Wednesday, April 22, 2015

Psychoanalysis Today

In the old days psychoanalysts never shared details about their personal lives. Aspiring to perfect blankness, they wanted to incite their patients to mistake them for someone else.

At times they had from their patients’ line of sight. At other times they remained silent for an embarrassingly long time.

If you don’t know who you are talking to, you are very likely to take that person for someone he is not.

Analysts believed that patients who indulged this form of mistaken identification would naturally evoke people from their past.

Were they to justify their practice, psychoanalysts will tell you that their neurotic patients are incapable of relating to real, live human beings. They are trapped in their past history and trying to escape it.

So said Freud, and most analysts have not gotten very much further.

Of course, the Viennese neurologist did not explain why he held such a bleakly negative view of his patients’ competence. Surely, they were not entirely trapped in the past.

And he did not explain, to anyone’s satisfaction, why people who are trapped in the past or in their dreams or in their fantasies can best escape by getting more involved with their past, their dreams or their fantasies.

Evidently, helping their patients to engage with their lives, to become active participants in their lives, to learn how to conduct and manage their lives… these were outside of the purview of serious psychoanalysis.

Of course, analysts were allowed to speak on occasion, but when they did they were limited to interpretation. They did not tell their patients anything of their ideas. They did not share anything about their own lives. They explained what their patients meant to be saying. By interpreting they tried to make good Freudian sense of their patients’ free associations.

It sounded like this:

“You are talking about trees and birds and traffic jams… what you really mean is that you want to copulate with your mother. If not that, you are in love with your mirror image.”

Some more modern psychoanalysts have found a way to share some selected thoughts. They might say that, while listening to a patient ramble on about rainbows, they had a flash vision of medieval armor.

Lest you imagine that his vision says something about the analyst, he will tell you that the armor is relevant to his patient’s mental life.

If a patient imagines that his analyst had actually become present to him, had offered something of himself, he will quickly be disabused. His analyst will invite him to offer up more of his own associations about medieval armor.

Still, the analyst remained opaque; only now he was more like a pure mind offering pure thoughts to your impure mind.

Today’s psychoanalysts believe that they have gone beyond Freud and beyond the bygone era of the blank slate and the silent treatment.

To which one might respond that they are no longer really doing psychoanalysis, but that would sound churlish, n’est-ce pas?

And yet, bad habits die hard. Many of today’s more enlightened therapists still refuse to share any personal information with their patients. Even those who do not practice anything resembling psychoanalysis have difficulty overcoming the curse of Freudian technique.

When he was undergoing treatment for lymphoma Adam Baer was assigned to a therapist, named Dr. Morgan. Hers was more of a cognitive/mindful approach to therapy. And yet, she never disclosed to him that she herself was also suffering from cancer.

Baer writes:

I’d been seeing Dr. Morgan, the founder of the hospital’s psychosocial oncology program, for about six months, ever since my Stage 4 lymphoma had relapsed. I had never seen a psychotherapist before, and I was resistant. I was sullen. I felt that I had a right to be depressed, a right to all these unusually helpful professionals.

But Dr. Morgan didn’t fight me. She just wanted to help. So I let her try, and she did.

She introduced me to mindfulness meditation, or, as she put it, thinking in the moment, feeling everything. This wasn’t indulgent psychoanalysis. We had short-term, practical goals: Keep the anxiety down; learn how to relax by tensing and releasing my muscles; focus on the good things, despite the nausea, chest pain and fear.

Dr. Morgan occasionally said that, like my parents, she had a son named Adam. This was, for her, a rare crossing of boundaries.

I would underscore two points. Baer emphasizes that Dr. Morgan was not offering “indulgent psychoanalysis.” The reason, he avers, is “she just wanted to help.”

You may believe that he has misunderstood what psychoanalysis really is, but he, as a consumer of mental health treatment, certainly has a right to his opinion.

His negative view of psychoanalysis counts as bad PR.

Later, when he tried to get back in touch with Dr. Morgan, Baer discovered that she herself had had lymphoma. And that she had died from it. She had chosen not to tell him that she shared the same illness.

Dr. Morgan had been sick, it turned out, the entire time that I’d known her. She’d had lymphoma, too. She died after an infection had overwhelmed her chemo-compromised immune system.

“She cared about you,” the woman continued. “She’d asked me to let you know if anything like this ever happened. She was sorry that she couldn’t tell you. She didn’t want you to feel betrayed.”

I couldn’t believe Dr. Morgan had never told me that she was sick with a version of my disease.

“There are boundaries,” explained the woman.

I said that that made sense. It didn’t.

One might say that Dr. Morgan was also suffering from the bad Freudian habit of not disclosing any personal information. Then again, it is not at all clear that the information would have helped Baer to learn mindfulness meditation.

You would normally expect that your dentist or accountant would share some information about his own life. Not too much and not too little. Too much makes the transaction about him. Too little is disrespectful.

Professionals have a job to do. They are providing a service. They ought to forge a real connection, to treat you as a fellow human being, someone with whom they might even socialize.

Telepathic (even empathetic) communications do not make for a connection.

When psychoanalysts refrain from sharing anything about themselves they are saying that, even if you are a fellow human, their job requires that they only deal with your diseased mind. Treating you like a human being would presumably make the task more difficult.

One is obliged to conclude that analysts do not really care about you as a human being. 

They are saying that they, being well-analyzed souls, liberated not only from mental illness but from the constraints imposed by civilization, are only willing to associate with you because they are being paid to do so. Apparently, they feel that you do not deserve the fellowship of a true conversation with so exalted a personage as they are.

Being unable to continue working with Dr. Morgan, Baer consulted with another psychiatrist, one who had a more flexible sense of boundaries.

He describes his experience:

When I began to resume some kind of life, my oncologist recommended that I see an old pal of his: a psychiatrist-oncologist in his 80s who disavowed the rules of therapy, including the maintenance of boundaries.

It worked out. This anti-therapist told me stories from his life. He even hugged me. “Boundaries,” he said, were “bull.” Therapy was for “suckers.” He worked with terminal patients who adored him and his no-nonsense attitude. His mantra: “Stop feeling sorry for yourself.” We had an entirely different kind of relationship than the one I’d had with Dr. Morgan. We became friends. With his help, I healed.

Some will tell you that psychoanalysis is alive and well and thriving.

It isn’t.

Adam Baer’s article appeared in The New York Times in a series called “Couch.”

If the newspaper of record has chosen to present psychoanalysis as an indulgent and ineffective treatment, and if it has offered a case study showing that the old habit of being a blank slate and refusing to offer any personal information, refusing to connect is ineffective, psychoanalysis is pretty much over.


Anonymous said...

"They are saying that they, being well-analyzed souls, liberated not only from mental illness but from the constraints imposed by civilization, are only willing to associate with you because they are being paid to do so. Apparently, they feel that you do not deserve the fellowship of a true conversation with so exalted a personage as they are."

Either way one person wants to be paid for social intercourse and the other person agrees to pay. These patterns express appetites for self-other communication in which money is a sign or symbol that first has meaning in early childhood.

Anonymous said...

Here is a short video about how for-profit schools use a pain-funnel to recruit students:

Many of the same tactics apply in so-called "therapy" although some of the experts are not conscious that their own needs are being served more than the needs of their clients.