CPPNJ - The Center for Psychoanalysis and Psychotherapy of New Jersey

Friday, February 25, 2011

Analyze this: What's so dynamic about psychodynamic therapy?

The prospective patient was aghast when he heard that I was a psychoanalyst. "Do you expect me to spend the next 30 years on the couch blaming my mother and poor potty training for all my problems?" he asked, rolling his eyes. "I've got real-life issues to deal with. I am not interested in any Freudian crap." (He may have used a different word than "crap.")

Like Lindsay Lohan, trans fats and the state of New Jersey, psychoanalysis has an image problem. Which is a shame, because the way psychoanalytic psychotherapy is taught and practiced by many of us today couldn't be further from the Woody Allen caricature. I don't even consider myself Freudian. Like many of my analytic colleagues, I practice in a way that is contemporary, interactive and deeply effective at treating real-life problems.

And so, with apologies to Woody (Freud would have had a field day with that name!), I would like to clear up some misconceptions about psychoanalysis, and to show how it is a uniquely transformative way to dismantle deep-seated patterns that keep people stuck in life.

In traditional Freudian analysis, the therapist was a neutral, removed expert who spoke little so as not to contaminate the process. When he did interject, it was to offer an authoritative interpretation of what the patient was inaccurately projecting from the past onto the analyst. Insight -- the imparting of knowledge from therapist to patient -- was what cured. To overcome the patient's resistances to recognizing aspects of his or her unconscious, it was necessary to attend sessions at least four times a week, and to lie on the couch so as not to be influenced by seeing the analyst. (Actually, Freud invented the couch partly because he didn't like patients staring at him all day.)

Over the last few decades, a much different analytic model, called Relational Psychoanalysis, has transformed the field. Influenced by infant research and the influx of women into the profession, relational analysts believe all people are uniquely shaped by social interactions, beginning in early childhood and continuing throughout life. We still value unearthing the unconscious, but we believe it is the therapeutic relationship, as much as insight, that is healing. The analyst is no longer a removed interpreter, but an active collaborator utilizing his or her unique personality to understand and reach the patient. The therapeutic relationship becomes an important means to working through the person's hopes and fears. Insight is still important, but only if the patient feels deeply understood.

As a result, the stereotype of the silent, bearded analyst has been replaced by the warm, flexible practitioner -- empathic, but also challenging, eager to give and receive feedback and to be adaptable to each patient's changing needs. The couch is still sometimes used, but most people sit up. More than one session per week allows the work to deepen more quickly, yet many people see great benefit at once a week.

Psychoanalytic psychotherapy can sometimes provide immediate relief from symptoms like anxiety, depression or phobias. But unlike any other treatment modality (including cognitive-behavioral therapy), it addresses and permanently loosens the very personality structures that caused these symptoms in the first place. Psychoanalysis, therefore, is the most in-depth form of psychotherapy. New research confirms it can have the most lasting, long-term impact.

What specifically goes on in a psychoanalytic treatment? In a forthcoming post, I'll show you what's so dynamic about psychodynamic treatment.

Monday, February 14, 2011

From Egypt: A triumph of the human spirit

Friday evening, I watched the news from Egypt and cried.

I sat in my expensive leather chair enraptured by the site of hundreds of thousands of people -- many of them young and poor -- as they erupted in ecstasy.

The reporter from Tahrir Square had to shout above the delirium. At times, he was literally swept up, pulled into the undulating masses around him. Tears rolled down the cheeks of some of the men and women in the crowd. Others shouted with unbridled pleasure. It was all so sudden. So unexpected. Surreal.

A man older than many around him suddenly walked up to the reporter and kissed him on the cheek. "Thank you!," shouted the elated older man. "Thank you to everyone! Thank you to the world!"

The reporter tried to maintain his composure and his footing. Within seconds, a woman held up her baby so that the infant, too, could offer a tiny kiss to the journalist. This time, the reporter lost his composure. He turned toward the baby thrust in front of him and planted a kiss on her lips. It was impossible to hear over the bedlam, but I imagined that the baby, like her mother, was squealing with joy. Surrendering to the moment, the reporter smiled broadly.

A young woman in a head shawl was next to be interviewed. The shawl highlighted her face and drew attention to its glowing features. Her dark eyes shone, her smile pure rapture. Her accented English was excellent. "I never thought I would live to see this day," she said. "I cannot tell you the pleasure I am feeling." She didn't need to; I could feel it myself.

It was at that moment -- watching the serene joy on the woman's face as delirium engulfed her -- that tears began to roll down my own cheeks. I remembered the ecstasy I felt at a party on election night, 2008, in front of the TV in somebody else's comfortable living room. The several-dozen people assembled erupted as the television announced that Barack Hussein Obama had been elected the first African-American president of the United States -- an event I had never expected in my lifetime. The feeling of accomplishment, pride and hope was palpable, just as it was in Egypt.

I thought back more than two decades, when I was a reporter myself and spent a week in Egypt on vacation. I had not expected to confront such poverty. The horses were so emaciated, they were too weak (or defeated) to swat flies that swarmed around them. Wherever I went, gaunt children tugged at my clothes, their fingers to their mouths in a gesture for food. I was appalled that a fellow tourist threw a cheap Bic pen at them, entertained by the sight of famished children diving for a trifle they might be able to sell.

In Cairo, I had been affronted by the noise and the mass of people, some hanging on the outside of packed, filthy buses, their faces grim. As a taxi drove me back to my hotel -- luxurious by Egyptian standards -- I passed military guards stationed on street corners, threatening machine guns in their hands. (My reaction to them would be recalled in the days after 9/11, as I walked uneasily by soldiers in camouflage and threatening machine guns in New York's Port Authority.)

My memory of the squalor and military presence made it all the more powerful to see unarmed Egyptians -- perhaps some the begging children I had seen when I visited -- rise up and do the impossible. And now there was a feeling of hope, a sense that destiny had played its hand.

And so I cried, like I do when I work with people who have been beaten down -- sometimes literally, more often psychologically by traumatic experiences beyond their control. I am moved by their strength and persistence. I am moved by the human spirit.