Menu

Blog

 
Seven Benefits of Psychoanalysis

Benefits of Psychoanalysis

What are the benefits of psychoanalysis?  Psychoanalysis benefits the individual in a number of ways that not all types of psychotherapy do.  

 

First, some context.  In a complex society such as ours, people are challenged to adapt to a constant flow of change.  Each of us is subject to cultural, ethnic, religious, economic, and political expectations while also trying to preserve our individual sense of self.  While we navigate our way through daily living, we do our best to preserve the values, ideals, and dreams that make us unique. 

Diversity and difference are essential on a large scale for a species to survive, while at the individual level consistency and integrity are essential for security.  Many of the issues that bring persons to seek psychotherapy relate to threats against security.  Loss of loved ones, conflicts with co-workers, struggles in school, or financial worries all share a basic threat to the preservation of one’s individuality.  Yet, people are expected to adapt and change to the relentless pressure to conform.

Unfortunately, many modern approaches to psychotherapy advocate on behalf of the prevailing society’s definition of health.  That is, the goals of some therapies involve helping the individual learn to accommodate his or her actions and ideas to those deemed “normal.”  A person “should” be extraverted, socially motivated, objective, and open to change.  Admirable as these qualities might be, they are not for everybody.  Likewise, psychotherapy that functions as a tool for social conformity may tend to diminish the value of the individual in favor of a socio-political agenda.

In contrast, historically psychoanalytic therapy has advocated for the enhancement of human diversity through the nurturing of a person’s self-development.  (Not surprisingly, psychoanalysis was banned in repressive totalitarian societies like the USSR).  This is at the heart of the benefits of psychoanalysis. 

Seven Benefits of Psychoanalysis

Benefits of PsychoanalysisPsychoanalysis advocates on behalf of the individual’s personal truths, as follows:

  1. Psychoanalytic therapy promotes a consumer-driven agenda as it is tailored to the needs of the individual and his or her life history. Childhood history is important as the reference of the normality each individual has known.  Everyone is born into a “normal” home in that childhood sets the context for one’s experience of the world.  Good, bad, or otherwise, one’s childhood has influenced how one knows the self and others.  Becoming aware of these historical influences is critical for any semblance of autonomy.
  2. The psychoanalytic patient is accepted for who he or she is, rather than being compared to some hypothetical “norm.”
  3. Likewise, the patient is not pigeon-holed into some pre-determined diagnostic category, but rather is appreciated in terms of his or her unique challenges and conflicts.
  4. Every patient is encouraged to talk about and explore whatever is important to him or her. No one else imposes an agenda of acceptable or appropriate areas of concern.
  5. Therapy is not time-limited, but rather affords the patient the dignity and respect to pace the treatment and to preserve the therapeutic relationship as long as it proves valuable.
  6. The role of the therapist is as an ally and partner in the therapeutic process. While it may sometimes necessitate confrontation, the over-arching principle is “in the best interest of the patient” wherever possible.
  7. The ultimate goal of therapy is to help mitigate human suffering and enhance the quality of the individual’s life. Whereas symptom reduction occurs, it is not the sole focus of therapy or the definition of success.

Too often, expedience and economic efficiency become the criteria for establishing a standard of care.  Psychoanalytic psychotherapies support relevance, meaningfulness, and humanity as the more appropriate gold standards.

To learn more about psychoanalysis, see Psychodynamics of the Therapeutic Relationship, Personality Disorders from a Psychoanalytic Perspective, Psychodynamics of Child Abuse and Trauma, Classical Psychoanalytic Theory, Ego Psychology, or Object Relations Theory.

Psychoanalysis and Mindfulness

Psychoanalysis and Mindfulness

Psychoanalysis and Mindfulness - AwarenessPsychoanalysis and mindfulness may seem to have little in common.  They both involve the mind and are often focused on taming disturbing thoughts and feelings.  But their methods seem to be completely at odds with each other.  Or are they?  Let’s take a look at mindfulness and see how it may be an excellent adjunct to psychoanalysis.

Mindfulness

Try, for a minute, to do nothing at all.  Don’t talk or move around or think about anything.  Just be.  For a full minute.  What happens?  If you’re like most people, you’ll find this to be harder to do than it sounds.  Your thoughts may wander.  “What’s the purpose of this?”  Thoughts or images of the past or future may emerge.  “What do I need to do tomorrow?”  “I wonder what he meant by that?” . . . 

