![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 5 to 29 of 38. Go back in thread:
Posted by naiad on December 20, 2003, at 15:43:41
In reply to Re: psychoanalysis vs. CBT » naiad, posted by Pfinstegg on December 20, 2003, at 15:23:42
Thank you both for the support! I felt so alone when I wrote the original post and now I am realizing that maybe it isn't just me whining but that my T really did screw up. I think he got angry (probably too strong a word) because he thinks I am being manipulative.
He says I have a pattern of bringing up my transferance issues but then not being able to talk about it. Then he feels like he has to pull information from me. I guess he's tired of it. All I can say is I'm doing the best I can.
Usually, when we're not talking about our relationship/transferance, I think we have a good rapport. In fact I think he is sensitive, kind, and very empathic. Even so, I don't think that I am particularly open. I am guarded and careful about what I say. I spoke to my older sister this morning and she is having the same issue in therapy -- self monitoring. It is not a coincidence , we were raised by a very critical, cold and domineering mother. My therapist knows this and he has acknolwedged it but last night, for some reason, he decided to be less tolerant. Maybe he was having a bad day :(.
Can I ask, how long have you been in therapy? I know analysis is a much longer process than other kinds of therapy. Why do you prefer analysis?
Thanks, again. This has really helped.
Posted by EmmyS on December 20, 2003, at 17:51:11
In reply to psychoanalysis vs. CBT, posted by naiad on December 20, 2003, at 7:16:04
CBT is designed to help people who are having problems with....yes, cognition! So, it's great for people who are dealing with depression for instance, since depression can really affect the way you think about things. Here is some info from the book Feeling Good by David Burns about cognitive distortions. Clearing up these distortions is sorta the basic direction of CBT. If you don't think that you have issues with these - you don't need CBT.
1. ALL-OR-NOTHING THINKING:
You see things in black-and-white categories. If your performance falls short of perfect, you see your self as a total failure.
2. OVERGENERALIZATION:
You see a single negative event as a never-ending pattern of defeat.
3. MENTAL FILTER:
You pick out a single negative detail and dwell on it exclusively so that your vision of all reality becomes darkened, like the drop of ink that discolors the entire beaker of water.
4. DISQUALIFYING THE POSITIVE:
You reject positive experiences by insisting they "don't count" for some reason or other. In this way you can maintain a negative belief that is contradicted by your everyday experiences.
5. JUMPING TO CONCLUSIONS:
You make a negative interpretation even though there are no definite facts that convincingly support your conclusion.
a. MIND READING:
You arbitrarily conclude that someone is reacting negatively to you, and you don't bother to check this out
b. THE FORTUNETELLER ERROR:
you can anticipate that things will turn out badly, and you feel convinced that your prediction is an already-established fact.
6.MAGNIFICATION (CATASTROPHIZING) OR MINIMIZATION:
You exaggerate the important things (such as your goof-up or someone else's achievemet), or you inappropriately shrink things until they appear tiny (your own desirable qualities or other fellow's imperfections). This is also called the binocular trick."
7.EMOTIONAL REASONING:
You assume that your negative emotions necessarily reflect the way things really are: "I feel it, therefore it must be true."
8.SHOULD STATEMENTS:
You try to motivate yourself with should and shouldn't, as if you had to be whipped and punished before you could be expected to do anything. "Musts" and "oughts" are also offenders. The emotional consequences are guilt. When you direct should statements toward others, you feel anger, frustration, and resentment.
9.LABELING AND MISLABELING:
This is an extreme form of overgeneralization. Instead of describing your error, you attach a negative label to yourself. "I'm a loser." When someone else's behavior rubs you the wrong way, you attach a negative label to him" "He's a Goddamn louse." Mislabeling involves describing an event with language that is highly colored and emotionally loaded.
10.PERSONALIZATION:
You see your self as the cause of some negative external event, which in fact you were not primarily responsible for.
Posted by Pfinstegg on December 20, 2003, at 22:36:32
In reply to Re: psychoanalysis vs. CBT, posted by naiad on December 20, 2003, at 15:43:41
I prefer the analytic approach because it has realy helped in the ten months I have been doing it. Before that I spent four years with a psychiatrist who had more of a supportive, problem-solving approach; this can be great for lots of people, but wasn't right for me. Transference, fantasy, and unconscious or semi-conscious memories and feelings are what we have been dealing with- I feel that for the first time i am really dealing with what went wrong for me in childhood. Lying down on the couch fosters a sort of benign regression that really helps to get in touch with all these things. My analyst and I get off-track and misunderstand each other, too, although less often as we get to know each other increasingly well. I think it is certainly a slow process, for sure. He expects that I'll be in treatment for several years, and will then see him on an as-needed basis. He doesn't believe in complete terminations- bless his heart!
