Flunking Dr. Phil: In Praise of Introspection

Americans like our self-awareness like we like our food -- fast, and in bite-sized McNuggets. We pop pills and turn to self help books and TV "experts" to prop up or moods and pep up our orgasms. Yet we feel more impotent than ever.

How did we become a culture that reveres Dr. Phil yet reviles Dr. Freud?

When smiley-faced emoticons have replaced genuine emotions, and instant messaging trumps introspection, the ability to know oneself has fallen upon hard times. Given how overwhelmed so many people feel, the desire for easy answers is understandable. The idea of looking inside can be frightening when what's inside feels dark and shameful. That's what's so tantalizing about therapies that promise symptom relief without having to look at how the problems got there in the first place.

Yet in their rush to avoid introspection, many people end up feeling more stuck and confused. People who put "positive energy" into the universe (the mantra de jure) with little result end up doubting themselves more. They never understand what's beneath their negative thinking. Someone who cleans up the mess in their house only to re-create it days later is unaware that the mess symbolizes how they feel inside. Part of them unconsciously needs to create mess for many complex reasons. The deep-seated feelings they are trying to get away from are now simply expressed through new obsessions, addictions and phobias.

To borrow a motto from the 1970s, a mind is a terrible thing to waste. Concrete techniques to change destructive thought patterns and behaviors can be very helpful -- I use them in my practice all the time. But without also understanding what the mind is struggling to express and not express at the same time, the root of what causes self-destructive actions never becomes unearthed. Shame, fear and confusion often linger.

Psychoanalysis offers more than just a Band-Aid for multilayered wounds -- although it often does provide immediate relief for disturbing symptoms. Psychoanalytic psychotherapy does something more deep and lasting. It takes you on a journey of self-awareness.

There are potentialities existing within us all. Psychoanalysis is about excavating our pasts, but also about unearthing new ways to be with oneself and others going forward. It is deeply personal and deeply practical. Understanding the genesis of our problems, and recognizing how we unwittingly contribute to their perpetuation in the present, allows us to feel more in control of our lives.

I sometimes catch a glance of Dr. Phil on my gym's large-screen TV. I watch him only in small doses, and with the volume down. Then I look away and see where my mind takes me. It's a nice work out.
-- Eric Sherman, LCSW

Talking about Talk Therapy

Recently, a cover story in the New York Times Magazine, “My Life in Therapy,” by Daphne Merkin (August 8, 2010) generated an onslaught of responses in print and the blogosphere that, I believe, anyone passionate about psychoanalysis should be aware of and concerned about. http://www.nytimes.com/2010/08/08/magazine/08Psychoanalysis-t.html?pagewanted=all

In the article, Merkin details her 40-year history in psychoanalysis with various psychiatrists. The piece reads like a tell-all revenge fantasy against her former analysts. Her portrayal of the analysts is cartoonish in its presentation. Several analysts are silent and withholding. Others are bungling, authoritarian, and arrogant. Merkin’s sarcastic tone throughout clues the reader that she believes the doctor is crazier than the patient.

Her article is an indictment against these individuals in specific and against psychoanalysis in general. She believes neither served her well, yet she returned again and again to “classical” analysis for treatment of her depression.

As I was reading the piece I had a building sense of dread that the author was painting an inaccurate portrait of psychoanalysis that would proliferate rather than dispel old stereotypes. Beyond a chronological detailing of how each therapist, in turn, failed her, she weaves in rudimentary explanations of drive theory and ego psychology.

She has little curiosity about developments in psychoanalytic theory and practice over the last several decades. Nor does she explore other therapy modalities. This created quite an outpouring, as you can imagine, from blog and letter writers from the CBT community.

Many of the letters to the editor and blog entries confirmed my dread. Responses ranged from assertions that psychoanalysis is dead and discredited to judgments that psychoanalytic patients, indeed anyone who seeks therapy, are whiny navel-gazers.

However, there were also postings from current and former patients who responded that psychoanalysis had saved and enriched their lives or had put a stop to self-defeating patterns. Many analysts wrote in to invite Merkin, The New York Times, and its readers to learn more about the process and efficacy of contemporary psychoanalysis.

