KIM FOEHL, MD
KIM FOEHL, MD
ABOUT PSYCHOANALYSIS
Psychoanalysis is an
intensive version of psychotherapy in which issues are addressed deeply
and comprehensively. The frequency of meetings and continuity of the
process allows people to make profound changes. Both children and adults
can engage in psychoanalysis. For younger children, the process
involves play as the medium of the work. For a clear and comprehensive
description of psychoanalysis, take a look at this essay from the
American Psychoanalytic Association (APsaA).
http://www.apsa.org/About_Psychoanalysis.aspx
Adult Psychoanalysis
Psychoanalysis as a type of treatment
What is psychoanalysis
about? What sort of help does the analyst offer, and what will be
expected of me? How does treatment work, and how will I know if it is
working for me?
Psychoanalysis is based
on the observation that individuals are often unaware of the factors
that determine their emotions and behavior. Because these factors are
unconscious, the advice of friends and family, the reading of self-help
books, or even the most determined efforts will often fail to provide
enough relief. Psychoanalytic treatment explores how these unconscious
factors affect current relationships and patterns of thought, emotion
and behavior. Treatment traces theses patterns back to their historical
origins, considers how they have changed and developed over time, and
helps the individual to cope better with the realities of their current
life situation. Analysis can be viewed as an intimate partnership, in
the course of which the patient becomes aware of the underlying sources
of his or her difficulties, not simply intellectually but emotionally as
well – in part by re-experiencing them with the analyst. From the
beginning of therapy, patient and analyst work together to build up a
safe and trusting relationship that enables the patient to experience
aspects of his or her inner life that have been hidden because they are
painful, embarrassing, or guilt-provoking.
In psychoanalysis, the
patient typically comes four times a week, lies on a couch, and attempts
to communicate as openly and freely as possible, saying whatever comes
to mind. These conditions create the analytic setting, which enables you
to become more aware of aspects of your internal experience previously
hidden. As you speak, hints of the roots of current difficulties that
have been out of your awareness gradually begin to appear – in certain
repetitive patterns of behavior, thought and emotion, in the subjects
which you find hard to talk about, in the ways you relate to the
analyst. The analyst helps to identify these patterns, and together you
and the analyst refine your understanding of the patterns that limit you
or cause you pain, and help you elaborate new and more productive ways
of feeling, thinking and behaving. During the years that an analysis
takes place, you wrestle with these insights, going over them again and
again with the analyst and experiencing them in your daily life,
fantasies, and dreams. You and the analyst join in efforts not only to
modify crippling life patterns and remove incapacitating symptoms, but
also to expand your freedom to enjoy intimate relationships and
professional and personal pursuits. Gradually, you will change in deep
and meaningful ways; you may notice changes in your behavior,
relationships and sense of self.
Before beginning
psychoanalytic treatment, many people find it helpful to learn about
some of the specific kinds of experiences that people often have when
they start in analysis. You may find that your analyst will talk less
once the treatment begins. He or she will listen carefully to what you
have to say, let you structure the sessions and set an agenda, allowing
you to take the lead. He or she will speak when he or she has
something to add to what you are saying. This may feel strange at first –
people quite naturally expect their analyst to tell them what to talk
about or to give them advice about how to solve their problems. But
learning to watch where your thoughts and associations take you, without
undue interference, is a vital part of the analytic process. Also,
psychoanalysts understand that even the best direction and advice is
limited in its potential to help you make meaningful and lasting changes
in ingrained patterns of behavior and emotion. Instead of providing
more advice, your analyst will help you develop a greater understanding
of the internal forces that are behind the difficulties that lead you to
seek help, to help you understand why you think and feel and do things
the way you do. In the end, this will enable you to change patterns that
no longer work for you. One of the key goals of analysis is freedom,
including the freedom of your mind to range freely in thought and
feeling.
It is very likely that
problems in relationships are a part of the reason why you originally
sought treatment. Relationships are often a source of conflict, and they
are an important source of information in psychotherapy. It will be
important to discuss your intimate thoughts and feelings about
significant people in your life, both negative and positive, with your
analyst—including any thoughts and feelings you have about your analyst.