Pfinstegg
Posted by naiad on December 21, 2003, at 6:42:14
In reply to Re: psychoanalysis vs. CBT » naiad, posted by Pfinstegg on December 20, 2003, at 22:36:32
Do you really lye on a couch? I know that is part of the classic psychoanalytic method but for some reason my T has never suggested that I do that. I see him in two different offices and one of his offices only has a tiny couch where I would be a bit cramped even though I am not a very big person. Does the couch induce relaxation, is that the point?
I, too, have been seen by other kinds of therapists who were mostly just supportive and I found that to be a real waste of time.
Can you give me any thoughts on how you are able to free-associate? Does it just come naturally or did you have to learn how to do it?
Thanks so much for your help.
Posted by naiad on December 21, 2003, at 6:49:39
In reply to Re: psychoanalysis vs. CBT, posted by EmmyS on December 20, 2003, at 17:51:11
Emmy,
I identified with some of those ways of thinking some of the time. I am going to get Burn's book to learn more. Thanks.
Posted by EmmyS on December 21, 2003, at 7:37:24
In reply to CBT list...Emmy, posted by naiad on December 21, 2003, at 6:49:39
It's a good book for an understanding of CBT and it's use with mood disorders. CBT is considered a brief therapy, so financially it is sometimes the best bet for people who use insurance which severely limits their ability to seek mental health services.
Personally, I find CBT to be a good place to start - just to help a person clarify their thought patterns, and help with current life dilemas. Once that groundwork in done, they can always continue on, if they can afford it, for any other required treatment.
Posted by judy1 on December 21, 2003, at 10:03:35
In reply to Lying on a couch? » Pfinstegg, posted by naiad on December 21, 2003, at 6:42:14
and lasted about 10 minutes. I know it's an integral part of analysis, but I can't stand not seeing my shrink and reading his body language. He accepts that I'm a couch failure:-)
Posted by Karen_kay on December 21, 2003, at 10:39:13
In reply to I've done the couch thing..., posted by judy1 on December 21, 2003, at 10:03:35
I do CBT. My therapist tried free association once and I didn't talk for 20 minutes. He soon (well, not soon enough!) realized that this approach just isn't for me. I censor myself too much. I prefer to be able to see his cute face :), even if I don't look at it! And, I am just so unsure what is going on in my mind that I would blank out. I'll stick with CBT, yes that's the one for me.
Posted by Pfinstegg on December 21, 2003, at 11:44:33
In reply to Lying on a couch? » Pfinstegg, posted by naiad on December 21, 2003, at 6:42:14
I do lie on the couch, but I got to know him face-to-face for about two months first. He's flexible, so it's fine if I sit up, which I do during real crises. It was very scary starting to do it, but has since become a lot more comfortable. It's actually much easier to free-associate from there, as one doesn't self-censor quite as much.
As to free-associating itself, I think everyone has to learn it, as we all normally continally self-censor in social conversation. You gradually learn to say the fleeting, seemingly irrelevant little things which come into your mind and then keep going with where-ever your thoughts lead you- and they always lead to something you are afraid of, or want to avoid! There are big rewards, though- you really learn how you felt as a child, and you also learn a type of trust in the therapist which we didn't have in our parents.
For me, the couch has turned out to facilitate this benign type of regression; however, from what I have read, people who need to actually see their therapists in order to feel safe can be analyzed while sitting up. The couch can be a help, but isn't essential, and may sometimes be a hindrance.
Pfinstegg
Posted by badhaircut on December 21, 2003, at 18:44:14
In reply to psychoanalysis vs. CBT, posted by naiad on December 20, 2003, at 7:16:04
Here's some semi-free associating by me on psychoanalysis:
I had about 4 years of psychoanalysis, going usually 4 times a week.
*ACTUAL BENEFITS*
I felt much more relaxed around children after about a year of analysis.*GOALS*
My analyst was a CSW, and I liked him personally. I enjoyed free-associating. But I was very frustrated with the fact, revealed to me over time, that "getting better" is not a goal of psychoanalysis -- at least not as theorized by my guy, the people he trained with, the other shrinks in his institute, and the majority of neo-Freudians I've read.The way they phrase it, a patient may get "better," start feeling happy, stop feeling miserable, find a love, get a more desirable job, etc, while in analysis, but that may not happen, even if the analysis is successful. The point -- for these practitioners -- is to free up the flow of ideas and emotions from within. It's not to change what's inside you, but to have a different attitude about what comes up from inside.
