Is Psychoanalysis ‘Good’ Therapy?

man being evaluated by psychiatristI’ve received two requests to add psychoanalysis to our list of therapies and thought this would be a valuable discussion topic, one that would help me to make a decision. Here’s my problem: I know this may be biased and outdated, but the association I have (no pun intended) when I think of psychoanalysis is of a withdrawn, unresponsive, and impersonal figure providing well-timed interpretations about the transference of their “patient,” who lies down with the analyst sitting behind and out of view.

I’m aware that this association is based on traditional psychoanalysis and that the model has evolved beyond its original forms into numerous approaches, such as object relations and self psychology. Neither do I underestimate the value of psychodynamic theory and its influence in my work. I even took part in a year-long object relations training about 10 years ago. But psychoanalysis presents more than a theory with useful concepts about the intra-psychic world; it’s the way psychoanalysis encourages the analyst/therapist to “be” with the client that concerns me.

So, I remain concerned that psychoanalysis does not fit our idea of what “good” therapy is and I’d like your opinion on it. More precisely, I’m questioning the following:

  1. Do contemporary psychoanalytic approaches hold that behind the layers of protection, no matter how self-destructive or hurtful to others one has been, there is a lovable and vulnerable Self at the very core?
  2. Do contemporary psychoanalytic approaches hold an unwavering belief that people can grow, heal, and transform?
  3. Do contemporary psychoanalytic approaches tend to view people as fundamentally and irreparably flawed on some level?
  4. Do contemporary psychoanalytic approaches work collaboratively by helping a client to tap into his or her own intuitive wisdom, or do these approaches instead rely more often on the analyst providing interpretation and insight to the client about his or her problems?
  5. Do contemporary psychoanalytic approaches encourage the analyst/therapist to be free in their use of Self, open to purposeful self-disclosure, and to hold a kind, caring, and compassionate state of being with their clients? Or is it encouraged that the analyst/therapist be the detached evaluator who relies solely on the working through of transference as the primary method of healing?

Please feel free to post your comments, and thanks in advance for sharing your wisdom.

© Copyright 2007 by Noah Rubinstein, LMFT, LMHC, therapist in Olympia, Washington. All Rights Reserved. Permission to publish granted to GoodTherapy.org.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • claire hershman

    claire hershman

    March 17th, 2007 at 11:10 AM

    hello . i think is a bit naieve to lump all psychoanalysis together. even in different countries and different groups there are differing ways of doing analysis. i m a jungian psychotherapist and i passionately believe in intensive psychotherapy. seeing a therapist 5 times a week gives the analysand the amazing opportunity to really get to know themselves and work things through with a living person. its the relationship that is healing not the theoretical underpinnings. the jungain community in london has 4 different groups who seem to find it difficult to agreee on anything let alone a coherant approach. so the work is on going and alive. and anyway the patients that presented to freud dont present to day. people seem to have very different problems.

  • Ker Cleary

    Ker Cleary

    March 17th, 2007 at 11:24 AM

    I don’t know anything about contemporary psychoanalysis, but I have the same impression as you, Noah. I just wanted to say: yes, I read your postings (!) and I thank you for your thoughtfulness in considering whether to include this approach on this site. There are plenty of places for analysts to be listed online, but the parameters of this site were very appealing to me specifically because of the support for a different way of viewing and working in therapy.

    My training is to not pathologize and to witness (not even imagine, but truly see) the client’s (and my own, and all of our) innate, inherent nature, which is clear and luminous and wise. So. My vote is to not dilute the impact of this site by listing modalities of treatment that don’t fit your stated purpose for the site and the movement in general…
    Thanks for your work and commitment!

  • Therapist Albert Park

    Therapist Albert Park

    March 17th, 2007 at 11:26 AM

    It sounds to me as though your ideas about psychoanalysis have been shaped by the out-moded ideas of the witholding analyst who primarily makes interpretations and analyzes the transference.
    I am greatful that you have posed important questions and are open to a dialogue. Contemporary psychoanalysis has grown and become much more dimensional in its approach. Interpretation (highly overrated as an intervention) is only one of many tools. Psychoanalysts today acknowledge the importance of the real as well as the transference relationship. They use their own depth of connection to the unconscious to meet the “patient” and allow the work to evolve on a deep emotional level. Psychoanalysis is the ultimate depth therapy. Its not about pathologizing – that is more the medical model. It is about recognizing that true growth and change takes place over time and that healing can take place in the context of an intimate and ultimately loving relationship.

