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Psychoanalytic Therapy & Psychoanalysis

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When I ask students what comes to mind when they hear the word "psychoanalysis," some familiar themes arise. They include: laying on a couch, talking about one's mother and early childhood, and the psychoanalyst  remaining silent for much if not all of the sessions. Each of these themes are examples of popularized caricatures that contain an important kernel of truth regarding psychoanalytic treatment.

Psychoanalysis is based on several core scientific ideas:

  1. All humans are born with emotional needs. We become aware of these needs by feeling them (e.g. anger when we need to get past a frustrating barrier; panic when we are separated from someone important).

  2. The main project of "growing up" is to learn how to go out into the world and meet these needs, especially in relationships with other people. This is no small project! We have many needs to negotiate within ourselves and in relationships with other people.

  3. We set the foundation for learning how to meet these needs in early childhood, in our relationships with early caregivers (this is where your mother/father/whoever took care of you will likely come up). We do not have room in our brains to actively think about how to meet all these needs all of the time. So, once we have figured out a way to meet a need, it becomes automatic or unconscious - whether it works well or not.

 

Symptoms (anxiety, depression, anger) are feelings - unmet needs that can be explored, thought about, and worked through many times in order to form new connections and use new pathways in the brain. Since humans are wired for relationships from day one, and symptoms occurred in the context of relationships in the past, it follows naturally that a relationship is the right setting to make these sorts of changes - in this case, a therapeutic relationship that is unique in its dedication to your mental well-being.

 

Changes on the inside will result in changes on the outside (changes in behavior). New ways of being will become automatic with time and practice. Meeting as often as possible (up to 5x per week) means more time and practice, deeper changes, and faster results.

So, what about the couch? I do in fact have a psychoanalytic couch. Many patients find it easier to focus on sharing their inner experiences without the distraction of eye contact. However, using the couch is not required and not a good fit for everyone. This is something we can talk about and you can decide what works best for you.

What exactly happens in sessions? For adults, you come in and talk about whatever is on your mind - truly, any topic is fair game in psychoanalysis. This can be surprisingly challenging, and our exploration often begins with looking at how and why it's challenging for you. For example you may feel that something is not appropriate to share (even though there is no off-limit topic in psychoanalysis). Talking about the feeling that it's not okay to share something is extremely helpful and important. The goal is to deepen the thoughts and feelings to which you have access, and to get to know the texture of your inner experiences over time. For children, depending on age and preference, this exploration may consist of playing together.

What do YOU do during sessions? Will you be silent the whole time? Your session is a time and space for you to fill with your thoughts and feelings. I will be quiet at times. When I'm quiet, I'm listening to you and paying attention to my own thoughts and feelings. I'll talk in order to support your exploration of particular topic or if I have something to share that I think could be helpful. If at any time you feel uncomfortable during a period of silence, please say so. My goal is not to torture you with silence, but to explore what silence means to you. Words are important, but they're not everything. Embodied experience and non-verbal communication are also very important, and there is value in simply being humans together.

Why should I pick psychoanalysis over other forms of therapy? It's highly effective. The positive changes experienced in analysis are a result of deep internal changes that are durable over time, and improvement can continue even after treatment has ended. Additionally, when engaging in intensive treatment, you want your brain to be in good hands. Psychoanalysts* have undergone extensive post-graduate training (many years of classes and supervision). We are also required to either be in (or have completed) our own psychoanalysis, as it's not possible to engage in the process of exploring someone else's emotional terrain without being familiar with our own.

*Not all practitioners who describe their approach as "psychoanalytic" or who describe themselves as "psychoanalysts" have the same training. I'm currently a third year psychoanalytic candidate in a five-year training program at the Michigan Psychoanalytic Institute.

a deep exploration of your emotional terrain

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