Analyze This II: A Look Inside a Treatment

Linda was distraught. She desperately wanted to get into a fulfilling relationship, but kept ending up with critical, rejecting boyfriends.

"No one wants to be with me," she said, her eyes welling with tears. "There must be something wrong with me."

Linda (a fictitious person for purposes of illustration) was referred to me by her physician, who knew I work psychoanalytically and might therefore help her get to the root of her depression.

I could quickly see why Linda was depressed -- in addition to feeling rejected, she was quite down on herself. As she spoke, she criticized her weight, which she was forever trying to control without success. She also presumed she must not be smart enough for the men she dated. As she spoke, I noticed she said things like, "I know this sounds stupid but..." and "You're going to think this sounds crazy but."

I told Linda that what she said struck me as neither stupid nor crazy, but that the way she put herself down sounded more critical than any of her boyfriends. Linda agreed, yet she looked slightly injured. "Of course," she said. "I knew this was all my fault."

And so we were off. In our very first session, we had already re-created an aspect of her relationship problems, now between the two of us. She had experienced me as a little like her rejecting, critical boyfriends, and she had responded by accepting the blame ("this is all my fault"). From a psychoanalytic perspective, it is not only expected that people re-create their problems in treatment, but that these reenactments are welcomed and utilized. They provide patient and analyst with a unique opportunity in vivo to work through the very unhelpful patterns that the person has come to solve.

With this in mind, I told Linda that I had a sense that she had felt criticized by what I had said, and had blamed herself. How had she experienced my comment? It soon became clear that she had heard me saying she deserved no better than her boyfriends, that I felt it was all her fault. It would never have occurred to her to tell me this, and without even realizing it, she had instead accepted the blame so that she would not upset me. As we continued to explore this, Linda was amazed. She had never considered that she not only attracted, but put up with and maybe even unconsciously (without realizing it) encouraged critical men by taking on both person's insecurities herself.

What was wonderful was that Linda could now recognize this without attacking herself or feeling criticized by me. I noted that she had stopped saying her feelings were
crazy or stupid. She had gone from unconsciously experiencing me like her critical boyfriends to whom she had no choice but submit, to someone who could help her feel better about herself -- precisely what she wanted from a relationship, but on some level felt she did not deserve.

As Linda and I continued to work together, her depression began to lift. It soon became clear where her negative self- image and pattern of choosing contemptuous men had come from. Linda's father was a loving man, but he could be critical and short-tempered. If he had had a bad day at work, he might lash out at Linda, as if his burdens were her fault. This seemed to only reinforce her view that she was lovable only so long as she was perfect, and that she had to work very hard to please men, even if it meant accepting their criticism. Linda's mother, although well-meaning, only reinforced this view. When she knew her husband was in a bad mood, she would become anxious and implore Linda not to provoke her father, also implying that his bad moods were somehow Linda's fault, and that she had to walk on egg shells to make him feel better.

I told Linda that her pattern of diminishing herself before critical men now made a lot of sense. Unconsciously, she still felt she had to agree to make herself the bad one to prop up a critical, insecure man in order to win his love.

By pointing this out, I provided Linda with insight into her own unconscious beliefs -- an important aspect of psychodynamic treatment. Psychoanalysis is the only modality that works with the unconscious -- the way we perpetuate problematic views of ourselves without even knowing we are doing so. Being alert to how we are contributing to our own unhappiness is vitally important. But insight alone is not enough. Psychoanalytic psychotherapy offers something even more important -- opportunities to work through these issues, often re-created with the therapist.

By attending to Linda's relationship issues as they also emerged between us, Linda had a powerful experience of creating a new dynamic with me the midst of familiar expectations. When I sensed that Linda might be injured by something I had said, but felt safer blaming herself than telling me about it, I would tactfully inquire about this. I would wonder if Linda had felt angry with me, and had instead turned the anger against herself through self-blame. Linda was often quite moved at these moments. She learned that she did not have to put her needs aside in order to maintain our relationship, and that is okay to feel angry -- something many women struggle with.

This is how psychoanalytic psychotherapy works -- and what makes it uniquely effective. No other treatment works with unconscious motivations, or utilizes the therapeutic relationship in such a specific, active way. Without recognizing and working through long-standing unconscious patterns, we are doomed to repeat them.

Psychoanalysis provides new experiences within the therapeutic setting that also take hold in the person's outside life. It offers new ways of seeing yourself that can make you feel more in control of your life.

-- Eric Sherman, LCSW