WHAT IS PSYCHOANALYSIS
People seek psychotherapy for different reasons. Sometimes they want to solve a specific problem produced by difficult circumstances; sometimes they want relief from feelings of general unhappiness and anxiety; other times they want to make a change, to feel less stuck, less depressed and more hopeful.
Asking for help is the first important step. It gives substance to our desire for change and makes concrete our wish to feel better. This very act of asking says that we feel entitled to support and serious consideration.
This brochure was written to educate people about one specific kind of psychotherapy - psychoanalysis. Psychoanalysis is a unique therapeutic approach to people and their feelings. Only when you gain some understanding of the special advantages of this approach - and the commitment it requires - can you decide if psychoanalysis is for you.
Psychoanalysis, developed by Dr. Sigmund Freud in Vienna in the early 20th Century, was both a revolutionary way of understanding human emotions and of helping people with their psychological problems. He helped the world understand that the "rational" adult who functions more or less successfully in the "real world" is only a part of the total person. Under the rational self is the unconscious self and Freud was able to demonstrate the powerful influence that unconscious feelings and thoughts had on the health of his patients.
Psychoanalysis is the process by which the unconscious is made conscious and the "truth" about ourselves is uncovered and accepted so that psychological healing and psychic growth can occur.
"Psychoanalysis helped me be happier, less likely to act out my anger or depression. I finally understood my own self-destructive patterns and why I had been so helpless to change them for so many years. Finally, l think I can be myself and get what I need to make me happy."
Gradually, over the last half century Americans have become at least superficially acquainted with psychoanalysis, but paradoxically, the very familiarity we have with the popular symbols of psychoanalysis - the couch, dreams and free association - obscures the fact that many people still don't know how it works or why one might want to choose it over other types of psychotherapy.
Although we may have read Freud, seen images of the analyst in films and heard what people have said about their own "analysis," we still may not know what actually goes on in psychoanalysis and why it is considered the most challenging form of therapy.
What is Unique to Psychoanalysis?
Psychoanalysis differs from other psychotherapies in its focus, depth and method. Other therapies help you solve particular problems. In psychoanalysis, specific problems are viewed in the context of the whole person. The quest for selfknowledge is the most important key to changing attitudes and behavior.
Of course, the patient comes to therapy because he'or she is in some sort of emotional pain. Initially the goal may be relief from uncomfortable feelings, frustration, depression, anxiety, confusion, or physical pain. As the treatment unfolds and you come to understand yourself better, you will begin to experience more freedom to live your life as you wish, without disabling symptoms, and with more pleasure.
"I was always a very frightened person and never thought I'd have the courage to go so deeply into my past. But, it wasn't as traumatic as I feared."
Psychoanalysis is based on the insight that our adult personalities are the result of many developmental st`ages; at any stage, the way we have reacted to events in our lives may have caused us to get "stuck." Of course we do "grow up." But we carry within the aspect of ourselves that "got stuck" that didn't have a chance to develop; we can have an adult exterior, and be functioning more or less successfully, but internally we may feel vulnerable, confused, depressed, angry, afraid etc. We may not feel able to bounce back from rejection, get past blocks, allow our real feelings to surface, or stay in touch with our desires.
Psychoanalysts believe that what happens first to the infant and then to the child shapes the way we see the world, the kind of relationships we form, the way we feel about ourselves in relation to others and the needs we seek to have fulfilled. Through the process of psychoanalysis we can dive deep into that past to re-experience and re-examine the formative and sometimes painful experiences we have had. It helps us come to terms with the relationships we had during the growing up years-both the good and the bad.
Psychoanalysis is designed to help you get in touch with your unconscious, the memories, feelings and desires that are not readily available to your conscious mind; it is designed to help you understand how your unconscious feelings and thoughts affect the way you act and react, think and feel today. As a result of this process you are enabled to act more effectively on your own behalf.
The Talking Cure
Psychoanalysis has been called the "talking cure" because change is made possible simply by talking with the analyst about all of our feelings, experiences and dreams. (Many analysts stress that it is the experience of the relationship between the patient and analyst itself that is crucial to the cure.")
People in analysis talk about everything: their current problems or concerns, their work, their relationships, their feelings, their childhood, their parents, their adolescent years, or whatever seems important to them at the moment. They find, by doing so, that they learn more about the sources of their current dilemmas, and how to make their lives better. By telling your story, in your own way, in your own time, and in your own words, to someone who knows how to listen and give new meaning back to you, you learn to hear yourself in a new way.
