Psychoanalysis is a way of approaching one’s inner, mental life. Ordinarily much of that life goes on “beneath the surface” and fairly automatically. This works well most of the time. However, there are times when stresses – from the outside or from within our own minds – leave us in “conflict” within ourselves. One example might be someone who works very hard to succeed in life but who also has fears of success which get in the way. Another example might be someone who very much wants to have a close relationship with another but who repeatedly sabotages any relationship that has some real potential for closeness.

Psychoanalysis depends upon the fact that, when we take the time to attend to our own minds, things start to “bubble up.” This is especially true when we take the time in the presence of a sensitive and attentive listener. The things that “bubble up” provide clues regarding the deeper currents that are active within our psyches. In psychoanalytic work the time given to this work is quite substantial: Roughly an hour a day for as many days in the week as one can manage.

Psychoanalysis is a partnership which involves two people – the patient and the analyst. If it is to “work” there are several requirements that must be fulfilled. From the side of the patient, we ask that he or she do their best to “speak their mind” without censoring their thoughts in any way. [This is much harder to do than it might seem at first glance.] From the side of the analyst, we ask that he or she listen carefully, attentively, and with respect. We ask that the two of them continue this work day after day, week after week, month after month, at a regular time and in a regular place. Often it is helpful if the patient lies down on a couch and relaxes, with the analyst present but out of sight. It is the analyst’s job to sort through the patient’s thoughts, feelings, fantasies, and actions, looking for the threads that connect these fragments.

A metaphor for psychoanalysis that I often use is that of two people assembling a very large jigsaw puzzle – but the puzzle comes without a box-top so neither partner knows what the completed puzzle will look like when assembled. Instead both must attend to the details of each piece, looking to see how they might fit together.

In this work many people find it surprising – and yet it is no surprise – that their own mental lives turn out to be just as complicated and contradictory as that of any character penned by Dostoyevski, Thomas Wolfe, or Flannery O’Connor.

Such inner contradictions are unavoidable – there are certain human strivings that cannot be satisfied without denying others. At times, however, the contradictions we find in psychoanalytic work derive from prior times – thoughts and feelings which might have been quite ordinary and unexceptional at age five or fifteen sometimes continue to affect us when we are thirty-five, fifty-five, or seventy-five. The process of psychoanalysis provides an arena within which we can see where such contradictions have developed and persist . . . and then can examine new options.

This work requires a degree of trust that takes a long time to develop. No one in their right mind would quickly or easily start talking about their most personal inner fantasies with someone they did not trust. Therefore one cannot “rush” this kind of work. It often continues for several years – until the patient feels that they have reached their own goals for the work.

Psychoanalytic work also requires privacy and confidentiality. It is vitally important that the patient feels sure that whatever he or she says will stay within the confines of the trusting partnership. This is because it is common for patients to experience thoughts, feelings, and fantasies toward their analyst that once belonged to other, prior relationships. This phenomenon, called “transference” (because these thoughts, feelings, and fantasies are “transferred” from one person to another), can make psychoanalytic work quite challenging. At the same time, it is transference that resurrects old conflicts and makes them “live” in the present, in the relationship between the patient and the analyst; there they become accessible to analysis and change.

Dreams are another important way in which patient and analyst together can learn about the deeper levels of the patient’s mind. Dreams are especially valuable because in them patients are free to think thoughts and to feel feelings that they “wouldn’t dream of” in waking life. The fantastical world of dreams is a frequent burial ground for our most closely-guarded inner conflicts. While dreams usually clothe those conflicts in various disguises, psychoanalytic work provides a way of coming to an understanding of the underlying issues.

In these times most people who choose psychoanalysis have had some prior experience with less intensive treatment. Often this has been psychoanalytic psychotherapy on a once- or twice-weekly basis. Their decision to shift to more intensive work may come because the less-intensive treatment has given them an inkling of what lies beneath the surface and they want to get on with the work that needs to be done.

Psychoanalysis is not something that one takes on lightly. It requires a very substantial commitment of time, energy, and money, usually over a period of years. Given the fact that most health insurance plans either (1) refuse to cover this kind of work or (2) require a degree of disclosure of personal information that makes the work impossible, most patients find they cannot count on outside financial support for this kind of help.

Most health insurance companies would prefer that their subscribers use drugs to deal with their emotional problems. These are relatively inexpensive (though by no means cheap!) and many of them have a fairly quick effect on feelings such as sadness, anger and anxiety as well as on behaviors such as poor attention, insomnia and impulsivity. Drugs, however, have side effects; and drugs pay no attention to the causes that lie beneath our thoughts, feelings, and fantasies. For these reasons many people are (understandably) very hesitant to use drugs. In addition, there is quite a substantial group of people who have tried various drugs and found that none of them were helpful.

Psychoanalysis is a way of approaching the life of the mind without drugs. It is not quick nor is it particularly easy. It requires some major commitments from both partners in the work. Despite these limitations, many people have found that psychoanalysis has provided them with a kind of relief from their inner battles that nothing else did.

The best way for someone to decide if psychoanalytic work might be appropriate and helpful to them is to sit down and discuss their personal situation with someone who is knowledgeable about this kind of work – a psychoanalyst. Ideally this person would be able to take on the role of listener in the long run since it is very hard to begin to tell one’s story to one person and then to be referred to another. At the same time, because this kind of work requires the development of a trusting relationship, there is a certain amount of personal “chemistry” involved. It is especially helpful and important that the person seeking help feels a certain degree of comfort with the person to whom they go for that help. This means that someone seeking this kind of help might have to meet with more than one person before they find a comfortable “fit.”

This description of psychoanalysis is my own. You can find another on the web site of the American Psychoanalytic Association; it is entitled, “About Psychoanalysis.”

[Home] [General Introduction] [Specific Services] [Psychoanalysis] [Child Psychoanalysis] [Psychotherapy] [Child Psychotherapy] [My Background] [Location - Directions] [FAQ] [Links]