In contrast to a friend, a relative or a boss, your analyst is prepared
to help you understand your experience – even if what you have to say
is uncomfortable or seems inappropriate or rude. For example, if you
think your analyst is condescending, clueless, intelligent,
overprotective, attractive or unkind – whatever you are thinking or
feeling at the moment – it is wise to share it with him or her. You will
find that with your analyst you will be able to talk about anything
that comes to your mind. Your analyst won't have any preconceived
notions about what is right or what is wrong for you or what the best
solution would be, and rather than repeating with you the sort of
patterns you may encounter in life, he or she will help provide you with
a new understanding.
At first, you may find it difficult to
talk about how you are experiencing your analyst. So, just like the
important issues that brought you into treatment, your analyst will
encourage you to share your thoughts and feelings regarding your
relationship with him or her. One way the analyst does this is by
encouraging you to speak as openly and freely as possible, sharing
everything in your experience – whatever thoughts and feelings come to
mind at the moment in session. Ordinarily, people edit many of their
thoughts and feelings, or may have never even put them into words
before, because they feel what they have to say is too personal, or
trivial, may hurt other people's feelings, or is simply absurd. Whatever
the concern – it doesn't matter – it is important to share it with your
analyst. What you think is too personal, trivial, hurtful, or absurd is
often the key to something very important.
Your analyst will
facilitate the therapeutic process by offering you use of the couch.
Analysis is the only treatment in which the patient lies on a couch and
does not look at the analyst. Lying on the couch and not looking at the
analyst may seem strange at first but in most cases enables patients to
think and feel more freely and spontaneously about their internal
experience – and to express themselves without excessive concern about
the analyst’s reaction. Most patients actually prefer to work this way
and become quite comfortable once they get accustomed to lying down.
Before long, you will find that you are able to talk freely and openly
and you and your analyst will be able to collaborate in useful and
unexpected ways that will help you grow.
While analysis is
productive and useful in a number of ways, you will encounter apparent
roadblocks along the way. Real lasting change does not come easy and is
often accompanied by unexpected discomforts, diversions, and
delays. For some, this means feelings of anxiety or depression or
crying episodes which may make you worry that you are getting worse. Or
the opposite may be true. You may feel all your difficulties have
vanished and you are ready to move on. For some, it means periods of
silence, or spinning ones wheels, or boredom, or excitement, or a sense
that nothing therapeutic is being accomplished. Sometimes you may even
not want to come to sessions. You can be assured that such negative
thoughts are completely to be expected, and they are typically a good
indication that you are working on important issues.
To promote
the kind of growth and change that analysis aims to accomplish requires
time and energy, therefore, analytic treatment is open-ended. The
treatment typically lasts for a number of years, a period to be mutually
determined over the course of time by you and your analyst. Together,
you and your analyst will decide when to end your treatment, and will
spend some time processing the decision. It is important for you to talk
about leaving treatment with your analyst before you stop coming. This
period can be a most productive period of work, when you and your
analyst review and organize your understanding of the work you have done
together, and when you process your experience of ending this period of
working together.
[Adapted from a piece
written by Eve Caligor, M.D. and Lisa Piazza, M.D., Columbia University
Center for Psychoanalytic Training and Research.]
Psychoanalysis as a “Theory of the Mind”
In addition to being a
specialized type of therapy, psychoanalysis is also a comprehensive,
in-depth theory of the mind. It has many applications. Using the
uniquely psychoanalytic explanatory tools of the unconscious,
transference and development, among others, psychoanalytic insight can
enrich the understanding of human beings, their behaviors and
motivations in a wide range of arenas from business to politics to
sports, the arts, education, advertising, the law, literature, family
relations, and popular culture.
While always acknowledging the
uniqueness of the individual, and the infinite variation of human
experience, psychoanalysis has, over the decades, developed a set of
useful understandings about common human psychological experiences. For
example, we know that human beings often have a powerful, unconscious
need to idealize their leaders and others in authority, and that they
can become angry and vengeful when idealized figures disappoint them.
