Many people, including those in the field of psychotherapy and psychoanalysis continue to debate the nature of psychoanalysis. With so many schools of thought, and within those schools, so many different personalities and individual interests, psychoanalysis has become anything but monolithic. At its core it offers a space in which to speak about the life of the patient in as depth as the two participants can accept for the purpose of promoting the best life the “patient” could hope for. Psychoanalysis, I believe, is enriched in this regard by drawing more explicitly from fields like philosophy, religion, sociology, linguistics, and other fields of study to offer people not only a place to vent their difficulties, but a direction, some guidance and a framework in which to understand ones life choices and one’s deepest motivations.
It is highly problematic when an analyst’s world-view overshadows that of her patient. For obvious reasons of respect for difference and for the multiple ways in which people seek fulfillment in life, the patient’s world view should always be the primary focus of any psychological treatment. Understanding and expanding on the “patients” life choices, circumstances and motivations though has not always been the primary goal of psychoanalysis. From its early days and deeply influenced by its historical time of inception, psychoanalysis as a practice was more about aligning patients with “reality”. Freud believed that people’s problems in living were related to their fixation, their arrest in early infancy needs that never matured to an adult level of acceptance of “reality”. The analyst’s role was to help the patient overcome their infantile desires and fears, and accept a more mature and less narcissistic, self involved life.
Today psychoanalysis is highly aware of the ways our personal and individual ways of growing up, living within families and social conditions and within certain cultural surrounds impact who we are as people. It is highly aware of the needs of children to adapt to these worlds and thrive as best they can within them. Part of that thriving is to learn the ways of the world from the people we rely on the most. We learn how to be and we learn who we are from those who care for us and from the world around us internalizing rules, lessons, identities and possibilities for ourselves and our futures. Psychotherapy seeks to become aware of these influences and how they might have shaped us and confine us to limited ways of being.
It was an interesting development in psychoanalysis (psychotherapy I use as a synonym) when it included within its sphere the ways in which the therapist’s own ways of being and her own values, learned from their own upbringings had an impact on the therapeutic setting. Inevitable as this was it placed an interesting responsibility on the patient to speak directly to the “analyst” as to how that personal impact impacted them. Therapy became then highly influenced by metaphors of dialogue between equals, discussions, a mutual challenging and expanding of minds in both directions. While the patient might have lost an “all knowing” “expert” therapist who could tell them what to do and to distinguish between right and wrong, they gained a thinking partner and would have to accept more of the responsibility of their life choices, their agency and freedom.
As opposed to some who preferred to keep psychoanalysis an esoteric and mysterious practice of psychological treatment, therapy’s healing potential derived more from a down-to-earth humanistic person to person dialogue that it offered. The psychoanalyst/therapist offers themselves as a mentor, friend, sometimes parent and fellow traveler on the sometimes difficult paths of life. Even though some might still wish the therapist be a magician of sorts, a medical doctor one brings an ailment to and is offered a cure, the psychological therapeutic relationship now requires both people to engage in a deep discovery of what it means to be alive and how one’s emotional life is deeply connected to one’s past and to one’s hopes and goals for the future.
When Freud developed his method of psychoanalysis he was under the influence of the thinking of his time. Victorian, repressive and very rational Vienna was observed by Freud as masking other more irrational forces in the human mind and he believed the repressive nature of his culture was a cause for many of the psychological problems people faced. His focus primarily was on sexuality and how culture forced a repressive hand on this natural and biological force. He was also influenced by the very optimistic belief that science and the rational mind could access “reality” as it is and that there was a clear distinction between reality and its distortion by the “sick” mind. His method of treatment was to allow the irrationality of the patient’s mind (the patient’s sexual and aggressive drives) to unfold and through “interpretation” (telling people what was really the case) have rationality conquer the irrational. The childish would give way to the adult.
Today we have a much different cultural environment. Authority is questioned, diversity of thought is valued, individualism is prized and one’s true “nature” is more complex than the couple of drives Freud postulated should be relinquished for the sake of maturity. Our concepts of right and wrong are in flux and our ideas of what ails people and makes life difficult have become more tolerant and humanistic. In addition and as a major cultural force, postmodernism and feminist thinking has allowed for a much more pluralistic notion of life and the values we hold dear and has recognized the hubris in any dominant cultural thinking. With those changes, psychoanalysis has gone from a profession that seemingly “knows” what is healthy and what is sick, that places the authority of the psychoanalyst above the authority of the “patient”, to a profession that allows and invites plurality of meaning and makes the reality of the patient be the central narrative. The curative aspect of psychoanalysis under this new focus is to hear (some might say to “bear witness”) as much as possible about the patient. Their thinking, their beliefs, values, fears and desires must unfold in the context of a safe and curious environment. Then we must help understand with the patient the function of these beliefs and values. What purpose do they serve? What are their benefits? Which beliefs and values lead to some of life’s difficulties? What might be the cost of giving some of them up? Where do they become overly rigid and where can a degree of flexibility be introduced? Rather than fix (or shrink), we try to learn more and expand.
The belief in psychoanalytic thinking that has influenced my opinion the most is that people are conflicted between their need to have secure and loving relationships with significant others and their need to become more themselves. Our identities, who we are to ourselves, is something we seek to be affirmed and even admired and yet we all have our identities and beliefs challenged by the world and by our day to day life. Others opinions of us, what we fear others will think of us, the fear we will lose the close connections we rely on significantly impact our self esteem and sense of worth. Self worth, connection to others, a sense of competence and usefulness is of central primary value and the extent to which these are threatened people can suffer psychological difficulties. We are after all a social animal that require connection, love, support, safety and a healthy degree of competition to maintain our sense of well being. It is sometimes this desire for connection to how we see ourselves, to what we have learned from our parents and culture that can keep us stuck in old ways of living that have passed their use-by date.
Emotionally speaking one can understand that a person (“patient”) might wish to seek out an expert in living. Someone who knows all the answers and can tell you what is “wrong” with your life and “know” how to fix it. It makes sense that we would all seek that out. Even psychoanalysts might turn to their books, their theories and hold on for dear life because it offers a direction. Answers. It offers authority and a clear sense of what one should do. In relation to that Id like to have two thoughts that seem to contradict each other. One is that we as psychoanalysts are responsible for having some ideas of what makes life problematic. We are obligated and should actually be hungry for the many answers that our cultural histories have offered us in relation to what makes life hard for us as humans. Eastern and Western religious and philosophical practices have taught us a lot. Buddhism, Existentialism, the multiple philosophies of language, ethics and consciousness, sociology, and anthropology have all given us so much to think about and apply to our work with people seeking life guidance. But the second thought is that we must be humble too. Practice humility when it comes to answers. There are many answers. Some better than others. But the beauty of psychoanalytic treatments, as they are hopefully practiced today, is that it allows the patient, the one seeking help to also become an expert on their own lives. To know themselves and become the authority in their own life that can make important decisions, live courageously and become a loving presence to others who might see the world also a bit differently from them.
For my colleagues reading this I believe I am advocating that our main task be to help people feel more alive and courageous in their lives. Courageous to think for themselves, become themselves, to be more caring of themselves and of others and for this we must do the same. I am advocating here for a wise, rational, human and kind form of psychoanalysis that sees the value in people, in their efforts to live a good life (as misguided as they might be at times) and for the heroic attempts to face the challenges of insecurity, heartbreak, disappointment, tragedy and even death with courage, love and compassion.