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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.

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.

The Value of “Having Your Head Examined”

Psychotherapy

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

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

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

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

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

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

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

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

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

Why Can’t We Simply Choose Happiness?

 

Happiness

HappinessAs a psychologist and psychotherapist, I’ve spent the last 30 years listening to people struggle with anxieties, depression, and loneliness, in search of ways to alleviate unhappiness.  And as a professor, I’ve spent as many years researching ways to build resilience—hoping to find ways to prevent people from “succumbing” to unhappiness.  The more I explore these issues, however, the more I’m convinced that Freud was on the right track.  We are extraordinarily complex creatures who, by nature, are probably not headed toward tranquility or happiness.  If we wish to build a happy life, we’ll have a darned hard fight on our hands.

Brain Research On Neurophysiology of Experiences

I keep returning to a delightful article by Hiss (2014) on the human brain published in the Reader’s Digest a couple of years ago.  Hiss reviews fascinating research on the neurophysiology of such experiences as love, procrastination, reactions to criticism, and road rage, and the basis for many of our emotional struggles. 

We like to think that our intellectual abilities accorded to us by the magnificent cortex provide us with the tools needed to control unpleasant emotions and primitive urges.  But why, then, do we feel our blood pressure rise and rage take over when someone “waves” to us with a single finger from their car?  What just happened?

As Hiss notes, the cortex is a relative newcomer to the brain party.  It’s built on a more primitive mammalian, emotional part of the brain, which is built on an even more primitive reptilian part.  How peaceful—or cooperative—a party should we expect? 

Our Expectations On Handling Life And Emotions

She draws an analogy to a speed boat that’s been built on a row boat base.  We expect to zip through life’s rough waters with ease—something our rickety base may not be able to manage.  It’s amazing that our brains aren’t out of service more often!

So when I hear patients question what’s wrong with them that they can’t seem to manage their emotions or just “choose” to be happy, I remind them that they’re not a Golden Retriever.  And some days, their lizard is active.

References

Hiss, K. (Sept. 2014). The beautiful life of your brain. Reader’s Digest.

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