About Psychoanalysis
For me Psychoanalysis has three aspects to it. First I think of it as a way of thinking about and being with different individual, interpersonal, social and political situations. It has an appreciation for the complexity of lives and the suffering we all experience as human beings. It is a way of listening to, witnessing and understanding a person or a group of people. Psychoanalytic thinking since its beginnings in the late 1800's has been informed by the biological sciences, art, literature, philosophy, history and the social sciences and has used these disciplines to further understand the human condition.
Secondly, Psychoanalysis is a body of knowledge and theory describing why humans do what they do. There are many different theories, old and new, in Psychoanalysis but all have one tenet in common: experience with other people from the very beginnings of life, even in utero some believe, matter and shape who we become. Many divergent fields of science are providing proof of what the early founders of psychoanalysis theorized without the benefit of the amazing scientific technology we have today.
Thirdly, Psychoanalysis is a system of strategies and techniques used to help people overcome the difficulties in living. It assumes that each person's life history is unique, determined by environment and genetics. As a Psychoanalytic therapist I strive to create a safe and protected environment for my patients to unravel the emotional and relational knots that keep them caught in difficulties. My ideas about the person's difficulties and my treatment strategies are co-created from the collaboration between the patient and myself and are particular to that person at that time in their lives and the treatment.
Psychoanalysis, also know as Psychodynamic Theory, has a substantial body of research evidence to support its efficacy in helping people manage their difficulties. These studies have been done in different parts of the world and have been published in prestigious journals, such as the Journal of the American Medical Association. Psychoanalysis and Psychoanalytic Psychotherapy are evidence-based treatments.
What is a Psychoanalytic Treatment?
As a treatment Psychoanalysis and Psychoanalytic Psychotherapy is based on the idea that what causes people emotional and interpersonal difficulties are outside of their ability to know about them. This is why the advice of family and friends, self-help books and strategies, and willpower, while helpful at times, fail to provide the lasting relief from the issues that bedevil a person. Psychoanalytic treatment explores how these unconscious factors affect current relationships and patterns of thought, behavior and emotions.
There are two aspects to the treatment. One, it traces these destructive patterns to their origins in part by elucidating how they are reenacted between the therapist and the patient; and two, in the context of the relationship with the therapist the person is provided with a new and transformative experience that disconfirms and heals the painfulness of old expectations and ideas about the self and the other. Old dysfunctional patterns are disrupted and new constructive ones are established through the therapeutic relationship.
As a person speaks about her/his difficulties in many different ways and reenacts them often in subtle ways with the therapist, new information and awareness emerge. I help you to elaborate and refine your understanding of these patterns and gradually, sometimes hardly being aware of it, you begin to relate to yourself and others in more constructive ways.
What does a Psychoanalytic Treatment look like?
The idea in Psychoanalytic treatment is that you say whatever comes to your mind. At the beginning of a treatment it is often difficult for people to talk about memories, experiences, emotions and thoughts as they often feel very vulnerable and ashamed. As time goes on and the trust in the therapist grows, you will be able to speak of these things. The therapy becomes a partnership between patient and therapist and makes it possible for you to know things about yourself not only intellectually, but emotionally as well. This eventually frees you from very crippling patterns in your life and it also expands your enjoyment of personal and professional pursuits. The change in a Psychoanalytic treatment is deep and enduring as the neural structure of the brain actually changes allowing more efficient and constructive processing of information that comes from your own unconscious and conscious processes as well as that from the environment. These brain changes can be facilitated in treatment at any age.
Different schools of Psychoanalytic thought define Psychoanalysis differently, some more stringent, some more flexible. Typically though Psychoanalysis means that you are coming 3 or more times a week and are using the couch during your sessions. Psychoanalytic Psychotherapy is 1-3 times a week, maybe using the couch or sitting facing the therapist. I do believe that the more frequently you can come during a week, the more efficient the treatment as you and your therapist can generate a lot or momentum in tackling your issues. You get a lot more bang for your buck, so to speak than coming less frequently. Yet this is often challenging or impossible for people due to time and money constraints. Attending sessions less frequently can be very productive. However a frequency of less than once a week for this kind of treatment will not enable you and I to get much traction on what is dragging you into your ruts.
