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Importance of Meaning in Psychoanalytic Psychotherapy

Importance of meaning in psychoanalytic psychotherapyThe importance of meaning in psychoanalytic psychotherapy is core to the field. Psychoanalytic psychotherapy recognizes that the meaning of behavior is important. Unlike most behavioral therapies where behavior is explained in terms of learning and contingencies, psychoanalytic theories support the idea that our behavior is purposeful and meaningful.

While there is no argument that we are influenced by rewards and punishments that encourage or discourage our actions, we also persist in actions regardless of consequences and against our better judgment. Some of these actions can be called addictions or habits, but these terms only address one aspect of their explanation.

Psychoanalytic presuppositions about purposefulness of behavior recognizes that, as humans, we are more than reflexive creatures at the mercy of external cues and internal biochemistry. We are active and creative authors of our life experience, continuously trying to make sense out of our circumstances. We think in stories while imbuing meaning into all that occurs within and around us.

Whereas much of that meaning is conscious and readily describable in words, there is also a deeper, more personal meaning that constitutes our private truths. Such truths are not always easily verifiable or empirically validated, but they remain rooted in our subjective experience of living and being.

A person molested as a child may remain in a subjective state of guilt and shame for a lifetime, regardless of any objective facts to the contrary. Likewise, growing up in a home that is emotionally cold and rejecting may forge an expectation for betrayal and mistrust in all subsequent close relationships. These types of truths are known viscerally and emotionally without conscious awareness. The importance of meaning in psychoanalytic psychotherapy allows the patient to process their history.

Through the exploration of meaning, the psychoanalytic patient is helped to discover their fundamental beliefs, values, and desires in the context of a therapeutic relationship, where transference reveals the dynamics of their personal history as they knew it to be. In turn, they come to know themselves as a unique being beyond the definition ascribed to them by others.

The patient’s truth is respected and witnessed by a therapist dedicated to enhancing the patient’s potential. Only the patient themselves can effectively re-define who they are and who they strive to become. Whereas the therapist may help illuminate unconscious meaning through interpretation of statements and actions, these interpretations are, at best, approximations of alternative truths and examples of empathic acceptance of the person.

Since the truths were constructed in a particular time and context, their meaning may become changed through reflection and discussion. Thought patterns, descriptive narratives, slips of the tongue, non-verbal gestures, and other subtle cues may lead to insights that are emancipating from the past.

Similarly, in current conflicts and issues, a patient may come to understand how symptoms belie an unconscious wish or fear. For example, a patient developed a sudden attack of hiccups for several days that prevented him from speaking freely with his girlfriend. Upon exploration it was discovered that the attack began after she brought up her desire to get married. The patient left our session discounting my interpretation of his hiccups as a defense against speaking with her. He denied any possible meaning to his symptoms and was convinced that his physician’s prescription for an anti-seizure medication was his best option. A few hours later, he left me a message that the hiccups had stopped once he got to his car in the parking lot outside my office. While he was relieved from his symptom distress, he was angry that he had to continue the discussion with his girlfriend.

Finally, I think it is important to note that meaning is not found or discovered, but rather created. Psychoanalytic therapy is a collaborative process of inquiry, exploration, and creativity that is uniquely tailored for every patient.

Thus, the use of “canned” or generic meanings or symbolism often does a disservice to our patients by ignoring the significance of their histories. When a patient asks, “what does it mean when…”, they are subordinating themselves to a position of ignorance and elevating the therapist to an idealized other who is supposed to know what they cannot know. The unequal power dynamic undermines the patient’s growth and fosters an undesired dependency.

The therapeutic relationship is, potentially, a mutually enriching process of meaning for both the patient and the therapist

If you would like to learn more about the psychoanalytic process, you may find the following articles to be of interest: 7 Reasons Why Psychoanalysis is Still Relevant Today; Value of Psychoanalysis; and Psychoanalysis, Resilience, and Meaning-Making.

APA Approved CE Online CoursesThe Institute of Advanced Psychological Studies is approved by the American Psychological Association to sponsor continuing education for psychologists. The Institute of Advanced Psychological Studies maintains responsibility for this program and its content.

Is Psychoanalytic Psychotherapy Empirically Validated?

Psychoanalytic Psychotherapy Empirically ValidateIs psychoanalytic psychotherapy empirically validated? The short answer is, yes. And empirical support for this long-established approach is rapidly growing.

Why do some people assume that it isn’t evidence-based? Probably because empirical research on psychoanalytic psychotherapy has been slower in coming than for some other clinical approaches.

There are a number of reasons why empirical validation of psychoanalytic psychotherapy has lagged behind other therapeutic approaches.

First, psychoanalytic psychotherapy is relatively difficult to assess with standard empirical techniques. Empirical research typically relies on quantitative data, observable outcomes, unvarying procedures applied across cases, large sample sizes, and replication of findings. Experiments with random assignment to discrete conditions with a control group (i.e., randomized-controlled studies) are considered the “gold standard” in research because they are highest in internal validity (i.e., determining cause-effect relationships). Each of these elements is problematic for psychoanalytic psychotherapy.

Let’s first consider the type of data involved. The aim of psychoanalytic psychotherapy is not merely to reduce problem behaviors; rather, it is to help deepen self-understanding and to achieve some outcomes that are important for an individual’s quality of life but difficult to measure. Psychoanalysis and psychoanalytic psychotherapy provide a setting where an individual’s personal truths can become known, understood, and shared. Some outcomes may be assessable through self-report, rating scales, or behavioral outcomes. Patient self-reports, however, may not reflect the deeper, sometimes ineffable changes that lead to greater health. Their validity can also be undermined by fabrications and/or a patient’s wish to validate (or invalidate) a treatment process. Even observable behavior change does not always accompany or reflect growth and improved well-being attained in psychoanalytic psychotherapy.

As we are complex creatures, psychoanalytic theories are also inherently complex, providing models for appreciating the uniqueness of the human experience. These models are difficult to understand, let alone to operationalize, by a researcher who is not an experienced psychoanalytic psychotherapist. And most researchers are not experienced psychoanalytic psychotherapists.

Then, there are procedures that must be standardized across cases in research studies. Psychoanalytic psychotherapy considers such constructs as the changing phenomenology of the patient and the transference relationship with the clinician—both difficult, if even possible, to replicate in a meaningful way, as each case is unique. The gold standard of research involves random assignment to condition. Random assignment requires that discrete conditions be pre-determined, which may be difficult, if even feasible, when the clinician’s focus is on responding to the changing, unconscious needs of an individual. Is psychoanalytic psychotherapy empirically validated? Because research involving psychoanalytic psychotherapy has tended to involve observational or case studies, the studies have not always been “counted” as evidence. Hence, the approach is often assumed not to be evidence-based.