"Nobody had really ever listened to me before, so it was a big relief when someone I respected, my analyst, wanted to know what I thought and felt."
The psychoanalyst is not judgmental and takes seriously whatever the patient talks about. People are encouraged to say what is on their minds without censorship or self-criticism. Free association, as it is called, is fundamental to a successful analysis.
Traditionally, the patient in analysis lies on a couch with the analyst seated behind. Not facing the analyst, a person may experience a new degree of spontaneity and freedom, and be more fully in touch with his or her deeper feelings and thoughts. Of course, whatever is said in the analyst's office is held in the strictest confidence.
Psychoanalysis provides a safe place for you to discover and tell yourself the truth. It will give you a unique opportunity to re-experience your personal history, see it in a new way and make connections between past and current conflicts that illuminate your situation and enable you to change. That process is educational as well as therapeutic.
The Role of The Patient
Some people compare psychoanalysis to an advanced course of study in which you are both the investigator and the object of investigation. Psychoanalysis encourages patients to take a major role in their own treatment, to work as partners with their analysts. The patient's only responsibility is to come to each session and bring up everything that comes to mind, including wishes and fears, memories and experiences, dreams and dilemmas. Of course, this is not always easy. As you feel more secure about your relationship with your analyst, comfort and trust grow and speaking your mind becomes easier to do.
"I'd never been able to get where I wanted in life but after a stormy analysis I realized my feelings about my father have been invisibly running my life. Now that I understand how that works, I can move on."
Psychoanalysis moves along according to the pace you set for it, you go as far and deep as you are ready to. But when you have difficulty in being honest with yourself and open with your analyst, you both can stop and look at that and, together, figure out the reasons for your reticence.
You also will be encouraged to talk about feelings that come up about your treatment or about your analyst. These feelings are important because elements of one's earliest affections and hostilities toward parents and siblings are often shifted on to the analyst. This phenomenon, known as transference, offers a rich source of understanding, for it enables you to re-experience and re-work important feelings from the past with the maturity of the present. As you work through old conflicts and put them to rest, you grow as a person.
For example, you may feel your analyst is being too critical about what you are saying. When you discuss this with the analyst, you may learn that you always feel that way about people seen as "authorities" and that your perception may be colored by expectations created in childhood.
The Role of the Psychoanalyst
The analyst acts as your guide as you explore your inner life. Together you examine your ideals, expectations, hopes and desires as well as your feelings of guilt, shame, doubt or despair. She or he aims to create an environment of safety so you can unfold your authentic self without fear of judgement or the pressure to please.
"I had a very chaotic life. This is the first time it makes sense to me."
Analysts are carefully trained to facilitate your exploration so that you are free to reflect on your experiences and your reactions to the process of psychoanalysis. The analyst is there for you; to listen, clarify, unravel, connect and help you remember and interpret what is unclear, problematic, or deceptively simple. To be helpful to their patients, analysts must be both empathic and objective. Analysts will not judge, tell you what to do, or let the focus shift from you to their own lives or problems. Contrary to stubborn stereotypes, they do speak, respond, ask questions and volunteer insights.
A very special relationship between the analyst and patient develops over time and through the dialogue in which both participate. It becomes a powerful alliance with the shared goal of change and greater understanding for the patient. This confidential relationship, central to psychoanalysis, is unlike any other relationship you will have.
The Analyst's Training
In order to qualify to treat people, the psychoanalyst has gone through his or her own analysis, in addition to other training, such as classes, supervision, etc. Analysts are the only psychotherapists for whom a personal analysis is an absolute requirement.
The importance of this training cannot be overemphasized. It typically lasts at least six years. Most analysts have completed other academic training before they begin this course of study. They are mature, experienced and fully professional before they see patients.
"I never thought l would be able to be a parent until I understood how my parents failed. Now I know that I don't have to repeat the mistakes they made. At the beginning I was in a rage, but finally I am able to understand and, forgive them and myself."
Psychoanalysts may or may not be physicians. Before 1945 most analysts were trained first in medicine and then as psychoanalysts. However, today, the majority of analysts have advanced degrees in psychology and social tvork while others come to analytic training from a variety of professional backgrounds: religion, nursing, counseling, the social sciences and the humanities.
Who Can Benefit from Psychoanalysis?