The mind easily gets lost in endless thinking.  Thoughts create emotions and emotions generate more thoughts, and so on.  This may be fine when these are positive and pleasant thoughts and emotions.  But often they are not.  And often they’re not about the immediate present.  Instead, they’re likely to be about past upsets or future worries.  You may lay awake at night because you worry about what might happen tomorrow.  Maybe you can’t stop thinking about that mistake you made last week.  You may constantly be busy with the things that need to be completed.

Mindfulness teaches how to bring more balance to this tendency, by focusing the attention on the here and now—attention to the things that are happening in this very moment, in a non-judgmental way.   Thinking about and learning from past mistakes, planning for the future, and acknowledging sorrows and worries are all important.  But people often get lost in thoughts about the past and future, to the detriment of experiencing life in the present.

Note that acceptance plays a key role in mindfulness.  Mindfulness is not turning off the mind.  Mindfulness does not restrict, deny, or inhibit thoughts or feelings.  Instead, through mindful attention and acceptance, you allow every feeling, emotion, sensation, or thought to be there.  Instead of fighting against them, mindfulness fosters willingness to acknowledge, allow, and accept these internal states.  

By letting go of this struggle, you may come to realize that many thoughts, worries, and feelings fade away automatically, and probably sooner than if they’d been fought against.  Emotions come and go and thoughts, worries, and feelings often fade away automatically if allowed to.  By letting go of the struggle against them and giving them room to exist, unhappy thoughts and feelings can be experienced as temporary and less overwhelming.  

Mindfulness helps you create a different relationship with your thoughts, feelings, and emotions.  When you become an observer of your own inner states, you are no longer identified by them or completely lost in them.  You can still experience the emotions or feelings, but now have the choice of being fully taken by them or not.

Psychoanalysis

What I’ve just described for mindfulness is actually similar to the stance of the psychoanalyst.  Inviting you to say whatever comes to mind without censoring your associations.  Helping you become aware of the thoughts, feelings, and patterns that arise.  Helping you make sense of them without judgment, until they can be dealt with instead of battled against. 

Mindfulness practices are helpful tools for bringing a person back to the present moment.  By allowing thoughts and feelings to be present without judgment, a person may also become more aware of the internal states, of recurring patterns of thoughts and feelings, and of issues that seem repeatedly to cause distress.  This self-awareness can be very helpful in therapy.

Resistances to meditation—boredom, distraction, sleepiness, etc.—are also common complaints in mindfulness practice.  They can be useful signals that outside guidance—as in psychoanalysis—may be helpful in removing barriers to further insights.  And yes, now we may need to delve into transferences from . . . the past . . .  But only so that the person can be freed from the past.

Psychoanalysis and Mindfulness

This brings us back to the question of whether psychoanalysis and mindfulness have anything in common.  The more experience I have with both as a clinician, the more excited I am about how they can be used together in practice, to facilitate a person’s self-understanding for a fruitful life in the present. 

To learn more about psychoanalysis, see Classical Psychoanalytic Theory.  To learn more about the theoretical foundations of mindfulness, see Mindfulness Meditation Training: Introduction, Attention, and the Present Moment, or for its applications, see Mindfulness Meditation Training: Body Scan Meditation and Informal Mindfulness Practices.

Criticisms of Freud: Commentary on the Freud Wars

Criticisms of Freud: Commentary on the Freud Wars

Criticisms of FreudToday’s Wall Street Journal offered a book review by Adam Kirsch of, yet another, “quasi-biography” of Sigmund Freud.  The book in question is Freud: The Making of an Illusion by Frederick Crews, the latest in his seemingly endless criticisms of Freud.  As noted by Kirsch, this endless war on Freud by Crews is a direct attack against the person of Freud and, by extension, an assault on nearly everything Freud had to say about the human mind.

Crews, a Professor Emeritus of English of UC Berkeley, is a well-established literary critic who had once embraced psychoanalytic theory, but has since become one of its most vociferous dissidents.  His current work goes beyond his usual attacks against psychoanalysis as a “pseudo-science” and is a direct disparagement of Freud himself as a con man, liar, bully, plagiarist, and false prophet.

As a psychoanalyst myself, I wonder if Crews’ apparent obsession with destroying Freud and psychoanalysis represents what would be labeled a reaction formation–the exaggerated attempt to conceal a private truth (envy) with its opposite (contempt).  This was not Crews’ first harsh criticism of Freud, which dates back decades.  His agenda to eradicate Freud and Freudian theory ironically betrays his indebtedness to Freud for having established a basis for Crews’ career.

