Menu

Blog

 

Tag Archives: Psychoanalytic Psychotherapy

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.

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.

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).

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.

What Is Psychoanalytic Psychotherapy?

Psychoanalytic Psychotherapy

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

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

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

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

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

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

Will a psychoanalytic psychotherapist offer advice or solutions for problems?

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

How long does psychoanalytic psychotherapy take?

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

Who should seek psychoanalytic psychotherapy?

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

Additional Resources

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

References

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

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

Isn’t Psychoanalysis Dead?

Psychoanalysis

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

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

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

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

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

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

Resources

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

Recent Posts

Archives

Categories

Tags

Connect With Us