I think that's a worthy goal. It may even be the basis of most long-lasting benefit in psychoanalysis, CBT, Gestalt or any other therapy.
*FAITH*
But I don't think that free-associating or getting into the anguish and scraps of what they insist on calling "transference" is likely to achieve that very well. From my reading and experience and conversations, I think that the analysis the neo-Freudians perform is less doctrinaire than what typically-trained shrinks did through the 1950s -- it's more dogmatically relaxed, more Zen, more cognitive, less sexist, less classist -- but it is still based on Faith.--Faith that despite nine months (or nine years!) of 5-times-a-week sessions after which you feel worse, sticking to this course of effort will produce some significant benefit to you!
--Faith that psychoanalysis provides SOMETHING worth having that cannot be gotten any other way -- despite NO STUDIES showing long-term efficacy of psychoanalysis, and many showing that people (like me!) are actually likely to feel worse the longer they are in it.
--Faith that feeling bad in psychoanalysis is a sign of progress!
--Faith that modern psychoanalytic theory has some validity despite the fact that MOST (not merely some or just the early work) of Freud's vividly depicted intracranial cosmology fails serious scientific confirmation.
--Faith that the insight from today's session is true and deep and meaningful -- despite there being no evidence for this other than a rather fleeting feeling of epiphany and the analyst's beaming approval. And despite the fact that you felt this way about that insight last week, and the week before, and nothing came of them, either.
The shrinks often tell their patients to "have faith." I'm sorry to say that in the end, that's almost all they've got.
-------
Incidentally, there's a little comparison chart of psychoanalysis and CBT here:
http://www.cognitivetherapy.com/jerry_compares.html
Posted by fallsfall on December 21, 2003, at 20:51:13
In reply to psychoanalysis vs. CBT, posted by naiad on December 20, 2003, at 7:16:04
There are real differences between the different therapy approaches. I was able to get some idea of how they work differently by reading some "case studies" in the different orientations. You probably would have to go to a University library to find them.
I believe that we each need different things (even at different times), and the key is to find the best match for you right now. Please talk to your therapist about how you are feeling and ask about the other orientations. You might want to "interview" a therapist from a different orientation and ask them to explain how they work. I think that if you did that, you would find some of them made "more sense" to you, and that is probably the direction you should go in.
Just to balance this thread a little...
I did CBT for 8 1/2 years. I learned a lot of important skills that I use every day. But it didn't "fix" my problems - it just taught me how to "cope" with them. That wasn't enough for me. Now I'm in Psychodynamic therapy (he does Psychotherapy of the Self), and I'm finding it suits me much better. I don't know that I could have started with Psychodynamic, though.
Posted by lookdownfish on December 22, 2003, at 3:39:25
In reply to psychoanalysis (unfavorable review), posted by badhaircut on December 21, 2003, at 18:44:14
I have only done psychoanalytic therapy. I chose this because from what I know of the CBT approach it is more about coping skills. I felt I wanted an in-depth solution to the problem - to find out why I get depressed - rather than to just cope better with it. I initially found it very frustrating - the lack of structure and focus, the lack of a deadline, the slow and drifting nature of it. Infact I am still finding that frustrating, but I have decided to put my faith in it, at least for a little while and see what comes of it. I am prepared to give it two years and then review where I'm at.
But, I have some sympathy with badhaircut's comments. It bothers me that psychoanalysts seem to insist upon their patients putting unlimited amounts of faith in the process. At some stage, surely they have to be answerable and the effectiveness of the treatment has to be assessed?
> The way they phrase it, a patient may get "better," start feeling happy, stop feeling miserable, find a love, get a more desirable job, etc, while in analysis, but that may not happen, even if the analysis is successful.
Is this self-contradictory? What are the criteria for success? How can an analysis be called successful if none of these things have happened? I guess I'm asking myself this question as much as anyone else.
> --Faith that modern psychoanalytic theory has some validity despite the fact that MOST (not merely some or just the early work) of Freud's vividly depicted intracranial cosmology fails serious scientific confirmation.
badhaircut: Are you referring to concepts like ego, id, superego? Isn't this just a model to help us understand how the brain works rather than a literal definition of how it works?
