graduate. To find these patients, institutes maintain referral services where adults seeking treatment can meet with a candidate at fees scaled to income. The William Alanson White Institute, the NYU Psychoanalytic Institute, the Columbia Psychoanalytic Center, the Chicago Institute, the San Francisco Center, and the Boston Psychoanalytic Institute all run such clinics.
The fees are real — typically $30 to $100 per session — and the supervision is intensive. Candidates have weekly supervision with senior analysts on each case, which means treatment errors are caught and corrected in a way that fully credentialed practice does not always provide. The catch is that candidates are still in training and graduate within five to seven years, at which point treatment may need to transfer or transition to private fee. Patients who can tolerate that arc — and who want the depth of treatment that high-frequency, supervised analysis offers — find the clinics extraordinary value.
When psychodynamic work is the right fit, and when CBT is
Psychodynamic and CBT approaches address different layers of human suffering. CBT works on present symptoms, behaviors, and thinking patterns through structured techniques over a defined number of sessions. Psychodynamic work addresses how a person became who they are, what unconscious patterns shape their relationships and choices, and how the inner architecture of self developed. Neither is universally better. The question is what the patient needs.
CBT is well suited to discrete anxiety disorders, OCD, panic, social anxiety, insomnia, and acute depression. Psychodynamic work is well suited to recurrent depression that has not responded to symptom-focused approaches, complex relational difficulties, characterological problems, and the wish to understand oneself rather than only feel better. Many patients eventually do both — symptom-focused CBT during acute episodes, depth-oriented dynamic work during stable periods. Our guide on therapy for adult survivors of childhood adversity discusses how layered approaches combine over time.
Frequently asked questions
Is psychoanalysis still practiced?
Yes. APsaA institutes train new analysts each year and several thousand certified analysts practice in the United States. The numbers are smaller than in the mid-twentieth century but the work continues with active research, journals, and clinical literature.
Do I have to lie on a couch?
For full analysis, traditionally yes. For psychodynamic psychotherapy, no — sessions are face-to-face. The couch is used in higher-frequency analytic work because it facilitates free association and reduces the patient’s monitoring of the analyst’s expressions.
Does evidence support psychodynamic therapy?
Yes. Meta-analyses by Jonathan Shedler, Falk Leichsenring, and others have shown psychodynamic therapy produces effects comparable to other evidence-based treatments, with gains that grow rather than diminish after treatment ends. Several brief psychodynamic protocols have RCT support.
Can I do psychodynamic therapy through telehealth?
Once-weekly psychodynamic psychotherapy works through video. Higher-frequency analysis is sometimes conducted by phone or video, particularly during the pandemic, though many analysts and analytic patients prefer in-person work for the depth it permits.
How do I know if I need analysis or shorter therapy?
A consultation with an analyst or psychodynamic clinician will assess what kind of work fits your goals and life circumstances. The decision is not just clinical — it includes time, financial resources, and what you want from treatment.
The bottom line
Finding a psychodynamic therapist or psychoanalyst in the United States requires looking past the directories that emphasize brief, manualized treatment. The APsaA Find an Analyst directory, the NAAP listings, and the institute clinics in major cities are the most reliable starting points. The work asks more time and more money than CBT but offers something different — the chance to understand the structure of one’s own life rather than only adjust its symptoms. For people whose suffering has resisted symptom-focused approaches, or who want a depth of self-knowledge that brief work cannot provide, the investment is rarely regretted. Begin with the directory at apsa.org.
If you are in crisis or thinking about suicide, call or text 988 to reach the Suicide and Crisis Lifeline, available twenty-four hours a day.
This article is for informational purposes only and does not constitute medical or psychological advice. Diagnosis and treatment of mental health conditions require evaluation by a licensed clinician. The mention of organizations, institutes, and clinicians is illustrative and does not constitute endorsement.