Furthermore, psychoanalytic psychotherapy often deals with issues that cannot be resolved quickly. This factor has several implications. First, many researchers depend on number of publications for tenure, academic promotion, etc., making long-term studies less desirable. No wonder there are so many more outcome studies on cognitive-behavior therapy (CBT). And, statistical power relies on having a large enough sample size to reveal subtle differences. When therapy is individualized and longer term, gathering a large sample is impractical.

Finally, psychoanalytic psychotherapy occurs through the relationship with the therapist—a vehicle that is viewed as sacred and to be protected from contamination by outside factors. As such, psychoanalytic psychotherapists have tended to be suspicious of and protective against incorporating empirical assessments that could influence the therapeutic process.

In contrast, cognitive-behavior therapy focuses on modifying observable behaviors and/or conscious cognitions, with protocols that are brief, relatively simple to manualize, and conducive to randomized controlled studies. Consequently, many research studies have been published on this approach, leading some to assume that it is the only valid type of therapy for many conditions. A self-fulfilling prophecy is then also engaged, with greater recognition leading to greater access to further research funding, for even more outcome studies and confidence in the approach.

Is psychoanalytic psychotherapy empirically validated? Despite the many challenges, the quality and quantity of research testing psychoanalytic psychotherapy is increasing. More proponents of the approach are becoming convinced of the importance of providing research evidence and becoming creative in ways to test its complex features. Midgley et al. (2021) recently published a narrative synthesis of such outcome studies, including a growing number of randomized-controlled studies involving psychodynamic techniques.

There are future challenges, however. More funding is needed for studies that are complex and difficult to operationalize. Randomized-controlled studies have routinely been favored by the scientific community; hopefully, observational studies will also come to “count” as empirical evidence. As noted by Midgley et al. (2021), “Whilst the findings of these studies cannot be considered as ‘rigorous’ as those of experimental studies, such studies may be more representative of a ‘real-world’ context, where treatments are not often delivered according to a specific manual, treatment length is not predetermined, and patients often present with a mixed picture of mental health issues” (p. 12).

I value the words of Eric Kandel, neuroscientist and Nobel Laureate: “Psychoanalysis still represents the most coherent and intellectually satisfying view of the mind” (1999, p. 505). https://ajp.psychiatryonline.org/doi/pdf/10.1176/ajp.156.4.505

To learn more about Midgley et al.’s (2021) narrative synthesis of outcome studies on psychodynamic psychotherapy, please see their open-access article: Midgley, N., Mortimer, R., Cirasola, A., Batra, P., & Kennedy, E. [2021]. The evidence-base for psychodynamic psychotherapy with children and adolescents: A narrative synthesis. Frontiers in Psychology12, 1-18. doi: 10.3389/psyg.2021.662671.

You may also earn 2 CE credits for reviewing the article by registering for the online course, Evidence Base for Psychodynamic Psychotherapy With Children and Adolescents: https://www.psychstudies.net/product/evidence-base-for-psychodynamic-psychotherapy-with-children-and-adolescents/

You may also enjoy our blog, Is Psychodynamic Psychotherapy Evidence-Based?

How Psychoanalysis Can Benefit Children

ChildAs a psychoanalytic psychologist who has specialized in treating children and adolescents, I have often been asked how psychoanalysis can benefit children. Given society’s attention to scientific evidence-based data, one would expect that theories that consider instincts, drives, and Oedipal Complexes must be archaic and obsolete.

Much of contemporary thought on psychotherapy seems to embrace treatments aimed at reducing problematic behavior, either through medication or learning theory principles of reward, punishment, and extinction. And while such focused treatment goals can appear efficient and simple, they typically result in temporary changes, or, more tragically, confirm a perception of the child as defective or pathological, hence the rise of diagnosed mental illness in children.

All people, and especially children, are in a constant process of growth and change. As living organisms, we are evolving creatures that adapt to the demands of life filtered through our emotional and cognitive systems. We are more than sensing organisms endowed with neurological and biochemical processes; rather, we are feeling and thinking beings seeking to understand and be understood.

Any parent who has had the privilege to observe an infant’s maturation toward adulthood should be astonished by the emergent capacities of the child. Sensorimotor abilities proceed at an amazing pace wherein infantile helplessness transforms into searching, grasping, crawling, walking, running, and exploration. Cries become intentional solicitations; babbling becomes conversations ripe with rich vocabularies and storytelling. These and innumerable other achievements attest to the growth trajectory, both in terms of overt actions as well as in mental capacities for thought and imagination.

As social creatures, humans depend upon a relationship with others to foster and promote these remarkable achievements. We are born into a complex network of relationships that influence the patterns and capacities of the participants bi-directionally. That is, both child and adult are transformed by their relationships to each other.

Whereas modern neuroscience has advanced our understanding of how our brains function, the experience of living—our phenomenology—is yet to be understood through such reductionism. As I used to tell my graduate students, we can explain how a watch works to measure time, but no amount of knowledge at that level will ever explain the phenomenon of time.

Psychotherapy addresses lived experience of phenomena, central to our being. Children, like adults, have a lived experience that is fundamental to their sense of self and their identification with others.

In these critical early years, children are subject to a myriad of socializations. The child creates mental representations as templates for how the world works, what people are like, a sense of self, and an understanding of what their emotions mean. All these creations are co-constructed through a child’s relations with others.

These meanings establish subjective “truths” that may be ineffable and therefore subject to interpretation by others. A child, for example, who feels restless, distracted, irritable, and forgetful may be interpreted by a parent, teacher, or doctor as having an attention deficit disorder. The child’s subjective truth may be an expression of worry, anger, or loss stemming from their own account of what is happening in their world. Perhaps the child had a pet die or run away, or the child may have recently moved to a new home or school. The child may be reacting to parental arguments that threaten the stability of the home, or perhaps a new sibling that conjures up feelings of jealousy.

Without considering the context of the child’s life, any manipulation of their behavior in the service of adult convenience runs the risk of estranging the child from themselves. Thus, my overriding rationale for working from a psychoanalytic orientation is always to consider the person over the diagnosis and respecting the context and integrity of the mind.

While psychoanalytic theories have been criticized for their esoteric jargon and complicated dynamics, they can also be highly informative models for appreciating the uniqueness of the human experience. When asked how psychoanalysis can benefit children, I respond that children’s minds are no less complex than those of adults and deserve to be recognized accordingly.

If you are interested in working with children, you may find the course, Psychodynamics of Child Abuse and Trauma, helpful.