Posted by badhaircut on December 22, 2003, at 11:17:47
In reply to Re: psychoanalysis (unfavorable review), posted by lookdownfish on December 22, 2003, at 3:39:25
> What are the criteria for success? How can an analysis be called successful if none of these things have happened?
THE GOAL
I think the "official" criterion for success in psychoanalysis is that both the analyst and the patient agree that it's complete -- not just ended or at a standstill, but complete. "You'll know," my analyst told me. It deals with a felt sense of self-understanding.That's why someone who flies into temper-tantrums, abuses those close to her, makes destructive choices in love, or is wracked with emotional pain, can still be said to have had a successful psychoanalysis. I think the best actual outcome that fits inside the official goal is that the patient has a less fearful attitude toward the emotions and ideas that come up from inside her. Even if they're nasty thoughts and feelings, the patient doesn't keep them in the Unconscious -- where they would still be active. The successful, completed analysand allows all these demons into consciousness, where she can make choices about them. Now, with those post-analysis choices, she might improve her life in the conventional ways (love, job, mood, etc) or, so choosing, she might not.
INEFFECTIVENESS
That's great. I think fear of spontaneous thoughts and feelings is at the heart of most personal dysfunction and their acceptance is a cornerstone of long-term happiness and enjoyment of life. I think most improvement is about conscious choices. But I also think that psychoanalysis is a roundabout, haphazard, goose-chasing way to have self-acceptance or choice-making skills -- and it's burdened with tons of dogma and rituals that are irrelevant to self-acceptance and can even obstruct it.ASSESSING SUCCESS
Because analysis is so poor at getting to even this one concrete goal, sincere, well-meaning analysts are (unconsciously) afraid to specify any dry, external, controlled measures for assessing it. Some might go so far as to deny any specific goal at all! In order to keep the Faith in the enticing, richly imaginative, *fun*, literate, burgeoning world of psychoanalysis, the analysts have to believe that its success can be measured only by them and their thoroughly analyzed (and indoctrinated) patients. That's why "success" must simply be at best the heartfelt agreement between the two in the dyad that the analysis is finally complete.And since cognitive, behavioral and drug therapies started publishing externally-measured, statistically-sound reports of life-improving success, psychoanalysts know that they can't even *imply* anymore that analysis will bring such verifiable results. (Real-life improvement was Freud's original claim, later retracted.) So they may allow patients to get the impression that some tangible, unique benefit will eventually come, but if a patient asks for specifics, the analyst will compassionately shrug that it's just too personal to describe.
RESPECT FOR ANALYSTS
I'm not being cynical. I was *INTO* psychoanalysis for years. I believed. I've read (and have) shelves of Freud, Klein, Winnicott, etc, and I almost entered a psychoanalytic clinical PsyD graduate program as a career move. I know that many psychoanalysts are sincere, thoughtful, smart, open-minded, compassionate, good people. Mine was. I'm only saying that to the extent they're practicing psychoanalysis, they're effective at trivia. To the extent that they're striving for demonstrable life-improving changes, they're engaging in some other therapy.--------
lookdownfish-- on Freud's unconfirmed theories: I didn't mean just the metaphor of superego etc, but his actual clinical techniques still practiced today. I'll try to post more later. (I too love your name.)
Posted by lookdownfish on December 22, 2003, at 15:31:43
In reply to 'success' in psychoanalysis, posted by badhaircut on December 22, 2003, at 11:17:47
Thanks for your post - very interesting.
I guess it's not really right to think about Success vs Failure, but to consider any small incremental improvements that one can make. My therapist didn't promise dramatic results, and I hope none of them do. However, I certainly have some fairly specific goals in mind for my own treatment and my therapist knows what they are. What worries me is whether or not we are headed in the right direction. The therapy is just so unfocussed, and she doesn't do anything to help me concentrate on the important stuff.
>it's burdened with tons of dogma and rituals that are irrelevant to self-acceptance and can even obstruct it.
Can you elaborate?
If you were into psychoanalysis at one point, what brought you to this point of view? I almost don't want to know, because I don't want to lose the Faith! but tell me anyway, if you can. Did you have a sudden realisation, or gradual. Was it during your therapy or after you terminated? I'm very into it myself at the moment although I also still retain a degree of scepticism, but I am prepared to suspend disbelief for a little while. Your post made me worry that I've been indoctrinated. I will strive to keep hold of my cynicism:)
totally love your nane too :)
Posted by Pfinstegg on December 22, 2003, at 16:14:39
In reply to 'success' in psychoanalysis, posted by badhaircut on December 22, 2003, at 11:17:47
Maybe it's a mistake to consider psychoanalysis as in some way radically different from other psychodynamically-oriented therapies. Aren't modern analytic ideas- those of analysts like Kohut, Winnicot, Loewald, Ogden, Mitchell, etc. the basic wellsprings from which most all of modern therapy is derived? I'm not talking about Freud here! The contemporary emphasis in psychoanalysis appears to be on empathy and the interaction between analyst and patient. Especially in dealing with trauma and abuse, a secure attachment is a necessity before any uncovering of unconscious memories can usefully take place- as Dinah pointed out to us recently with that excellent article on dependency in the treatment of sexual abuse.