No doubt that Freudian psychoanalysis has changed significantly since Freud (who died in 1939), as he, himself, revised his ideas at least five times over a 40-year period.  Nevertheless, he provided 23 volumes of writings on the human condition that have stimulated the search for understanding the complexity of the human mind, our motivations, and our unique forms of psychological sufferings.  Freud offered a humane approach to understanding madness, an early attempt at clinical treatment, a recognition for the importance of child development and child-rearing practices, and a method for understanding the humanities.  Obviously, the legacy of Freud’s ideas has been remarkable.

Despite Freud’s many critics and continued controversy, Nobel-laureate neuroscientist, Eric Kandel, noted that “psychoanalysis still represents the most coherent and intellectually satisfying view of the mind” (Kandel, 1999, p. 505).  Freudian theory, while not a rigorous scientific model that can be easily tested in a laboratory, poses necessary questions that require inter-disciplinary study from all the humanities.  Humans live in both a shared empirical reality and a private, personal world of fantasies and imagination.

Rational-empiricists, like Crews, seem to believe that science, in its purest form, is the only truth. If that were so, why become an English professor?  Science is not a subject matter, but rather is a methodology for research.  The humanities represent other methodological forms that also explore stories about the human experience.  A psychological truth that ignores these other stories denies the essence of the inquisitor.  Humans are ultimately story-makers regardless of what those stories are about; physics, poetry, or dreams.  All our knowledge, no matter how rational or empirical, will always remain human knowledge.

Criticisms of Freud can make important contributions toward a dialogue of ideas.  Unfortunately, character assassination presents as excessive disputation that does little to promote meaningful discussion.  Freud, the man, is dead; eviscerating his corpse appears to me as spiteful and mean-spirited and serves no intellectual or scientific advantage.

To read more on Freud’s theory, see Classical Psychoanalytic Theory.

Kandel, E. (1999). Biology and the future of psychoanalysis: A new intellectual framework for psychiatry revisited. American Journal of Psychiatry, 156, 505- 524.

Kirsch, A. (2017, September 30-October 1). Why the Freud wars will never end. The Wall Street Journal, p. C7.

 

 

DSM-5 Diagnoses and Defense Mechanisms

DSM-5 Diagnoses and Defense Mechanisms

Most clinicians in the United States make psychiatric diagnoses with the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders).  While “DSM-5 diagnoses” and “defense mechanisms” are rarely terms seen together, the diagnostic process is benefitted by a deep understanding of the person.

The DSM-5

Checklist for DSM-5 DiagnosesFirst published by the American Psychiatric Association in 1952, the DSM began as a brief manual listing 106 diagnoses; now, in its fifth edition it consists of a weighty book outlining nearly 300 diagnoses. 

The DSM is controversial.  Each diagnosis is presented as a series of largely behavioral criteria that must be met or ruled out, with checklists and decision trees.  Its reliability and validity have been challenged by many sources.  Some find it to be too superficial, while others too subjective.  Nevertheless, it is a central focus of most diagnostic training courses in psychology and psychiatry.

DSM-5 Diagnoses

Unfortunately, the DSM-5 itself is often misunderstood and misused.  The manual does in fact begin with a discussion of the importance of clinical judgment in diagnosis.  Many clinicians, however, view the criteria as factual checklists to be memorized and applied in a concrete manner.  As a member of the task force involved in the creation of the DSM-5, I can attest to the importance of applying the diagnoses cautiously, with an understanding of the person you are trying to describe.

People are not diagnoses; people are unique.  At the point that they struggle in ways that significantly interfere with their functioning or that cause significant distress, they may be described with a diagnosis.  But a diagnosis is also not a tangible tumor-like entity to be extracted; a person’s struggles cannot be summarized well by a mere listing of behaviors.  

Understanding defense mechanisms can help deepen and guide the clinician’s judgment in making helpful psychiatric diagnoses, especially for Personality Disorders.

Defense Mechanisms

Simply defined, defense mechanisms are the unconscious or automatic mental activities a person engages in to balance subjectivity and reality.  In psychoanalytic theory, they refer to a constellation of mental processes developed to protect the integrity of the ego system (mind).  As such, defenses protect against threatening impulses and desires (internally generated) as well as against potential threats from the external environment.

Examples of Defense Mechanisms at Work

A person might “forget” to sign an alimony check or gasp “no!” when hearing of the death of a valued friend.  Both acts can be understood as the product of denial.  A politician who says “I’ll tell you the truth” has already admitted to a tendency toward deception.  Likewise, Shakespeare’s “me thinks the lady doth protest too much” demonstrates reaction formation as a defense used to disguise a truth with an exaggerated opposite presentation.

