Questions & Answers

 

(For convenience in this section, I use the term “psychoanalytic therapy” to refer to both psychoanalysis and psychodynamic psychotherapy.)

How does psychoanalytic therapy work? What happens during therapy?

Psychoanalytic therapy is a relationship where you can  talk freely about what is concerning you in your life, as a result of which we learn about the interferences blocking your happiness, and causing  symptoms such as anxiety and depression. .  We focus part of the time on the unconscious and on dreams, part of the time on what’s happening in your daily life, and part of the time on the experiences of the two of us during therapy sessions.

How do I know if the therapy is working?

If I am the right therapist for you–that is if we are a good match– you will feel at least a small degree of improvement in something important, after almost all sessions. That may sound vague, but when it actually happens, your experience will be  clear.

Where does your type of therapy come from and how long has it been around?

Psychoanalytic  therapy ,  originated in the work of Sigmund Freud about 125 years ago, and it has been refined and modernized, especially in the last 30 years. .  So today’s therapy  is the distillation of the experiences of thousands of therapists and clients for over a century.

What is unique about this type of therapy/analysis?

(1) The  highest priority is for your subjective, personal thoughts and feelings, and our search for your true self

(2) Deep listening  on my part

(3)  You are free to  talk about anything–at all–that comes to mind.

(4) As discovered by some recent research , this kind of therapy can create the capacity for continued growth and improvement even after the treatment has ended.

(5) Psychoanalytic therapy can be helpful for a very wide range of difficulties, including but not limited to anxiety, depression, post-traumatic stress disorder, difficulties in relationships, uncertainties about sexuality, hard-to-pin-down roadblocks in one’s life, and stress-induced physical ailments.

What exactly is the difference between  psychoanalysis and psychotherapy? Which do I need?

Analysis and therapy are on the same continuum. Analysis usually means three or more sessions a week, therapy one or two sessions a week; analysis means using the couch, therapy means sitting up. But even with those distinctions, there can be some  overlap and exceptions. As concerns what you need, one way of thinking about it is that persons who want to resolve certain problems opt for psychotherapy, and persons who want to work on all their difficulties, opt for psychoanalysis.

How long does psychoanalytic therapy require?

This type of treatment is all about change, the change in yourself needed to improve symptoms and discover your true potential. Some people require deep change to gain what they want, others not so deep. So length depends on depth–which varies a whole lot from one person to the next. The length of the treatment  usually can’t be predicted at the beginning, but not too long after the beginning you and I  should find  a clear agreement about what the goals are and have a prediction about how long the work will take.

Do you prescribe medication? Is that part of  psychoanalytic therapy?

I prescribe  medications, and that is sometimes part of the treatment.

Do you do therapy or analysis by skype?

Yes, if there are some in-person sessions to begin with.

How much scientific evidence is there for psychoanalytic therapy?

Until the 1980’s, evidence was limited to the experiences and the reports  of individual therapists and patients, although there were many of each, world-wide. Starting about 25 years ago,  a striking   amount of  evidence from studies has emerged. First, imaging and other studies in neuroscience have demonstrated that passion, reason, and conscience are distributed in differing areas of the brain, consistent with the concept of the mind in  psychoanalysis. Neuroscience has also validated the analytic concepts of the unconscious and repression. Since  the 1990’s, brain studies using imaging have supported our psychoanalytic understanding of dreams, including the powering  of dreams by deep instinctual drives. Furthermore, some studies now show  a variety of positive changes in the brain from talk therapy, that is,  talk changes brains. Finally , although much work remains to be done, studies are accumulating on the results  of various types of psychotherapy, which tend to show positive and lasting effects from psychoanalytic therapy.

(See papers, books, and on-line resources about  this research listed in the Resources section of this website .  For neuroscience evidence, see especially the works by Norman Doidge, and for evidence on the results of therapy, see especially the works b y Jonathan Shedler.)

I’m worried that therapy might lower my creativity. What’s the deal?

The opposite of that is the deal, at least in my work. I think that psychoanalytic therapy should increase  creativity, and I find that is almost always what happens. The liberation of suppressed creative energy is part of the fiber of psychoanalytic  therapy.

How much does talking about childhood come into psychoanalytic therapy?

Sometimes a lot, but not always. And there are no requirements about that. In therapy or analysis, most people find that their life as a child is important to who they are today, and is important to their emotional difficulties. Sometimes  this leads to very helpful and fairly detailed discussion about events of childhood. For other people there is only a light touch on childhood, and most of the focus is on life as an adult.

What about cognitive behavioral therapy (CBT)?

In my view, CBT can be helpful for the relief of symptoms in a variety of situations. In some people(not all) that relief can be lasting. In general, I think that CBT is more superficial than psychoanalytic therapy. There is a large  amount of enthusiasm for CBT currently, based in part on results of studies. However, I think this reflects a bias in the mental health field which has happened because studies are so much easier and cheaper  to do with CBT than with psychoanalytic therapy. Psychoanalytic therapy is much more individualized than  CBT and this means that more complex methods of evaluation have to be used.

Do you know about and use meditation? is it helpful? What type of meditation do you recommend?

I have experience with three of the major traditions of meditation and can  help people work meditation into their therapy. There are many types of meditation, using  a variety of techniques; most originated in Asia and are hundreds or even  thousands of years old. I think each tradition exists because it works differently for different people. So I  encourage  clients to try different methods, if needed, to get some benefit.

What are the benefits, in this context?

Meditation can improve sleep, reduce anxiety and depression, increase creative thinking, and decrease the symptoms of PTSD.  Thus its can have a powerful beneficial effect on  the results of psychoanalytic therapy.

I think I have aftereffects of traumatic events. There are many other treatments for these. Why psychoanalytic therapy?

Though not widely known, there is a very long history of the benefits of the psychoanalytic treatment of trauma after-effects. Some of the earliest psychoanalysts  provided help to war veterans during and after World War I. The nature of PTSD was famously documented  by the analyst Abram Kardiner in New York in the 1930’s. Many analysts and analytic therapists worked with combat survivors from  World War II, others with Holocaust survivors, and still others with survivors of rape trauma,  sexual abuse, and disasters, over  the last several decades. Much of our modern understanding and capacity to help trauma victims derives from psychoanalytic work.

The somatic or body therapies (Somatic Experiencing, the Feldenkrais and Alexander methods, EMDR(Eye Movement Desensitization and Reprocessing), yoga, and meditation, all have been shown to be of benefit to some people with trauma after-effects.  In my practice, I understand psychoanalytic therapy to be  the key element  in treatment of trauma effects, because it guarantees that all parts of a person’s life and personality are attended to and cared for, while the other treatments  can be brought into play as needed by the individual.