I think I have made a lot of gains in my ten months of analysis- primarily in a reduction in depression and anxiety. I have really deepened and secured my attachment to my (adorable) analyst, but have not yet explored the abuse too much. I think I'm getting ready to, however, as I am feeling so much better.
Pfinstegg
Posted by Adia on December 22, 2003, at 19:30:55
In reply to Re: 'success' in psychoanalysis » badhaircut, posted by Pfinstegg on December 22, 2003, at 16:14:39
Hi..( I haven´t been posting because I am really struggling-I see my therapist again on feb 13th.)
but I just wanted to say that I agree with you, Pfinstegg, and I feel the same way..
I think it all depends on the needs of the patient, on the nature of the issues, etc. In my case, after years of abuse and the isolation and lack of human support and nurture and the secrecy of it all...and everything..I do need that deep emotional bond and analysis has helped me..it took me a long time to build the trust I feel now that it is letting me for the first time start talking or trying to talk or telling what I´ve kept inside for so long...I need that safety...and it takes a long time to build trust when you never learnt how to trust before or your trust was betrayed. It´s a slow, painful progress..and I need to have a psychologist willing to go with me back all of that and help me, it´s something so basic, it´s like you don´t even know how to feel you are good and I feel in psychoanalysis you can get to those beliefs..
I think that in abuse cases, it is really important and necessary to have that secure environment...to feel that connection with your therapist..I feel that even though I progress at a very, very slow pace..and my T gets frustrated many many times, I am making some progress with analysis..I am feeling it is possible that someone can accept me with all of me, I am feeling it is possible to share those secrets and have someone to listen without thinking I´m dirty or not lovable, I still can´t name the things, I still can´t share the feelings and I am feeling really on the edge right now, but I am learning how to reach out...I have a really long way to go and right now I am finding it really hard to cope but I wanted to share a bit..and I just wanted to say I feel the same way..
for any useful work to take place, it is really essential to build trust and safety first and that takes a long time for some.sorry I´m not in the best place to share or post..
I just wanted to say I understand...sorry if this doesn´t make any sense..I wanted to say I´m glad you posted this, Pfinstegg.lots of support,
Adia.> Maybe it's a mistake to consider psychoanalysis as in some way radically different from other psychodynamically-oriented therapies. Aren't modern analytic ideas- those of analysts like Kohut, Winnicot, Loewald, Ogden, Mitchell, etc. the basic wellsprings from which most all of modern therapy is derived? I'm not talking about Freud here! The contemporary emphasis in psychoanalysis appears to be on empathy and the interaction between analyst and patient. Especially in dealing with trauma and abuse, a secure attachment is a necessity before any uncovering of unconscious memories can usefully take place- as Dinah pointed out to us recently with that excellent article on dependency in the treatment of sexual abuse.
>
> I think I have made a lot of gains in my ten months of analysis- primarily in a reduction in depression and anxiety. I have really deepened and secured my attachment to my (adorable) analyst, but have not yet explored the abuse too much. I think I'm getting ready to, however, as I am feeling so much better.
>
> Pfinstegg
Posted by Pfinstegg on December 22, 2003, at 20:29:26
In reply to Re: 'success' in psychoanalysis » Pfinstegg, posted by Adia on December 22, 2003, at 19:30:55
Hi Adia.. I'm really glad you posted. It seems a very long time until Feb 19. Do you just see your therapist every two months or so? I really commend you for being able to work so hard and build up trust, even with such infrequent visits. I am able to go twice a week, so that it isn't so long between visits- time I tended to use in getting worried about whether my therapist ever wanted to see me again and in building up mountains of self-hate. That was when I didn't feel securely attached. Now, it is so much better, as I am beginning to feel more confident that the analyst will be reliably empathic and understanding- that I can just count on him being THERE for me. As you say, it's a completely new experience for many of us, and very healing in and of itself, even before the trauma has been explored. Of course, you know I wish you could see your therapist more often. It must be so hard to open up these extremely painful, vulnerable areas, and then have to wait two months before continuing.
