Psychoanalysis

Reclining on a psychoanalytic couch helps the person to look inward

Reclining on a psychoanalytic couch helps the person to look inward

What is psychoanalysis?

Psychoanalysis is a theory and a research method, and most importantly, a form of intensive psychotherapy. Psychoanalysis can help you to change your character or personality, in some deep and fundamental ways. How does it work? For whom is it the optimal treatment of choice? What methods are used? And, most importantly, will it work for you?

The goal of psychoanalysis is character development and character Change

The goal of psychoanalysis is character development and character change. Psychoanalysis can help you to become more secure, confident, thoughtful, less reactive, less frightened of abandonment, appropriately assertive, serene, whole and mature. These changes, in turn, can allow you to develop closer relationships with partners, family and friends. A helpful psychoanalysis typically allows people to derive more fun and gratification from work and play.

How can Psychoanalysis be transformative?

How does psychoanalysis help you to change your character or personality?

For any of us, character changes when we deepen our understanding of ourselves. All of us have parts of ourselves that cause us pain. When we think about them, we feel sad, angry, helpless, hurt, frightened, angry, alone or vulnerable. Because these parts of ourselves are so painful to think about we may (quite unconsciously) avoid these feelings in various ways. We protect ourselves by dismissing them or tuning them out or by blaming these feelings on someone else or by being very critical of another person with the same struggles.

Protecting ourselves by avoiding our feelings

There are lots of ways to avoid ones feelings. For example, we might make sure that we are busy all of the time – too busy to reflect about what we feel and why we feel it. Or, we might compartmentalize so that we don’t have to think about our painful feelings in our day-to-day, lives. Or, we might attribute our feelings to others – and lament that they are critical of us when, actually, we are critical of ourselves. And, we might shut others down. That is, we might make it difficult for them to get close to us by refusing to listen to them because when we do listen, we feel something that we do not want to feel. This is understandable. But, unfortunately, it doesn’t lead to intimacy or mutuality in relationships.

Similarly, we might, unconsciously, find other ways to make ourselves unavailable for intimate relationships; some people do that by selecting partners that are psychologically unavailable. In any case, psychoanalysis aims to help us to know ourselves deeply – so that we can make deep and abiding changes and lead more fulfilling lives

Gaining access to the parts of ourselves that we have avoided isn’t easy. And, this is why when individuals have been struggling with discomfort, dissatisfaction, unhappiness, low self-esteem, avoidance, anxiety or depression for a long-time, they might consider psychoanalysis. In this way, they can take the journey inward with a collaborative partner: their psychoanalyst.

An example of how psychoanalysis can be useful

A man enters into a new relationship and begins to fall in love. He and his girlfriend decide to be monogamous. But, then he finds himself desperately drawn to other women. He begins to resent having agreed to monogamy. He doesn’t like having, “all of his eggs in one basket”. He’s uneasy about relying on his girlfriend. He feels resentment – but, he has no idea from what well the resentment springs.

He has not yet recognized that his wish to see other women is a frantic attempt to avoid the anxious and panicky feelings that commitment engenders in him. He’s not entirely aware that he is terrified that he’ll rely on his girlfriend and she may dump him. Still worse, he may feel trapped. Although his fear of being trapped is intense, he has not yet come to appreciate that at an unconscious level, he is afraid to trust anyone. Similarly, he may be unaware of the childhood antecedents that led to this fear.

What causes these types of difficulties? Each person is unique. However, here’s a possibility: perhaps, during his early years, his primary caretakers were unreliable, maybe they were sick and unavailable. Or, maybe they had difficulty with drugs or alcohol. Or, maybe they were so bound up in themselves they could not think clearly about, and respond sensitively to, his needs. Or maybe they lacked the ability to recognize and to be well attuned to his emotional needs.

Thus, at a level outside of his awareness he may have felt that he couldn’t rely on his primary caretakers. Yet, he needed them. Perhaps he attempted to manage this as a small child by trying not relying on others. Now, as an adult he encounters others who may be reliable. But, he neither knows how to assess who is reliable nor how to trust anyone. So, intimacy feels unsafe and dangerous.

His fear of being trapped is so great that he begins to surreptitiously date other women. When his lover learns this, she rejects him. He feels bereft and abandoned.