How Lacan’s Theory Can Be Helpful in Psychotherapy

Lacan's theory can be helpful in psychotherapyHow Lacan’s theory can be helpful in psychotherapy may not be obvious and is often overlooked.

The theories and concepts of French psychoanalyst, Jacques Lacan, are considered by many as among the most significant contributions to psychoanalytic thinking and praxis since Freud; yet his work is largely unknown to many American psychotherapists. Lacan is mostly known in the US in terms of applications to literary criticism and socio-political theory, and those who are familiar with Lacan typically describe his contributions as intriguing, but esoteric and enigmatic. Much has been written regarding Lacan’s philosophical, political, and mathematical influences, but many Lacanian theorists have adopted an obscure and cryptic style, perhaps in homage to the master. Discussions have tended to be abstract and esoteric, making their practical application to psychotherapy difficult. Whereas Lacan’s concepts are complex, both philosophically and logically, my reading of his work suggests that he sought to promote creative and relevant applications by clinicians. Lacan’s theory can be helpful in psychotherapy–his constructs can be helpful in guiding one’s thinking in the clinical process.

Let me be clear—I do not consider myself to be a “Lacanian,” nor do I apply his concepts in what some may consider an “orthodox” manner. Rather, as a practicing psychoanalyst and psychologist of over 35 years, I have sought to integrate the wisdom from many theories and mentors. Lacan’s writings, published as Écrits, include discussions of art, literature, religion, culture, philosophy, and music, all as expressions of the human experience that are essential for venturing into a serious consideration of the psyche.

My original attraction to Lacan came from my interest in psycholinguistics. As linguistic creatures, our conscious thoughts are structured by our language. Lacan, perhaps more than any other psychoanalytic theorist, emphasized the role and function of language as the organizer of the mind.

Language serves as a vehicle for communicating subjective experience into a shared collective objectivity. In speaking, the person enacts their language to externalize what is intuitively known internally. This externalization is always an approximation of the internal known, and thus constitutes a compromise formation. In this way, speech is symptomatic of the unconscious since this linguistic translation is an approximation, adapting the subjective into the objective, with some aspect of that private experience being lost and changed in translation. The important question for psychotherapy is, what is being approximated? For Lacan, the answer is the patient’s personal truth. The speaker (Subject) works toward expressing a personal private truth by speaking in a language that is not their own but is required to be used for social discourse. The fact that all participants of that language/speech process are expected to use their language conventionally makes neurosis inevitable.

The enactment of language through speech or conscious thought must always be considered in a relational context, or discourse. Lacan proposes a psychologically-based model of social discourse that is informed by structural linguistics, political theory, and psychoanalysis.  He offers four structures that are contexts in a social exchange. These four structures are his discourses of Master, University, Hysteric, and Analyst, which serve as archetypal categories for social relations. Lacan’s discourses are comprised of a Subject, as the agent who initiates the communication, and an Object, as the “Other” who serves to complement the dialectic. When engaging in speech, the Subject’s motivation is an unconscious derivative of a subjective truth. This truth is “known,” but ineffable. Through the dialectical exchange with the Other, a product in the form of a verbal response is created by the Other for the Subject. In this way, the Subject’s truth is named by the language of the Other. By naming the Subject’s truth, one is subjugated into a social order that compromises the Subject in accordance with social convention. As was stated earlier, the process of socialization necessitates compromise and thereby ensures a degree of self-alienation.

Each of the four discourses establishes a variant in the dialectic between the person and others. The intent behind psychoanalysis becomes the empowerment of the person as their own master, without the necessity for the subordination by another. Lacan confers upon psychoanalysis an ethical directive to allow the patient the authority to know their self. Lacan’s theory is helpful in psychotherapy even through its emphasis of this directive.

This pursuit is different from a medical or scientific agenda where the removal of symptoms is the goal. Symptoms and complaints expressed by the patient are respected as statements attempting to speak a personal, private truth known only to the patient, but repressed from speech owing to the inadequacy of language. The medical agenda for reducing or eliminating symptoms is at complete odds with Lacanian therapy. Emotional suffering, in this regard, demands understanding by and for the patient alone. Implicit in this suffering lies a passion and desire that eludes direct linguistic expression, yet may be knowable from recognizing the limits set by language. Herein lies the neurotic dilemma of speaking the unspeakable to another who is likewise a divided self.

Another of Lacan’s contributions to the understanding of the mind is the mental registers: Real, Imaginary, and Symbolic. These registers can, I believe, be thought of as forms of information created by the mind that together form knowledge. These mental registers add another degree of complexity in understanding the human experience. Lacan was most concerned with the phenomenological over a mechanical or biological understanding of mental experience. His mental registers can be thought to emphasize a multileveled nesting of mental processes that could provide a framework for appreciating the humanness of the mind.

It is important to reiterate that the focus of treatment is the patient in relationship to others. This position is in contradistinction to those forms of psychotherapy aimed at altering psychic structures such as the ego and its defenses or in working toward the targeting of specific symptoms. Lacan adopted an epistemological stance consistent with systems theories. From this position, a patient’s psychic conflict arises from an effort to preserve sanity in the context of living among others. Contemporary clinical psychology and American psychoanalysis tend toward promoting change in the patient by addressing diagnosed psychopathological conditions that are constellations of symptoms. The current Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5) and other nosological systems such as the International Classification of Diseases by the World Health Organization (ICD-10), give primacy to the disease (disorder) and secondarily to the patient wherein it is thought to manifest.

I have found that Lacan’s key concepts are helpful in understanding and guiding the therapeutic process. As clinicians, our primary tool for treating patients is rooted in our use of language to communicate and approximate understanding. Understanding, itself, is a lifelong pursuit that may be fundamental to the mind and our sanity. Lacan’s theory can be helpful in psychotherapy.

If you would like to learn more about how Lacan’s basic constructs can be applied in clinical work, please see the video course, Lacan – Inspired Psychotherapy (4 CE Credits). In it, I review the basic constructs and apply them to two clinical cases. For a more thorough review of his theory in a reading, please see the course based on an article written by an expert on Lacan: Jacques Lacan: Introductory Overview (4 CE Credits).

APA Approved SponsorThe Institute of Advanced Psychological Studies is approved by the American Psychological Association to sponsor continuing education for psychologists. The Institute of Advanced Psychological Studies maintains responsibility for this program and its content.

How Can Psychotherapy Help?

