What Happens In Psychoanalytic Treatment?

What happens in psychoanalytic treatment? How is it different from behavioral type therapy? Why does it take a long time? And why is it often so hard for people to benefit? What is the reason for taking a journey inside? And why do some leave the trip before it’s over? And is it ever over?

Psychoanalysis is a treatment based on the observation that individuals are often unaware of many of the factors that determine their emotions and behavior. These unconscious factors may create unhappiness, sometimes in the form of recognizable symptoms and at other times as troubling personality traits, difficulties in work or in love relationships, or disturbances in mood and self-esteem. Psychoanalysis provides a way of understanding these unconscious conflicts and beliefs that leads to the resolution of symptoms, and increased happiness and productivity in life.

Psychoanalytic treatment usually involves meeting numerous times weekly with a psychoanalyst and attempting to talk freely about one’s thoughts. This frequency of sessions is important for a person to become aware of the underlying sources of his or her difficulties not simply intellectually, but emotionally – by re-experiencing them with the analyst. Through this process the analyst and the analysand are gradually able to see the ways the person relates to the analyst, areas of life about which the patient is hesitant to talk, or patterns that emerge in dreams, memories or behaviors. Through this process change occurs.Psychoanalytic psychotherapy is a similar form of treatment, less intense but also effective. Both psychoanalysis and psychotherapy can be combined with psychoactive medication if it becomes appropriate to alleviate anxiety or depression.

The last question, is it ever over, is important. My opinion is no. What happens is that the traveler reaches a point where she can travel on her own, without a guide. She becomes her own guide, equipped to see life with new vision, to navigate rough spots with new skill, and to continue life’s journey with new strengths.

The real goal of psychoanalytic work is double edged. The ability to connect to others and autonomy seem opposite however, real connection can best happen when one is self sufficient. We all like to lean on someone once in awhile – but relationships that are based on dependence are often doomed to fail. The disappointments in a partner or even a friend can become overwhelming and can destroy connections if they are based only on need. Sure, people need each other for different things but the ability to stand on one’s own two feet is what builds the self esteem we all want. Kahil Gibran wrote about this when he said: stand together, yet not too near together: For the pillars of the temple stand apart, And the oak tree and the cypress grow not in each other’s shadow.

Behavioral therapies like CBT are quite popular and work for many people with specific issues. But many who want a deeper understanding of their problems move into psychoanalytic therapy.

Returning to a travel analogy, the therapist/guide is enriched by each voyage she takes. She learns more with each unique journey. Her experiences inform her every day. Yes, she realizes that there are some common themes but she values and respects individuality. Sometimes the voyages last a very long time.

The clients have often tried behavioral methods and have been disappointed because such treatment does not last.

Here is what I think happens: As treatment progresses, the client/patient tells the stories of her life. She tells them in different ways and as she travels she finds old friends and enemies, places she had forgotten about, events that stand out, and emotions and fantasies that have been buried. As she gradually puts into words the love and hatred, the envy fueled rage, the fears of separation, the dread of dependency, and the pain of unrequited love, along with the laughter and richness that she has repressed or acted out, often in relationships with others, something happens. Scenes shift. New light casts different shadows that create new sights. Shame, once buried, diminishes with the light. Guilt is alleviated. Intimacy becomes possible. Needs change. Talents blossom.

The lenses thru which a person sees have been shaped by early impressions of his/her reality. In many instances early caretakers have been abusive, intrusive, neglectful, and narcissistic. Sometimes loss or illness of a caretaker has taken a toll. The manner in which these early figures and their actions are registered by the brain (internalized) depends on the child’s perception and colors its future perceptions, along with its age-appropriate ability to process relationships and events. I say age appropriate because the same experience is registered differently by the one year old and the four year old. Perception is effected by what Freud called libido and aggression, fantasies, and the development of defenses.

By working with the transference, (with the analyst informed by her own transference,) these experiences take on new shape and the inner self and object world of the patient gradually shifts. Perceptions that had been black and white and one dimensional expand into colorful multidimensionality. (Carol, towards the end of analysis developed a sense of color and shape that she had not experienced before.) A false self fades as it becomes unburdened by the need to please. Winnicott (a pediatrician/analyst from England)introduced the concept of true and false selves. (True self and false self are concepts introduced into psychoanalysis in 1960 by D. W. Winnicott. Winnicott used “True Self” to describe a sense of self based on spontaneous authentic experience, and a feeling of being alive, having a “real self”. “False Self”, by contrast, — one which in extreme cases could leave its holders lacking spontaneity and feeling dead and empty, behind a mere appearance of being real.

(Winnicott, D. W. (1965). “Ego distortion in terms of true and false self”. The Maturational Process and the Facilitating Environment: Studies in the Theory of Emotional Development (New York: International Universities Press, Inc): 140–157.)

Self esteem builds as the ego strengthens and the superego loses its harshness.