This psychoanalytic concept, one of many hundreds, can be extremely
valuable in understanding certain political phenomena.
The
themes of psychoanalysis are those found in great literature – power,
ambition, insecurity, ideals, attachment, isolation, longing, and so on.
The careful studies of psychoanalysts have enabled us to develop an
explanatory theory that puts these great passions in context and allows
us to predict the course they may take.
Essentially,
psychoanalysis is about the story of human beings, what motivates,
inspires and sometimes cripples them, but it looks at these phenomena
and tells a story from a unique perspective – “what lies beneath” the
surface.
Is Psychoanalysis only a Therapy?
Although psychoanalysis
began as a tool for ameliorating emotional suffering, it is not only a
therapy. It is, in addition, a method for learning about the mind, and
also a theory, a way of understanding the processes of normal everyday
mental functioning and the stages of normal development from infancy to
old age. Furthermore, since psychoanalysis seeks to explain how the
human mind works, it contributes insight into whatever the human mind
produces. In so doing, it has had a profound influence on many aspects
of 21st century culture.
As a general theory of
individual human behavior and experience, psychoanalytic ideas enrich
and are enriched by the study of the biological and social sciences,
group behavior, history, philosophy, art, and literature. As a
developmental theory, psychoanalysis contributes to child psychology,
education, law, and family studies. Through its examination of the
complex relationship between body and mind, psychoanalysis also furthers
our understanding of the role of emotions in health as well as in
medical illness.
In addition,
psychoanalytic knowledge is the basis of all other dynamic approaches to
therapy. Whatever the modifications, the insights of psychoanalysis
form the underpinnings of much of the psychotherapy employed in most
other individual, family, and group therapies.
The Psychoanalytic Tradition
Sigmund Freud was the
first psychoanalyst. Many of his insights into the human mind, which
seemed so revolutionary at the turn of the century, are now widely
accepted by most schools of psychological thought. Although others
before and during his time had begun to recognize the role of
unconscious mental activity, Freud was the preeminent pioneer in
understanding its importance. Through his extensive work with patients
and through his theory building, he showed that factors which influence
thought and action exist outside of awareness, that unconscious conflict
plays a part in determining both normal and abnormal behavior, and that
the past shapes the present.
Although his ideas met with
antagonism and resistance, Freud believed deeply in the value of his
discoveries and rarely simplified or exaggerated them for the sake of
popular acceptance. He saw that those who sought to change themselves or
others must face realistic difficulties. But he also showed us that,
while the dark and blind forces in human nature sometimes seem
overwhelming, psychological understanding, by enlarging the realm of
reason and responsibility, can make a substantial difference to troubled
individuals and even to civilization as a whole.
Like any other field of
inquiry, the ideas of psychoanalysis did not "freeze" with the work of
the field's founder a century ago.
Building on the
foundational ideas and ideals of Freud and his contemporaries,
psychoanalysis has continued to grow and develop as a general theory of
human mental functioning, while always maintaining a profound respect
for the uniqueness of each individual life. Ferment, change, and new
ideas have enriched the field, and psychoanalytic practice has adapted
and expanded. But psychoanalysts today still appreciate the persistent
power of the irrational in shaping or limiting human lives, and they
therefore remain skeptical of the quick cure, the deceptively easy
answer, the trendy or sensationalistic.
Like Freud, they believe
that psychoanalysis is the strongest and most sophisticated tool for
obtaining further knowledge of the mind, and that by using this
knowledge for greater self-awareness, patients free themselves from
incapacitating suffering, and improve and deepen human relationships.
Conscious/Unconscious
In the late nineteenth
century, Freud formulated a theory of the human mind, psychoanalysis,
which had at its basis the discovery of the unconscious. He pursued a
theory of treatment to help patients bring traumatic memories and their
accompanying affect into consciousness in ways that would allow them to
form associative connection with other conscious thoughts and achieve
expression.
