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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

HappinessCan’t we simply choose happiness? As 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. Why can’t we simply choose happiness? Our brains may not be wired that way.

Mindfulness exercises may help. To learn more about mindfulness, see Mindfulness Training: Introduction and Mindfulness Training: Body Scan Meditation and Informal Mindfulness Practices.

References

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

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 contents.

Are There Really No Psychological Accidents?

Psychological Determinism

Psychological Determinism
Slip of the tongue?

Perhaps the single most representative concept of psychoanalysis is that of psychological determinism.  By this I mean a fundamental belief that human behavior, consciousness, and experience are determined or explainable.  Freud followed in a scientific tradition that was dedicated to uncovering the laws and mysteries of life, hopefully to lead to a comprehensive theory of the mind.  

Is Action Accidental or Random?

Such an approach would never be satisfied with a conclusion that suggested that a certain action was “accidental” or “random” or that a thought occurred strictly from a spontaneous, meaningless neurochemical action.  Unlike radical behaviorism or even social learning theory, which propose to account for some behaviors as incidental contingencies or fortuitous accidents, psychoanalytic thinking would tend to view such explanations as naïve, simplistic, or superficial.  

What Does Psychoanalysis Tell Us About Action?

Psychoanalysis proposes to describe mind and behavior as meaningful and understandable.  Thus, our lives are the products of our being.  Our intentions, as well as our accidents, are worthy of understanding.  While critics may argue that psychoanalytic theories make too much out of too little, the supposed error is committed in the pursuit of knowledge, with an implicit expectation and respect for the complexity of life.  It should also be noted that such an attitude is reflective of an appreciation for the humanism of psychology, not its mechanization or reduction to biochemistry.

What is the Focus of Psychoanalytic Explanation?

Even if one could demonstrate, once and for all, that the universe and life are random, nonsensical phenomena, this would not contradict the view of determinism.  The focus of psychoanalytic explanation is on the human experience of life.  What is characteristically human is our mind’s proclivity for making sense out of nonsense.  We cannot tolerate being in a state of uncertainty or confusion.  Psychological determinism addresses this characteristic of being human by suggesting that all human knowledge, no matter how sophisticated, abstract, or profound, is always, ultimately, human.

Freud and Breuer’s Studies in Hysteria

Freud’s and Breuer’s Studies in Hysteria are classic examples of the humanity inherent in a view of psychological determinism.  In their investigation and treatment of hysteria, they stressed how patients’ peculiar behaviors stemmed from important but forgotten episodes of their lives.  Hysteria, understood in the context of a person’s life, represents a meaningful continuity of being, such that the mental life of the patient is respected as relevant and the patient is further accepted as exhibiting psychological processes common to humankind.  The “logic” of symptoms soon led to an appreciation for the logic of dreams, mistakes, jokes, and slips of the tongue.  With acceptance of determinism, we can never take life’s events for granted again!

For more on psychological determinism and other psychoanalytic concepts, see the course Classical Psychoanalytic Theory.  If you would like to receive a specialization Certificate in Psychoanalytic Psychotherapy and learn more about issues of interest, please see our home study psychology continuing education courses, available online.

Psychoanalytic Psychotherapy with Adolescents

Psychotherapy with Adolescents

 

Psychotherapy with adolescents could help this young man.Psychotherapy with adolescents provides a unique opportunity to impact identity at a key time in development.  Understanding the roles of “self” and “identity” is helpful in this process.

Self and identity have been variously defined and, at times, viewed as synonymous.  It is clinically helpful to distinguish between the two in psychoanalytic psychotherapy with adolescents.  Compensatory identities are sometimes formed during this period, in response to profound psychic conflict.  Exploring the function of these identities as objectified processes to cope with psychic trauma must be balanced with respect for the “subjectivity of self as a vehicle for psychological truth.”  

In a recent article, Dr. Michael Gerson discussed such distinctions and their clinical implications, as they applied to his psychodynamic treatment of two adolescent patients.  The article is “Clinical Implications for the Expressions of Self and Identity in Adolescent Psychotherapy: Case Studies of a Vampiress and a Gangster,” published in volume 24, issue 6 (pp. 718-732) of Psychoanalytic Dialogues: The International Journal of Relational Perspectives.  

Struggles with self and identity impact the adolescent mind.  The adolescent’s experiences of self–as derived from bodily experiences and emotional confusions–can create an ineffable sense of alienation from others.  In adolescents, self-conflicts can also present with transient dissociative states.  Experiences of identity, by contrast, can provide a compensatory, reflective function.  

The article describes Dr. Gerson’s work with two troubled adolescents.  One had taken on the identity of a vampiress and the other of a gangster.  The psychodynamic treatment focused on exposing, understanding, and working through the internal conflict, thus helping the patients negotiate between the perspectives of self and identity.  By examining the contrast between identity and self, these patients were able find ways of living that, ultimately, felt more truthful, authentic, and integrated.

Please contact Dr. Gerson at mgersonphd@psychstudies.net to receive a free personal copy of the article.

For more background on self and identity, also see the courses Classical Psychoanalytic Theory or Ego Psychology.

“Self” and “Identity”

Neuroscience, Self, and Identity

Neuroscience, Self, and IdentityWhat do we mean when we refer to self?  Is self distinct from identity?  The constructs of self and identity have been understood and discussed historically in diverse ways.  Neuroscience research is now supporting that they are indeed distinct constructs.

Neuro-imaging research is consistent with self as reflecting right hemisphere, reflexive, nonlinguistic experience.  In contrast, identity involves left hemisphere, reflective, linguistically-mediated experience.  

Self and identity have distinct functions as well as developmental significance.  Self refers to how we experience the moment, from the perspective of “I”.  Feeling the exhilaration of reaching a mountain top, for example, would be engaging the self.  Identity reflects our experiences from the observer, or “me”, perspective.  Thinking of oneself as an adventurer would be an example of identity.  

Very young children are more likely than adults to be in touch with the self.  Clashes between self and identity are often particularly evident during adolescence–a stage of enormous neurological growth and changes.  As noted by Erikson and many other theorists, adolescence may be a time of turmoil as a life-long identity is forged.

Understanding the differences between self and identity can be helpful clinically.  To read more, view the fascinating article, “Reconsidering Self and Identity Through a Dialogue Between Neuroscience and Psychoanalytic Theory,” published in Psychoanalytic Dialogues, 24(2), 247-251, as well as the commentary with discussion, Gerson, M. J. (2014). “A meta-commentary: Response to the commentaries of Marks-Tarlow and Solow Glennon.”  Dr. Gerson discusses the empirical study of consciousness in terms of contemporary psychoanalytic concepts and argues for interdisciplinary research in which neuroscience and psychoanalysis may engage in a mutually informing dialogue.  Please contact him at mgersonphd@psychstudies.net to receive a free personal copy of the article.

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