Psychoanalysis
Psychoanalytic Psychotherapy
Clinical Consultation

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Psychoanalysis

It is difficult, if not impossible, to define psychoanalysis in a few words. At one level it can be defined as a method of treating mental disorders developed by Sigmund Freud and his followers, based on the idea that mental life operates on both conscious and unconscious levels and that early life events, and how we interpret them, exert a powerful influence throughout life. Accurate as this is, it doesn’t say anything about what it’s like to engage in analysis, which is generally what people want to know when they ask—what is psychoanalysis?

This important question is not easy to answer for several reasons. First, the method involves close attention to the patient’s spontaneously occurring thoughts and feelings, the course of which cannot be known in advance by either patient or analyst. Second, we live in a culture that privileges conscious mental functions and gives short shrift to the sway of unconscious processes in shaping our experience of ourselves and of others. Moreover, we are used to things being “explained” to us rather than having someone to help us create the conditions for having an experience of our own—finding out what we think, what we feel, consciously and unconsciously.

Nevertheless, having experiences in the presence of another, watching them take shape in our minds and noticing how they change over time is an indispensible part of being what we call our self. And developing a robust and resilient sense of self grounded in emotional experience is often felt to be an outcome of embarking upon and completing the psychoanalytic voyage.

Easier to describe are the conditions or circumstances in which a psychoanalytic process is likely to occur. First, the person offering psychoanalysis must be trained to provide this unique form of treatment. Second, the person interested in having an analysis must understand the requirements of this collaborative type of treatment and give their consent. Typically, analysis involves 50-minute sessions at designated times of the day, four to five times weekly. It is often difficult for those who’ve not had such an uncommon experience to understand how the frequency of sessions supports the analytic process. For this reason, some find it useful to engage in an introductory or trial analysis for a period of a month or two as part of evaluating whether to go ahead with full analysis. Others who’ve had previous psychotherapy and are familiar with the benefits and limitations of less frequent treatment may feel comfortable beginning analysis upon completion of the assessment process, assuming it is the modality recommended by the analyst.

As for the subjective effects of treatment, whether psychoanalysis or psychotherapy, these will vary from person to person. Each person brings a distinctive set of present day concerns and a unique personal history to the treatment situation. Similarly, the analyst will apply the accumulated wisdom of psychoanalytic theory and practice in various ways according to the needs of each patient. Given these variables it is difficult to predict—and perhaps this is one of the best things about analytic process—how one may feel changed as a result of engaging in analytic treatment. That said, most who have had the experience agree that analysis provides an opportunity to discover and share one’s thoughts and feelings more openly than is normally possible in human relationships. And, as the novelist Gombrowicz puts it, “States which we live through and share openly with someone else are not a threat, but without a partner they become unbearable.” Psychoanalysis is, among other things, a curative partnership founded on this profound and simple truth.

Psychoanalytic Psychotherapy

Psychotherapy is a general term used to describe the treatment of emotional disorders by psychological methods. Psychoanalysis and psychoanalytic psychotherapy are related forms of treatment aimed at addressing the present day causes of emotional distress and fostering healthy development. Both are based on psychoanalytic principles, including an appreciation of the role unconscious mental processes play in shaping how we feel about ourselves and others. Both employ the medium of the therapeutic relationship to investigate patterns of relating that interfere with wellbeing and to nurture the ongoing possibility of emotional growth.

The major difference between these two modalities, at a practical level, is intensiveness related to the frequency of sessions. Psychoanalysis involves meeting four to five times weekly, whereas psychoanalytic psychotherapy is conducted on a once to three times weekly basis.

The literature on therapeutic outcome* suggests a synergistic relationship between frequency and duration. That is, multiple sessions per week widen the aperture for observing what is normally difficult to detect—submerged or subtle dimensions of one’s spontaneously occurring thoughts and feelings. Increased attention to these phenomena increases the emotional intensity of the treatment, which in turn facilitates internalization of the growth-promoting aspects of the analyst’s presence and of the analytic relationship. Moreover, the data on efficacy indicates that the longer the treatment continues (toward a natural ending) the more likely it is to endure as a stable part of the patient’s inner life after treatment is concluded.

The reasons for seeking professional help from a psychoanalyst or psychoanalytic psychotherapist are innumerable. A life changing event or circumstance—marriage, childbirth, death of a loved one, divorce, personal injury, unexpected illness, or sudden improvement of one’s position through promotion or professional recognition—can sometimes overwhelm one’s inner emotional resources resulting in unwanted symptoms and maladaptive coping strategies. When support from family and friends are not sufficient to help regain one’s inner equilibrium, psychoanalytic psychotherapy may be useful in addressing emotional suffering and preventing the development of more serious difficulties.

The decision to engage in either form of treatment—psychoanalytic psychotherapy or psychoanalysis—is often complex and always dependent on a number of variables, including the extent and severity of emotional distress, capacity for introspection, curiosity about one’s own emotional makeup, available time, and financial resources. In many cases, psychoanalytic psychotherapy (once to three times weekly) is entirely adequate to address the sorts of concerns that initiated seeking professional help. In other cases, when maladaptive ways of reacting to inner and outer stressors have become habitual or entrenched, it may be beneficial to receive full analysis. In any event, the decision about whether mental health treatment is indicated and the format will be addressed during the assessment process which typically extends over several sessions.