There are currently
diverse approaches to treatment within psychoanalysis, yet these
approaches all share the aim of helping patients bring to their
consciousness what is unconscious or difficult to acknowledge.
Unconscious occurrences may include, for example, an individual's
vulnerabilities, motives, tensions, impulses, guilt, fantasies, or
urges. One of the goals of psychoanalysis is to help the patient develop
insight into his/her unconscious processes. Psychoanalysis encourages
us to search for personal truthfulness and focuses specifically on the
irrational dimensions of our mental life, as it applies rational
procedures to achieve its goals.
Who can benefit from psychoanalysis?
Psychoanalysis is an
effective treatment for many people with moderate to severe difficulties
and who have had unsuccessful attempts with briefer therapies.
Because
analysis is a highly individualized treatment, people who wish to know
if they would benefit from it should seek consultation with an
experienced psychoanalyst. Still, some generalizations can be made. The
person best able to undergo psychoanalysis is someone who, no matter how
incapacitated at the time, is basically, or potentially, a sturdy
individual. This person may have already achieved important
satisfactions - with friends, in marriage, in work, or through special
interests and hobbies - but is nonetheless significantly impaired by
longstanding symptoms: depression or anxiety, sexual incapacities, or
physical symptoms without any demonstrable underlying physical cause.
Many
people come to analysis because of a pattern of repeated failures in
work or in love. Others recognize self destructive patterns of behavior
they are unable to change. Others need analysis because the way they are
- their character - substantially limits their choices and their
pleasures. Some feel a painful but vague sense of unease and emptiness.
And still others seek analysis definitively to resolve psychological
problems that were only temporarily or partially resolved by other
approaches.
Whatever the problem -
and each is different - that a person brings to the analyst, it can be
properly understood only within the context of that person's strengths
and life situation. Hence, the need for a thorough evaluation to
determine who will benefit - and who will not - from psychoanalysis.
Who is a Psychoanalyst?
The designation
"psychoanalyst" is not protected by federal or state law: anyone, even
an untrained person, may use the title. It is therefore important to
know the practitioner's credentials before beginning treatment.
Graduate psychoanalysts
trained under the auspices of the American Psychoanalytic Association
have had very rigorous and extensive clinical education. Candidates
accepted for training at an accredited training institute must meet
high ethical, psychological, and professional standards. These
candidates are either physicians who have completed a four-year
residency program in psychiatry, psychologists or social workers who
have completed a doctoral program in their fields or hold a clinical
masters degree in a mental health field where such a degree is generally
recognized as the highest clinical degree; all must have had extensive
clinical experience. Outstandingly qualified scholars,researchers,
educators, and selected other professionals may also be approved for
psychoanalytic training. All accepted candidates, whatever their
background, then begin at least four years of psychoanalytic training.
This training consists of
three parts. Candidates attend classes in psychoanalytic theory and
technique. They undergo a personal analysis. And they conduct the
psychoanalysis of at least three patients under the close and extended
supervision of experienced analysts. Candidates who plan to treat
children attend further classes and, with supervision, analyze boys and
girls ranging in age from toddlers to late adolescents.
Besides conducting
psychoanalysis, most graduate analysts also practice intensive and brief
psychotherapy. Those who are psychiatrists sometimes prescribing
medication. Many treat couples, conduct family or group therapy
sessions, and work with the aging.
Because psychoanalysts
are provided with the most thorough education available in normal and
pathological development, their training enhances the quality of all
their therapeutic work. It also informs their community activities as
teachers, supervisors, consultants, and researchers, in the many
different settings - hospitals, medical schools, colleges, daycare
centers - where analysts are found.
Child and Adolescent Psychoanalysis
Child and Adolescent Psychoanalysis
In addition to treating
adults, some psychoanalysts also treat adolescents and children after
receiving special training. APsaA's publication on child and adolescent
psychoanalysis tells how treatment can be beneficial.
