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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.

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Psychoanalysis is based on several core scientific ideas:

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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 why feelings are so important - they are a compass we use to feel our way through the world. But, meeting our needs 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 leftover feelings from childhood - compasses that helped us survive in the specific circumstances of our childhoods, but are oftentimes not so helpful when it comes to navigating any other circumstance. These feelings - unmet needs - can be explored, thought about, and must be worked through many times in order to create new pathways and strengthen new connections 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. You could think of therapy as a "relationship lab."

 

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.

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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.

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​What exactly happens in sessions? For adults, you come in and talk about whatever is on your mind - and 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.

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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 a 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 rather 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.

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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 experience, supervision, and classes). 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 one's own.

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What are the differences between psychotherapy and psychoanalysis? This depends on who you ask. Some people consider a treatment to be psychoanalysis if there is a “psychoanalytic process” that emerges between the therapist/analyst and the patient, regardless of how often they are meeting. Some people only consider a treatment to be psychoanalysis if they are meeting a particular number of times per week (usually 3-5x.)

 

What are the goals of treatment in psychoanalysis? Some goals apply to every patient. These are all important, but may be of relatively more or less importance to each individual patient:

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• Expansion of your access to the full texture of your emotional life. This includes any feeling regardless of the valence (i.e. regardless of whether you experience the feeling as positive/comfortable or negative/uncomfortable.)

• Ability to examine defenses (i.e. to notice and think about the ways you protect yourself from painful feelings, as these protections are often overly relied upon, resulting in suffering/dysfunction.)

• Narrative reconstruction of the roots of your ways of feeling and being (again, this is where your parents/early childhood are going to come up)

• The use of transference (i.e. to be able to talk about the here-and-now experience of our therapeutic relationship. This is an essential way to access important information about your emotional and relational world because it’s happening right now between us.)

• A general movement from action to reflection (i.e. from acting out relational dynamics toward being able to think and talk about them together. For example, a shift from actually no-showing appointments to showing up and talking about the urge to not show up, and what it means for you.))

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Altogether the ultimate goal is increased freedom from the ways that you're "stuck." The old stuck pathways will always exist, but once new and more adaptive ones grow, you will be more free to choose them, resulting in more satisfaction in many areas of your life.

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How long before I can expect changes to occur? It’s not possible to say for any given person. Internal change of this nature is non-linear, meaning that you are very unlikely to simply feel a little bit better each day as the treatment goes on (humans/life/brains are much too complicated for that.) Additionally, since one of the goals is to expand access to all different types of feelings, it’s likely that at some point you will experience a negative/uncomfortable feeling in therapy, and that this would be considered progress.

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Can you guarantee that psychoanalysis will work for me or my child? No. While studies have shown that psychoanalysis is helpful, it’s difficult to predict who exactly will benefit from psychoanalysis and to what extent. It depends on a complicated mix of “you factors”, “me factors,”, and the unpredictable nature of exactly how things will play out between us. The “me factors” are addressed throughout your treatment by my training and the experience of having been in my own psychoanalysis. Addressing the “you factors” is part of your treatment. Like any endeavor or relationship, difficulties are expected to arise in treatment. For example, you may feel that it’s unhelpful or frustrating. It’s only through exploring those feelings in the context of the psychoanalytic process/relationship that we can determine whether they are important dynamics that, if worked through, will result in positive change – or whether there is a true barrier such that you are unable to benefit from this particular type of treatment with me. If I think the latter is occurring, I will certainly let you know

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*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.

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