Psychoanalysis is a powerfully effective therapy. And, we need to get the word out. Recently a peer-reviewed journal article asserted that “talk therapy” works and keeps on working after sessions stop. Check out:

http://www.scientificamerican.com/article.cfm?id=talk-therapy-off-couch-into-lab

Researcher, Jonathan Shedler, has published articles that can be downloaded from his website. I recommend:

https://portfolio.du.edu/pc/port?portfolio=jshedler

The Efficacy of Psychodynamic Psychotherapy (American Psychologist, 2010)

That was Then, This is Now: An Introduction to Contemporary Psychodynamic Therapy

Analysts are wonderful listeners and profound change agents in the privacy of the consulting room. Now they must be excellent talkers and changers in the larger world as well. We need to present an accurate picture of what psychoanalysis is and how it helps people. Merkin will soon be enlarging her article into a book. We have our work cut out for us.

Sally Rudoy, LCSW

"Altar-ing" perceptions: On working with gay couples and individuals.

June is flying by -- the month when thousands of (heterosexual) Americans marry. June is also Gay Pride Month, when thousands more Americans still can't.

Imagine a fictitious gay couple, Tom and Jeff. They have been together for 17 years -- longer than either of their divorced parents. Imagine they are in couples therapy the day after attending the (heterosexual) wedding of Tom's niece in Pennsylvania, a state (like most) that does not recognize their not-quite-equal civil union from New Jersey.

In the session, Jeff complains about Tom's driving on the way home from the ceremony. "All I did was ask him to slow down a little and not be so aggressive," he tells the therapist. "He was driving like a madman."

"I was not," Tom snaps back. "You were very critical and harsh."

The therapist acknowledges Jeff's frustration and concern about Tom's driving, and encourages him to consider other ways to articulate his feelings. She comments on how the couple's disagreements sometimes devolve into power struggles, and offers advice on how they each might better communicate and express their needs. Tom and Jeff move on to another topic, and the therapist is satisfied that she has replied in a useful manner, based upon her work with many (heterosexual) couples and her own experience with a husband sometimes prone to aggressive driving.

In assuming that Tom and Jeff are like all the couples she has seen, however, the therapist has failed to realize that their relationship faces unique obstacles. Their fight was not simply a power struggle, but also expressed the hurt, shame and anger from feeling marginalized at the wedding.

Tom and Jeff need an opportunity to talk about how dejected they felt watching other couples slow-dance. Or how they both blanched when Tom's mother introduced them to others: "Tom, you remember your cousin Janet! And this is her husband, Paul. Janet and Paul, this is Tom and his, um... Jeff."

Most gay couples (and individuals) must deal with this sense of difference and even shame at times in their lives. In fact, the therapist would be wise to wonder if these feelings ever come up with her, a straight married woman. She may have been avoiding her own fears of not knowing enough, of being judged as different or inadequate. Had she been able to recognize her countertransference, she might have marveled at how similar she was feeling to them as an unacceptable other. She may have found a way to turn her discomfort into empathy.

Of course, gay, lesbian, and bisexual therapists would have their own countertransference reactions to this couple based on their own life experiences. Subtle expressions of homophobia are inevitable regardless of the analyst's sexual orientation. From a psychoanalytic standpoint, the goal is not to exorcise our countertransference, but to find ways to recognize and utilize it.

As analysts, we have a responsibility to become aware of our own beliefs and assumptions as they surface with patients. Additionally, I believe we have a personal and professional obligation to advocate for fairness for all people. Our commitment to alleviate suffering does not end at the consultation room door. Making marriage equal is no panacea, of course. But working for it is a good start.

-- Eric Sherman, LCSW

Eric Sherman is the author of Notes from the Margins: The Gay Analyst's Subjectivity in the Treatment Setting (The Analytic Press).

To find out more about supporting same-sex marriage, visit the websites of Human Rights Campaign (www.hrc.org) and Garden State Equality (gardenstateequality.org).

Common Psychoanalytic Myths: Part 2

Here is another installment in our look at a few common myths about what psychoanalysts and their patients actually do during sessions. We invite your comments and the sharing of your own myths.

