Using the various analytic theories to assess mental problems, several particular constellations of problems are particularly suited for analytic techniques (see below) whereas other problems respond better to medicines and different interpersonal interventions. To be treated with psychoanalysis, whatever the presenting problem, the person requesting help must demonstrate a desire to start an analysis. The person wishing to start an analysis must have some capacity for speech and communication. As well, they need to be able to have trust and empathy within the psychoanalytic session. Potential patients must undergo a preliminary stage of treatment to assess their amenability to psychoanalysis, at that time and also to enable the analyst to form a working psychological model which the analyst will use to direct the treatment. Psychoanalysts mainly work with neurosis and hysteria in particular, however adapted forms of psychoanalysis are used in working with schizophrenia and other forms of psychosis. Finally, if a prospective patient is severely suicidal a longer preliminary stage may be employed, sometimes with sessions which have a twenty minute break in the middle. There are modifications of techniques due to the radically individualistic nature of each person's analysis.
The most common problems treatable with psychoanalysis include: phobias, conversions, compulsions, obsessions, anxiety attacks, depressions, sexual dysfunctions, a wide variety of relationship problems (such as dating and marital strife) and a wide variety of character problems (for example, painful shyness, meanness, obnoxiousness, workaholism, hyperseductiveness, hyperemotionality, hyperfastidiousness). The fact that many of such patients also demonstrate deficits above makes diagnosis and treatment selection difficult.
Analytical organizations such as the International Psychoanalytic Association, The American Psychoanalytic Association and the European Federation for Psychoanalytic Psychotherapy, have established procedures and models for the indication and practice of psychoanalytical therapy for trainees in analysis. The match between the analyst and the patient can be viewed as another contributing factor for the indication and contraindication for psychoanalytic treatment. The analyst decides whether the patient is suitable for psychoanalysis. This decision made by the analyst, besides made on the usual indications and pathology, is also based to a certain degree by the "fit" between analyst and patient. A person's suitability for analysis at any particular time is based around their desire to know something about where their illness has come from. Someone who is not suitable for analysis expresses no desire to know more about the root causes of their illness. An evaluation may include one or more other analysts' independent opinions and will include discussion of the patient's financial situation and insurances.
The basic method of psychoanalysis is interpretation of the patient's unconscious conflicts that are interfering with current-day functioning - conflicts that are causing painful symptoms such as phobias, anxiety, depression and compulsions. Strachey (1936) stressed that figuring out ways the patient distorted perceptions about the analyst led to understanding what may have been forgotten (also see Freud's paper "Repeating, Remembering and Working Through"). In particular, unconscious hostile feelings toward the analyst could be found in symbolic, negative reactions to what Robert Langs later called the "frame" of the therapy - the setup that included times of the sessions, payment of fees and necessity of talking. In patients who made mistakes, forgot, or showed other peculiarities regarding time, fees and talking, the analyst can usually find various unconscious "resistances" to the flow of thoughts (sometime called free association).
Freud's patients would lie on this couch during psychoanalysis
When the patient reclines on a couch with the analyst out of view, the patient tends to remember more, experience more resistance and transference and be able to reorganize thoughts after the development of insight - through the interpretive work of the analyst. Although fantasy life can be understood through the examination of dreams, masturbation fantasies (cf. Marcus, I. and Francis, J. (1975), Masturbation from Infancy to Senescence) are also important. The analyst is interested in how the patient reacts to and avoids such fantasies (cf. Paul Gray (1994), The Ego and the Analysis of Defense). Various memories of early life are generally distorted - Freud called them "screen memories" - and in any case, very early experiences (before age two) - can not be remembered (See the child studies of Eleanor Galenson on "evocative memory").