  • Therapist Albuquerque

    Therapist Albuquerque

    March 17th, 2007 at 12:04 PM

    There are many variants of psychoalysis: classical, modern, self [Kohutian]. Many of these variants and many psychoanalysts are consistent with the principles of “Good Therapy”, though not all

  • Geoffrey Steinberg, Psy.D.

    Geoffrey Steinberg, Psy.D.

    March 17th, 2007 at 12:35 PM

    I strongly support including psychoanalysis in this list. What you’re desribing as the detached, cold, impersonal analyst is a negative stereotype fueled by countless cartoon and movie depictions. It couldn’t be further from reality.

    I practice from a psychoanalytically informed perspective, which was how I was trained, and I aspire to join an analytic institute for postdoctoral training. Meanwhile, to be clear, I talk with my clients. I have emotions and I show them. And I view the relationship as an egalitarian. I’m a lot less interested in insight and interpretation than I am in understanding what’s unique about the relationship I’ve formed with each client, and using that relationship to help the client achieve their potential.

    The way I see it, the values that you’ve described in this site, Noah, are aligned in a broad sense with contemporary psychoanalytic work. I also want to say that such values are held by individual practioners more so than by theoretical orientations in any collective sense. In my experience, many analysts and analytically-informed practitioners hold the kinds of values to which this site aspires, and others probably hold different views. The same could probably be said for members of any grouping along theoretical orientation lines. That’s why individual practitioners may self-select their participation in a group such as the one formed on this site.

    I have difficulty responding directly to the five questions you posed. Perhaps others will have an easier time of it. I think my difficulty comes from the dichotomies that are posed and my inability to speak for the totality of analytically informed clinicians.

    For instance, when you asked is our belief in our clients’ potential “unwavering” as you put it? Well, if we as therapists didn’t believe our clients could grow, then what would be the point? But “unwavering” sounds kind of superhuman.

    The reality of a human interactions is much more of a process. Psychoanalytic approaches are especially helpful as a theoretical roadmap for the clinician is to understand when such a belief wavers, to understand why. It provides a map to look within the clinician, to look within the client, and within the unique relationship between the two. So the challenge is to understand the wavering and collaborate as two people to repair it. When such a rupture is repaired within the therapeutic relationship, this can generalize to other relationships in the client’s life.

    Where am I going with that? Well, among contemporary psychoanalytic approaches, including Modern Psychoanalysis, Object Relations, Self Psychology, and Intersubjective approaches, the relationship between two people is key. The experience of engaging in such a relationship with another person in psychotherapy is fundamentally a human endeavor, with the twist being that the relationship can be a crucible for change in the client.

    In my opinion, this happens precisely because the therapist is actively involved in shaping an interpersonal relationship that will allow the client to develop capacities for growth and development that the course of ordinary life has not provided.

    It’s also most often today a face-to-face encounter (though the couch may have its tie and place too). Among other reasons, we now understand so much about the value of face-to-face communication in forming attachment (from infancy through adulthood).

    I’m interested in your reactions to what I wrote, Noah, as well as others’ reactions. Does it sound to you like what I said dovetails with the intentions of goodtherapy.org ?

  • Therapist Alfred

    Therapist Alfred

    March 17th, 2007 at 1:27 PM

    Regarding your questions of psychoanalysis, I agree with one of the respondents that the notions you have seem connected more with an outdated model. I approach analysis through a Jungian/archetypal lens. In my experience and training, analysis certainly affirms the worth of the individual, and the possibility of change. One of the advantages of analysis is the approach to pathology: many of us feel that pathology isn’t something to be cured (e.g., depression); rather, it is the cure–that is, depression has something of worth to teach us. It doesn’t have to be the enemy. Analysis is certainly collaborative in my experience. I teach my patients (read this word to mean “in the care of” and not “sick, needing to be cured”) that the answer comes from their psyche, and from their connection with soul. The folks with whom I work experience me as deeply engaged and open or transparent with them. Analysis, from my perspective, is still a viable modality that has a lot to offer. Besides, when the cognitive-behaviorist therapists burn out, where do they turn? Jungians!

  • Bill Wysong

    Bill Wysong

    March 17th, 2007 at 2:14 PM

    Psychoanalysis? Why not? No one therapy is good for everyone. Psychoanalysis will appeal to some clients/patients and they have a right to choose to quit if they are not getting what they want. Will psychoanalysis cause client dependence? Yes, and so will any other therapy.