How can psychotherapy help?What is the purpose of psychotherapy? Many new patients ask, “How can psychotherapy help? How will talking about my problems make my life better?” The question seems well founded. People often seek psychotherapy when they feel at a loss for what to do about the misery in their lives. They may recognize that their sleep is disrupted or they are gaining weight, preoccupied by distressing thoughts, easily angered or irritated, arguing with their family and friends, and wondering who or what is to blame.

Television commercials for the latest pharmaceuticals inform the public that a person’s misery is likely the result of undiagnosed or unmedicated mental illness. We are shown depressed, manic, and psychotic people miraculously transformed by a new drug that will return them to happy and productive lives (albeit with the legal disclaimer that there may be a host of significant, even fatal, side effects). But the take-away is clear, if you are unhappy in your life you have a medical disease that is victimizing your happiness. Can psychotherapy help? What possible benefit could come from talking to a therapist?

All too often, some therapists see their role as helping people accept their fate as being mentally ill and encouraging them to simply take medications. In fact, not encouraging your patients to take medications might be considered unethical and incompetent. The overriding message from the medical mental health community is that mental illness is a disease, like diabetes, degenerative heart disease, or Alzheimer’s.

The assertion is compelling, but what is the evidence? We now know about the role of neurotransmitters, various brain regions, and genetic correlations that support a physiological basis for our emotional and behavioral experience. This empirical evidence, however, is descriptive not explanatory. We can describe how the physiology of the body creates and influences our mental life, but it doesn’t explain why a person may be miserable. All disorders in the DSM are determined by the appearance, frequency, and intensity of various emotions or actions, i.e. symptoms. Symptoms are signifiers of an illness. Chest pain could be a symptom of a heart attack, a headache could be a symptom of a brain tumor, high blood sugar levels could be a symptom of diabetes, but the symptom is not equivalent to the disease. Further examination is necessary to determine if there is an organ malfunction, a tumor, or some other underlying disturbance. In no case, however, is simple symptom reduction competent or ethical treatment.

Psychiatric diagnoses, by contrast, equate the symptom with the disease, such that the presence of a “symptom” is considered empirical validation of the disorder—a misguided example of circular logic that removes the person of the patient from the equation. Rather than considering the unique circumstances or subjective experience of the person’s life as significant to their emotions and actions, they are replaced by a generic diagnosis.

A teenager who cuts herself at night is said to have a “non-suicidal self-injury disorder;” a middle-aged man who stays up nights watching pornography rather than being with his wife is said to have a “sex-addiction.” These conditions are presented as if they exist independent of the persons who possess them. What is rarely considered is that these people are trying to retain their sanity with solutions that have become an expression of their suffering. What is the teenager trying to release from her body? Who or what imaginary world is the sex-addict trying to find on the internet?

Rather than helping patients understand themselves, modern disease-based treatments aim to substitute the suffering with a generic condition (a diagnosis) that can be medicated. No wonder there appears to be an epidemic of mental illness if nearly every expression of human misery is made to fit into a diagnostic category. Consider that, since the DSM-III (1980), there has been nearly a 100% increase in the number of diagnosable conditions, as compared to the current DSM-5 (2013). (DSM-II had 182 disorders, DSM-III had 265, DSM-IV had 279, DSM-5 has 500).

Can psychotherapy help? Freud introduced the “talking cure” as an alternative to the radical, and sometimes barbaric, treatment of persons who suffered from psychological distress. For over 100 years we have seen the growth of psychotherapeutic treatments evolve into many forms whose effectiveness rivals that of medications. These treatments typically center around the significance of human-to-human relationships that provide acceptance, empathy, and self-empowerment. How can psychotherapy help? Patients are helped to find a voice for their personal truths that expresses how they have come to understand themselves and others and to challenge beliefs that may not be valid. The therapist’s role serves to facilitate that self-expression and to bear witness to truths that may seem unspeakable. The goal is not to be a panacea for the human condition, but rather to help persons develop and sustain the necessary skills to manage life with dignity and humility.

To read about what adolescents say helped them in psychodynamic psychotherapy, see What Works in Psychodynamic Psychotherapy With Adolescents?  You may also find the following interesting: Evidence Base for Psychodynamic Psychotherapy With Children and Adolescents. Both sites provide links to free articles.

APA Approved SponsorThe Institute of Advanced Psychological Studies is approved by the American Psychological Association to sponsor continuing education for psychologists. The Institute of Advanced Psychological Studies maintain responsibility for this program and its content.

7 Reasons Why Psychoanalysis Is Still Relevant Today
Psychoanalysis is still relevant

Psychoanalysis is still relevant because:

  • Psychoanalytic theories and therapies strive to understand the unique phenomenology of a person. In doing so, the meaning and values that give significance to our lives are honored and supported. In our modern era of brain research, a person’s experience of living is sometimes reduced to a discussion of biochemicals and brain structures. Love, happiness, sadness, or misery can be simplistically “explained” by neuropathways, select brain regions, and neurotransmitters. While the remarkable advances of science have allowed researchers to understand how biological systems function during the experience of such emotions, they actually offer descriptions of how they happen, not explanations for these phenomena. By reducing the essence of the human experience (or any living creature’s experience, for that matter) to an objectified mechanistic system, we deny the most salient of human abilities, our imagination! Our capacity to create seemingly limitless ideas and stories has allowed the mind to be emancipated from the constraints of sensory reality. We imagine, invent, create, and transcend beyond the material world toward a world of potentialities. Certainly, psychoanalysis is still relevant today!
  • All civilized societies require that persons conform to the standards, rules, and expectations that are necessary to live cooperatively. Our socialization begins at birth and requires that a person learn to adapt to social demands and to internalize those demands as one’s own. The primary task for mental health is to achieve this conformity while preserving one’s personal integrity. This integrity requires us to respect our diversity in many forms, such as ethnic, religious, sexual, etc., while balancing our needs for social connection and acceptance. Psychoanalytic therapies have kept these existential considerations central to the mission of advancing human understanding and promoting personal growth. 
  • As today’s technology has allowed us nearly immediate gratification for many of our needs, such convenience can undermine a person’s emotional maturity by circumventing the ability to tolerate frustration. Tolerating frustration involves the ability to delay gratification, self-containment of tension states, inhibiting reflexive action, and the ability to engage in thoughtful, reflective planning. Lacking in this capacity, one is prone toward impulsive and potentially addictive lifestyles. No wonder, then, that these addictive and impulsive styles have historically been seen as characteristic of adolescence, where mature brain development has not yet been achieved. If, however, needs and demands can be satisfied in nanoseconds, there is little motivation to cultivate self-containment. Psychoanalytic therapies are not quick fixes, intentionally, so as to allow for the facilitation of the maturing processes to unfold. So, while some might call this old-fashioned, it is actually a principle aligned with how nature works. The emergence and unfolding of the mind is better supported by engaging our internal emotional and cognitive potentials to grapple with life’s challenges, than by adopting canned answers from the internet or random facts from Google searches.
  • Psychoanalytic therapies strive to enhance self-awareness. Patients are encouraged and empowered to seek their personal truths through introspection and insight. The role of the therapist serves as a guide who accompanies the patient through the exploration and examination of one’s private mind. As a guide, the therapist offers some protection from the fear of self-knowledge and, most importantly, serves as a witness to the self-truths that may need to be proclaimed. Guiding and witnessing are among the most important interpersonal functions as they offer a secure acceptance and validation of the individual. These functions establish the conditions for healthy attachment and honor a person’s value and purpose. It is important to recognize that psychoanalysis is still relevant today.
  • As a system for understanding mental illness, or human suffering, psychoanalytic models provide a compassionate and normalizing perspective. Whereas symptoms are expressions of suffering, they also represent a person’s best effort at retaining whatever sanity that person has achieved. Psychoneuroses are distinguished from other forms of misery by referring to the mental suffering derived from conflicts within and between persons. The gift of our imagination can also be a curse when it comes to facing unfathomable thoughts, fantasies, and recollections. Psychoanalytic therapy allows the patient to distinguish perceptions from fantasies, desires from needs, or speculations from truths. Insight and corrective emotional experiences with the therapist can help us regain our ability to care for ourselves and our loved ones.
  • Why do critics of psychoanalysis say that it is not a science and that it does not stand up to rigorous empirical validation from scientific testing? This criticism is partially true, but misleading. In psychoanalytic therapies, the focus of inquiry and treatment is exclusively upon a person’s unique subjective experience and thus each treatment is unique in itself. Therefore, every therapy is tailored to the specific needs of the individual based upon his/her personality, background, abilities, and maturity. One person’s therapy cannot be accurately compared to another’s, precluding the meaningful comparisons needed for scientifically controlled research studies. Simply put, psychoanalytic therapies treat people, not diagnoses. This approach to therapy values the person over the diagnosis. That is, the focus of treatment is to help a patient achieve an improved quality of life, not simply to reduce problematic symptoms. This goal may be achieved by reducing symptoms to some degree but may also include acceptance of one’s self and that some of life’s issues need to be survived rather than “fixed.” Furthermore, many studies have shown that the single most important factor for any successful psychotherapy, regardless of type, is the quality of the relationship between the therapist and the patient. The therapeutic relationship has been the cornerstone of psychoanalysis since its inception. Yet another example of how psychoanalysis is still relevant today!
  • Nobel laureate, Eric Kandel, has stated that psychoanalytic theory offers the most comprehensive understanding of the mind among all other psychological theories. The ideas and concepts have undergone over a century of revisions and modifications aimed at helping to understand the human condition. As complex and multi-faceted creatures we are endowed with an incessant curiosity and remarkable resilience. We not only invented science, but also the humanities. Art, music, literature, and dance are methods humans have created to express the enormity of our shared lives and the drive to understand the essential meaning of our existence. Psychoanalytic theories also examine our relationship to these humanities as they may hold personal significance for the individual. Psychoanalysis evolved from Freud’s devotion to understanding himself and others as members of a dominant world species. All of our methods for expression serve to approximate, but never fully elucidate, human uniqueness.

Psychoanalysis is still relevant today; in fact, it has never been more important.

To learn about current research validating the approach with children and adolescents, see the course, Evidence Base for Psychodynamic Psychotherapy With Children and Adolescents. It will provide you with a link to a free peer-reviewed article.

More research is also cited in the blog post, Is Psychoanalytic Psychotherapy Empirically Validated?

If you are interested in learning more about psychoanalysis, you can earn a Certificate of Advanced Study in Psychoanalytic Psychotherapy. The program is built on CE courses, entirely online, accessible at any time, and paced at your convenience. To learn more, see https://www.psychstudies.net/specialization-certificates/

APA Approved SponsorThe Institute of Advanced Psychological Studies is approved by the American Psychological Association to sponsor continuing education for psychologists. The Institute of Advanced Psychological Studies maintains responsibility for this program and its content.

Is Psychodynamic Psychotherapy Evidence-Based?
Evidence-Based Psychodynamic Psychotherapy

Is Psychodynamic Psychotherapy Evidence-Based?

The public—and many clinicians—often assume that it is not. In fact, many university courses teach that only cognitive-behavioral approaches have current empirical support. This assumption is false and does a disservice to the field and to the public alike. A growing number of studies demonstrate that psychodynamic psychotherapy is evidence-based, and support the value of psychoanalytic and psychodynamic approaches, especially for complex cases and long-term change. 

Some Psychological Approaches Are Easier to Research Than Others

Clinical psychology is a multifaceted discipline, with a history that spans over 100 years. Since its origins, approaches and perspectives have come and gone in popularity. Classical psychoanalysis, object relations theory, and ego psychology; humanistic client-centered, gestalt, and existential therapies; behavior therapies; cognitive, cognitive-behavioral, and mindfulness-based cognitive therapies; interpersonal therapy; eye movement desensitization therapy; dialectical behavior therapy; integrative or holistic therapy—and the list continues to grow. Some approaches have been studied more than others. Many show promising results in some studies, only to be found to be limited in others. Some win favor because they are simple to research, and so garner publicity and research grants. Others draw attention because they are easy to teach and to master, or are short in duration and so inexpensive. Psychoanalytic and psychodynamic approaches are complex; they are not easily taught and they pose challenges to research. But, despite this, they continue to have many followers and are gaining impressive scientific support.

A Growing Body of Research Supports the Value of Psychodynamic Psychotherapy, Despite Its Complexity

Is psychodynamic psychotherapy evidence-based? Absolutely! Numerous current scientific studies support the value of psychodynamic and psychoanalytic approaches. In fact, meta-analyses—studies that gather evidence across multiple studies—demonstrate the effectiveness of psychodynamic and psychoanalytic work and indicate that, in some cases, psychodynamic approaches may be more effective in the long-run than other therapeutic models (e.g., Abbass et al., 2014; Baardseth et al., 2013; Bastos, Guimaraes, & Trentini, 2015; Buchheim et al., 2012; Busch, 2015; Grande et al., 2009; Johansson et al., 2010; Kallestad, Valen, McCullough, Svartberg, Høglend, & Stiles, 2010; Klug, Zimmermann, & Huber, 2016; Leichsenring, & Rabung, 2011; Midgley & Kennedy, 2011; Parker & Turner, 2014; Rizeanu, 2016; Shedler, 2010; Shepherd & Beail, 2017; Soares et al., 2018; Waldron, Gazzillo, Genova, & Lingiardi, 2013; Waldron, Gazzillo, & Stukenberg, 2015).

