Monday, February 13, 2006

Celebrating Psychoanalysis

Many people are unfamiliar with psychoanalysis and get a glimpse of it in caricatured form through movies, television or books. In these mediums, psychoanalysis is often presented as a stilted experience, where a couch-lying patient drones on about emotions and feelings to a stoic therapist who is busily taking notes. The other polar extreme is that the analyst, fatigued from his or her patient's narrative, falls asleep [1].

The misconceptions go even further where mental health professionals who work within other psychological treatment modalities are often misinformed about the mechanics of psychoanalysis, dismissing it as if it were a singular homogenized school of thought. Many are not even aware that research and empirical studies have shown that psychoanalysis and psychodynamic therapy are successful treatments [2].

Psychoanalysis is grounded on the observation "that individuals are often unaware of many of the factors that determine the emotions and behavior. These unconscious factors may create unhappiness, sometimes in the form of recognizable symptoms and at other times as troubling personality traits, difficulties in work or in love relationships, or disturbances in mood and self-esteem. Because these forces are unconscious, the advice of friends and family, the reading of self-help books, or even the most determined efforts of will, often fail to provide relief. Psychoanalytic treatment demonstrates how these unconscious factors affect current relationships and patterns of behavior, traces them back to their historical origins, shows how they have changed and developed over time, and helps the individual to deal better with the realities of adult life. Analysis is an intimate partnership, in the course of which the patient becomes aware of the underlying sources of his or her difficulties not simply intellectually, but emotionally - by re-experiencing them with the analyst "[3] .

Psychoanalysis has evolved over the last 100 years from Freud's initial model, and it has grown to include many different and compelling schools of thought. It is a rich, deep and involved process. It offers a modern vitality and introspection that many may not realize. And most of all, it needs to be celebrated as a viable option for the treatment of psychological symptoms [4].

[1] Serani, D. (2002). Understanding psychoanalysis. The Participant-Observer, 4(1): 4-6.

American Academy of Psychoanalysis
American Psychoanalytic Association
American Psychological Association: Division 39 - Psychoanalysis
American Psychological Association: Division 39 - Section: Psychoanalytic Reserarch Society
American Society of Psychoanalytic Physicians
Argentine Psychoanalytic Association
Asociacición Psicoanálitica Mexicana
Association for Child Psychoanalysis
Association for the Study of Dreams
Australian Psychoanalytic Society
Brisbane Centre for Psychoanalytic Studies, Australia
British Psychoanalytical
Buenos Aires Psychoanalytic Association
Canadian Psychoanalytic Society
Centre for Psychoanalytic Studies
International Psychoanalytical Association
Italian Psychoanalytic Society
Mexican Psychoanalytic Association
Psychoanalytic Federation of Latin America
Sociedade Psicanalítica de Porto Alegre
The Swedish PsychoAnalytical Society

*Thanks to my many blogfriends who have suggested a post be written about psychoanalysis *


alan said...

We finally got mental health included in our benefits a few years ago; for years the company resisted I am sure as much due to stereotypes as cost. As I talk to people at work, more have used that benefit than most would think.

Now that the company is trying to "control cost" of our benefits, I am sure this will be a benefit they try to reneg on...

Hopefully I am wrong!


Cheryl Fuller, Ph.D. said...

As a Jungian psychotherapist with a healthy dose of psychoanalytic background as well, I often feel like buggy whip makers must have felt when automobiles came along. Most of the young clinicians I know simply do not understand what psychodynamic theory is about. Several of them have contracted with me for clinical supervision in order to learn more. If it weren't for them, I would fear that what I have found so valuable in my work would die when those of us now in our 50's and 60's die.

Godwhacker said...

Excellent post Dr. Deborah, as usual.

Heidi said...

Thankyou to the many blog friends who have suggested this topic for Deb.

Very interesting.

Precisiongirl said...

It's so amazing when you realise how much your past can influence your future - and even more amazing when you realise you can break the repeated cycles.

Stacy-Deanne said...

Hi Deb, this time last year I was full of stress to the point where I was at a breaking point. So many things were bothering me. So I went to talk to a therapist. I poured my heart out and Deb, can you believe she told me to, " Go out dancing and make new friends."? Needless to say I didn't find that helpful. It was like she didn't even try to delve into what was really bothering me. But something happened when I left and I figured out things for myself. I learned to let go of these problems on my own and I became positive. Now I am a much better person. I agree with all that you said. But I tell you it upset me to have someone tell me to go salsa dancing like that was going to ease my pain. I don't know how long she'd been in the business (she looked very young), but she didn't seem to take my situation seriously. I just wanted to share, LOL! Anyway, I answered your Brandy question. Drop back by my blog when you get the chance. Bye for now.