Defense Mechanisms in Personality Disorders

Personality Disorders (character pathology) are largely evidenced through their consistent use of a rigid set of defensive patterns.  

The Paranoid Personality projects aggressive thoughts onto others, creating a view of the environment as dangerous and untrustworthy.  The Obsessive Compulsive Personality works diligently to pre-empt chaos and disorder by being overly conscientious, detailed, and meticulous.  The Histrionic Personality fears rejection and being unloved, leading to flirtatious, seductive, and approval-seeking interactions.  In each of these examples, the blueprint for the structure of the person’s lifestyle is characterized by the repeated set of ego defenses used for preserving sanity.

The online course, Personality Disorders from a Psychoanalytic Perspective, provides an in-depth discussion of the ego defenses that underlie each personality disorder and how they are manifested.

DSM-5 Diagnoses and Defense Mechanisms

Having a clear understanding of defense mechanisms and how they manifest can help the clinician better understand the complexity of human experience.  Some theoretical orientations, such as Cognitive Behavior Therapy, focus on easily accessible world views, cognitive “errors,” “maladaptive thoughts,” “irrational thoughts,” etc.  Others, such as behaviorism, focus solely on observable behaviors.  Regardless of clinical orientation, however, the DSM-5 is used by psychologists and other health care professionals in the US as the authoritative guide to diagnosis, and it describes Personality Disorders in terms of rigid and pervasive ways of relating to the world. 

Whatever one’s theoretical perspective, knowledge of various motivating factors enriches the clinician’s toolbox and promotes an empathic appreciation for psychological suffering.

Tips for Meditation Challenges

Tips for Meditation Challenges

 

Meditation ChallengesYou know it’s good for you.  Many studies have shown the benefits of including meditation in your life.  But, whether you already meditate regularly or just wish you could, you’re probably aware of challenges to establishing it as a regular practice.  You may feel bored, restless, or impatient.  Or start to feel physically uncomfortable.  Maybe you can’t reign your thoughts back from wandering to worries or to the sound of a dripping faucet.  Meditation challenges can interfere with your progress.

There are many kinds of meditation.  I’ll be focusing on mindfulness meditation here, as research shows its benefits go far beyond relaxation.  With mindfulness, a person learns to focus attention on the present moment, without judging or evaluating thoughts or feelings (see Mindfulness Training: Introduction, Attention, and the Present Moment for a full discussion on mindfulness and its benefits).   

Let’s look at three common problems for all kinds of meditation—boredom, restlessness, and impatience—and some suggestions for managing them.

Boredom

Your mind starts to wander.  “I’ve got so much to do…”  “When will this be over…”  Boredom may allow your thoughts to focus on the past—and ruminations about past disappointments—or on the future—and anxieties about what’s in store next.  Or it may just disengage you from the present moment.  How can you bring your mind back, fully engaged with the present?

First, be kind to yourself.  Acknowledge the feelings—accept that they’ve occurred and let them be.  Boredom is a common problem and an opportunity to practice refocusing on the present.

Become aware of the thoughts related to boredom.  “What’s the point of doing this?” 
“When will it be over?”
“I can’t be bothered.”  “This is a waste of time.”  Allow them to be and then to pass on.

Attend to the sensations with curiosity.  Where did the boredom come from?  Where is it going?  Where is it felt in the body?  Where is it leading you—are you wanting to fall asleep?

Take a third party perspective and simply observe the boredom within you, as separate from yourself.  You are not the boredom.  It is simply an experience that will come and go.  Do not judge it, just allow it to be.

Now, focus back on the breath, in the present moment.  Observe your thoughts, feelings, and sensations as they come and go. 

You are likely to find that feelings, thoughts, and sensations really do pass with time—this itself may be interesting.  And it’s an important lesson to remember, next time you feel overwhelmed by any of them in other areas of your life.

Restlessness

“I can’t stand laying here for one more minute…”  Restlessness is similar to boredom, but with more energy.  You may be feeling fidgety. 

If you’re struggling with settling into meditating, begin with something more active.  Mindful activities, in which you are fully focused on the present moment, can be beneficial in and of themselves.  They may also help calm the mind and prepare it for meditation.  You may wish to begin your meditation time with mindful walking or mindful yoga.  Mindfulness Training: Body Scan Meditation and Informal Mindfulness Practices presents more ideas for informal mindfulness practices.

As with boredom, if restlessness occurs during meditation, observe your thoughts, feelings, and sensations, without reaction.  Just notice what the mind wants but continue to sit or lay.  This is an opportunity to discipline the mind.  You are in control of your mind, not the other way around.

