Psychoanalytically oriented psychotherapy – or psychoanalytic work as I refer to it – is a method of looking inside oneself. This does not mean that the ‘outside’ is not important – but when we look carefully we begin to see that much of our external world is deeply effected by what we have experienced in the past. For instance, someone who has experienced abandonment in childhood (loss, lack of attention, divorced parents) will often grow up with degrees of wariness about making new attachments. This will affect a person’s willingness and ability to connect to a new person. Connection is seen unconsciously and sometimes consciously as dangerous and so avoiding close connections becomes a modus operandi or set way of living. In analytic work, fear about closeness is usually repeated in the analytic dyad (therapist and patient) where both parties gain the cognitive and the emotional insight that lead to change.
Work begins during the first consultation. Actually, it begins when a person tries to figure out by herself* what bothers her. But, when the problems persist, and when friends or behavioral type therapy cannot help, psychoanalytic work becomes an option. During the first session, both analyst and analysand size each other up. If they click they usually decide to continue. The major goal is to have another meeting so that each party can mull over what they learned during the first session. When a decision is made to embark on treatment the analyst offers her opinion of what she thinks will best serve this individual. Taking into account such things as severity and urgency of the problems (eg. thoughts about harming someone or oneself) the therapist may suggest a next day meeting. If a person shows an ability to reflect on what causes her problems and is curious about why she feels what she feels I will recommend psychoanalysis, explaining this kind of work and its benefits. Another way of deciding on the best way to proceed is to have a few consultation sessions where the dyad explores how best to work. I like to begin twice a week at the start and to increase sessions in order to deepen the treatment when this is feasible. Some people feel most comfortable wading in – testing the water – and when they find it’s ok – they often see that more time would be valuable. No matter what is agreed to, both parties commit to a time, a day, a fee, and payment schedule. (see frame)
The way the two parties relate is based on both reality and past experience. Most people are used to medical doctors assessing and diagnosing them and so we expect the same from the ‘psychoanalytic doctor.’ But, when working with the mind there is no quick or easy diagnosing. Psychoanalytically oriented therapists are not there to judge or to label. Rather, they are interested in what causes problems for the individual – how the common human emotions are played out in life. We each have a large role in creating our own lives and echoes of the past effect us deeply. In therapy we have a chance to see how those echoes sometimes get in the way. Listening to them in order to quiet them is necessary. The past (childhood) is the foundation upon which we build our lives. Love, hate, anxiety about intimacy, anger, sexual yearnings, are feelings that can be traced to early childhood, people, and events. The analyst, because of his/her own analysis has taken her own journey and this enables her to listen with open, non judgmental ears. Pure neutrality is impossible but the ability to listen for many sides of story is necessary. One analysand came in hating her mother. By the end of her analysis she was able to experience a whole range of feelings about this once hated mother. The analyst in this case was careful not to reinforce or diminish the hatred but over time other feelings emerged. Another person came to therapy about issues that interfered with his work. Accepting authority was the problem. After a few months he and his therapist saw that he was in fact rebelling against a tyrannical father. Eventually this man began transferring his rage to the therapist and the analytic work allowed him to modulate the anger and to accept the present as different from the past. The analyst and the present boss were exposed to the flak that was really meant for the father but examining the anger made it less and less viable. Childhood anger is intense and if not offset with love it often is carried into the present. The analyst, as a new person, was able to provide an atmosphere of acceptance and understanding enabling new growth.
Many clinicians separate ‘psychoanalysis’ and ‘psychoanalytic psychotherapy’. The former usually involves 3 or more times a week sessions, with most people using the couch which frees one from distraction. The later form of treatment is usually conducted twice a week with face to face sessions. As a psychoanalyst I view all my work as psychoanalytic work – regardless of the frequency and position. I feel that as a patient begins to trust me and the method of saying what comes to mind he/she becomes motivated to come as often as possible.
When the agreement to undertake the treatment is made what happens next is pretty much up to the patient. She decides where to begin and the therapist listens. I find it helpful to hear something about how a patient grew up, where, number of siblings, childhood illness, childhood in general, and anything that will help me get to know her. This knowledge gets filled in and added to during the course of therapy.
Because each person is unique the journey of psychoanalytic work is different for each person. As the dyad settles into the work, all sorts of feelings come up – from love to hate and everything in between. Talking freely about what comes to mind is a new skill and over time it becomes easier. In the long run, both parties see things with new eyes. Changing one’s lenses, and looking at everything from different perspectives, makes the world look and feel different. Neuroscientists are finding evidence of changes in the brain. What had seemed like insurmountable problems shrink. Fears lessen and negative feelings no longer need to be projected onto others. Instead these negative feelings are traced to their roots, become understandable, and allow for positive growth to occur.
During the course of psychoanalytic work the dyad experiences many feelings sometimes referred to as transference and countertransference by professionals. These feelings are welcomed and help each party understand where these feelings come from. Of course, there are real, non transferential feelings too.
The work takes varying amounts of time – but we need to remember that by the time an adult visits a therapist many years have been spent with whatever problems exist. Patience is necessary. Altho psychoanalytic work is not a fast fix, most people feel better once they begin the process. After all, it is a unique experience to be able to tell someone her deepest and often surprising thoughts, knowing they will be accepted and will remain confidential and will eventually make sense.
*for the sake of brevity I use she,her instead of he, his etc.