Those who know him well may see that he is in quite a bind. Caught between a rock and a hard spot, if he’s committed and monogamous, he feels trapped. If he attempts to alleviate the frightening feelings of being engulfed or controlled, by dating others, he loses the woman for whom he cares.

How psychoanalysis helps in this example

Often, a person with these kinds of struggles can benefit greatly from psychoanalysis, IF he has the capacity to make a commitment to this sort of treatment. Of course, this is a big IF because if he enters psychoanalysis, ironically, he will experience the very same anxieties with his analyst that he experiences in relationships. Unconsciously, he will feel drawn in some way to two-time his analyst in the very same way he two-times his girlfriend. He may find that as he’s talking to his analyst he also seduces someone else into a similar role. So, that as with his girlfriend, he doesn’t risk having, “all of his eggs in one basket”.

This is, “good news”, “bad news”. The “good news” is that if he can allow himself to hang in there with the analysis, he can come to learn about what is so frightening about commitment for him. The “bad news” is it won’t be easy. And, he will have the urge to do what he does everywhere else, to flee.

The unique virtue of psychoanalysis is that the psychoanalyst (hopefully) will not respond like the rejecting lover. Instead, she will try to gently help him become aware of his fears and understand them.

For Whom is Psychoanalysis an Optimal Treatment?

Psychoanalysis is the optimal treatment for people who are sturdy enough to tolerate its rigorous nature.

Psychoanalysis entails an earnest commitment to working to deepen one’s understanding of oneself. It requires an ability to tolerate examining one’s shortcomings and recognizing one’s strengths. Typically, the people who are most able to tolerate these rigors are those who have had some areas of success in their lives or who have some specific strengths. In terms of areas of success, although these individuals may be struggling in relationships they may have been successful in school or in the workplace. Or, while they may be struggling with workplace concerns they may have longstanding relationships with friends or family. Or while they may be terribly anxious or depressed they nevertheless have been a successful parent or friend.

Beyond these kinds of accomplishments: a capacity to perspective-take, that is, to step back and reflect on one’s behavior and thoughts, an ability to think psychologically about one’s motivation, a capacity to be candid with the analyst about one’s feelings towards her, a strong motivation to work in psychoanalysis (having that feeling of “fire in your belly” about pursuing analysis) bode well for a successful analysis. Of course, most people considering analysis have some and not all of these capacities at the beginning of treatment. But, with hard work, these capacities can be more fully developed.

It should be noted that most people who seek psychoanalysis may not feel sturdy when they seek treatment. However, at a fundamental level, despite their pain they are hardy and psychologically healthy enough to tolerate the self-examination inherent in this work.

What methods are used in psychoanalysis?

Psychoanalysts use many methods to help analysands to become more self-aware. These include: regular and frequent appointments – 4 or 5 times a week – over a significant period of time, creating a safe and confidential atmosphere, asking the person to talk about their life: the “there and then”, the “here and now” and their hopes and fears about the future, “free association”, dreams, “flash thoughts”, day dreams, fantasies and the couch. Each will be addressed in turn.

Frequent appointments four or five times a week over a period of several years

Typically people come to psychoanalysis to deal with difficulties that have troubled them for many years. Some have had previous therapy and have found that it did not allow them to fully resolve their difficulties. Others have had no previous treatment, but, recognize that this more intensive approach is warranted in order to overcome their difficulties.

For example, they may struggle with long-standing difficulties: expressing their feelings, asserting themselves, making commitments, having intimate relationships, having satisfying relationships with family, relating to bosses and coworkers, feeling anxious or inhibited, feeling depressed, selecting friends or lovers who are consistently unreliable or disappointing, completing or excelling in school or college, identifying and pursuing their work-life goals, or not getting what they want out of life.

Since the origins of these troubles are outside of their conscious awareness, they need help getting to know themselves. To heighten awareness of one’s inner feelings and motivations, analysands come several times a week.

Often, successful people who are struggling with a knotty and persistent difficulty are surprised at the recommendation for psychoanalysis. In particular, they are daunted by the frequency, the time and the cost. They may fear that the recommendation for multiple sessions per weeks reflects the depth of their pathology.