MYTH #2

Will I have to spend all my time in a psychoanalytic therapy talking about sex?

FACT

Your question reflects two concerns you might have about psychoanalysis. One is that you will “have to” do something that you may not want to do – in this case talking about a subject that your analyst feels is most important. The second is the concern that your sex life will be the focal point of inquiry.

Tackling concern one: Many people new to analysis imagine their therapist will be an authority figure who will set the agenda for what is discussed. Many worry that they will be criticized, judged, or made to feel embarrassed. Although an expert in human psychology, the analyst’s view of the therapy process is collaborative and accepting. The analyst creates a climate where what is most meaningful and salient to the patient can be explored in a manner that is safe and respectful.

Concern two addresses the stereotype that psychoanalysts believe that sex is at the root of all problems. During the repressed Victorian era when Freud was developing psychoanalysis, he indeed encountered many patients with debilitating symptoms related to sex. He called sexual energy, libido -- a drive from the most unruly, uncivilized parts of ourselves.

Over time, with the benefit of many years of study and clinical evidence, analysts have also observed other causes for emotional difficulties such as ingrained patterns of being in relationships, vestiges of traumas, cultural and environmental influences, and individual genetic and body endowments. All of these and more are possible topics of discussion in an analytic therapy.

The thought that sexual matters may be discussed can be anxiety provoking. However, reflecting on the role of sex in one’s life is important. An essential aspect of the human experience, sex impacts our perception of ourselves, our relationship with others, and the choices we make in all arenas of life. So, analysts will invite you, when appropriate, to talk about sex. To never talk about it would be to bypass understanding yourself fully and omit tapping into a resource for happiness and positive change. Psychoanalytic therapists provide the confidential, private, and safe space for such exploration.

Sally Rudoy, LCSW

Can This Relationship Be Saved?

If you're anything like me (and for your sake, I hope you're not), you were a little unsettled by the recent separation of Al and Tipper Gore. If Washington's charmed couple could come undone after four decades, whose relationship is safe?

Who knows what happened that, seemingly out of the blue, what worked for the Gores for 40 years suddenly no longer did. Was it an affair? A slow drifting apart? After more than 14,000 days spent together, could Tipper no longer stand the toilet seat being left up one more minute?

Anyone who has ever done couples therapy (or been in a couple) knows that needs and interests that were once compatible can shift over time. We certainly hope they do. A relationship that doesn't change becomes stagnant. What marks a successful couple from an unhappy one is not whether the partners fight or how often, but how well they complement each other -- and how they navigate things when they don't.

Often, the very characteristics that attract us to our mates can pull us apart over time. The way he was so carefree and spontaneous now feels childish and irresponsible. "Why does he 'yes me’ whenever I ask him to do anything -- but then not do it?" The way she hung on our every word now seems suffocating. "Can't she give me a little space when I ask for it?"

We were so happy at first. What changed?

Undoubtedly many things. Here's one that a couples therapist, working from a psychoanalytic perspective, might consider. Without realizing it, we (unconsciously) choose a mate who embodies undeveloped aspects of our own personalities. His spontaneity excites us because we get anxious taking risks. We are afraid of our unmet dependency needs, and so are drawn to her seemingly unflinching trust. His ying is her yang. He introduces us to the world of freedom, she to safety and commitment. So far so good. But so long as our partner expresses a part of us we cannot tolerate, we become jealous of him for what we think we don't have. What we loved in them now frightens us. How come he gets to go out and have fun when we are always stuck with the kids? Ying and Yang remain split, and conflict brews. So long as she is the needy one, he never has to confront his own neediness, and she her fear of being alone.

Couples therapy helps each partner take back what the other is burdened holding for both of them. He begins to see that he has always been afraid to depend upon others for fear he will be abandoned. In fact, by ignoring her whenever she makes a demand, he in essence abandons her before she can reject him. Similarly, by choosing a critical, distant man, she has married someone just like the father who ignores her and shuts down her confident, fun-loving side.

