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.

Navigating Transference in Psychotherapy

Most of us who work in psychoanalytic psychotherapy owe a debt to Sigmund Freud, whose first steps defining the field shone a great light on the role of our unconscious minds. Freud’s body of work is not without its flaws, but his insights across a broad diversity of subjects have more or less stood the test of time. One of the issues Freud took particular interest in was the dynamic of the therapist’s office. Analytic therapists are generally discouraged from revealing too much about their personal lives, for fear of staining the therapeutic process with unwelcome details. As a recent New York Times piece described it:

In psychoanalysis, there is a specific rationale for this rule. The theory holds that patients tend to re-enact with therapists the relationships they had with their parents. This is called transference. By paying careful attention to this unfolding drama — as it plays out, right there in the office — the therapist and patient can uncover and resolve childhood conflicts. If a therapist interjects information about herself, she clouds the mirror and compromises the process.

Follow this story to its conclusion, however, and you can see how the benign neutrality of the therapist might come to be seen as a hindrance in some cases, even an act of hostility. In the case study within the piece, a patient desperately needs a sense of reciprocity, even a shallow one, in order to build the trust necessary to do the work:

As therapy continued with her, I heard how flat and tinny I sounded whenever I attempted to analyze what was going on between us. When I lapsed into too clinical a mode, our connection would wobble, and her alienation became palpable.

No two talk therapies are the same, and of course every psychoanalyst develops her own approach and rhythms. Learning and adapting is part of what makes an effective therapy worthwhile, for patient and therapist alike. If you’d like to embark on a journey to address longstanding feeling of depression, anxiety or loneliness, please contact the expert NYC therapists of PPSC today.

Road Rage and Transference: Traveling Companions

A grisly road accident that seemed to have no specific cause began garnering attention recently when witnesses helped authorities piece together what happened:

Other drivers that had been on the road at the time described two cars that had been engaging in “a deadly road-rage game of cat and mouse,” as cops told a local NBC reporter. One car was aggressively pursuing the other; when one car flipped and crashed, witnesses said, the other one “just kept going.” Police said that the 27-year-old woman’s death was “being treated as a case of road rage.”

What is road rage? It is a disproportionate response, of course. Road rage arises when a minor slight – getting cut off, being tailgated – becomes first a cause, and then a mission. Revenge fantasies which might otherwise evaporate in an instant are made manifest through the mighty instrument of the car itself. Drivers accelerate wildly, jockey for a “winning” position, and trade epithets as best they can.

That road rage is self-evidently dangerous seems unable to discourage its practitioners. Even though this behavior can and does lead to injury or death, these concerns seem to hold no water against the overwhelming compulsion to enact payback.

What is going on here? Feelings this sudden and powerful are rarely just about the present. One psychologist consulted for this story hit the nail on the head:

He says that the psychological root of this behavior is often something called Hostile Attribution Bias—the belief that every accidental injury or threat is purposeful, and personal. People with IED over-personalize every interaction, and then over-react with immediate aggression.

Jargon aside, this description nicely mirrors the notion of transference in psychoanalytic thinking. Whether you want to call this irrational response road rage, IED, or transference, the mechanism is much the same. Deeply emotional memories inform the things we do and feel well into adulthood, imbuing them with resonances that do not always reflect visible reality. If feelings of helplessness were a theme in your childhood, for instance, you might respond in an unduly explosive way to any gesture that causes you to revisit those feelings, no matter how small – a reaction which can look “crazy” to an outside observer.

The only way to unlock how your past may be coloring your present is through psychoanalytic therapy. Here in New York, PPSC is home to dozens of psychotherapists who can help you understand why overwhelming feelings are still dictating your behavior and holding you back – and help you resolve what is behind them.