Psychodynamic Psychotherapy Is Often Misperceived

As noted by Shedler (2010) in an article published by the American Psychologist—a well-regarded publication of the American Psychological Association, “the perception that psychodynamic approaches lack empirical support does not accord with available scientific evidence and may reflect selective dissemination of research findings” (p. 98). This faulty perception has led some educational programs to downplay its significance or even dismiss it as an “outdated” approach. It is in the public interest that the field conduct scientific inquiry into the potential benefits and mechanisms of all therapies that clinicians have found to be valuable. Researchers cannot adequately investigate theories that they do not fully understand—research draws from a theoretical base (Britzman, 2012), which must be clearly understood before meaningful studies can be conducted regarding its mechanisms (e.g., Gazzillo et al., 2017; Laska, Gurman, & Wampold, 2014; Waldron et al., 2015). It is, therefore, crucial for science as well that the field continue to be educated about the premises of these valuable therapeutic approaches. Unlike some behavioral theories, many of the constructs of psychodynamic and psychoanalytic theory can only be assessed indirectly. Fortunately, many researchers are accepting the creative challenge.

It Is Important to Continue Researching All Psychotherapy Approaches

It is important for psychologists, psychoanalysts, and counselors to stay current, with scientifically grounded evidence, regarding issues relevant to enhancing their service to the public and the profession. Research, and informed discussion and practice, strengthen the profession. Is psychodynamic psychotherapy evidence-based? Yes, psychodynamic and psychoanalytic therapies are indeed empirically validated as valuable approaches for a wide range of disorders and clients. And, to quote Eric Kandel, neuroscientist and Nobel Laureate, “Psychoanalysis still represents the most coherent and intellectually satisfying view of the mind” (1999, p. 505).

Interested in learning more about the evidence for its approach with children and adolescents? You may find the following article and course valuable: Evidence Base for Psychodynamic Psychotherapy With Children and Adolescents

 

More References for Evidence-Based Psychodynamic Psychotherapy

Abbass, A. A., Kisely, S. R., Town, J. M., Leichsenring, F., Driessen, E., De Maat, S., Gerber, A., Dekker, J., Rabung, S., Rusalovska, S., & Crowe, E. (2014). Short-term psychodynamic psychotherapies for common mental disorders (review). Cochrane Database of Systematic Reviews, 7, 1-108.  doi: 10.1002/14651858.CD004687.pub4

Baardseth, T. P., Goldberg, S. B., Pace, B. T., Wislocki, A. P., Frost, N. D., Siddiqui, J. R., Lindemann, A. M., Kivlighan III, D. M., Laska, K. M., Del Re, A. C., Minami, T., & Wampold, B. E. (2013). Cognitive-behavioral therapy versus other therapies: Redux. Clinical Psychology Review, 33, 395-405. http://dx.doi.org/10.1016/j.cpr.2013.01.004

Bastos, A. G., Guimaraes, L. S. P., & Trentini, C. M. (2015). The efficacy of long-term psychodynamic psychotherapy, fluoxetine and their combination in the outpatient treatment of depression. Psychotherapy Research, 25(5), 612-624. https://doi.org/10.1080/10503307.2014.935519

Britzman, D. P. (2012). What is the use of theory? A psychoanalytic discussion. Changing English: Studies in Culture and Education, 19(1), 43-56. https://doi.org/10.1080/1358684X.2012.649143

Buchheim, A., Viviani, R., Kessler, H., Kächele, H., Cierpka, M., et al. (2012). Changes in prefrontal-limbic function in major depression after 15 months of long-term psychotherapy. PLoS ONE, 7(3). https://doi.org/10.1371/journal.pone.0033745

Busch, F. N. (2015). Discussion: Psychoanalytic research: Progress and questions. Psychoanalytic Inquiry, 35, 196-203. https://doi.org/10.1080/07351690.2015.987607

Gazzillo, F., Waldron S., Gorman, B. S., Stukenberg, K. W., Genova, F., Ristucci, C., Faccini, F., & Mazza, C. (2017). The components of psychoanalysis: Factor analyses of process measures of 27 fully recorded psychoanalyses. Psychoanalytic Psychology, advance online publication, 1-12. http://dx.doi.org/10.1037/pap0000155

Grande, T., Dilg, R., Jakobsen, T., Keller, W., Krawietz, B., Langer, M., Oberbracht, C., Stehle, S., Stennes, M., & Rudolf, G. (2009). Structural change as a predictor of long-term follow-up outcome. Psychotherapy Research, 19(3), 344-357. https://doi.org/10.1080/10503300902914147

Johansson, P., Høglend, P., Ulberg, R., Amlo, S., Marble, A., Bøgwald, K.-P., Sørbye, Ø., Sjaastad, M. C., & Heyerdahl, O. (2010). The mediating role of insight for long-term improvements in psychodynamic therapy. Journal of Consulting and Clinical Psychology, 78(3), 438-448. http://dx.doi.org/10.1037/a0019245

Kallestad, H., Valen, J., McCullough, L., Svartberg, M., Høglend, P., & Stiles, T. C. (2010). The relationship between insight gained during therapy and long-term outcome in short-term dynamic psychotherapy and cognitive therapy for cluster C personality disorders. Psychotherapy Research, 20(5), 526-534. https://doi.org/10.1080/10503307.2010.492807

Kandel, E. (1999). Biology and the future of psychoanalysis: New intellectural framework for psychiatry revisited. American Journal of Psychiatry, 156, 505-524. https://ajp.psychiatryonline.org/doi/pdf/10.1176/ajp.156.4.505

Klug, G., Zimmermann, J., & Huber, D. (2016). Outcome trajectories and mediation in psychotherapeutic treatments of major depression. Journal of the American Psychoanalytic Association, 64(2), 307-343. https://doi.org/10.1177/0003065116644742

Laska, K. M., Gurman, A. S., & Wampold, B. E. (2014). Expanding the lens of evidence-based practice in psychotherapy: A common factors perspective. Psychotherapy, 51(4), 467-481. http://dx.doi.org/10.1037/a0034332

Leichsenring, F., & Rabung, S. (2011). Long-term psychodynamic psychotherapy in complex mental disorders: Update of a meta-analysis. The British Journal of Psychiatry, 199, 15–22. https://doi.org/10.1192/bjp.bp.110.082776

