Psychoanalysis is a form of intensive psychotherapy based on the belief that factors beyond our conscious awareness have a profound influence on our behavior. Unbeknownst to us as we go about our daily lives, these factors (implicit beliefs about self and others, unconscious wishes and fantasies) are often related to the difficulties for which patients seek treatment.
Psychoanalysis is often indicated for people whose lives are essentially stable, who have achieved some success in work and relationships but for whom an enduring sense of life satisfaction or relief from troubling symptoms has proved elusive. Psychoanalysis can be helpful for people who experience:
- Chronically poor self-esteem
- Feelings of ineffectiveness and failures of performance in work
- Inflexibility, rigidity, and a strong need for control
- Chronic anxieties
- Recurrent depression
- Problems feeling happy and satisfied, even when things are “going well”
- Problems with anger and irritability
- Recurring disappointments in love relationships and friendships
- Problems with intimate and sexual relationships
Patients in psychoanalysis attend four times per week and are encouraged to lie on an analytic couch during sessions. Both the session frequency and the use of the couch are designed to help patients explore the full range and content of their mental and emotional life, without censor, and without attention to what is socially appropriate. The patient’s dream life, fantasies, memories, experiences in relationships and work, and reactions to the analyst are frequent subjects of investigation in psychoanalytic treatment. By examining the themes raised by the patient and through learning about repeated patterns of behavior, thought, and feeling in the patient’s life outside of treatment, the psychoanalyst is able to generate and share hypotheses about the patient’s underlying, unconscious motivations, and how these relate to the patient’s present-day difficulties.
Psychoanalysis is frequently caricatured as a treatment that focuses on the patient’s past. Although many psychoanalysts would agree that one’s experience of early family relationships forms important templates for later experiences, many modes of contemporary psychoanalysis involve an intensive examination of the patient’s current life through the lenses of work, love, and interpersonal relationships. This characterizes my approach to psychoanalysis.
Psychoanalysis is a collaborative venture in which learning and growth occur not simply through the intellectual understanding of the patient’s difficulties, but through the emergence of problematic behaviors, thoughts, and feelings in and related to the relationship with the psychoanalyst. The emergence of the patient’s difficulties in the treatment relationship and their discussion in ‘real-time’ with the psychoanalyst promotes an emotion-based learning that is particularly powerful.
Over the course of an analysis, through the enactment time and again of troubling behavioral patterns and their discussion in the treatment, the jointly constructed understanding of the patient’s difficulties sharpens. Patients start to feel that they have greater sense of self awareness and control in their lives, resulting in an expanded range of choice in work and relationships. Ultimately, an enduring, more positive experience of oneself, one’s relationships and one’s activities prevails.