We have many stereotyped images of people who undertake psychoanalysis: we see them as middle-class, highlyverbal and very intellectual. In reality, anyone can benefit from psychoanalysis, and men and women of very different social groups, personality styles and backgrounds have chosen psychoanalysis. According to some analysts, psychological traits that can facilitate the analytic process include:
a capacity for reflection
a desire to understand the past
a problem-solving attitude
a curiosity about the meaning of things
a tolerance for vulnerability and painful feelings
an ability to observe and experience at the same time
a sense of humor
resilience under stress
Of course not everyone has all of these traits. Some people who have had successful analysis wouldn't have been able to identify with these traits at first. What is most important is the desire to take an honest look at yourself, and the desire to change.
Deciding on Analysis
When people consider whether or not to start psychoanalysis, they typically and reasonably want to know how much - how much time, how much money and how much stress. Here are some answers that you can use as guidelines to help you decide if psychoanalysis is for you.
"I am not a new person now but the person I am is the person I really like and that is very new. I realize that life will never be pain-free but l feel ready to take what it has to offer."
Psychoanalysis is not short-term therapy; it does take time to explore the complex layers of feeling and experience that make up your own unique history. People find that their analysis can extend for four, five or more years, but there is no prescribed length of treatment. When you feel you have accomplished what you wanted, you and your analyst can set a termination date.
Psychoanalytic exploration is never completely linear or predictable. You may discover "side" issues of great importance, or obstacles that slow you down. There may be times when you undo your own progress, because as much as you may want change, change is frightening too.
"I was in analysis for I4 years. When I started I was functioning very poorly. Over those years I overcame my problems so that I could do the "ordinary" things - take vacations, change jobs, get married. I don't think I lost time, I gained time."
Psychoanalysis demands an investment of time every week. In contrast to other therapies, psychoanalysis works best when you have three or four 45-50 minute sessions a week. The frequency allows you and your analyst time to fully explore topics without long breaks between sessions; it helps you focus and stay in touch with your feelings. While your analyst will try to accommodate the constraints of your work life and lifestyle, from time to time the scheduling of sessions can be inconvenient.
Since psychoanalysis demands an investment of time, it also calls for an investment of money. While psychoanalysis does not cost more per session than other forms of psychotherapy, there are more sessions over a a relatively long period of time. To make psychoanalysis affordable to everyone, most training institutes provide low-cost analysis. Both single and married people willing to re-order their spending priorities find they can afford it. However, no matter what the dollar amount is, any long-term additional expense makes a difference in one's budget and plans for the future. While we may spend great deal of money to escape our problems, few of us are accustomed to tackling personal problems with a financial commitment analysis can call for. Therefore, it is important to consider if you are willing to make adjustments in your lifestyle so you can include this new expense.
Finally, all people in analysis find that talking about what bothers them sometimes causes them to feel sad, anxious or irritable during or after their sessions. Some people are afraid that once they lift the lid on memories and feelings, they won't be able to function and will lose the stability they have fought hard to maintain. "I'm afraid if I get started crying, I won't be able to stop". In psychoanalysis, "lifting the lid" is an important part of the therapeutic process, but you don't ever have to do it alone; your analyst is there to help you through the "rocky times" so that you can finally have resolution and relief.
The Rewards of Analysis
For all that psychoanalysis demands in terms of time, cost and stress, these are far outweighed by its rewards, in the opinion of the great majority of those who choose and persevere in the process.
While in psychoanalysis, people typically find that both their personal relationships and their work lives improve. As they understand themselves and the people in their lives better, they can live more freely. As they resolve conflicts, they have more energy than before to do the things they really want to do. They waste less time, their days become fuller. Often they are better able to negotiate salary increases or go on to more rewarding careers.
"I've been on the couch for two years now and it's been an amazing experience. I never realized how many layers I contained and how complex the route to reaching them. Now, I understand why simple choices are never so simple."
People also find great relief in having a special, absolutely confidential relationship uninfluenced by other social, professional or familial ties. All of their feelings are dealt with and taken seriously by a skilled, compassionate analyst who is knowledgeable about emotional life. They are reassured by the fact that there is someone whose job it is to see that they don't get overwhelmed by their feelings or undone by the pressures they are under.
Psychoanalysis aims to help you experience life more deeply, enjoy more satisfying relationships, resolve painful conflicts and better integrate all the parts of your personality. Perhaps its greatest gift is the essential freedom to change and to continue to change.