As they work through these issues together in therapy, he can finally risk being more vulnerable with her, and she can discover her own strengths and capabilities. Each can feel safe learning from the other rather than railing against them. Differences can complement and enhance, not threaten. Not only does the relationship grow stronger, so do both individuals, as they get in touch with parts of themselves that were hidden within them all along.

-- Eric Sherman, LCSW

The New Jersey Couples Therapy Training Program (NJCTTP), a division of the Center for Psychotherapy and Psychoanalysis of New Jersey, offers a unique multitheoretical training program for mental health professionals, from both family systems and diverse psychoanalytic points of view. For more information, visit http://cppnj.org/njcttp.php.

Common Psychoanalytic Myths

Woody Allen has famously been called the “poster child” of psychoanalysis. Ironic isn’t it that the comedian/filmmaker has become the recognized face of psychoanalysis? Well, perhaps not. Psychoanalysis -- what it is and what happens during sessions has historically been the butt of jokes in culture, film and literature. Here we tackle a few myths about what psychoanalysts and their patients actually do during sessions. We hope to dispel, elaborate, or corroborate those familiar myths. We invite your comments and the sharing of your own myths.

MYTH

Psychoanalysts encourage patients to re-hash their troubled childhoods over and over

FACT

While analysts do encourage exploration of the patient’s experiences in childhood, parental and family relationships, cultural background, and traumas, they are not the exclusive focus of attention. What all analysts share in common is a profound respect for the unconscious: the contents of mind that operate out of awareness but influence and direct our thoughts, feelings, behaviors, and relationships. It is usually problems and disturbing patterns in these areas that bring people to treatment.

Analysts help patients become acquainted with the unconscious so as to have more freedom to make choices about their lives. Talking about childhood experiences and parents is one route to uncovering the invisible influences. But also, we examine how the patient functions in the world today and the perennial obstacles that stanglehold the person from achieving goals. Tuning into what is going on in the mind, body, and action in the present moment is a valuable source of information. Recent dreams, fantasies, everyday actions and reactions provide rich clues to where difficulties originate.

One of the most powerful ways the unconscious is revealed is in the very current, very alive relationship of analyst and patient. Once trust has been established, analysts invite the patient to collaborate on how the dynamics evolving between them may replicate difficulties in other relationships. The therapy room becomes an “in vivo” laboratory for the study of the unconscious with the goal of untangling the patient from past and present constraints.

Sally Rudoy, LCSW

All the rage

April 15 was particularly taxing this year, what with having to survive another round of Tea Party protests steeped in anger. The sound and the fury that ratcheted through the country after Congress passed health care reform has subsided a bit, but it is clearly still simmering. As psychoanalysts, trained to understand the complex workings of the mind, how do we comprehend the fear and loathing?

From a psychological lens, change frequently stirs anxiety. The bigger the change, the greater the uncertainty. Even when there is much to be gained, it's easy to fixate on all that might be lost. We see this in individuals as well as in the larger social system. There's something safe and familiar about the status quo, even when it isn't working. Change becomes equated with danger, and a fight-or-flight mechanism takes over.

Much has been written about how the Tea Party movement is dominated by white men terrified about the country's changing demographics -- especially about a powerful African-American in the White House. Psychoanalyst Neil Altman has written that those who are different frighten us with their foreignness. Through a process called projective identification, they become convenient receptacles for disturbing aspects of our own psyches. In this mechanism, parts of ourselves we cannot tolerate are unconsciously projected into somebody else, and then railed against. We can then cling to an image of ourselves as all good, devoid of malice or aggression, since these aspects are now found in others. We are not dangerous, angry and out of control, black people are.

Although many minority groups have served this function throughout history (including Jews in Nazi Germany), African-Americans are convenient receptacles for our disowned dark sides because their skin color is, in fact, darker. Black-and-white thinking -- literally -- has a temporary advantage of creating order in a dangerous world. With an us-versus-them mentality, at least we know where we stand. The problem is, where we stand is actually shakier than before since now the world is even more threatening, and the messier parts of ourselves more dangerous than ever.

Prejudice is endemic to the human condition. To rise above it we first have to locate ourselves in it. By staring at our own fears and prejudices -- by tolerating our own dark sides -- we become more human in the process.

-- Eric Sherman, LCSW