Dr. Deborah Serani said...

Dear Alan,
Psychotherapy is usually the first to cut, that's true. I can only hope that insurance companies will realize that health is a balance of physical and emotional well being.

Dear Dr. Fuller,
I hear you! I am a big believer in keeping psychoanalysis alive and well. It is a vital, modern and thoroughly fascinating form of treatment.

Dear Godwhacker,
Coming from you, I take the compliment to heart!

Dear Heidi,
I've been asked to write about psychoanalysis for a while...

Dear Precision Girl,
I have been in psychoanalysis and it was life changing. Not only did it take care of psychological symptoms, but it offered so much quality and depth in my life.

Dear Stacy-Deanne,
Hmmm....I think what that therapist said *was* insensitive.


T`bou said...

Mental Health is needed in our society today. My biggest fear since I'm in Houston is the concern of the Hurricane Victim who never rec'd any psychological help for their loss in New Orleans and soon they will be put out on the streets of no where.

One thing I love about Nursing was Mental Health- Thanks for sharing your knowledge and giving us a place to learn and respond.

Raine said...

My understanding is that psychoanalysis is just as effective as antidepressants in many cases......... not always of course, but food for thought

Nabeel said...

nice resourceful blog you have here

Deb S. said...

I, too, think that this is an excellent post. Very thoughtful. By the way, the cartoon is too cute!

jumpinginpuddles said...

i wish our t would let us lie on a couch while she went to sleep with our talking, at least it would mean she couldnt come and bite us on the butt at times we dont wish she would because shes listening :P.

Anonymous said...

I like this entry Deb. Having been in some form of "therapy" for several years now, it's cool to learn more about where it came from. Amusingly, my husband and I were watching some mindless show on t.v. this evening and one of the lines was "Do you know Freud did cocaine?" I chuckled and thought "Oh great, now there's a great advertisement for therapy." LOL

Dr. Deborah Serani said...

Dear T'bou,
The media focus has shifted away from the Gulf Coast and the devastation there (physical and emotional). There are many people who are in need of help, and it is a very sad fact.

Dear Raine,
You are correct. But there are many forms of excellent psychotherapy out there, and adding medication to the treatment can bolster success. The goal is to know what works for you and get it.

Dear Nabeel,
Thanks. Your blog is very interesting as well.

Dear DCS,
I found it and thought it was a good fit for the subject.

Dear JIP,
I know what you mean....knowing that your therapist is an active listener is a good thing, but sometimes it can be a reminder of other sorts.

Dear Traci,
Freud did use cocaine, quite a bit in fact. He suffered terrible from cancer (from cigar smoking) and used the drug to offset his pain. You're right, it's not a great endorsement for therapy...


Fallen Angels said...

I'm with Jumping in Puddles!! But of course, she's actively listening...always...even when we aren't actually in her office. She reads our blog, almost daily. Almost because the times she doesn't read is if blogger is having "issues" or she is out of town, but then she catches up as soon as she can.

I agree with your response to Raine. In my case, meds make therapy possible. Without them I wouldn't be an active participant so it would fail. I also think that in many cases the type of therapy used changes from time to time. Whatever approach seems to best fit the situation is used. With us, that change could happen moment to moment. :P


Nancy said...

I remember the first time I went to a therapist and I loved it! Before I went I was nervous and told my sister in law. She told me being Jewish, it was just expected that they would see a therapist at some point. GOM's mother told them when they were children, "Tell it to your therapist when you grow up," any time she did something they didn't like. I thought that was funny.

Therapy is lost on some people who really need it. They still have that stigma in their head that it must mean they are crazy. Who cares? Getting help has helped me more than I can ever say. Now I go to the psychiatrist once every six months for meds and a short chat!

I hope lots of people read this Deb!

Anonymous said...

I agree with your response to Raine as well...without the meds I take, I don't think my therapy would be as helpful. My therapist isn't as "actively listening" as Sera's is however she always pays attention during our sessions! I'm with Jumping in Puddles though too...sometimes I find myself wishing she wouldn't listen so well! LOL

Donna said...