My view is that new experiences with the analyst, especially those that involve the emotions as well as the intellect, change the body chemistry and stress level, and along with cognitive growth, form new brain templates that exist along side of the old ones or perhaps blending with them. Think of a river that widens as it travels. As the lenses change and vision deepens reparations are made and the energy once spent on necessary but crippling defenses is freed. The past gets revised due to fresh perception. What was experienced by the child changes when the adult has new capacities to perceive. For instance, size alone changes how we see. A toddler must look up at an adult. As the toddler grows, the view changes. The adolescent grows to tower over the parent in many cases. But the early view seems to form the pictures we store in the mind. Travelers on the psychoanalytic journey learn to adjust to a different reality. Shame diminishes and pride becomes comfortable. Distortions are recognized. The internalization of the analyst and of the analytic process is thought to occur when the hormone oxytocin is released by the positive and even erotic transference. Here is the opportunity to stop the repetition of the past and to move on. The loving aspects of the self, originally perhaps shaded over by early trauma and ongoing discomfort, become available enabling recognition of the other as less and less distorted and as separate. Empathy grows. Anger subsides. Forgiveness is possible, and the past is mourned. Sounds pretty neat? Well it isn’t when you’re going thru it. Revisiting old sites with a reliable guide is required. Each journey is unique.

But how? How do all these things really happen. First I will talk about what some analysts mean by self and object representations. The word ‘object’ means people and even parts of a person that we store in our minds. For instance, Eve remembered her mother as a relative stranger. She was not very present in the early years due to post partum depression and went on vacation leaving Eve with a nursemaid. As she grew into latency she remembered her as frightening. Why? Partly because Eve projected her own feelings about the nanny’s disappearance on to her mother. Eve also saw her as spending most of her time with her father. This created feelings of envy that she remembers as starting in her fourth or fifth year and so the reality of her Mother’s mood swings combined with the envy and jealousy created a picture in Eve’s mind of an unlovable and at times a hated person. At the same time, Eve felt unlovable so her picture of herself (self representation) was bad. As any daughter would, Eve also wanted her Mother’s love very badly. So as much as Eve tried to be a good girl, she also rebelled. At first the rebellion was directed at her mother but as time went on, it became part of her character. Eve had a conscience which helped her know right from wrong. Yet the part of her that needed freedom along with her wish to be loved created conflict in Eve’s mind. Two feelings competed and were fueled by love and hatred. Wanting to be a good girl and wanting to get rid of mother clashed. As a child Eve needed her mother but pushed her away at the same time. Mother’s punishment (lack of love that grew into real dislike) was taken over by Eve. As a result she became accident prone. She punished herself by hurting herself in other ways too. During our journey, Eve began to see that doing poorly in general was multi-determined. Failure in projects was not only a call for help but also a way to disappoint her mother and to scold herself. No one seemed to notice so Eve grew up battling herself. While on the journey, Eve tried to sabotage all progress. Eventually the analyst became the object of Eve’s rage. Her goal became defeating the analyst/guide in several ways. One was not applying what she learned to her life. Another way was threatening to end the journey prematurely. The analyst was able to contain these wishes to defeat the trip and to explain what was happening so that Eve could keep going. Sometimes however, a patient will rest before continuing.

Change is difficult and the road was bumpy but over time, Eve noticed a difference. The main point here is that by reliving the conflict while on the journey, the traveler experiences old fears with growing comprehension and strength. She also sees that the guide hears her, stays with her, does not criticize her or abandon* her. This allowed Eve to identify with and to internalize the guide’s attitude, along side the troubling mother representation. In my mind, this new internalization is the change agent in psychoanalytic work. All the interpretations or explanations help the traveler keep going.

*Sometimes the analyst/guide gives up. It seems as tho the patient is unable or unwilling to continue but if the analyst is strong enough, she will usually find the issue that blocks further travel.

Bill had difficulties with an unsteady father. Prone to alcohol use his father was strict, demanding, unreasonable, and absent for periods of time. Bill was his mother’s ally and helper. She leaned on him and tried to control him. He was highly intelligent and did very well in school. He left home after college and paid his own way through med school. He went on to have a family but all of his achievements did not give him a sense of fulfillment. He became depressed as the children grew up and left home. He divorced his wife and went into debt. Nothing could lift the depression. He was reluctant to begin therapy having experienced a failed analysis in his early 30s. But he decided to try again with a woman analyst. It was hard to admit defeats to a woman who at first stood for his Mother. He was a proud man, justifiably so because of his achievements and it was very difficult to face needing someone. As he began to tell his stories he struggled. Privacy meant life to him. How could he trust another analyst after being so damaged by the first one. But, gradually, he found that being listened to was important and also soothing. Even when he expressed anger and disdain for the analyst he kept going. He came to grips with his once buried feelings towards his parents and as he did so, his relationships grew. He stopped blaming others for their weaknesses and because he experienced his analyst’s empathy, he began to feel empathic too. In other words, he softened. He changed from a strict task master to an understanding man. He spent more time with his grandchildren who grew to adore him and that softened him too. He stopped running away and instead walked towards.

In sum, the analytic dyad takes a journey that is often as rugged as it is pleasurable. Both parties grow and that growth is internalized which means that they will continue traveling even after they say goodbye.

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