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Lloyd I. Sederer, MD Headshot

Psychoanalysis: Journeying Into Therapy

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Third in the series Ink-Stained for Life

When it came time for my therapy I started in the deep end of the pool.

My marriage had ended. It was time for me to change jobs after heading a clinical service at a prestigious teaching hospital. I had a young son who would soon get to know divorce first hand. I felt depressed, guilty about everything, too alone, and staring into a deeply uncertain future. While this was several decades ago, I can readily summon up the intensity of my dysphoria. I was already a psychiatrist and had sidestepped therapy as part of my training. I had waited long enough.

Instead of looking for a psychotherapist, I decided to go for the full Monty. I found a traditional Freudian psychoanalyst, a past president of Boston's major analytic institute. Psychoanalysis, by the time I entered its pool, did not have the eminence it did in the good old 20th Century, having been eclipsed by the promise of neuroscience and an explosion of medications. But analysis was not dead -- Woody Allen notwithstanding -- nor were its conceptual roots in the power of the unconscious in driving how we feel and act and its methods of free association ('say whatever comes to mind') and dream interpretation.

I was on the couch, four times a week. After four years, I was convinced I was done. That led to another year of analysis after which I pronounced to my analyst that now I was surely done. A year later I was. I paid out of pocket for this treatment, which virtually no insurance covered then and I can't think of one today that does. For me, analysis was exceptionally helpful where Freud said it counted the most, namely in love and work.

I wonder what helped? Was it the traditional technique of couch, dream interpretation, free association and analysis of the transference (how the demons of our past continue to impale us on the spikes of early, troubled relationships)? Or was it the relationship with my wise analyst who knew every psychological evasion in the book (and I had read the book), demanded that I take responsibility for how I felt and lived, and was deeply kind.

Research has repeatedly shown that active listening, genuine empathy, and support are fundamental healing techniques in therapy, whatever its form: short or long, analytic, cognitive, interpersonal and others. In fact, therapy research shows that its most salubrious element is what is called the "therapeutic alliance," namely the trusting bond fashioned between patient and therapist.

My dream life, rich then and more so with age, was a centerpiece of my psychoanalysis, since dreams are the "royal road to the unconscious." They are revelatory of hidden wishes, drives and fears. They portray how we perceive and respond to others thus complementing transference interpretations as a means of having 'corrective emotional experiences.'

For me, analysis was a journey into the mind, into the primitive ways we can feel and judge and behave. It helped my ego take the reins of life away from my unconscious and its misguided ways. Psychoanalysis, notably, has evolved in recent decades and is now far more focused on relationships than instinctual sexual and aggressive drives.

Where does psychoanalysis measure on what today is called the value equation: what is the return in well being, more successful relationships and work, and reduction in human suffering from the time and money it costs? Maybe it has that value if you are a mental health professional providing therapy yourself. Maybe for artists and other creative people. Maybe for those where shorter, more focused treatments did not do the job. Not for many.

What tends not to get said, however, in the cartoons and parodies about psychoanalysis is that it spawned the field of psychoanalytic psychotherapy with its basic tenets of what drives us, how the mind works and the role of a therapeutic relationship. When I needed a 'booster' shot of therapy over a decade after my analysis was over I went to an analyst, but for psychotherapy, not for analysis. I had had my dose of analysis, wanted focused work on what was then getting in my way to love and work, and could not bear the time and money to get back on the couch.

Analytic psychotherapy is not all that is available to people struggling with the pains of being human. We now have focused, proven, short term therapies like cognitive-behavioral, interpersonal, or problem solving therapy. Even very brief, motivational enhancement techniques (used in primary care and addiction treatment) work for some.

I am glad I swam in the deep end of the therapy pool. I admire those who today take on the work of analysis, and for those practitioners who can still master its formidable art and technique. When people ask me about what treatment they might undertake I think few will be able to bear analysis but can say that their options are many and that my field has more than medications to offer.


For other 'Ink-Stained for Life' articles see...
http://www.nytimes.com/2010/12/24/opinion/24iht-edsederer24.html?_r=1&ref=labor and http://www.huffingtonpost.com/lloyd-i-sederer-md/inkstained-for-life-great-teacher_b_828031.html

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The opinions expressed herein are solely my own as a psychiatrist and public health advocate.

Dr. Sederer receives no support from any pharmaceutical or device company.

Visit Dr. Sederer's website for questions you want answered, reviews and stories -- www.askdrlloyd.com

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