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"What is psychoanalysis?" This is a question I am asked frequently. I resist the temptation to answer a question with a question, and try to educate and demystify. However, I know that if I do a reasonable job of responding more questions will follow: Why does it take so long? Who can afford the time and money? Who still does that? Why do you have to be on a couch? What good does it do? Haven't medications made that obsolete? The list goes on, but curiosity is a good thing. Now let me try to share my response to the first question.
I begin by clarifying that psychoanalysis can refer to a method of treatment, a model of the mind, and a research tool. As a set of theories that endeavor to understand and explain human nature – emotions, behaviors and relationships – psychoanalysis is the most comprehensive. And, this body of knowledge and the psychoanalytic perspective is not a relic frozen in time since Sigmund Freud's passing. Indeed, ongoing theoretical revisions, clinical experience, developmental research and other sources make this an alive and growing model of the mind. But it is psychoanalysis, the treatment, that I want to bring to life.
For me in a word psychoanalysis is about freedom. Freedom from anxiety (irrational fears), from conflict, from self-deception, from the past, from black and white thinking, from impulse, from criticism and excessive sensitivity, from envy, from shame and guilt, from environmental influences (peer pressure), from emotional constriction, from things only limited by our imagination. With such independence comes what I think of as a capacity for contentment. More energy is freed up to be curious, autonomous, honest, tolerant, passionate, empathic, creative, and capable of intimacy, of work and of relaxing recreation. The content person can find and maintain the critical balance between love, work and play. He or she realizes that to have balance one must be able to say "no" to opportunity (you can't do it all), and deal with the loss that entails. Such a person knows "good enough" which is freedom from perfectionism. And, the content person is better able to live in the present. The past provides a sense of continuity, a history and lessons to be learned, but it is not dwelled upon with despair and resentment. The future is to be anticipated so that realistic trouble can be avoided, but not dreaded with paralyzing anxiety. While respecting past and future, the individual has plenty of energy to invest in the moment, in experiencing the bitterness and sweetness of life. And, the content person has confidence and a solid sense of him or herself. Their self-esteem is not ruled by popularity or adoration. They listen to what others say about them but have an internal yardstick that provides standards, values, aspirations, and self-satisfaction. They know what they are about and can be intimate without loosing their identity. They can connect, yet stay separate. Many of these sound like opposites, but reflect the dialectics of human nature. To be content is to embrace the polarities and ambivalence intrinsic to the psyche.
I feel like I've just scripted a commercial touting the incomparable virtues of psychoanalysis. So, what's the catch? It's not for everyone; it's hard work; it takes a long time; it requires commitment and conviction. It''s a long war in which one must do hand to hand combat with his or her own demons. An intellectual ‘knowing' why you are who you are won't get results. You have to ‘believe' the insights you achieve and that requires a strong feeling component. You can't just see your demons, you have to feel them too.
Our defenses and capacity for self-deception are impressive and create invisible barriers that keep us from seeing things about ourselves, others and reality that we don't want to see – but need to see. To appreciate these defenses the analyst asks the patient to say whatever comes to mind (free associate) and refrain from editing. This sounds like a jail break, but invisible bars constrain the patient and he or she censors, edits, etc. – "I can't say that, it is inappropriate, offensive, silly, crazy, embarrassing, etc. etc." The opportunity for forty-five minutes of psychic freedom reveals the patient's inhibitions, defenses, and anxieties. With the analyst's patient and persistent interpretation of these the layers of the onion are gradually peeled away and the hand to hand combat with the demons ensues.
In addition to free association, two other "windows" into the mind are particularly valued in psychoanalysis – dreams and the transference. Dreams, and similarly daydreams, fantasy and reverie, are very private and personal. Night dreams are not random electrical discharges but screenplays written, produced and directed by the patient. As such they are revealing. The transference is the various beliefs, feelings and fantasies the patient develops towards the analyst. Because the analyst attempts to keep his or her own personal features in the background and, if the patient can suspend reality and indulge in the "as if" and "what if," the ways of relating to the person over their shoulder can reveal much about the mind of the patient. Indeed, many of the relationship difficulties that have complicated outside relations may emerge in the office making them more evident and available to be analyzed.
This description does not do justice to the complexity of psychoanalytic treatment, but provides some highlights and some basics. For people who struggle with love, work, and play, who struggle with balance in their lives, who lack the peace of mind I call contentment, psychoanalysis holds great promise. It is rarely the first therapy someone seeks and often quicker and less painful solutions need to be pursued. If they don't get the desired results then it helps them develop the conviction necessary to "bite the bullet" and commit to the most intensive of therapies. And, contrary to some assumptions, psychotropic medication and psychoanalysis are not antithetical. Medications can make painful feelings of anxiety and depression less overwhelming – thus easier to talk about and experience. These medicines can expedite therapy and analysis and make some people be able to benefit from a therapy that they could not have tolerated before.
Oh, how could I forget – the money question. People need to pay what they can afford for psychoanalysis, but for those who can't afford hundreds of dollars per week over several years, analysis is still possible. Because of the existence of the Dallas Psychoanalytic Center, one of approximately thirty institutes in the United States accredited by the American Psychoanalytic Association for training of future analysts, there are always experienced psychiatrists, psychologists, social workers and licensed professional counselors, who are in various stages of their psychoanalytic training. Supervised conduct of psychoanalysis is one of the three central components of psychoanalytic training, and these candidates are often willing to see persons for whom psychoanalysis is an appropriate treatment at significantly reduced rates.
In closing, I hope I have provided a satisfactory description of psychoanalysis. To my colleagues I would like to say that what I have offered here is what psychoanalysis is to me. In fact analysis is like the proverbial elephant – too large to be seen comprehensively from only one angle. Indeed, I would welcome and invite those of you who have different perspectives to contribute on this subject in future newsletters. And, to those of you who have been told that analysts never talk, note that one simple, innocent question produced all these words!
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