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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 RegistersHow 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, and that his constructs can be very 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.

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.

How Lacan’s theory can be applied in psychotherapy? 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.

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).

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.
  • 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 theseexistential 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.
  • 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.
  • 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.

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).

Psychoanalysis, Resilience, and Meaning-Making

Psychoanalysis, Resilience, and Meaning-Making

Psychoanalysis, Resilience, and Meaning-MakingCan psychoanalysis help build resilience?  Psychoanalysis, resilience, and meaning-making may go hand-in-hand.

Resilience involves being able to do better than expected in the face of difficult circumstances.  It requires inner strength.  What factors may help promote such strength?  Meaning-making—finding a sense of purpose and meaning in life—seems to be especially important.

Research has long pointed to the potentially important role that spirituality can play in building psychological well-being and resilience (e.g., Anum & Dasti, 2016; Fombuena et al., 2016; Foskett, Marriott, & Wilson, 2004; Porter et al., 2017; Smith & Carlson, 1997).  Studies have explored many aspects of spirituality—experiences of transcendence and awe that can come from sensing something greater than the self, feelings of connection with others, and the meaning-making involved in a personal search for purpose and meaning in life (intrapersonal spirituality).  A recent study (Gerson, 2018) has found that intrapersonal spirituality—meaning-making—best predicts both resilience and life satisfaction, at least in early adulthood.

The study explored predictors of resilience and life satisfaction in over 400 undergraduates at two universities in the US.  Measures included sense of purpose and meaning in life, spiritual connection to others, and feelings of spiritual transcendence, as well as a host of other variables.  Contrary to many current studies which have focused on the importance of transcendent spirituality and social support, the study found that, at least in young adulthood, resilience is best predicted by more individual factors, including a personal sense of purpose and meaningful life.  And the relationship between resilience and meaning-making is strong.

What implications may this finding have for psychoanalysis?  We know that psychoanalysis seeks a deep understanding of the human psyche—rather than focusing merely on behavior change or symptom resolution, psychoanalysis explores deeper motivations and the potential sources of emotional turmoil.  Psychoanalysis and intrapersonal spirituality share a common goal—that of meaning-making.  Resilience requires stamina in the face of hardship.  It makes sense that a mindset of seeking understanding and a meaningful life—and resilience—may be strengthened by the process of psychoanalysis. Psychoanalysis, resilience, and meaning-making may go hand-in-hand.   

To learn more about psychoanalysis, see Classical Psychoanalytic Theory or other courses in psychoanalytic psychotherapy.  You may find the brief article on Psychoanalysis and Mindfulness interesting as well.

References

Anum, J., & Dasti, R. (2016). Caregiver Burden, Spirituality, and Psychological Well-Being of Parents Having Children with Thalassemia. Journal of Religion and Health, 55, 941-955. doi: 10.1007/s10943-015-0127-1

Fombuena, M., Galiana, L., Barreto, P., Oliver, A., Pascual, A., & Soto-Rubio, A. (2016). Spirituality in Patients With Advanced Illness: The Role of Symptom Control, Resilience and Social Network. Journal of Health Psychology, 21(12), 2765–2774. doi: 10.1177/1359105315586213

Foskett, J., Marriott, J., & Wilson R. F. (2004). Mental Health, Religion and Spirituality: Attitudes, Experience and Expertise Among Mental Health Professionals and Religious Leaders in Somerset. Mental Health, Religion and Culture, 7, 5-22. https://doi.org/10.1080/13674670310001602490

Gerson, M. W. (2018). Spirituality, Social Support, Pride, and Contentment as Differential Predictors of Resilience and Life Satisfaction in Emerging Adulthood. Special Issue on Positive Psychology, Psychology.

Porter, K. E., Brennan-Ing, M., Burr, J. A., Dugan, E., & Karpiak, S. E. (2017). Stigma and Psychological Well-Being Among Older Adults with HIV: The Impact of Spirituality and Integrative Health Approaches. The Gerontologist, 57(2), 219-228.  doi: 10.1093/geront/gnv128

Smith, C., & Carlson, B. E. (1997). Stress, Coping, and Resilience in Children and Youth. Social Service Review, 71(2), 231-256. doi: 0037-7961/97/7102-0004

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.

 

 

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.

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