getting started: thinking about therapy
Are you thinking about therapy?
The following short essays offer my views about therapy and psychoanalysis. They discuss the differences between the two, and what conditions are necessary for change. These four essays are meant to answer questions; to dispel myths. Perhaps, they will peak your curiosity. Mostly, I hope they pave the way to an informed decision about the choice of therapy for yourself or someone you love.
When is the right time to start therapy? There isn’t one answer to this question. Maybe things aren’t going the way you want, and you don’t know why. You’re struggling with feelings you have no idea what to do with. Or, worries you can’t talk to anyone about, even your friends. These are good reasons to consider therapy. But, how do you choose a virtual stranger to talk to, and choose well? As your therapist – what could you expect from me?
A place . . .
To talk. To be listened to closely. To find words for what troubles you.
To build trust. To learn there’s nothing wrong with asking for help. That you’re not alone.
That needing someone is not a failure.
To work out what scares you. What makes you run away; or hide. To undo the ways you’ve protected yourself from being hurt.
To share your raw-est feelings. To be yourself without judgment or shame. To stand up tothose guilt-ing, shame-ing voices in your head.
To be angry. To learn not to feel guilty about what you want. To untangle misperceptions. To see things the way they really are.
To be understood. To be found. To become free.
Who you are; what you need; and what you bring to each therapy hour – determines what happens in your therapy. It may be difficult to imagine if you’ve never been in a psychoanalytic kind of therapy before, but therapy is a process that unfolds and deepens over time. What emerges between us, what needs to be understood, and what needs to change, sets the course for a therapy like no one else’s.
You are probably thinking about therapy for a specific reason – a problem you’ve lived with for a very long time. Although it doesn’t seem like it – that problem (depression; anxiety; a creative block; unsuccessful relationships; cutting or injuring yourself; difficulties with food; a critical, self-hating voice you can’t get out of your head – and many others) is not the actual problem, but a symptom. Symptoms are feelings that you shut out of your awareness, for complicated reasons, sometime early in life; ‘remembered’ in your body; your behaviors; your doubts; in the places where you are stuck.
These ‘past’ feelings, now hidden in your symptoms, are still ‘alive’ in your misinterpretations of long ago events; in your closest relationships; your doubts; the ways you blame yourself; and in things that hurt you. We all repeat what we don’t know we’re repeating. And, these repetitions seem related to a current situation, but aren’t. Although therapy isn’t about me, the unique nature of our relationship is a microcosm; a window into your very individual internal universe; into the ways the past is still alive right now. As we talk, hour by hour, we piece together the unknown origins of your symptoms and we work them out – freeing you to do what you want to do and be who you’re meant to be.
Change is hard. There’s no way around it. So, when it comes to deciding to change and starting therapy, there are some important questions to ask. What does a therapist do to help you change? How do you choose a therapist, or type of therapy, best suited for change? What do you contribute? And, what makes change happen? There are three essential ingredients for change: a therapist who understands what you don’t understand;willingness to change – and time.
A therapist must listen closely. Keep what you say in mind. Create a safe place for your feelings; without judgment. Understand, with compassion, any feelings you bring. Think things over with you. And, offer you ideas about yourself that seem new and right. A therapist who pays attention to the details of your problems, and talks to you with understanding and directness – can help you get through the difficulties of opening up, and trying to change.
Willingness may seem simple. There are things you want that you don’t have. Ways you feel that you don’t like. Why wouldn’t you want to change? But, sometimes it seems much less risky to keep things as they are. Especially if you’ve had deep disappointments and people who’ve failed you in the past; and could only expect more of the same. So, maybe it seems wiser to run in the other direction, using your own familiar methods to manage your feelings – busyness, sleep, sex, drugs, alcohol, food; to name a few. It’s not easy to try therapy, in spite of your fears – to stick with it, and to take the time.
Time is probably the most difficult commodity to come by in our current fast-paced culture. You can jet all over the world. The Internet takes you where you want to go in seconds. Answers are at your fingertips. Why, then, shouldn’t a therapist identify the problem and fix it, right away? And, if she doesn’t – aren’t old cynicisms and doubts stirred up? Allowing time (even to take a deep breath, sit down, clear your mind) is a 21stcentury problem. And, in the 21st century, psychoanalytic therapy – which takes time – is supposedly outdated. But, it’s not. The problem is that something else, before you, usually comes first. What is outdated is our ability to give ourselves the time.
The reality is – problems take years to develop and time to change; mostly beginning early in life – with experiences, losses, and betrayals that are terribly painful, often misconstrued, and harmful to your view of yourself. Change comes from talking things out, from giving yourself the chance for an awareness you didn’t have before – of ways you think; ways you’ve come to manage your feelings. To form new experiences of yourself and others – and to become who you are meant to be – takes time, courage, and help you can grow to trust.
