What’s The Patient's Job in Psychoanalytic Therapy?

Most people who are familiar with psychoanalytic therapy are familiar with the notion of transference, that is, the idea that the dynamics of “the room” can act as a prism and a simulacrum to enact and explore various relationships the patient has experienced before. What is less well known is what the patient should know going in, and how he or she can best contribute to a meaningful therapy. This piece in The Huffington Post examines some of the issues surrounding patient choices, beginning with a quick primer on what kind of therapy we’re talking about:

Before I go on I should clarify that the sort of therapy I'm referring to isn't directed or based on a manual. It's called psychodynamic, psychoanalytic or depth psychotherapy. This is traditional talk therapy as opposed to cognitive and behavioral therapies, in which the client is given specific directions. While cognitive and behavioral models have their benefits, many people prefer depth therapy because it makes space for thoughts and feelings to rise up organically, because it aims to get to the root of problems, and because it aims to promote growth by working with the entire personality rather than focussing on the eradication of specific symptoms.

An apt definition, and in important distinction for what’s to come. As the author explains, the patient’s responsibilities require forging a sense of honesty, both within herself and with the therapist:

1. Get real: Take off the mask and show your many faces.

2. Channel the flow of feeling: Have your feelings without your feelings having you.

3. Enough about them: Look deeply within for the sources of change.

4. Don't hold back: Forge an authentic connection with your therapist.

5. Be curious, not judgmental: Observe yourself honestly without attacking yourself.

6. Carry your fair share, and only your fair share: Differentiate when to take responsibility and when not to.

7. What's your story? Identify the recurring themes and fundamental beliefs that guide your life.

8. It ain't necessarily so: Build a better narrative and choose your beliefs consciously.

9. Do something! Continue your psychological work outside of sessions.

10. Into the fire: Use the challenges of your life as opportunities for growth.

It’s all good advice that hews to the experiences we have as therapists here in New York City. Patients who take an active role in their development and who continuously look for ways to understand themselves without judgment often do well in the analytic space.

To start your own psychoanalytic psychotherapy, please call or write us today.

A Poignant Piece About the Special Space of Psychoanalytic Therapy

A number of psychoanalytic therapists have been passing around this beautifully written piece from the New York Times. In it, the writer describes the strong and respectful relationship she always shared with the therapists who occupied the office next to her own. It is an unusual relationship: these are figures she sees several times a week, but they are people with whom she maintains a respectful distance, as accorded by the psychoanalytic endeavor and its emphasis on discretion. When one of those doctors grew slowly sick and eventually succumbed to illness, she was moved more than she ever would have thought possible:

Why am I sharing this small story? Perhaps because I love that psychoanalysis is a frame through which I have permission to pay close attention to peripheral vision, to things that are out of focus and not so conscious. Enigmatic dreams, childhood memories and mourning are all welcome, and they open me to my own feelings and to a wider range of human experiences.

Psychoanalytic therapy is about a great many things: communication, trust, exploration and facing that which is hard. It’s also about the small interactions that surround the therapeutic space, and how they cultivate a climate of emotional mindfulness.

At PPSC, we believe that psychotherapy can serve people’s health in uncountable ways, helping to ease depression, anxiety and a number of related maladies of the soul. If you’re interested in exploring what analytic therapy can do to improve your life, please contact us today.

Wrestling with Fertility in Analytic Therapy

We have written before about what happens when the veil of privacy lifts between a psychoanalyst and her patient, and about how such personal disclosures (by the therapist) can change the tenor of “the room.” This recent piece explores one of the most common issues that prompts therapists into candid conversations : pregnancy. As the author describes:

Traditional psychoanalytic theories envision the therapist as a blank slate on which patients project their thoughts and fantasies, a distant expert interpreting the patient from behind an inscrutable facade. Patient’s concerns are seen as problems the doctor can “fix” through psychological suturing. Contemporary psychoanalytic viewpoints, by contrast, have given rise to a very different understanding of the therapeutic alliance, one in which the relationship itself is ultimately what’s curative. But the therapist’s quasi-anonymity remains a central tenet. Patients might inquire about a therapist’s personal life, but unless it benefits the patient’s growth to answer the question directly, the therapist usually explores what the question means to the patient.

In practice, such questions become harder to avoid when a visible pregnancy enters the therapeutic space. The author of this piece wrestled with a number of approaches to manage and explore the feelings her growing belly inspired, but the responses for her and patients were often more personally charged than other conversations.

After negotiating a heartbreaking miscarriage and another pregnancy, the author describes how she has come to a sense of accommodation about discussing some personal issues surrounding pregnancy and childbirth with her patients, and how the work is often more beneficial for it:

There was a time when I would have reflexively asked Maya what my maternity might mean to her. But instead I considered revealing a small but profound piece of my life. What I hope to offer my patients now, in both subtle and demonstrative ways — shared and silent — are the arduous lessons learned through personal pain and reflection. Far from a blank slate, but no longer a focal point of the therapeutic relationship, I’ve landed somewhere in between, a much more ideal middle ground.