  • Murray S. Kaufman, MA.LMFT

    Murray S. Kaufman, MA.LMFT

    March 17th, 2007 at 2:47 PM

    I really appreciate your invitation to respond to your question, Noah. I can speak from my own experience with psychoanalysis. My therapist was a Jungian, and I found the therapy to be helpful. My seat was not a couch, and his seat was across from mine, not behind me. In addition, I saw him one time per week, not 5 times per week. In terms of whether this form of therapy should be added, I strongly agree that it should. As is true for all types of therapy, each is done a little differently depending on the therapist’s approach. Even though the goal for you, and me is that people have the best chance for Good Therapy, I feel that each of us must
    have an opportunity to choose a Good Therapist. Psychoanalysis is another form of therapy that, hopefully, will yield good results. As in other
    forms of therapy, people will ultimately judge for themselves whether their experience with an individual therapist has been helpful to them, not the type of therapy.

  • dyan

    dyan

    March 17th, 2007 at 3:58 PM

    dear noah…I tend to agree with your comments on the more traditional aspect of psychoanalyse…..most of my clients have been under “traditional” councelors and therapist for quite a long time…often seeing there therapist 3 times a week (one lady for 10 years)….i think one of the fundamental points to be made is…we can understand deeply and implicitly why we do and act and react in a certain way…but does that actually help us change or overcome these patterns?actually most of my clients have quite a deep understanding of why they do ,what they do…..it gives the client something interesting and facinating to dwell on…I personally prefer therapies like Dr David Reynold s, ( constructive living )and cognitive behavoiur therapies….these therapies state that it is o.k to feel lousy sometimes…actually its part of human nature not to be “up” continually..these therapies state that “feelings follow behavoiur’…not the other way around….i have found that a lot of my clients who have been in traditional therapy for a long time are continually “in their head”…they have often become almost paralyzed by constant analyzing of issues…it is an never-ending quest…i am not against gaining insights into behavoiural patterns…but ,for me.these insights have to be lived and acted out in our world, physically,mentally emotionally…when clients who have been deeply derpressed start doing something…cooking classes…exersise groups….whether they feel like it not..
    their moods often lift…
    thanks Dyan Moore

  • Jason Seidel, Psy.D.

    Jason Seidel, Psy.D.

    March 17th, 2007 at 4:02 PM

    Hi Noah and esteemed colleagues-
    The most important people to answer these questions are the clients/patients of psychoanalysts, don’t you agree?

    I’m an analytically informed (not dyed-in-the-wool) therapist, and a past analysand (in a 3x/wk Kleinian analysis, which is pretty old-school). I’ll do my best to answer your 5 questions from my perspective about the broad field of contemporary analysis, and this does *not* necessarily represent my own way of conducting therapy.

    First, my general comment is that it is therapists, not schools of therapy, that will meet the conditions of goodtherapy.org. After we’ve been practicing for a while, we all meet other therapists who may claim to be practicing humanistic, client-centered therapies, but in actuality are operating from “shadow” in a way that is interpersonally violent, objectifying, pathologizing and so on. In my opinion, the client’s best friend in evaluating the appropriateness of a therapist is their own gut sense, along with interviewing several therapists when possible, and tracking whether they are getting where they want to go as time passes in treatment.

    Unfortunately, it’s just too hard to know who is “really” practicing “goodtherapy” just from where or how they get their training. Regardless, I see little in psychanalysis that would inherently conflict with the principles of this site. Individual analysts will have to determine the answer for themselves from the requirements, as we all have done.

    Specifically in answer to your questions:
    1) Do contemporary psychoanalytic approaches hold that that behind the layers of protection, no matter how self-destructive or hurtful to others one has been, there is a loveable and vulnerable Self at the very core?

    Yes, either there is that self, or the makings of a self that may be helped by a caring and skilled helper to foster the integration and growth of the self.

    2) Do contemporary psychoanalytic approaches hold an unwavering belief that people can grow, heal, and transform?

    Within psychoanalytic theories and circles there will always be those that hold a more optimistic and deeply humanistic view, while others are more cynical or prescriptive about diagnoses, etc. But this is probably true in some way or another of all theories listed on goodtherapy.org. As Geoffrey put it, “unwavering” may be too stringent for any of us mere mortals.

    3) Do contemporary psychoanalytic approaches tend to view people as fundamentally and irreparably flawed on some level?

    Fundamentally flawed, yes: like every leaf on the tree and as part of the human condition. Psychoanalytic theories generally agree that all of us are wounded by life; and all in different ways; and some more than others. Irreparably flawed, sometimes. I’d like to think that the best analysts would see this question of irreparability as a mystery that is affected by context, opportunities, and other complex factors that in the worst case would not be known until the end of life rather than as determined a priori by diagnosis or the analyst’s narcissistic position that if s/he can’t help then the patient can’t be helped.