And now there's the Psychodynamic Diagnostic Manual (http://www.pdm1. org/) too. It will be interesting to see how it flies and if it becomes as well-known and well-used as the DSM.

Grumpy Old Man said...

I'm no expert, but I'm a skeptic when it comes to the Freudian "theory." So often the patient's confirmation of the theory is taken as evidence that it's correct, and non-acceptance is taken as "resistance" that also supports the theory. So much of it (e.g. "Moses and Monotheism") seems made up out of whole cloth.

Nevertheless, I accept that (1) some talk therapy can be valuable; (2) childhood experience can powerfully shape the adult; and (3) people are often unconscious of the motives and explanations of their behavior.

The proclamations from the oracle, the schisms among the multiple successors, and that fact that so much of what Freud said is not falsifiable (can't be tested scientifically) are all characteristics of a cult, and support my skepticism.

Raine said...

LOLOL as anyone who knows me could tell you I actively advocate meds-please dont think I was belittling their usefulness. I was just pointing out that therapy when used properly and appropriately has equal value

Dr. Deborah Serani said...

Dear Sera @ Fallen Angels,
I feel the very same way. For me, the combination of meds and therapy were llife changing and life saving.

Dear Nancy,
Your S-I-L is so funny. It is hard for some people to trust therapy, but I am glad you had, and continue to have, a good experience with it.

Dear Traci,
Sometimes I get the feeling my patients feel that way too! I always strive to make my input meaningful and sensitive to my patient's needs.

Dear Donna,
Hey, I didn't know about that. Thanks for the update! I'm gonna check it out now.

Dear GOM,
Freud would not recognize what he started over 100 years ago. Modern psychoanalysis is not stuffy, accusatory, etc. I can understand how one could be a skeptic, but I invite you to keep an open mind that the psychoanalytic practice of today is vastly different and vibrant(and research supported).

Dear Raine,
That came through clearly. I was just saying that there are many routes to well being. ;)


dragonflyfilly said...

Happy Valentine's Day everyone,

dragonflyfilly said...

hey Cheryl, yeah i agree with you, although i am not a practicing clinician. A long time ago i wanted to become "a Jungian Analyst", but the nearest training centre that would qualify me was in San Francisco, and i was not able to do it. In 2001 i started a 2 year Certificate Program in Process Work Training, based mostly on Arnol Mindell's theories and practice, but with a strong Jungian component, however it was very expensive, and as i was not going to have much use for it in my work, i did not complete the 2nd year. People just don't want to spend the time and money on lengthy, deep, emotional work that it takes to search for self-knowledge. (it seems most people want the "magic silver bullet" or in this case, pill, to fix 'em.

Hi Deb, i like the way you put it: "... it is a rich deep and involved process...", it is indeed unfortunate that our mental health system does not give it the time and money it deserves, i think a lot of people would be better served by this than the many chemical band-aids that are offered in its place. i know from my experience with the teen-age girls at the now defunct treatment centre where i worked, i was sometimes able to use some of my knowledge, and i could see a little "light-bulb" going on in their heads, so to speak, (and it was gratifying to know that perhaps i had planted even just the smallest seed of knowledge and hope that they could maybe use when they were ready.)

cheers for now, thanks for the continued fab posts.

Kim said...

Best psychotherapist I ever visited sat on a couch opposite my chair (the office looked like a den) and "shot the bull" with me, managing to get right down to the issues within minutes. Damn, she was GOOD! She supported what needed supporting and confronted what needed confronting on the spot.

We ended our theraputic relationship six weeks later with my insight exponentially sharper than when we

SkyeBlue2U said...

Hello, I see you here and there so today I decided to stop by and say Hello. Hello! :)

kath said...

When I took my two sons to see a family therapist many years ago.. because they seemed to hate each other..

he threatened to have cory removed from my home ( he was about 12 or 13 )
because he said his brother would hit him.. he did, of course, which is why we were there.. but it was more common for cory to hit his older brother.. ( or to trash his things)who was 18 or 19 at the time..

an adult.. so the therapist said..and gave me 24 hours to get the older
( smaller ) brother out of the house. and thereatened me with CYS etc...
I called his supervisor in a panic ..
he didn't do that to anyone else in that practice..

years later.. I tried to find a therapist.. i was about to leave dan for someone else.. three women i talked to..
the first one wanted to pray over ( and with ) me ... no thanks

the next two didn't want to hear about how i felt.. they both told me over and over to stay where i was..

ended up i did.. but not because of what they said.. life happened .. people happened..

