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.