A Psychoanalytically oriented therapist will most likely be less active with you than in other types of treatments. I will listen to what you have to say very carefully and let you structure the sessions and set the agenda. I will also pay very careful attention to the non-verbal aspects of your communication of which you may not be aware, such as the tone or loudness of your voice, your choice of words, how you move your hands, your posture, etc. These can be very powerful indicators of your emotional state. If I feel the time is right I may point these out to you and we can begin to explore more deeply emotions that you may not have even known about, or even knew that you were communicating.
To promote the kind of emotional growth that Psychoanalysis can provide requires time and energy and resources. It is not always a smooth path as change does not always come very easily. There are parts of each of us that want things to stay the same and can throw up powerful distractions and diversions to avoid change. Also as change begins to occur, you may feel worse rather than better. This does not meant hat the treatment is not working but that it is as you are able be aware of and feel previously walled off emotions. People often find that they may feel worse emotionally in the therapy, but that their lives are much better outside of treatment.
Who can benefit from a Psychoanalytically-
oriented treatment?
Many people can benefit from this kind of approach, including those that people usually think of as untreatable, such as people with schizophrenia or other severe mental illnesses. Many come to this kind of treatment after unsuccessful attempts at the briefer models of treatment or trials on different medications. Others come because they have recognized destructive patterns in their lives which cause repeated failures in love and work relationships, and/or limits their choices and opportunities in life and other approaches have not been able to change these.
Emotional and relationship problems can be experienced
in many ways. Here is a partial list:
- anxiety and inability to concentrate or cope
- feelings of emptiness, sadness, or depression
- extreme mood swings
- frequent outburst of anger or rage
- low self-esteem and a lack of confidence that contributes to underachievement
- trouble in making or sustaining relationships
- repeatedly becoming involved din unsatisfying, destructive, or violent relationships
- sexual problems
- shyness, or social isolation
- addictions
- eating disorders
- impulsive or compulsive behaviors
- difficulties sleeping, nightmares
- phobias
- panic attacks
- unrelenting physical symptoms or psychosomatic illnesses
- paranoia
- delusions, hallucinations not caused by substance abuse
Psychoanalysis can address many different kinds of problems, because it sees these symptoms as manifestations of underlying unconscious processes and coping strategies. The therapist does not treat the symptom per se (although they are monitored closely and managed) but helps the patient get to the cause of the symptoms. And this leads to enduring changes as in this process the brain is actually rewired so that the dysfunctional nerve pathways are overwritten by constructive ones, thus eliminating the need for the symptom in the first place.
Psychoanalysis and other treatment models.
The briefer models of therapy, such as CBT, ACT, support, education, coaching, DBT, EBT, etc. are not antithetical to a Psychoanalytic treatment, and in fact most Psychoanalytic therapists will incorporate these strategies into their work with patients when it is relevant. I use a number of these techniques with patients when I feel it will help them. Patients can greatly benefit from these and can gain a sense of confidence and strength when they are able to use a constructive technique to manage a difficulty rather than the old destructive pattern. The trick is to introduce these when the patient has a good chance of succeeding. Otherwise a sense of failure and inadequacy will result and too many repetitions of failure can result in a sense of despair, futility and hopelessness. As a Psychoanalytic therapist I take the time to learn a great deal about my patients, their strengths, limitations, and vulnerabilities, so that the techniques that I introduce into the treatment are adapted to the person, rather than requiring the person to adapt to the treatment protocol.
I hope this brief discussion of Psychoanalytic treatment has helped you to gain a better understanding of this model and its potential to improve people's lives.
Please visit my Approach page for more information.