How many times have I heard the questions: “Isn’t once a week enough? Don’t only sick people come more often?” And, four or five times a week? That’s practically sacrilege. There’s no question that myths haunt psychoanalysis. Hasn’t “Freud is Dead” been splashed across a magazine cover more than once in recent decades? Why do people want to kill Freud – and, along with him, psychoanalysis as a therapy of choice?
I would say the answer is fear. If so, what’s scary about psychoanalysis? Quite understandably, I think, it’s what we don’t know. After all, Freud brought to our attention that realm, in each of us, called the ‘unconscious’ – and how it works. But, don’t we all too often repeat the ‘reassuring’ mantra: “What you don’t know can’t hurt you”? When, actually – what you don’t know can oppress and defeat you.
Many of us spend our lives living out fantasies that get in the way of having the life we want – fantasies that don’t seem like fantasies at all. Like: “I’m a complete failure”. “No one loves me”. “I’m doomed to be alone forever”. “I’ll never get what I want; so why should I try.” And, when you believe these kinds of things – what happens? You find ‘proof’ everywhere. Those untruths – the ones you trust without question – are, really, just the tip of an iceberg. Psychoanalysis unveils them for what they are, and helps you find the other side.
Although everything I said in “On Therapy” is true of psychoanalysis; psychoanalysis allows for a deeper look. Yes, taking that look requires some courage. But, if I were your analyst, I would be there every step of the way – as what is forgotten, or unknown, slowly comes into view; hidden in your symptoms and behaviors, in the words you say; session by session. Uncovered in the repetition of old experiences, which occurs in every analysis.
Our relationship takes on whatever you bring – early fantasies, unsettled hurts, anger, longings, and losses. We have the benefit of frequent hours together, to talk things out; to make space for something new to emerge – over time. There is a misperception that psychoanalysis is an intellectual therapy. But, it’s not. An emotional language grows between us; a language that belongs to the two of us alone.
Psychoanalysis is having a heart to heart talk; letting me help you find your real self – lost amidst the symptoms, the fears, the blocks, and the false explanations about who you think you are; or aren’t. That rumor, “Freud is Dead”? Don’t listen to it. Psychoanalysis has changed a great deal since Freud – but it is alive and well; and the best option for persistent symptoms. In a good analysis, you have the chance to put the pieces of your self back together; see your personal history in a new light; and recreate yourself in your own image.
on the use of the couch
If you’ve heard of psychoanalysis . . . or seen some of those New Yorker cartoons, you probably know that the iconic symbol for psychoanalysis is the couch. The two go together. Tangled, unfortunately, with disturbing stereotypes of a distracted analyst who prefers not to look, falls asleep, or sits silently behind – leaving you, all too alone, to come up with your own help.
What to do, then, if you walk into, let’s say, my analytic consulting room? Keep your eyes from trailing over to that offending part of the room, as if the couch doesn’t exist – hoping I won’t bring it up? Or, if you are among the more forthright, let me know in no uncertain terms: “I will never lie on that thing – don’t even think about it”.
What is that thing – the couch? And, what is it for? Stereotypes, of course, are best dispelled. And, one stereotype is – I’m going to make you lie down on it. My work as an analyst is not to make you do anything, but, instead, to understand your feelings. There are many things in my office, including myself. All can provoke reactions, which are grist for us to learn about you. The couch, in that endeavor, is not excluded – nor is any concern you have about why I would consider using such a ‘relic’. And, why would I?
The couch is a tool. For some, it is hard to look at me. Gauging my reactions, or feeling my gaze as a demand, doesn’t leave you free to have your own thoughts. The couch can be a peaceful respite from such pressures. Much has changed since Freud, but his instruction not to censor what comes to your mind still has its merit. Understandably, that is easier said than done. When it is not easy, or even possible, to be open with your thoughts – that very difficulty is an essential part of our work. Sometimes, though, lying in a supine position encourages something close to dreaming in the session – giving nearer access to what is right below the surface.
On the other hand, you might have a lot of concern about your relationship with me; due to failures or abandonments in your early history. For you, then, looking at me might be the only evidence I am there. And, the act of keeping me in close visual range is what paves the way to proof that I am the least bit trustworthy. In such instances, the couch is a far off consideration.
Feelings must be respected, and everyone’s timing – and needs – are exclusively their own. Will every analysis, eventually, make use of the couch? I might say yes – because once the worries, distrust, and fears are worked on between us, the couch is often naturally open for a try. But, I really can’t, and won’t, take a single-minded position. The true answer is – I don’t know. Since the couch is a tool and not an expectation – whether, how, and when it is used is interwoven into the fabric of every individual analysis.