Impatience

“Why am I not feeling better?  I’ve been meditating every day for a week now!”  Many beginning meditators expect to get immediate results from meditation.  Meditation takes time, effort, and practice for results.  It requires a great deal of patience.

The good news is that patience is something that can be built—it is strengthened with work and practice.    

If impatience arises during meditation, simply observe the impatience without reacting.  As with most feelings and thoughts, the impatience is likely to pass.  Each time you are able to allow it to be, without reaction, you are building patience as a skill.  

To reap its benefits, it’s important to schedule meditation into your daily routine and practice it for at least a month.  If you’re ready to give up on it, ask yourself how long a period you could tolerate for now—15 minutes? 10 minutes? 5 minutes?  Even if it’s only for 1 minute, start with that.  Continue to practice it, as scheduled, gently increasing the time as you can. 

With regular practice, you’ll notice your impatience lessening.  And the patience you’re building is likely to translate to other areas of your life.

It’s Worth the Effort

The goal of mindfulness interventions is to teach participants to become aware of body sensations, thoughts, and emotions and to relate to them with an open, nonjudgmental attitude (e.g., Shapiro, Astin, Bishop, & Cordova, 2005).   Such an open state of mind can be cultivated by repeated practice.   

Studies show that mindfulness meditation engages many underlying mechanisms, including regulating impulsivity and building self-control (e.g., Fetterman, Robinson, Ode, & Gordon, 2010).  It helps build skills that can translate into success in other areas of your life.  Academic performance, interpersonal relationships, and life satisfaction have all been found to benefit from regular mindfulness exercises. 

Every challenge to meditation presents an opportunity to strengthen your control over your mind.

Additional Resources

Mindfulness Training: Body Scan Meditation and Informal Mindfulness Practices provides more meditation tips as well as discussion and demonstrations on the body scan meditation and informal mindfulness practices.

See Facing Dreaded Projects (How to Make a Mole Hill Out of a Mountain) for more ideas on approaching tasks that seem insurmountable.  

Learning about the theory behind mindfulness and research findings on its benefits may also be helpful—see Mindfulness Training: Introduction, Attention, and the Present Moment

References

 

 

 

Fetterman, A. K., Robinson, M. D., Ode, S., et al. (2010). Neuroticism as a risk factor for behavioral dysregulation: A mindfulness mediation perspective. Journal of Social and Clinical Psychology, 29, 301-321.  https://doi.org/10.1521/jscp.2010.29.3.301

Shapiro, S. L., Astin, J. A., Bishop, S. R., & Cordova, M. (2005). Mindfulness-based stress reduction for health care professionals: Results from a randomized trial. International Journal of Stress Management, 12, 164-176. https://pdfs.semanticscholar.org/00a3/f4a4906373dff0a0290f1354d7bd0f2bd016.pdf

Are Ego Defenses Bad or Good?

Ego Defenses

 

Are Ego Defenses Bad or Good?
Are ego defenses bad?

Are ego defenses bad or good to have?  Is the goal of psychotherapy to remove defense mechanisms or strengthen them?  Can mental health be defined as the absence of ego defenses?  Or are some ego defenses better to have than others? Questions like these are posed frequently by graduate students, clinicians, and even psychotherapy patients who want to better understand this crucial topic.

Therapy’s view

For over 100 years, the psychoanalytic literature has explored and catalogued the various methods people use to manage their sanity.  Even psychoanalysis’s harshest critics have implicitly endorsed the importance of recognizing defenses, albeit, by renaming them as cognitive appraisals, thinking errors, or some other term for automatic mental gymnastics.  The point remains that how a person manages and “massages” thoughts and perceptions greatly influences how the world is known and how relationships are handled.

Pros of defense mechanisms

Breaking down or taking away a person’s ego defenses would leave the individual vulnerable and frightened.  The task of psychodynamic psychotherapy is to help the patient be more deliberate (conscious) and flexible (adaptive) to the demands of everyday life.  The capacity for tolerating anxiety makes the reflexive defense against fear and tension unnecessary.  Ego defenses, when conscious, can become effective coping processes.  Once understood, they can become cues that something is feeling threatening and needs attention.  When under one’s control, they can allow for a more realistic perspective on how to manage life’s challenges.

Cons of defense mechanisms

Ego defenses evolved because, at some point in a person’s life, they were helpful.  They can continue to provide emotional safety throughout one’s life as long as they don’t become overused or too rigid—overuse or rigidity cause problems themselves, interfering with a person’s ability to deal effectively with the world.  Minimizing the impact of a difficult situation, as in denial, may allow a child to function in an abusive home.  Continuing to deny unhappy realities as an adult, however, can stand in the way of resolving problems.  The cons of defense mechanisms come when they interfere with a person’s ability to work effectively with reality.