Midgley, N., & Kennedy, E. (2011). Psychodynamic psychotherapy for children and adolescents: A critical review of the evidence base. Journal of Child Psychotherapy, 37(3), 232-260. http://dx.doi.org/10.1080/0075417X.2011.614738

Parker, B., & Turner, W. (2014). Psychoanalytic/psychodynamic psychotherapy for sexually abused children and adolescents: A systematic review. Research on Social Work Practice, 24(4), 389-399. https://doi.org/10.1177/1049731514525477

Rizeanu, S. (2016). Psychotherapy of borderline personality disorder. Romanian Journal of Experimental Applied Psychology, 7(3), 76-81. doi: 10.15303/rjeap.2016.v7i3.a7

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98-109. doi: 10.1037/a0018378,

Shepherd, C., & Beail, N. (2017). A systematic review of the effectiveness of psychoanalysis, psychoanalytic and psychodynamic psychotherapy with adults with intellectual and developmental disabilities: Progress and challenges. Psychoanalytic Psychotherapy, 31(1), 94-117. https://doi.org/10.1080/02668734.2017.1286610

Soares, M. C., Mondin, T. C., Silva, G. D. G. D., Barbosa, L. P., Molina, M. L., Jansen, K., Souza, L. D. M., & Silva, R. A. D. (2018). Comparison of clinical significance of cognitive-behavioral therapy and psychodynamic therapy for major depressive disorder: A randomized clinical trial. Journal of Nervous and Mental Disease, 206(9), 686-693.

Waldron, S., Gazzillo, F., Genova, F., & Lingiardi, V. (2013). Relational and classical elements in psychoanalyses: An empirical study with case illustrations. Psychoanalytic Psychology, 30(4), 567-600. Waldron, S., Gazzillo, F., & Stukenberg, K. (2015). Do the processes of psychoanalytic work lead to benefit? Studies by the APS Research Group and the Psychoanalytic Research Consortium. Psychoanalytic Inquiry, 35, 169-184. https://doi.org/10.1080/07351690.2015.987602

Psychiatric Diagnosis Needs Rethinking

Psychiatric Diagnosis Needs Rethinking: Psychologist Richard Bentall’s Alternative Paradigm

Psychiatric DiagnosisFor many years, British psychologist Richard Bentall has promoted rethinking about the way psychiatric diagnosis has been conceptualized. When I first read his book, Madness Explained (Bentall, 2006), I was immediately impressed by his carefully researched and referenced arguments that challenged many mainstream views on mental illness. For example, he challenged the prevailing assertion that genetic research has demonstrated conclusive evidence that schizophrenia and bipolar illness are genetically determined and are fundamentally medical diseases. His work is careful not to rehash outdated arguments of nature versus nurture or mind/body dichotomies, but rather to put into proper focus the evidence and limitations of such research.

Bentall’s justification for abandoning the Kraepelinian model for mental illness is built upon Kraepelin’s presupposition that mental disorders are discreet entities, like diseases. The medical model of madness insists that mental disorders exhibit the same characteristics as physical processes and have etiologies rooted in identifiable alterations of the organism’s structure. To that end, neurotransmitters, brain regions, and genetic associations have been researched and are promoted as causal.

However, biochemistry, structure, and ancestry do not directly predict any mental disorder and are, rather, descriptions of how the human organism functions—not why. Whereas some neurotransmitters are clearly related to certain psychological phenomena, such as pleasure, excitement, or comfort, none are pathognomonic to any specific conditions. In fact, no specific genetic findings for specific mental illnesses have been established. Instead, research is favoring multiple etiological factors as both biological and experiential.

Given the complexity of contributing factors, Bentall also notes that some psychiatric categories are outdated artifacts of ancient traditions and concepts. Schizophrenia is not a “split mind,” nor is hysteria a “wandering womb.”  Instead, Bentall proposes a psychiatric diagnosis based on the patient’s presenting complaints, with careful consideration being given to hearing the patient’s life story. The need for an encompassing category (i.e., a psychiatric diagnosis) is both unnecessary and potentially misleading. He advocates for the individuality of the patient, rather than the fitting of the patient into preconceived categories.

Given the constantly expanding number of mental disorders being developed by the DSM system (American Psychiatric Association, 2013), it is clear that no category completely captures the significance of each patient’s needs. When used as a glossary of technical terms, the DSM is clearly useful for operational definitions; where it fails to be useful is in capturing the humanity of the patients under examination. Perhaps the consideration in the DSM-5 for dimensional diagnoses, as seen in the section on personality disorders, may extend across all of the conditions.

Perhaps too, we will stop talking about conditions or disorders, and consider people. Ironically, at the same time that progressive societies espouse the importance of difference and tolerance, we are also pathologizing and labelling each other with great confidence. 

For more on diagnosis, see DSM-5 Diagnoses and Defenses.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Bentall, R. (2006). Madness explained: Why we must reject the Kraepelinian paradigm and replace it with a “complaint-oriented” approach to understanding mental illness. Medical Hypotheses, 66, 220-233.

Value of Psychoanalysis

Some of you have read my earlier blog, “Isn’t Psychoanalysis Dead?”  I lamented that psychoanalytic theory is often excluded from discussions in psychology courses—at what I believe is a great loss to future clinicians’ ability to understand their clients/patients deeply.  Well, I recently ran into another example of the value of psychoanalysis, of its omission from typical training, and of the limitations that excluding it from training may pose to successful treatment, even beyond psychotherapy.

I was recently talking with a young woman who is completing her doctorate in Physical Therapy.  When she learned that I am a psychologist, she mentioned that she’d taken Abnormal Psychology to fulfill an undergraduate requirement and how interesting parts of the course had been.  “Which parts had been most helpful?” I asked, trying to gain some pointers for my own upcoming class in Abnormal Psychology, which includes many exercise science majors.  She noted that, while depression and anxiety can affect a person’s physical health, some things in the course hadn’t felt relevant–she felt the course had been too limited.  And then SHE began lamenting that no one had ever even talked about Freud or the possible value of psychoanalysis or psychoanalytic psychotherapy.  She added that her psychology instructor had said they would be skipping the chapter on psychoanalytic theory “because no one uses it anymore.”  She continued, “sure, he developed his theory a century ago, and some aspects may make more sense than others, but wasn’t some of it still helpful to know?  And what about all the new stuff now coming out in neuropsychology and neuro psychoanalysis?  Aren’t psychology teachers aware of it?”  One of her colleagues, who apparently had been introduced to some basics in psychoanalytic theory, commented that he’d actually recently seen a case of a Conversion Disorder, with physical symptoms without physical basis—“like with Anna O!”  He noted the many possible connections between some physical symptoms and unconscious conflicts, and how helpful that notion had been to his work.  Having many lenses through which to understand an individual’s experience is helpful to those in fields both inside and outside of psychology.