Pfinstegg.
Posted by Adia on December 22, 2003, at 20:49:58
In reply to Re: 'success' in psychoanalysis » Adia, posted by Pfinstegg on December 22, 2003, at 20:29:26
Hi Pfinstegg,
Thank you for your response. I see her once a week, but she´s going away on holidays, this time..I had a very difficult time opening up, being unable to say a word even,but I am slowly starting to trust her and as you said it is a new and healing experience..I´ve just just started talking about the abuse in words out loud, and I had never done that..and her absence is so hard right now for me..it´s such a long time..in the last session she told me not to try to go deep into those things when she´s just going away and I can´t have her support..I am trying to hang on till feb, I have my psychiatrist..and I am trying to trust friends too..i´ll hang on.
I tell myself she´s not abandoning me and I tell myself I can count on her ...
I am glad you are building trust with your therapist too and slowly feeling more secure in your relationship...it is hard to sustain trust..and to open up...but it is so relieving to be able to trust someone and not get hurt and be accepted with all you carry inside.Thank you for your response,
lots of support,
Adia.> Hi Adia.. I'm really glad you posted. It seems a very long time until Feb 19. Do you just see your therapist every two months or so? I really commend you for being able to work so hard and build up trust, even with such infrequent visits. I am able to go twice a week, so that it isn't so long between visits- time I tended to use in getting worried about whether my therapist ever wanted to see me again and in building up mountains of self-hate. That was when I didn't feel securely attached. Now, it is so much better, as I am beginning to feel more confident that the analyst will be reliably empathic and understanding- that I can just count on him being THERE for me. As you say, it's a completely new experience for many of us, and very healing in and of itself, even before the trauma has been explored. Of course, you know I wish you could see your therapist more often. It must be so hard to open up these extremely painful, vulnerable areas, and then have to wait two months before continuing.
>
> Pfinstegg.
Posted by Pfinstegg on December 22, 2003, at 21:07:20
In reply to Re: 'success' in psychoanalysis » Pfinstegg, posted by Adia on December 22, 2003, at 20:49:58
Oh, I understand- it's just a very long break. I had one of those last spring (one month) and my analyst suggested that I "keep him in mind". He said it was much better to miss him, than to get feeling alone, and have the feeling that he was no longer there at all. To help do that, I sent him notes and postcards almost every other day. It really did help keep him mentally and emotionally present, and he did not mind at all. he also said just what yours did- not to try to think of the abuse when I was alone.
I do wish you well during this time. From what you have said, I feel confident that you will be able to keep on making wonderful gains once she returns. It sounds like this interruption is coming at a particularly difficult time.
Pfinstegg
Posted by badhaircut on December 22, 2003, at 22:04:26
In reply to Re: 'success' in psychoanalysis » badhaircut, posted by lookdownfish on December 22, 2003, at 15:31:43
lookdownfish, Pfinstegg, others-- Thanks for this dialogue. I'm sorry this post is so long, but it would take another day for me to make it shorter, ha ha!
> If you were into psychoanalysis at one point...
For a couple of years, my life was mostly going to analysis and reading & thinking about analysis. My day centered on my time on the couch. I loved psychoanalytic theory and its creative, offbeat writers. I read & read.
> ...what brought you to this [skeptical] point of view?
While I was in psychoanalysis, Frederick Crews brought war on it to the New York Review of Books and I read him.
http://www.nybooks.com/authors/6671 [pay access; libraries may have back-issues; also "The Memory Wars: Freud's Legacy in Dispute" and "Unauthorized Freud" ]
I had no response to his criticisms except contempt for him. I dedicated my life on the spot to finding the defense of analysis that could withstand his disrespectful assaults. I couldn't think of anything but I was sure that somewhere there was something! Then many prominent analysts sent in ripostes, printed a few weeks later. But that made it even worse. They had nothing. They were fools for Freud. They had only their faith.
Sigh.
I stuck it out another year or so while reading other skeptics and getting more hostile with my poor shrink all the time. "What about this criticism! What about that one!" I'd shout. He'd nod and very kindly say, "Yeah, what about them?" He was like the little old priest in the hut: he had peace in his heart because he believed. Logic, facts, critics weren't troubling to him.
But they were troubling to me, highlighting as they did the 4 years, 1,600 man-hours, increased emotional problems, and $48,000 that I had traded for those few real but discrete and relatively small benefits.