What is the verdict?

What is the verdict–are ego defenses bad or good?   Defense mechanisms can become problematic if they are rigid and overused.  If a person learns about the defenses they tend to use to manage internal or external stress—whether by seeking organization, wanting to hide under the covers, seeking others’ reassurances, etc.—they have a source of information they can use as a signal for constructive action.  “I see I’m spending a lot of time reorganizing things this week… Is something bothering me?”  Having insight into oneself is an invaluable resource.

You can find more information on psychoanalytic theory regarding ego defenses in the online courses, Classical Psychoanalytic Theory or Ego Psychology.

What Is Psychoanalytic Psychotherapy?

Psychoanalytic Psychotherapy

Psychoanalytic PsychotherapyPsychoanalytic psychotherapy (also called psychodynamic psychotherapy) is a contemporary form of treatment for mental health issues that has evolved from its roots in psychoanalysis over the last 100+ years.

This form of treatment emphasizes a comprehensive understanding of the client (“patient”) as a person, as opposed to following a strictly symptom-oriented approach. By considering the importance of a person’s life history and their capacity to take ownership of their choices, psychodynamic therapy works toward long-term growth and change.

The patient develops an honest and personal understanding of who they are, what they desire from their lives, and how they can effectively pursue these goals. While gaining insight, understanding, and acceptance, the patient also develops improved interpersonal skills vis-à-vis their relationship with the therapist. Research has shown that the therapeutic relationship (alliance) is a key factor in any psychotherapeutic success (Wampold et al., 1997). As a microcosm of the patient’s life, the therapeutic relationship has the unique potential of promoting an exploration of sensitive and important questions that may not be possible in any other context. Likewise, the therapist’s focus is determined by the best interests of the patient. The specifics of psychoanalytic psychotherapy are unique to the person as are the goals of the treatment. Overall, the intent is for the therapist to help the patient enhance their life with minimum conflict and stress, while also maximizing their sense of self-efficacy.

Are psychoanalytic therapies really all about sex, mothers, and toilet training?

There are a lot of misconceptions and myths about psychoanalytic theory and psychodynamic therapy. The approach views the person both historically and in terms of their present life. Scientific research has confirmed the importance of early childhood experience and the quality of early relationships as determining factors for shaping personality (Shedler, 2010). What makes each of us unique is how we have navigated the trials and challenges in our histories.

From a psychodynamic perspective, sex is a broad concept that encompasses all of a person’s biological predispositions. The importance of understanding sexuality is largely to recognize the basic life drives and needs. Over time and maturation, these drives differentiate into the pursuit of pleasure, comfort, love, and personal identity. Mothers, of course, typically provide our first experience of love and acceptance and set the prototype for all subsequent intimate relationships. And, while toilet training may seem like a strange event for extensive concern, it represents another prototypical experience regarding socialization. Toilet training may be illustrative of the quality of a child’s experience with being socialized into the standards and expectations of the culture. Most importantly, at the time psychoanalysis was being created, toilet training was an indicator of harsh and punitive child-rearing practices. So, while out of context, these concepts can sound bizarre or archaic, they have come to be recognized as important metaphors for describing a young person’s challenges with the world.

Will a psychoanalytic psychotherapist offer advice or solutions for problems?

In most cases people are intelligent and resourceful enough to solve their life’s problems, but may be blocked by fears, thoughts, and memories that are obstacles. In psychoanalytic therapy, patients learn to identify those obstacles and explore what can be done to move beyond them. A person’s strengths and creativity are built upon so that expertise in living becomes part of the patient’s skill set.

How long does psychoanalytic psychotherapy take?

Psychoanalytic psychotherapy is not time-limited. The length of therapy is a mutually determined issue, based on the patient’s needs and desires. As everybody has different needs and issues to consider, it would be presumptuous to dictate how long a therapeutic process should take. On the other hand, the therapist recognizes and addresses when therapy is no longer necessary or counter to a person’s needs. The goal of any effective psychotherapy is to become no longer necessary.

Who should seek psychoanalytic psychotherapy?

People best suited for this form of therapy are those with a sincere interest in knowing themselves better. The prospective patient should be willing to examine their thoughts, actions, and emotions honestly and openly in a trusted relationship with a qualified professional. While “quick-fixes” are not typical or even the intent of this form of therapy, many patients find significant improvement within weeks of beginning treatment.

