Psychoanalysis • Psychotherapy • Consultation
It is difficult, if not impossible, to define psychoanalysis in a few paragraphs. At one level it can be described as a method of treating emotional disorders developed by Freud and his followers, based on the notion 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 the experience of analysis, which is generally what people want to know when they ask—what is psychoanalysis?
This question is not easy to answer for several reasons. First, the analytic method involves attention to spontaneously occurring emotional experience in the analytic hour, the nature of which cannot be known in advance by either party. Second, we live in a culture that tends to privilege rational thought and conscious cognition over unconscious thought processes (reverie and dreaming) without understanding how they’re linked. Nevertheless, the analytic method is designed to create an environment in which the connection between these two realms of experience can be observed and meaningfully interpreted by the analyst and patient working together.
Although difficult to describe, engaging in an analytic process over time can be transformative precisely because most enduring emotional change takes place outside of conscious awareness. For example, a patient who was previously impatient and rageful with their spouse and children notices feeling calmer and less reactive. Or a patient suffering from chronic insomnia and nightmares begins to have nights of more restful sleep and less frightful dreams. Or a patient who has struggled for years with unbidden thoughts of self-harm suddenly realizes the relative infrequency of these fantasies.
Although conscious striving for change is not a necessary ingredient for a successful analysis, other elements are. Chief among them is an attitude of introspective curiosity and the courage required to honestly report one’s innermost thoughts and feelings no matter how irrelevant or, at times, unacceptable they may seem. Additionally, being able to commit to a mutually agreed upon schedule that typically includes three to five sessions per week.
As for the subjective effects of treatment, whether psychoanalysis or psychotherapy, these will vary from person to person. Everyone brings a distinctive set of concerns and a unique personal history to the treatment situation. Similarly, the analyst will apply her intuition and conceptual understanding in various ways according to the needs of each unique analytic partnership. Given these variables it is difficult to predict—and perhaps this is one of the best things about the process—how one may be transformed by analytic treatment. That said, many who have experienced this form of treatment feel that it provides an opportunity to discover and share a fuller range of one’s thoughts and feelings than is normally possible in human relationships. As the novelist Witold 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.
Psychotherapy is a general term used to describe the treatment of emotional disorders by psychological methods. Psychoanalysis and psychodynamic 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 forces play in shaping how we perceive ourselves and relate to others. Both employ the medium of the therapeutic relationship to investigate patterns of relating that obstruct wellbeing, nurturing omnipresent possibilities for emotional growth.
The major difference between these two modalities, at a practical level, is related to the frequency of sessions. Psychoanalysis involves meeting three to five times weekly, whereas psychodynamic psychotherapy is conducted on a once to twice weekly basis.
The literature on therapeutic outcome* suggests a synergistic relationship between frequency and duration. That is, multiple sessions per week widens 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 analytic relationship. Moreover, the data on efficacy indicates that longer term treatment is 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 analytic treatment 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 is not sufficient to help regain one’s inner equilibrium, psychodynamic psychotherapy may ameliroate emotional suffering and prevent the development of more serious difficulties.
The decision to engage in either form of treatment—psychodynamic psychotherapy or psychoanalysis—is often complex and dependent on several variables, including the severity of emotional distress, capacity for introspection, curiosity about one’s own emotional makeup, available time, and financial resources. In many cases, psychodynamic psychotherapy is adequate to address concerns that motivate seeking professional help. When there is a desire for a more immersive treatment experience or when maladaptive ways of reacting to inner and outer stressors have become habitual or entrenched, psychoanalysis may be preferable. In any event, evaluation of which modality is most appropriate will be addressed during the assessment process which typically extends over several sessions.
* For an overview of the research evaluating analytic treatment and the relationship between frequency, duration, and outcome click on the links below:
Consultation refers to the process of a psychotherapist or psychoanalyst conferring with a senior colleague identified as having expertise in a specialized area of clinical practice or in a particular theoretical orientation, or both. Supervision is a form of consultation with the added implication of legal responsibility on the part of the supervisor for the supervisee’s clinical work. For example, if a therapist is post-graduate and accruing hours toward licensure, he or she will need to obtain consultation from a Washington State approved supervisor. In either case, information shared with the consultant/supervisor is privileged and confidential, just as with any mental health treatment relationship.
In terms of the philosophical roots of consultation, there is a long history in psychoanalysis 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 and conscious intellectual effort. Moreover, as stated in the sections above, it is 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 oneself or another—a built in ‘blind-spot.’ Put simply, it takes (at least) two minds to know one. This is the starting point for the efficacy of psychoanalysis or psychodynamic psychotherapy as forms of treatment. It is also the basis of the view that all mental health treatment providers (regardless of theoretical orientation) can benefit from clinical consultation throughout their careers to ensure continued learning and the highest standard of practice.
Consultation is provided individually or in small groups. Individual consultation allows for the greatest degree of focus on a colleague’s clinical work. Group consultation provides an opportunity for learning from others in addition to sharing and receiving feedback on one’s own work with patients. There are advantages and limitations to either modality that can be discussed during the initial telephone contact prior to scheduling a consultation appointment.
Colleagues interested in learning about my qualifications as a consultant and supervisor are invited to read more in the About section.