    4) Do contemporary psychoanalytic approaches work collaboratively by helping a client to tap into their own intuitive wisdom or do these approaches instead rely more often on the analyst providing interpretation and insight to the client about his or her problems?

    Again, this is more about the therapist than the theory. Most contemporary analytic approaches (certainly the ones I’m familiar with) are based on principles of collaboration and intersubjective process that also involves the offering of interpretations and reflections. It’s not black-and-white: either just the client’s intuitive wisdom, or just the analyst’s interpretation and insight. There are two people in the room: not the client alone sitting there and self-healing, nor the analyst alone acting on the patient-as-object. At its best moments, it’s a being-with not a doing-to. In these moments, all therapies converge to the common factors that research shows make therapy effective. And that includes analysis but definitely not all analysts and who knows: maybe not even *most* analysts or most therapists for that matter.

    5) Do contemporary psychoanalytic approaches encourage the analyst/therapist to be free in their use of Self, open to purposeful self disclosure, and to hold a kind, caring, and compassionate state of being with their clients? Or is it encouraged that the analyst/therapist be the detached evaluator who relies solely on the working through of transference as the primary method of healing?

    That’s an easy one. The former.

    -Jason Seidel, Psy.D.

  • Therapist Allen

    Therapist Allen

    March 17th, 2007 at 4:04 PM

    I am not an analyst, but I am Jungian oriented as well as cognitive-behavioral oriented, systems oriented, feminist, etc, etc. Good therapy depends a lot on the therapist. Most of us use a variety of approaches, and Jungian theory adds depth to the quality of my work. Jung’s concepts (of individuation, complex theory, archetypes, as so on) are not at all reductionistic, just the opposite. Many modern psychoanalytic theorists have enriched and updated Freud’s original work as well and do not insist clients come several times a week. Is behaviorism good therapy? It depends on the therapist, the patient, the situation. But the more we are versed in all therapies, the more effective we will be. Include it!

  • Barbara

    Barbara

    March 17th, 2007 at 5:43 PM

    I think psychoanalysis CAN certainly be good therapy, if the clinician is a GOOD therapist. Let’s include them.

  • Garth Amundson, Psy.D.

    Garth Amundson, Psy.D.

    March 18th, 2007 at 6:06 AM

    I practice from a psychoanalytic theoretical perspective and find this approach to be extremely helpful with clients of every description, although one must be willing to modify this approach to include more education and support when needed by the client. This includes people struggling with extremely severe and unremitting emotional problems: working in a state mental hospital for several years, I was deeply moved by the ability of (so-called) “chronic” schizophrenics to make real progress in such things as talking about their thoughts, making friends, etc. simply because they were listened to and understood at a level beyond that of consciousness, without unecessary and intrusive cajoling, pressure to change, and/or “suggestive” techniques.

  • Therapist Almeria

    Therapist Almeria

    March 18th, 2007 at 7:26 AM

    Hi. Interesting dialogue. I think the answer to your questions about psychoanalysis is yes. Just like other kinds of therapists psychoanalysts can be supportive and believe that their patients/clients have the power to transform themselves and grow. I do not think it is right to exclude a particular approach to therapy. Your views of psychoanalysis are outdated and too generalized. There are people who can benefit a lot from psychoanalysis and it is a discredit to the people looking on your site to exclude an entire modality. Why not believe that the potential clients searching on your site have the power and discernment to choose what is good fro them among the choices offered. the more choices and options, the better. as an art therapist, I am quite familiar with being excluded, misunderstood and put in a category “lower than” more traditional therapies. Now that art therapy is being given the respect it deserves, it is important to continue to include more traditional therapies as options. Many psychoanalysts that I know have an eclectic approach to therapy and have been trained in a variety of approaches. As with art therapy, I think having more knowledge should never be penalized. Good therapy is not about one’s philosophical approach as much as it is how human and compassionate the therapist is in action.