Additional Resources

For more information on the basics of psychoanalytic psychotherapy, see the online course Classical Psychoanalytic Theory.

References

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 66(2), 98-109.

Wampold, B. E., Modin, G., Moody, G., Stitch, F., Benson, K., & Ahn, H. (1997) A meta-analysis of outcome studies comparing bona fide psychotherapies: Empirically “all must have prizes”. Psychological Bulletin, 122, 203-215.

Isn’t Psychoanalysis Dead?

Psychoanalysis

PsychoanalysisI heard the question again just last week, this time from an undergraduate in my Abnormal Psychology class. I’ve heard it many times over the years, from colleagues and grad students as well. I had also been taught, all through college and throughout graduate training, that no one considered Freud’s work anymore. I suspect that most Americans have been taught the same.

I left my graduate training, armed with all the “best practices” in “empirically-based” primarily cognitive and behavioral techniques. I recall arguing with colleagues who mentioned psychoanalysis or psychodynamic approaches that research had not demonstrated their effectiveness. When one colleague commented that some patients had found them to be helpful, I privately wondered about his competence as a clinician.

Then I met Mary. She had been referred to me for depression. No problem, I thought. Lots of techniques had been demonstrated empirically to be effective in treating depression. When she asked if she could leave a cup in my office because medication had made her mouth dry, I had been trained to think only in terms of the practicality of having a cup available. But I quickly came to understand that such questions, and many others that followed, had far deeper significance—dependency needs, unconscious tests regarding acceptance, attempts to challenge boundaries, splitting. Her feelings—and relationship with me—were filled with turmoil. Idealizations swung to devaluations, and back again. She raged and despaired. She challenged all of my beliefs about the therapeutic process as manageable by the “right” charts and techniques.

I feel so fortunate to have met Mary early in my practice. To this day, I do believe that cognitive and behavioral techniques have merit, but I also see the enormous value of psychodynamic psychotherapy, as well as humanistic, emotion-focused, supportive, and countless other approaches. Humans are very complex creatures. Each therapeutic approach provides us with a lens through which to view a person. I believe we have a responsibility to become as familiar as we can with multiple ways of viewing each case, so that we can best address our patients’ needs in the moment, and as they evolve.

I was heartened to hear a comment from another student later in the week that she appreciated that I included psychoanalytic approaches when talking about treatment options with patients. Interestingly, she is a foreign exchange student from a region of the world where such approaches are generally understood to be of value.

To quote Eric Kandel, neuroscientist and Nobel Laureate, “Psychoanalysis still represents the most coherent and intellectually satisfying view of the mind” (American Journal of Psychiatry, 1999).

Resources

For the basics of psychoanalytic theory, see the course Classical Psychoanalytic Theory.  For more on the psychotherapeutic relationship, you may find Psychodynamics of the Therapeutic Relationship interesting.

The Value of “Having Your Head Examined”

Psychotherapy

PsychotherapyThe profession of psychotherapy has been around for over 100 years, with less formal versions of personal consultation going back to biblical times.  So why is it that the voluntary seeking of psychotherapy can be such a polarizing issue?   

Skeptics of psychotherapy cast doubts on the effectiveness of “talk” to change anything in a substantive manner.  Human beings are talkative creatures, so what is so special about talking to a psychotherapist rather than to a hairdresser, bar tender, cab driver, or next-door neighbor?  “If all therapists do is talk, then I can get that anywhere, and for a lot less than $150 per hour!”  

But talking is only one part of the picture.  An even more significant aspect of psychotherapy is the therapist’s capacity to hear what is being said—not just with words, but also in a larger implicit sense—hearing the meaning of a person’s truth.

Some advocates of psychotherapy might argue that it has changed their lives, saved their marriages, or even freed them from a life of abuse.  

What does seem clear to me though is that many people are afraid of psychotherapy.  Considering how therapists get portrayed in movies or the embarrassing presentation of media psychologists, there seems to be good reason to fear them.  I am often asked if psychotherapists are motivated by their own deep-seated issues and if they are as “crazy” as the people that they portend to treat?  My answer is simply . . . of course!  Being human is, in itself, a crazy proposition.  We live in an artificial world of our own invention by rules we make up, and we kill ourselves needlessly in wars, with drugs, on highways, in airplanes, and sometimes for pleasure.  There is good reason to think humans are crazy!

Yes, we do good things too, and we invented science and ethics and laws.  But while it is easy to be seduced into exalting the remarkable advances produced by the human race, our fellow (nonhuman) creatures may have a profoundly different opinion of us—if we could only hear them speak!  Humans have one foot in a virtual world of seemingly limitless creativity that seems wonderful, if not artificial, and the other in a biological reality, with specific needs and limitations.  People need to be nurtured, for instance, by another person who will validate their existence and uniqueness.  (Think about how painful it can feel to be ignored, or have your feelings and thoughts dismissed and devalued).  