Value of Psychoanalysis - Eric KandelEric Kandel, renowned neuroscientist, would agree with the enormous value of psychoanalysis.  I know I’ve quoted Kandel before, but he’s a Nobel Laureate(!) and worth mentioning again.  In 1999, he wrote, “…psychoanalysis enters the twenty-first century with its influence in decline.  This decline is regrettable, since psychoanalysis still represents the most coherent and intellectually satisfying view of the mind” (1999, p. 505).  

Writing about couples therapy, Judith Siegel, well-respected object relations couple therapist, has also noted that, “while object relations concepts provide a wealth of information regarding the ways family systems influence their offspring and the ways grown children revisit these influences as they select partners and engage in adult intimacy” (2010, p. 134), “today’s therapists enter training programs that do not uniformly include the psychoanalytic theories that were previously regarded as the cornerstone of therapy” (2010, p. 134). 

How sad. 

And it isn’t just recent courses in psychology.  I too—several decades ago—had been taught that psychoanalytic theory had long since been “disproven.”  (Just as I’d also been taught that the whole nature-nurture debate had been settled…)  In a graduate psychology class, I’d even written a paper extolling the virtues of cognitive-behavioral approaches and arguing that psychoanalytic theory was a waste of time.  And I believed it.  Until I began to work with clients/patients for whom CBT was not enough…  

Don’t get me wrong.  I do believe that CBT can be helpful, as can humanistic approaches, Gestalt therapy, narrative therapy, mindfulness exercises, etc. etc.  But therapy is not a “one size fits all” undertaking.  The value of psychoanalysis is that it respect the “individualness” of the individual–it provides us with means to promote an awareness and understanding of the inner world and its influence over relationships in our patients.  Psychoanalytic theory provides a valuable lens through which to understand the human condition and our patients’ suffering, and tools to help them build a meaningful life. 

What was your introduction to psychoanalytic theory in your own undergraduate and/or graduate training?  Was it dismissed for you as well?  I’m wondering if this is primarily an American phenomenon, or if it’s world-wide and would love to get your input! 

Please email me at mgersonphd@psychstudies.net regarding your experiences, and indicate whether I may share them in a future blog.

References

Kandel, E. R. (1999). Biology and the future of psychoanalysis. American Journal of Psychiatry, 156, 505-524.

Siegel, J. P. (2010). A good-enough therapy: An object relations approach. In Alan S. Gurman & ProQuest (Firm). Clinical casebook of couple therapy. New York, NY: Guilford Press.

Jacques Lacan: A Real, Imaginary, and Symbolic Psychoanalyst

Jacques Lacan: A Real, Imaginary, and Symbolic Psychoanalyst 

Jacques LacanAs a practicing psychoanalyst for the past 30-plus years, I have sought to integrate the wisdom from many mentors. My supervisors and training analyst guided me through the collected works of Freud, Klein, Winnicott, and Spotnitz. While writing my doctoral dissertation on clinical psycholinguistics, I learned of the work of Jacques Lacan, a French psychoanalyst.

The more I read of Lacan’s ideas, the more fascinated I became with his unique take on the role of language for shaping the mind and the practice of psychoanalysis. Equally intriguing were the stories about Lacan, the man, who fought to promote a view of psychoanalysis that dared to challenge the prevailing orthodoxy of the psychoanalytic establishment.

Psychoanalysis has been fraught with in-fighting, exclusiveness, and dogmatism since its inception, which bears an embarrassing irony toward unresolved Oedipal feuds. Fortunately, my training had encouraged an appreciation for psychoanalysis as one of the humanities. Art, literature, religion, culture, philosophy, and music are all expressions of the human experience that are essential for venturing into a serious consideration of the psyche. Lacan’s masterpiece, simply titled, Écrits, included discussions of all of these topics and more.

Certainly his writing is dense and difficult; yet, I found it compelling as a source of provocative ideas and observations. A learned colleague once warned me that life is too short to read Lacan. In fact, most of my colleagues have shared similar negative biases, although they had never read his work themselves and relied, instead, on second- and third-hand critiques. Like most contemporary textbooks on psychology that summarily dismiss Freud out of ignorance or misinformation, these colleagues were content to preserve their allegiance to a particular school of thought.

Some Lacanian theorists have since become a somewhat esoteric group in the US, often adopting an obscure and cryptic style, perhaps in homage to the master. Whereas Lacan’s concepts are complex, both philosophically and logically, my reading of his work suggests that he sought to promote creative and relevant applications by clinicians, not to develop sycophants.

As an addition to Freud’s structural model of the mind consisting of the Id, Ego, and Superego, Lacan proposed that our subjective experience is contextualized with regard to how phenomena become registered in the mind. He identified three constituent contexts for the mind: the Real, the Imaginary, and the Symbolic. Broadly described, the Real is fundamentally a derivative of our senses, the Imaginary is derived from perceptual and fantasied mental processes, and the Symbolic is derived from culture and through language. These registers function as interlocking systems of knowing that collectively form one’s sense of awareness.

With the premise of these mental registers, I will attempt to describe Lacan himself. The Real Lacan was a man trained as a psychiatrist in the first half of the twentieth century. He appeared as an intellectual and scholar who studied philosophy, art, science, medicine, and politics, as well as psychoanalysis. His personality is described as intense, passionate, and charismatic. Reportedly, he successfully obtained the release of his wife from Nazi custody by charging into Gestapo offices and demanding her immediate release.

The Imaginary Lacan is the one we know as we read his words. The thoughts and questions that emerge as the reader forms associations to his ideas and through his playful use of words that tease us to push our thinking a bit further.

The Symbolic Lacan is a provocateur of psychological theory. The word “Lacanian” has come to represent courageous and radical commitment to understanding the depth and vastness of the human condition, with full acceptance of the impossibility and ineffability of that task.

Whereas Lacan is mostly known in the US in terms of applications to literary criticism and socio-political theory, he is considered one of the most influential psychoanalytic thinkers in Europe and South America. Regardless of the difficulty that some of his ideas pose, the questions he raises about self-authenticity and one’s capacity to retain sanity in a civilized society has never been more timely.

To learn more about Lacan’s theory in a reading, Jacques Lacan: Introductory Overview (4 CE Credits), provides an article written by an expert on his theory. For a briefer overview of his theory and a more practical discussion of how it may be applied in psychotherapy, see the video course, Lacan – Inspired Psychotherapy (4 CE Credits).

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