I sound bitter. I'm not, or not anymore. I'm glad I know what it's like to willingly undergo psychoanalysis.YOUR FAITH
I don't want to be doctrinaire myself. I don't have contempt for analysts or look down on their patients as poor deluded fools. I'm generally skeptical of *everything* in the mental health world: SSRIs, CBT, AA, EMDR. Psychoanalysis has just had longer to prove itself and instead it's just gotten cleverer at moving the goal line.I can't cite any of the fact-based criticisms as well as the people in Crews' articles and books. Or write as well! But I will do what I think Crews has never done, and list what benefits I think I got out of analysis and say why I stayed in it as long as I did.
REAL BENEFITS TO ME
After a year of talking to this reasonable, kind man about my worst shames and guilts and so on, crying on the couch so much my ears filled with tears, I became (and still am) a little less rigid.I posted earlier that I relaxed around children, I believe, due to analysis. I also found at the time that I could appreciate art in museums more. I don't think either of these results were magic. I was remembering -- and imagining -- for hours every day what I had felt like as a little kid. Naturally, I think, I was able to empathize with current little kids more and enjoy their company. Also, I was getting daily experience in noticing, even milking, any feelings that came up inside me. In the museums I started noticing that feelings were evoked in me by the art. They were there before, I think, I just didn't know to check for them.
My analyst pointed out that I'd been assuming responsibility for most that went wrong in my childhood relationships and that others were involved and shared responsibility. This was a relief to me -- but it's not psychoanalytic. It's family systems and cognitive theory. I'm glad I see it now, but those other disciplines tackle such matters systematically, not just as one side-comment outside the role of psychoanalyst. And he never followed up any such helpful insight with a guideline like, "If you feel guilty, see if there are any other people or things that may also share responsibility." (No helpful guidelines -- now that's psychoanalytic! <wink> )
I also began to assume that other people are often more complicated, conflicted and afraid, etc, no matter what kind of front they present. That may be the most valuable thing I got from analysis. (I wish my last drug-pdoc had been psychoanalyzed! Or something.) I'm also more alert to tell-tale signs of inner conflict in others like overly strong assertions and spontaneous negations. These insights are not unique to psychoanalysis and might not be found there by every analysand, but that's where I picked them up.
> I guess it's not really right to think about Success vs Failure, but to consider any small incremental improvements that one can make.
These were discrete improvements worth making. But they're hardly unique to analysis.
MY HOPES
I didn't, while in analysis, even get a reduction in my depression. I didn't much reduce social anxieties (except, on those occasions, around little kids). I didn't stop obsessing 24/7 about what other people think of me. That's what I was in analysis "for". My analyst said, and I quote, "Those things may happen or they may not," and, "We don't know what you're in analysis for." Nevertheless, I stuck it out for years, believing that "by summer," or "next year" I'd access my core demons and then get to have a happier life.I didn't, while in analysis, make any external life-improvements like moving, getting a new job, making new friends -- although we talked about those things. When, long after analysis, I did move, get a whole new line of work, get involved in the community, regain lost friends, it improved my life more than therapy did. And the analysis did not, so far as I can see, help those things come about.
Posted by badhaircut on December 22, 2003, at 22:31:00
In reply to Re: 'success' in psychoanalysis » badhaircut, posted by lookdownfish on December 22, 2003, at 15:31:43
>> it's burdened with tons of dogma and rituals that are irrelevant to self-acceptance and can even obstruct it
> Can you elaborate?I'll try. This assumes my theory that accepting spontaneously-arising emotions is the ultimate benefit of psychoanalysis. I'm saying that many of the central tenets of the practice of psychoanalysis are irrelevant to the patient becoming more comfortable with what comes up from inside.
==Psychoanalytic dogma that's irrelevant to SELF-ACCEPTANCE==
"Understanding inner motivations is important."
This is, I think, the key axiomatic assumption in psychoanalytic therapy. I can accept myself more fully only if I learn -- and then accept -- hidden thoughts that psychoanalysis brings to light. But I would argue that I can start accepting the parts of myself I already know about. They are the parts that I *know* give me problems."Childhood experiences control current emotions."
Suppose I'm wrong (or Melanie Klein is) regarding insights into my childhood experiences or suppose I change my mind about them later. Would my adult feelings then be somehow illegitimate? Of course not. Even if (hypothetically) someone did not even have a childhood, she could still accept herself and her feelings. Even if our feelings are caused by tumors or space-rays or those popular "chemical imbalances", we can still accept them, tolerate them, work with them. Theories about childhood are more likely to distract from acceptance of current, adult self-disappointments."Dreams (i.e., REM-type imagery) are important."