Perhaps the most valuable contribution made by the profession of psychotherapy has been to create an industry designed to help persons retain their connection to their humanity.  In spite of all we have invented, we remain fragile living organisms, clinging to each other for survival—a reminder that there is no substitute for real human contact.  

With dozens of forms of psychotherapy to choose from, what they all have in common is that they provide a private, protected space, where the challenge of being alive can be acknowledged and supported by another who respects and listens to the struggle for sanity.

A good resource for clinicians for more information on the complexities of the therapeutic relationship is the course Psychodynamics of the Therapeutic Relationship.

An Unforgettable Patient: The “Meerkat Boy”

 

Child Psychotherapy Case

Child Psychotherapy Case: Meerkat BoyOne of my favorite child psychotherapy cases is that of the “Meerkat Boy.”  He was only 4 ½ years old.  His father had mentioned to his own therapist that the child had rarely (if ever) spoken, was reclusive, and was defecating in the corners of rooms.  The therapist recommended that the child be evaluated.  Hence, my first meeting with the boy. 

The child entered my office alone, apparently uninterested in having his parents join him.  His skittish movements reminded me of a Meerkat, on the lookout for danger but nevertheless engrossed in exploring his environment.  He moved through the room quickly and with curiosity, gently opening and poking through drawers.  What was he searching for? 

Suddenly, he stood straight up and beamed a broad, excited smile.  He had found a treasure!  He swung around and motioned for me to sit down in a nearby chair, positioning me so my face was at his level.  He was about to share his treasure with me!  He held out a roll of transparent tape.  What next?  He gently approached me, but no longer with caution.  He took my head and began to wrap it in the tape.

Should I stop him?  Should I be using this as an educational opportunity to teach him about boundaries?  Should I insist that he put into words what he was demonstrating in action?  The next 10 minutes were painfully long as I wrestled with how to be most helpful to him.  But we’d only just met…  So I said nothing.  And, with both care and determination, he wrapped my head until the entire roll of tape was gone. 

With that, he stood back examining his work with pride, and pronounced, “I wish I could do that to Mommy!”

I soon came to know that he was not on the Autism Spectrum or struggling with intellectual developmental delays, as others outside his family had suspected.  The boy was a bright and curious child, coping with extraordinarily odd and intellectually disabled, although well-meaning, parents.  His parents, after all, had not recognized anything unusual about his lack of language and odd behaviors, but had willingly brought him for therapy when this was suggested by a professional.

In meeting with the child’s mother, I learned that she also had some unusual interests that challenged normal boundaries.  (“I wish I could do this to Mommy!”—that is, containing her with tape.)  Whenever a family member used the bathroom, she would call all others to view the “product” before flushing.  She had also removed all bathroom doors, purportedly due to a fear that her son might drown if allowed to be alone in the bathroom.  The child’s preference to defecate privately in the corners of rooms now made sense to me.  When his need for some privacy was explained to her as developmentally appropriate, she willingly returned the doors and stopped calling for audiences.  He responded positively.

With my encouragement, she also enrolled him in a nearby preschool.  Teachers responded to his intelligence and curiosity, and he thrived.  More clues to his concerns about boundaries came with his first “show and tell” at school.  Children were to bring something from home to share with the class.  The day before the event, the boy came bounding into my office, both excited and anxious, to show me what his mother had prepared for the event.  He pulled a clear plastic bag from his pocket and laid it on the ottoman.  The baggie revealed a multi-year supply of cotton swabs dripping in ear wax.  He announced that his mother had been saving it from before he was born.  I worked hard to maintain my composure (and breakfast) and agreed that this was indeed something the other kids might find really interesting.  Knowing though that some children (and the teacher) might not respond positively, I wondered out loud whether he might want to take something a little less unusual for this first share.  His body language showed great relief and he proceeded to explore my office for something he could take instead.  He decided on some paper clips, which he linked together into a long chain. 

I passed the change in plans on to his mother and, although confused that there could be potential controversy, she complied.  The linked paper clips also appeared to gain special meaning for the child, as thereafter he would ask if he could take two for his pocket whenever there was to be a break between our sessions.

I have had the great fortune to work with this young man periodically through the years, as various issues have arisen for him.  I’m so glad that I’d chosen to observe and listen.    

Subscribe to
Our Newsletter

Connect With Us