Child and
adolescent psychoanalysis, offshoots of adult psychoanalysis, share with
it a common theoretical framework for understanding psychological life,
while also using additional techniques and measures to deal with the
special capacities and vulnerabilities of children. For instance, the
young patient is helped to reveal his or her inner feelings and worries
not only through words, but also through drawings and fantasy play. In
the treatment of all but late adolescents, parents are usually consulted
to round out the picture of the child's life. The goal of child and
adolescent analysis is the removal of symptoms and of the psychological
roadblocks that interfere with normal development.
What kinds of problems or symptoms can psychoanalysts help with?
-anxiety
-fearfulness
-sleeplessness
-nightmares
-night terrors or sleepwalking
-excessive sadness or depression
-physical symptoms without physical cause
-extreme aggression
-cruelty to animals or people
-disturbances in conduct or behavior
-excessive sibling rivalry
-bullying, or being a scapegoat or a class clown
-risk-taking
-compulsive thinking or rituals
-learning disorders
-inattentiveness and disinterest in learning
-excessive shyness and separation problems
-lag in emotional and social development
-eating disorders
-loneliness or isolation
-preoccupation with death
-suicidal thinking or behavior
-sexual confusion
-sexual conflicts
A guide for parents, teachers and healthcare professionals.
Children and adolescents
often behave in ways that puzzle and worry their parents, teachers and
friends. Sometimes their behavior reflects passing problems that arise
in reaction to temporary stresses. But sometimes the troubles do not go
away by themselves.
Children and parents may
feel guilt, shame, and anger as they struggle to understand these
problems, why they are happening, and what to do. Families and schools
can get stuck in a confused cycle of blaming and helplessness.
Evaluation
Psychoanalysts can help:
-Evaluate a troubling situation
-Understand different treatment options
-Find the best treatment for each individual child
Psychoanalysts are highly
trained mental health professionals who may suggest an array of
techniques to help children with mental health treatment needs. For
example, some children may benefit from medication, some may benefit
from in-depth psychodynamic therapy, some from both. Every child and
every problem are unique.
Child and adolescent psychoanalysts approach each child individually
-They respect each child and adolescent as a unique individual within a family and a community.
-They understand that unconscious factors outside a person's awareness influence feelings, thoughts and actions.
-They help children, adolescents and parents understand how the past shapes the present, and can influence the future.
-They help children and adolescents become happier, and more caring, productive and creative.
The goal of child and
adolescent analysis is the removal of symptoms and psychological
roadblocks that interfere with normal development.
Psychoanalysis is the best treatment when
-Other therapies and attempted solutions have failed to deliver deep, long-lasting change.
-The emotional or
psychological difficulties are primarily the result of unconscious
conflicts. When children or adolescents are not aware of the underlying
issues that affect their feelings, behavior, and relationships to
family, friends, or teachers, and these troubles interfere with the
development of their personality, they may need intensive help to
explore and master them.
-Children or adolescents
have several and/or complex emotional disturbances. Such children may
have intense and dramatic emotional states, may hunger for positive or
negative social responses, may be clingy, hyperactive, or have temper
tantrums. Sometimes these children also have been diagnosed with
attention deficit/hyperactivity disorder, conduct disorder, separation
anxiety disorder, or mood disorder.
-Psychoanalysis is often
the best treatment because the intense relationship formed between the
child/adolescent and analyst enables children, either through play,
action, or words, to express and exhibit their problems to the
psychoanalyst. The psychoanalyst then can help the child or teen
understand and solve the problems.
-Two children or
adolescents can have similar symptoms, but their underlying difficulties
may be very different and require different treatments. A thorough
evaluation usually includes a series of interviews with parents and with
the child or adolescent in order to learn about the current problems,
how the parents have been responding, the child and family's history,
possible precipitating events and potential genetic and physical
contributing factors. At times, educational, medical or neurological
examinations may be needed.
source:
http://www.apsa.org/About_Psychoanalysis.aspx
http://apsa.org/About_Psychoanalysis/Child_and_Adolescent_Psychoanalysis.aspx
Kim Foehl, MD Cambridge MA Therapist
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