Never had any luck with this sort of thing..

Cory needs to talk to someone .. he has anger management issues.. but .. when i try to talk about it.. he brings up the past .. bad.. experieince he had .. ( our home was a nightmare for abouat 2 days ) and he refuses

It is too bad really.. as my life is rather.. well.. hellish.. and help would be wonderful.. especially help for and with him

maybe its in the water here?

an employer of mine once hired a therapist to try to sort out strain in the workplace..
( she caused it.. well. she wwas one of those who did ) and that was a nighmare..

Once.. one of the employees just experiencing a failed relationship said she felt like killing herself..
the other employess locked her in a kennel.. and she ended up being locked up for 2 days, when they got her "help"

I am in no way saying that all therapists are bad.. just.. well
all that I have met..

except for you :)

I firmly beleive that you ar different..

you want to help

Dr. Deborah Serani said...

Dear Dragonflyfilly,
Like you said, small seeds that can grow is what it's all about for me.

Dear Kim,
What an amazing and wonderful story. That's what therapy should be and should do.

Dear Skye,
Thanks for stopping by. I'm coming to visit you now.

Dear Kath,
Wow. You have had terrible experiences with therapists. My mouth is still wide open with disbelief. It is very regrettable that you have had many bad exchanges, but I am glad that you can believe in me.


Dirk the Feeble said...

I would love for you to give me an analysis sometime. I promise not to put you to sleep, but I do need to be laying on a couch to talk about anything.

Dr. Deborah Serani said...

Dear Armaedes,
If we were to work together, you would never put me to sleep - that is for sure. Your wit and intensity would be most interesting to experience...and I am certain you would learn and grow!


Anonymous said...

I just stopped by today to tell you how much I appreciate you and this blog of yours. Peace.

Chris said...

Dr. Deb: I had to drop a note~last night while finishing up some office work, and channel surfing at the same time:), I landed on Law and Order SVU and lo and behold the judge was Hr.D.Serani! I wanted to tell someone "I know her" (but actually I don't~just through your blog:). I just wanted to pass on my excitement~ have a good day--Chris

Dr. Deborah Serani said...

Dear Traci,
You touch my life as well.

Dear Chris,
I think saying you know me is quite authentic...even if it comes from blogging. It's a kick when I see that episode as well.


Lilly said...

Very interesting blog you have here doc.
The last time I tried psychoanalysis, the doctor needed some sessions himself. haha.
You guys picked the perfect profession. Get paid lots to listen to people, (or not) and the thing about it is, TIME heals everything. Not talk therapy, not medication to upset the seratonin levels in your brain. You really have to be careful with that stuff because unless your particular mood disorder requires your seratonin levels to be adjusted, you will have a very bad reaction to the meds. Alot like doing LSD. General practioners hand this stuff out like candy these days. In the end, everything passes with time. I worked for a psychiatrist who didn't even carry a beeper. He explained the reason he didn't was by the time he was notified of an emergency, the episode would be over with before he could even get to the patient. I thought he had a great point.
Come visit my blog sometime. I'll be one for the psycho-journals. haha!

Dr. Deborah Serani said...

Dear Lilly,
Time does help...but some people do need medication and therapy to help move through issues. Gonna go visit you now.


Lilly said...

yes, some do. it is very important that they get the correct diagnosis by a professional who sees disorders every day rather than the general md. maybe that was my point? haha who knows. glad you stopped by..

Dr. Deborah Serani said...

Dear Lilly,
You make a good point. Same here for stopping by.


urban dream machine said...

Dear Dr Deb
It's heartening to read your 'celebrating psychoanalysis'. Here in London it thrives but is struggling against the claims of cognitive behavioural therapy. The government has just announced a big boost for cbt in the NHS. This is not in itself a bad thing but there have been extraordinary claims on the main news programmes in the last 2 days that this will 'cure' millions of anxiety and depression.
I am a practising psychoanalytic therapist and have just started a blog. I can send you the link if you wish.
Stephen Gee

Deb said...

Dear Stephen,

Will link you on mine.

Happy to know you're out there blogging about psychoanalysis!!