What is Psychoanalysis?

By Holly Gordon, Psychologist/Doctor of Mental Health (DMH)

Psychoanalysis is a method of treatment that promotes self-understanding, with the goal of feeling freer, more in control of one’s life and more fulfilled in relationships. Psychoanalytic theory holds that there are struggling forces within us, fears or convictions we hold, which are unconscious and outside of our awareness. These push us to both behave and experience life and relationships in particular ways.

People use psychological defenses to protect themselves from bad feelings. For example, being clinging and guilt tripping may help a person feel that they have hooked the other, abating insecurity; bragging and adopting a superior attitude can cause one to feel important, not insignificant; being aloof may cause one to feel immune from relational hurts; exploding in anger when one feels slighted may dispel feelings of inadequacy. As these examples demonstrate, these ways of behaving may be self-destructive or cause unhappiness, but they feel immediately necessary to protect a sense of safety or self esteem. Defenses fool the client more than they fool anyone else, and that is the goal: to protect oneself from immediate psychic pain, no matter the consequences in reality of failed relationships, lost jobs, inhibited lives. In fact, people often seek psychoanalysis because their defenses no longer work for them. Either people see the cost of their behaviors, or troubling emotional states persist. Psychoanalysis seeks to understand the unconscious anxieties and needs that press the client to use these life-limiting defenses, to quiet the inner storm, which makes life so painful. The client can bring these emotions to the psychoanalytic relationship and address those hurts.

In psychoanalysis, the client comes 3-5 times per week and usually lies down on a couch with the psychoanalyst sitting behind them. The reason the couch is used is to free the client to be in touch with his or her feelings as they emerge in the psychoanalytic setting. When one is sitting up and looking at the therapist, the relationship is structured more like a conversation, and the client may be more focused on the responses of the therapist, with a need to keep up a back and forth conversation. The couch allows for thoughtful silences and reflections, and may permit a greater freedom about disclosing difficult issues.

A psychoanalyst is trained to listen for repetitive patterns, restrictions, and the effects of injuries. This focus includes noticing how the client experiences the analyst’s intentions and attitudes, so as to better understand the unconscious maps of him/herself in the world that the client holds. Often the relationship with the analyst comes to contain many of the frustrations and fears that have characterized the client’s early relationships, or the attitudes that the client has come to hold toward him or herself. This is called “transference”.

By having an emotionally active relationship of exploration with the analyst, the client comes to see motives and fears that he/she never fully understood before. This is referred to as “insight”, a greater awareness of our shaping fears and how we cope with them. Psychoanalysis can be a safe place to feel and explore feelings never before tolerated or faced. By bringing these fears into the light of a safe relationship with the analyst, the client can reconsider whether he/she needs to be ruled by these forces. Our memories are stacked in our brains according to emotional salience, and when the client can experience emotions similar to painful emotional dilemmas in the past, old memories are awakened and attitudes that accompany them can shift according to the new relationship with the analyst.

The relationship with the analyst is also supportive of developing selfhood, as the analyst listens for emerging or inchoate aspects of inner life, and helps to bring words to never before known parts of the self. The analyst’s words, which capture subtleties and varied aspects of the client’s experience, come to form a kind of emotional scaffolding for emerging awareness. The relationship is collaborative, as the analyst offers reflections about how he/she understands what is troubling the client and the client’s response helps to fine tune that mutual understanding. Bringing these feelings about ourselves to the psychoanalytic relationship and discussing them in a nonjudgmental and caring setting frees the client to have different perspectives, be more creative, and less driven by anxieties.

Who is the best client for psychoanalysis? Since psychoanalysis requires a significant commitment of time, effort and money (although psychoanalytic institutes offer reduced fee psychoanalysis to people who are seen by analysts in training and many established analysts also offer fee reductions), one must feel that one’s problems are having a significant impact on one’s life, and to feel that the source of these problems originates in one’s outlook, emotions and behaviors. I recommend psychoanalysis when both the client and I see that the problems are well-established in the personality, for example the client is unable to stop trying to control all situations and people in his/her life; or the client is unable to engage emotionally, remaining always in a thinking mode; or the client feels that all experiences will be or are disappointing. The third condition that leads me to recommend psychoanalysis is the ability of the client to use self-reflection to develop a fuller picture of internal mental life, and to benefit from that increase in perspective with freer choices, changed outlook or increased emotional capacities. Psychoanalysis is most effective when the problems are well established in the personality, psychological in nature, and the client is able to use insight to expand his or her potential.

I love working psychoanalytically because I feel that psychoanalytic theory offers the most comprehensive model of how the mind works, allowing for the complexity of emotional life. Contemporary psychoanalysis also incorporates findings from brain research, attachment research, social theory, and fields of gender and sexuality, in order to most deeply reach our clients.

Holly Gordon, DMH, San Francisco, CAAbout this Contributor: Holly Gordon DMH (Doctor of Mental Health) is a psychologist who practices in San Francisco seeing adults, adolescents and couples. She is a member of San Francisco Center for Psychoanalysis where she teaches candidates in the Extension Division, and she is an Assistant Clinical Professor in Psychiatry at UCSF. She received the American Psychoanalytic Association Edith Sabshin Award for Excellence in Teaching. She has been in practice for over 25 years. 

To find out more about Holly Gordon, visit her website at www.drhollygordon.com.  

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