Treatment

If you are reading this, you may be hurting or struggling, unable to find your way forward in life. You may also be uncertain about who to turn to, because there are many people who call themselves counselors or psychotherapists. What sets us apart is an intensive training that gives us a deep understanding of how the mind really works, not only in illness but also in health.

Indeed, the human mind is capable of astonishing achievement. We enjoy this achievement every day in the music we listen to, the art and architecture that surround us, the technologies that bring us into proximity with one another and the political compacts that keep the peace within and between our nations. And when our own mind works right, we can enjoy immense creativity, both personally and professionally, in meaningful, loving relationships and in productive, exciting work endeavors.

But divided in conflict and turned against the self, this same profoundly creative mind can also produce the distressing symptoms of depression, anxiety, and psychosis; painful states of being such as low self-esteem and the inability to enjoy life; relationships that are throttled or tragically ended by lack of trust and fear of intimacy; and careers that never get launched or end in failure.

Psychotherapy can help to resolve the inner conflicts that create all this anguish. It can–and does–lead to the discovery of parts of ourselves we did not know existed or were too afraid, on our own, to explore in any depth. More open to ourselves, we are, through psychotherapy, more open to others and more able to embrace the challenges that life brings our way. Over time, we become freer to make better choices in relationships and in our careers. We become more authentically ourselves and able to lead richer, fuller, and more meaningful lives.

The psychotherapy that is offered by our clinicians is known as psychoanalytic or psychodynamic psychotherapy, because it explores unconscious as well as conscious mental processes, and because we focus on the ways in which these processes are always dynamically at work to shape our experience of ourselves and others. In this treatment, the patient meets face-to-face with his or her therapist one or more times per week in sessions that typically last 45 to 50 minutes. Sometimes the duration of treatment is just a few months. Sometimes treatment can last several years or longer. Sometimes, psychotherapy leads to psychoanalysis.

Regardless of its duration, psychodynamic psychotherapy covers a range of topics, including the patient’s current symptoms, past experiences, significant recurring thoughts and feelings, fantasy life and relationships with others–including with the therapist. Together, patient and therapist explore these topics in order to understand the unconscious narratives in the patient’s mind that have given rise to his or her symptoms and conflicts.

Psychodynamic psychotherapy is the offspring of psychoanalysis.

Psychoanalysis was the first psychotherapy and today remains the gold standard of treatment for many psychiatric and neurotic disorders. Developed by Sigmund Freud over a hundred years ago, psychoanalysis involves frequent sessions–often four to five times per week–in which the patient, or analysand, lies on the couch and the analyst sits behind the analysand or just out of the analysand’s view. Because of the frequency of sessions, the analysand can explore in depth feelings and issues that otherwise might be overwhelming or too threatening to examine in once or twice weekly psychotherapy. Because the patient is recumbent and freer to focus on his or her own thoughts and feelings than on the listener’s responses, material that might not come to awareness in face-to-face psychotherapy can become an integral part of the psychoanalytic process. It is not surprising that patients often describe their experience of psychoanalysis as both emotionally challenging and profoundly supportive.

Psychoanalysis is a deeply creative therapeutic process. It engages the mind on many levels, mobilizing memories, feelings, spontaneous and sometimes surprising thoughts and associations, dreams, and fantasies. No topic is off-limits for discussion during the analytic session. Over time, one topic, the patient’s experience of and relationship with the analyst, may become especially salient. While the patient’s experience of the analyst is of course shaped by the actual person of the analyst, it is also powerfully influenced by the patient’s childhood experience of his or her parents and other significant family members and individuals. The analysand at various times may feel idealizing or contemptuous of, loving or angry toward, or erotically attracted to the analyst. Sometimes, the analysand discovers that he or she is profoundly blocked in the ability to experience feelings of any kind or of a certain type. As these feelings and impediments to them are explored, the analysand feels safer and consequently more able to experience a wide range of thoughts and feelings in the treatment. In this way the treatment deepens, which in turn facilitates a deeper, more authentic engagement by the analysand in his or her life outside the treatment.

In order to safely and skillfully guide patients on their analytic journeys, the analyst needs to be able to understand and work with feelings and fantasies of his or her own that may be stirred by the analysand. For this reason, psychoanalytic treatment is always conducted by an analyst who has had extensive training, usually over four or more years, including coursework, supervision, and his or her own personal analysis.

In addition to being a method of treatment, psychoanalysis is also a theory about the human mind. As such it can enrich our understanding of human behavior across a wide range of areas, including politics, business, the arts, literature, and education. With respect to politics, for example, psychoanalysis shows us that individuals have a deep and largely unconscious need to idealize their leaders. When leaders and others in positions of authority disappoint these idealized expectations, people can become angry and vengeful, and they may act collectively in ways that are contrary to their own interests. In the area of literature, we find all the themes of greed, lust for power, envy, ambition, isolation, loneliness, and deep longing for attachment that so painfully and powerfully infuse the day-to-day work of an analytic treatment. And in the field of neuroscience, exciting recent advances have led to a richer understanding of the relationship between brain and mind and of the biological basis for the clinical efficacy of psychoanalytic treatment.

Finally, beyond the couch and the classroom, psychoanalytic activity also takes place in the community. Although this application of psychoanalysis is less well known, psychoanalysts have been deeply engaged in the larger communities and societies in which they live and work from the earliest years of psychoanalysis. One example of this public mindedness is the spread of free psychoanalytic clinics throughout Europe in the early 20th century. The spirit of the free clinic movement survives in the training clinics of today’s psychoanalytic institutes, which routinely offer sliding-fee psychoanalytic treatment to patients who otherwise could not afford it.

Psychoanalytic insights can also make a difference in efforts to resolve political conflicts and to meet pressing social needs. Psychoanalysts throughout the world have been active in finding ways to ameliorate the deeply entrenched antagonisms that fuel ethnic conflict and in efforts to reduce urban violence. In our own country, psychoanalysts have developed programs to decrease school bullying, work with city governments, and educate parents and teachers in order to prevent experience-derived emotional disorders.