“Yes,” I began my reply to Maya. “I have two children.”

Psychoanalytic therapy is a deep and lasting process such feelings are worth exploring and where patients can make great strides in a safe space. To speak with an expert psychotherapist in New York today, contact PPSC.

Finding Low Cost and Sliding Scale Therapy in New York

It’s a common concern: where can I find low cost and sliding scale therapy here in New York City? The simple fact is that analytic therapy can be expensive over the long term, and many patients don’t have the financial means to make that kind of commitment. This PBS article gives you a way out. It’s a basic guide to the different avenues you may explore to secure lower fees and subsidized treatment. Although the author points toward several good sources, the most resonant advice in the piece is also the simplest:

The first place to check is with your current therapist. Many, but not all, therapists offer a fee service schedule for cash-only clients that may "slide" – that is, the fee goes down based upon your income. If you're making a middle-class salary, the discount offered by such sliding scales may not be much. But if you're in the lower socio-economic class, this discounted fee schedule can cut a regular therapist's fee in half or more.

Here at PPSC, we offer low cost therapy and sliding scale therapy across the board on a need-based basis. Our psychoanalytic psychotherapists are experienced in low cost structures, so often you simply need to engage your therapist in conversation to agree on a more viable fee.

To start your own affordable therapy in New York, contact us today.

Why Analytic Therapy Works

One of the byproducts of our science media’s sea shift toward evidence-based everything is that those of us who work in psychoanalytic psychotherapy are learning a little more about why this form of therapy works so well. Of course we have always taken an ongoing interest in how it works psychologically, but now there are some focused looks at precisely which parts of this process works the best, for the longest. Take, for instance, this recent piece, which tries to unpack why psychotherapy works when it does, and fails when it does. Unsurprisingly, the great benefit of analytic therapy rests on subjectivity, especially the relationship of transference/countertransference that defines the analytic space:

But we should keep things in proportion. Medications are way overused. Psychotherapy is way underused. Drug complications and overdoses are a serious public health problem. Psychotherapy complications are much less common. And much less severe. It would be a better world were there more therapy, less drugs.

Psychoanalytic therapy is a journey, and millions of people have experienced its lasting results. If you want to unpack some of the issues that may be holding you back, contact the Psychoanalytic Psychotherapy Study Center in New York City today.

One More Endorsement for Psychoanalytic Psychotherapy

We wrote recently about the growing number of think pieces dedicated to “rediscovering” psychoanalysis and calling for its return to the mainstream. (Some of us maintained that it never went away, but no matter.) This recent piece in Forbes makes the case as well as any of them, pointing not just to the lasting and substantive benefits of analytic therapy, but also to its increasingly strong showing in a number of empirical analyses:

For example, a 2013 randomized control trial demonstrated the efficacy of psychoanalytic psychotherapy for treating panic disorder. A 2010 meta-analytic review of available outcome studies showed that “empirical evidence supports the efficacy” of psychoanalytic psychotherapy. It further showed that the magnitude of change in psychoanalytic psychotherapy is “as large as those reported for other therapies that have been actively promoted as ‘empirically supported’ and ‘evidence based’.”

But the piece also identifies one of the key criticisms leveled at this kind of therapy, namely that its bespoke nature resists a one-size-fits-all training regime, or testing protocol:

Because psychoanalytic psychotherapy adapts technique to the unique individuality of each patient, it can seem to some like all art and no science. “Where’s the manual!” goes the cry. The fact is that psychoanalytic psychotherapists typically rely on research to guide the moment-to-moment decisions of a clinical encounter, especially infant development research and increasingly neuroscience. If CBT, as a way to illustrate, can be thought of as someone expertly playing sheet music, psychoanalytic psychotherapy is more like well-structured improvisational jazz.

Of course this isn’t a flaw, but the source of psychoanalysis’s prodigious strength—and the reason so many people of different beliefs and predilections find it singularly effective.

Our psychoanalytic therapists offer depression therapy, anxiety therapy, LGBT-friendly therapy and even low-cost therapy right here in New York. To get started right away, click here.

A Brilliant Author’s Defense of Psychoanalysis

If you don’t recognize the name Gary Shteyngart, you may have seen his endlessly witty verbal pyrotechnics in places like the New Yorker. Shteyngart is that rare writer who can capture the endless regression of our interiority without getting bogged down in all the sad parts. To what does he credit his prolific effectiveness, after a lifetime of false starts and cowering anxiety? A lengthy psychoanalysis that helped him surface all the issues that held him back. As one thoughtful piece in UTNE noted:

But psychoanalysis is a profound exploration of human subjectivity—our inner world with all its memories, desires, and impulses—and its relation to the external, objective world. And it is much more than a treatment. It’s also a set of theories about the complex nature of human experience. “Analysis is the most elaborate and nuanced view of the mind that we have,” Nobel-winning neuroscientist Eric Kandel recently told a meeting of the American Psychoanalytic Association.