* For an overview of the research evaluating psychodynamic treatment and the relationship between frequency, duration, and outcome click on either of the links below:

1. “The Efficacy of Psychodynamic Psychotherapy” by Jonathan Shedler, PhD.

2. “The Effect of Frequency and Duration on Psychoanalytic Outcome: A Moment in Time” by Allan Frosch, PhD, FIPA.

Clinical Consultation

Clinical consultation refers to the process of a therapist conferring with a colleague identified as having expertise in a special area of clinical practice or in a particular theoretical orientation, or both. Supervision is also a form of consultation with the added implication of legal responsibility on the part of the supervisor for the therapist’s clinical work. However, whether a consultant calls themselves a “consultant” or a “supervisor” has little to do with the actual legal responsibilities involved in the relationship with the therapist. More significant is the therapist’s situation with respect to licensure. If the therapist is post-graduate and accruing hours toward licensure, he or she will likely need to obtain consultation from a Washington State approved supervisor. If, on the other hand, the therapist is already licensed as a mental health provider, he or she holds a higher degree of responsibility for their own clinical judgment and practice. In either case, information shared with the consultant is privileged and confidential, just as with any mental health treatment relationship.

In terms of the philosophical base of clinical consultation, there is a long history in psychoanalysis toward the value of experiential education and mentorship. Learning the art and science of psychoanalysis is pursued through didactic study, personal analysis, and supervision of clinical work. A basic assumption of this approach is the belief that understanding human mental life requires more than academic study or conscious intellectual effort. Moreover, as stated in the sections above, it is taken as a given that emotional life operates simultaneously on both conscious and unconscious levels. This means that there are limits to what one can know about one’s self or another—a built in “blind-spot” so to speak. Put simply, it takes (at least) two minds to know one. This is the starting point for the efficacy of psychoanalysis or psychoanalytic psychotherapy as forms of treatment. It is also the basis of the point of view that all mental health treatment providers (regardless of theoretical orientation) need clinical consultation, at times, throughout their careers to facilitate learning and ensure the highest standard of practice.

Consultation is provided individually or in small groups. One-to-one consultation allows for the greatest degree of focus on the therapist’s work with patients. Group consultation provides an opportunity for learning from others in addition to sharing and receiving feedback on one’s own clinical material. There are advantages and limitations to either modality that can be discussed during the initial telephone contact prior to scheduling a consultation appointment.

As with treatment, the reasons for seeking consultation will vary. Sometimes the therapist feels out-of-their-depth in terms of how best to approach a complex set of concerns that a patient brings to the beginning of treatment. In other cases a therapist trained in one approach may be curious to learn more about another orientation as a way of expanding one’s theoretical understanding and clinical skills. Then, too, there are times when very seasoned and well trained therapists need the containing presence of another’s mind to hold the emotional turbulence associated with psychological growth in psychoanalytic psychotherapy or psychoanalysis. The additional layer of support provided by consultation often helps to illuminate transference/countertransference dynamics that, when recognized, free the therapist to approach their clinical work more creatively and effectively.

Therapists interested in learning more about my theoretical orientation and qualifications as a consultant and supervisor are invited to read more in the About section of this website.

Teaching, Training, and Professional Presentations

As a clinically experienced and highly trained psychoanalytic psychotherapist and psychoanalyst I have taught post-graduate courses and given presentations locally, nationally, and internationally. This partial list of titles offers a sample of the subjects I have taught or been invited to address in conferences, scientific meetings, and post-graduate courses for mental health professionals.

Love, Envy, and the Longing for Oblivion in Wagner’s Tristan and Isolde

Building Blocks for Clinical Practice: Ethical Mental Health Practice

Negative Therapeutic Reaction: Why We Sometimes Bite the Hand that Feeds Us

Varied Approaches to Treating Anxiety: A Psychoanalytic Perspective

Visiting a Parent-Infant Mental Health Clinic in South Africa

Infant Observation

Working Analytically with Parents and Infants

A British Object Relations approach to Parent/Infant Psychotherapy

Words, Quietude, and Wonder: Verbal Discourse and Silence in the Analytic Hour

Learning to Think: Psychoanalytic Consultation and the development of Psychic Space

The Energetic Impact of the Therapist’s Laughter in the Psychotherapy of Adults with a History of Physical or Sexual Abuse

Object Relations, Self Psychology, and the Body

A Bioenergetic Understanding of Somatization

Mother’s Body and Daughter’s Emerging Sexual Identity

Positive Uses of Projective Identification in Psychotherapy with Borderline Patients

Female Sexual Development: Completing the Oedipal Task

The Role of Ambivalence in Creating and Dissolving Therapeutic Impasse

Theories of Substance Abuse: Implications for Clinical Social Work Practice