However, the reality is that this is not the case. Rather, the frequency of sessions is vital to helping a person to truly know themselves. It provides a continuity that allows for self-reflection, exploration and revelation. Unlike a less frequent therapy in which the person talks about their day-to-day challenges, meeting daily allows the individual to make connections between their early experiences, their current behavior, and how they relate to others, including importantly, their psychoanalyst. Most analysands find that the frequent meetings intensifies the process, leads to greater openness and a more comprehensive understanding of themselves.

Creating a confidential and safe atmosphere

A confidential atmosphere allows patients or analysands to begin to speak openly. Except for in a few limited circumstances (which your analyst can discuss with you prior to embarking on a psychoanalytic journey), your psychoanalyst is legally bound not to divulge your confidences. That is, your communication with your psychoanalyst is completely private. This level of privacy allows you to become aware of, think about and talk about things that you may have suppressed or denied in the past.

Reclining on a Couch

To promote a focus inward, people recline on a couch, with their psychoanalyst sitting behind them. Often, this helps the analysand to be less preoccupied with what the psychoanalyst is thinking and to be more able to look inward and explore their own thoughts. Also, it allows both analysand and analyst to reflect, more deeply, on the analysand’s thoughts and associations. Initially, lying on a couch in a psychoanalyst’s office seems unfamiliar. However, with time, most individuals find that it allows them to focus on their inner world.

Talking about your life: The, “there and then”, the “here and now” and your hopes and fears about the future

Analysands are helped to share their life story and to think about and talk about their fears and struggles – and, as importantly, the successes, triumphs and satisfactions in their lives. In short, your psychoanalyst will want to know as much as she can about you: all of it, the good, the bad and the ugly. And, she will work with you to create a nonjudgmental atmosphere so that you both can speak openly.

Free Association

Typically, what interferes with our accomplishing our goals are not those things in our conscious awareness. Rather, like the man in the example above, we are driven by things outside of our awareness. The task in psychoanalysis is to help people to become aware of the anxieties, fears, sadness and other feelings that are outside of their conscious awareness. Therefore, analysands are asked to “free associate”, or to say what comes to mind, without censoring. Unlike everyday talking where, as a matter of tact, one edits one’s thoughts, in psychoanalysis, the patient is asked to report their thoughts without fear of reprisal or regard to the listener.

Of course, this is easier said than done and it takes practice. However, although it may be daunting at the beginning, as you become more comfortable you will become more proficient at “free association”.

Reporting Dreams, Day Dreams, “Flash” thoughts and Fantasies

Like free associations, dreams, day dreams, ‘flash thoughts’ and fantasies are other ways to access feelings and thoughts that are outside of our conscious awareness. So, individuals in psychoanalysis are asked to report them. Also, both analysand and psychoanalyst attend to the meaning of “slips of the tongue” and to the individual’s demeanor. Notably, Freud characterized dreams as, “the royal road to the unconscious”. The idea in psychoanalysis is that we are motivated or driven by conflictual aspects of ourselves that are outside of our awareness, the goal of analysis is to make the unconscious conscious. Since an aim of psychoanalysis is to gain a window into the individual’s unconscious. Saying what comes to mind, reporting dreams, describing fantasies and avoiding censorship allows both analyst and analysand to become increasingly aware of the individual’s unconscious fantasies and beliefs.

As these Unconscious Fantasies & Beliefs become more explicit, change occurs

Psychoanalysis is demanding, time-consuming and expensive. If you are interested in seeking psychoanalysis but feel that you may not be able to afford it, many major cities have sliding scale clinics which offer affordable psychoanalysis.

If you are interested in a psychoanalytic approach but feel that your concerns warrant a less intensive approach, consider seeking a consultation with a psychoanalyst. A careful psychoanalytic assessment will help you to clarify whether analysis is warranted or whether your difficulties might yield to a once, twice or three times a week (insight-oriented) psychoanalytic (aka psychodynamic) psychotherapy. Most psychoanalysts provide psychotherapy as well as analysis. Typically, they are highly proficient at both. So, they are in an ideal position to provide a consultation and make a recommendation to you.

Psychoanalysis with me

People often ask me, can I help them to evaluate whether psychoanalysis would be helpful to them or whether psychodynamic psychotherapy would be more useful. I have active practice, on the Washington, DC border (Friendship Heights, in Chevy Chase, MD) in which I provide psychotherapy and psychoanalysis. Anyone interested in exploring the possibility of working with me is welcome to call: 301.656.9650.

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