The piece is part of a broader trend toward celebrating the rebirth of psychoanalytic therapy—or at the very least, disproving its premature death. After all, analytic therapy remains the most in-depth tool we have for enacting lasting change, and the studies bear this out:

Jonathan Shedler, an associate professor of psychiatry at the University of Colorado School of Science, has examined the efficacy of psychodynamic therapy—a term describing treatment based on psychoanalytic theory and methods but briefer and less intensive—for everything from depression and anxiety to panic disorders, personality disorders, and substance abuse. He has found that the benefits of psychodynamic therapy extend well beyond symptom relief.

“The benefits of newer therapies often start to decay after treatment ends,” Shedler contends. “Studies of psychodynamic therapies show that people not only look much better in terms of symptom relief, personality functioning, and social functioning after treatment, but also stay better. What’s more, they display continued improvement.”

The whole piece is worth a read, not least because it helps resolve some of the sticky debates between neuroscience and psychology, revealing both camps to be far less at odds than many have feared.

Want to get started with a psychoanalyst or low cost psychotherapy today? Contact PPSC here.

On Buddhism, Mindfulness and Psychoanalytic Therapy

We have written before about the subject of mindfulness in psychotherapy, especially since a growing body of literature suggests that both paradigms may have something to teach one another. Although they share a common goal of contentment, it has been noted that the two approaches are in a sense mirrors of one another:

The main challenge for each side in this dialogue is resisting the temptation to swallow the other. It's easy for a therapist to reject Buddhist awakening as an escapist fantasy, and just as easy for Buddhists to dismiss a psychotherapeutic focus on relationship problems as obsessing with past events rather than realizing one's true nature and living fully in the present. This temptation is aggravated by the fact that the cultural and historical gap between them is so great, which tends to activate Eurocentrism ("the intellectually imperialistic tendency in much Western scholarship to assume that European and North American standards and values are the center of the moral and intellectual universe," according to Jeffrey Rubin) or to idealize Orientocentrism ("the idealizing and privileging of Asian thought--treating it as sacred--and the neglect if not dismissal of the value of Western psychological perspectives"). If we are honest with ourselves, most of us have a bias favoring one side or the other.

This excellent and scholarly piece discusses some ways to resolve this tension, which would seem a worthy goal considering how many psychotherapists practice some elements of mindfulness and meditation. It is especially important because meditation and analytic therapy are directed at somewhat different issues; psychotherapy is concerned with causes, while mindfulness is concerned more with present experience.

[M]ore than a generation of Buddhist practice by committed Western students has made it apparent that meditation by itself is sometimes insufficient to resolve deep-rooted psychological problems and relationship difficulties. In its own short history the psychotherapeutic tradition has gained considerable insight into the mechanisms of denial, rationalization, repression, projection, and so forth, which can help us understand how Buddhist practice sometimes goes wrong--for example, the complicated transference/countertransference that can distort the relationship between therapist and client (or between teacher and disciple).

Of course both approaches show benefits, and both are concerned with liberating the mind from its tortures. There is also no question that mindfulness comes with great benefits, just as psychoanalytic therapy does.

Here at PPSC, we offer an eclectic approach to talk therapy that combine both schools of thought, and that constantly strives for the very latest ideas to help our patients. Contact us today to learn how you can effectively incorporate mindful approaches into your therapy.

Wait, Humans Have How Many Emotions?

A provocative new study out of Scotland studied human facial expressions – and our ability to read them – and came away with the conclusion that human beings are really only hardwired for four emotions:

This leaves us with four "basic" emotions, according to this study: happy, sad, afraid/surprised, and angry/disgusted. These, the researchers say, are our biologically based facial signals—though distinctions exist between surprise and fear and between anger and disgust, the experiment suggests that these differences developed later, more for social reasons than survival ones.

http://youtu.be/6ptmo8dAwwA

Of course the study looked only at computer-generated expressions, which are somewhat less nuanced than you get from actual people with actual emotions. And to see something in an instant is wholly unlike the experience of navigating real-world feelings such as anxiety, depression or love on a daily basis. One could be forgiven for calling this a study of responses rather than feelings per se, a point the authors concede:

"Our data reflect that the six basic facial expressions of emotion, like languages, are likely to represent a more complex set of modern signals and categories evolved from a simpler system of communication in early man developed to subserve developing social interaction needs," the authors wrote. By that they mean these four emotions are the basic building blocks from which we develop our modern, complex, emotional stews.

Other cultures might disagree, of course. And there is no question that these studies, while valuable, do not begin to address what happens when experience and circumstance combine into the puzzle of human psychology.

Want to explore more about analytic psychotherapy or psychoanalysis? Check out our analytic training programs here today.