"Transference is important."
The doctrine of transference also assumes the primacy of childhood experience in current emotional responses -- as well as pre-eminently heightening the importance of emotional responses to the analyst. The analyst's calm reaction to disclosures of feelings about him can help a lot toward self-acceptance of similar feelings in general. Certainly some emotions toward the analyst will parallel relationships that occur outside. But feelings about the analyst won't be more important than feelings about, for example, one's family. Intensely focusing on feelings about the analyst may distract from the patient accepting his (pre-existing) feelings about his loved ones or coworkers."Slips of the tongue are important."
"The taboo is important."
Taboo issues, I honestly believe, just don't come up very often in real life. Because of their actual rarity, I suspect that dealing with taboo issues is more likely to be a mental exercise void of strong emotion than something from which to model self-acceptance. I could be wrong.==Psychoanalytic RITUAL that's irrelevant to self-acceptance==
Lying on the couch.
Long silences.
Frequent sessions. Repeating the same procedure, same time, same place, every day isn't necessarily going to evoke the kinds of feelings that come up from other experiences. There isn't a scrap of evidence that 5-times-a-week analysis is more effective at anything even analysts say they're trying to do than once-a-week analysis.
Posted by Pfinstegg on December 22, 2003, at 23:02:54
In reply to What turned me from analysis » lookdownfish, posted by badhaircut on December 22, 2003, at 22:04:26
I think the problem, for me, with taking Drew's book on Freud and thinking, from it, that all psychoanalysis is useless and even fraudulent, is that contemporary analysts don't practice anything like the way Freud did. They have lessened their emphasis on drives, conflict and aggression, and added a lot of emphasis on the interpersonal aspect of the analytic relationship. And it doesn't just meander along. I have a diagnosis of PTSD with resulting Ego State Disorder- sudden switches into very anxious and/or depressed moods. My analytic treatment has three parts: first forming a secure relationship, then exploring as much of the abuse and neglect as I am able to remember, and finally, trying to integrate these experiences into my life without the huge emotional upsets I have been having. I'm only at stage one, but getting close to stage two. This is being done by a prominent teaching and training analyst. I think he may be a bit ahead of his colleagues in his thinking and approach, but he is very highly thought of by them, so he can't be TOO far ahead!
I guess my main point is that no analyst practices the way Freud did, because it wasn't very helpful. However, the newer ways of thinking, emphasizing the importance of the analytic relationship as well as the reality of the tremendous amount of neglect, physical and sexual abuse which occurs- actually occurs, and is not just a wishful fantasy, as Freud thought, has made the various forms of psychoanalytic therapy far more effective than they originally were. There's a big range in how it's done now: some few people go everyday, with the sickest patients usually sitting up for the additional security that provides, others on the couch. A lot of people have exactly the same kind of therapy, but go once or twice a week. I'm one of those.
Pfinstegg
Posted by Pfinstegg on December 22, 2003, at 23:20:23
In reply to Re: What turned me from analysis » badhaircut, posted by Pfinstegg on December 22, 2003, at 23:02:54
Maybe you all know this, but I didn't. I never heard of an Ego State Disorder. But it's on the continuum of MPD and is one of the Dissociative disorders- just a less severe version of it. I have just one conscious self, unlike people with true DID, who have two or more. However, unconsciously, I have at least one split off childhood part, which is much more aware of the abuse than *I* am. That will be the part to try and reach in Stage 2. I am just learning all this stuff myself, so thought I'd share it, in case others are in a similiar position.
Pfinstegg
Posted by Kalamatianos on December 22, 2003, at 23:32:15
In reply to 'success' in psychoanalysis, posted by badhaircut on December 22, 2003, at 11:17:47
badhaircut>>>...the patient doesn't keep them in the Unconscious -- where they would still be active.
...begs the question:
"Since the mind is the manager and processor of thought, when was the last time your unconscious mind had an unconscious thought?"
...more perplexing:
"How did you know it was happening?"
...and,
"Does a healthy unconscious mind do us any real good (if we're not stuck in magical-thinking)?"
RSVP. These are not a rhetorical questions.
Perhaps you meant to say "backgroaund awareness" for the unconscious mind.
(see Roger Penrose, "The Emporer's New Mind").
Posted by Kalamatianos on December 23, 2003, at 0:13:59
In reply to 'success' in psychoanalysis, posted by badhaircut on December 22, 2003, at 11:17:47
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