  • Therapist Altamonte Springs

    Therapist Altamonte Springs

    March 18th, 2007 at 8:24 AM

    Dear Noah–I deeply appreciate your interest in opening this topic up for discussion. I was rather ambivalent before reading all the responses. I am not an analyst but I certainly have a psychodynamic perspective with clients that has been very helpful to formulate part of my clients’ stories and tx approaches. But I also held antiquated ideas about psychoanalysis that included the couch, interpreting the transference as a primary technique, and 5/day a week sessions. So I thank everyone who took the time and energy to correct these, and accordingly, I believe the site should include psychoanalysis. Obviously there are actively caring, engaged, and collaborative psychoanalytic practitioners who beautifully fit the ideals of “GoodTherapy.” Blessings and peace, Patti

  • Arnold Morgan, PsyD

    Arnold Morgan, PsyD

    March 18th, 2007 at 11:29 AM

    After more than 20 years in the field, I still can never be sure what will help effect change in the people I work with. I have studied a number of models and utilize the ones that fit my cosmology as well as those of the client. I am against exclusion generally… but than what is the point of this website and attempting to define ‘Good Therapy’? I don’t think the question is, “Is psychoanalysis ‘good therapy'”, but how do you choose to operationalize the term.

  • admin

    admin

    March 18th, 2007 at 1:00 PM

    Thanks to everyone who took the time to join the discussion. To those of you who may have been triggered by my original post, please know that my intention was to be curious, open, and to learn. I shared my questions with the group because I’m not an expert in psychoanalysis, I knew I was harboring bias, and I knew that I could draw on the collective wisdom of this group. I’m pleased to have received all of these responses. I feel like I have a much better understanding of contemporary psychoanalysis, more clarity about how my experience with psychoanalysis produced my own generalizations about analysis, and totally prepared to include Psychoanalysis in our list. The following is my response to each of your comments:

    Claire, Yes, I think you are right. It is naïve to lump different kinds of analysis together. I too see the relationship, both the relationship between the therapist and client, and the relationship between the client and his parts/ego states as more important than theory.

    Ker, Thanks for your understanding. I too was suspicious about my own associations about psychoanalysis because I knew the information I had was probably outdated. The postings to my questions have been very informative and have helped me to feel comfortable including psychoanalysis. I can see that my hesitation was based on fear and prejudice.

    Suzanne, You are right about this, my beliefs about psychoanalysis have been mostly shaped on this outdated version of traditional analysis. It was also shaped by my experience in an object relations consultation group. That was over 10 years ago, but I am still left with an impression of the work being much less about the relationship and of the ideal analyst being much more removed, disconnected, and, frankly, arrogant in a way I don’t prefer to work. But based on everyone’s comments, my impression about psychoanalysis was in large part a result of the training/consultation group I was in. As a number of you commented, it is the therapist, not the model that has the most impact.

    Bud, Thank you, yes. That’s what I’m being reminded of by a number of you. It leaves me interested in knowing about the different branches of contemporary analysis and if it would be helpful to include these as well. I do have Jungian work and Self Psychology listed, are there others we should add in addition to general Psychoanalysis and Object Relations?

    Geoffrey, Thank you also for pointing out the stereotype I’ve held. It’s actually a relief to feel safer about including analysis and I can see how my own experience with the old training consultation group I attended influenced this stereotype. I also think that my training in Internal Family Systems (IFS) psychotherapy, which is one of the most respectful and collaborative psychodynamic models I know of, has really made me sensitive to anything that’s other than respectful. I’m pleased to hear how you conduct yourself in your work: egalitarian, with some transparency, focused on the relationship. …. Yeah, I know that the word “unwavering” can sound a bit strong, if not grandiose. The reason I use the word “unwavering” is because in the face of all the doubting, skeptical, and self-defeating parts of our clients the only way one will attempt to go to the dark and hurting places within, in an effort to heal, is if one senses absolute confidence in their therapist that it is possible to heal safely without decompensating, as clients often fear. Richard Schwartz the developer of IFS calls this being a “Hope Merchant.” I believe my clients can heal if they want to and if they put in the time and energy that is sufficient and necessary. Though sometimes healing doesn’t happen. I believe a good therapist never gives up hope that a person can heal in this lifetime, but also recognizes that he or she may not be the one to help, that the time may not be right, the client not ready, and that, for whatever reason, one may never do the work we envision them doing. To good therapy it helps to let go of expectations and outcomes for ourselves and for the people we work with; though without giving up. I will find a word that suits this approach better than the word “unwavering.”

    Scott, Yes, the element you described so succinctly about how “the pathology is the cure” is the foundation of what nonpathologizing is. It’s easy to pathologize. Most of our clients come to therapy already pathologizing and disgusted with themselves. They tend to hate whatever it is they’re suffering with, whether it’s depression, anxiety, addiction etc. I love the process of witnessing a client discover the positive intention or purpose behind their depression and having, for the first time, an appreciation for how and why their depression was shutting them down. I agree with you that this kind of process is not something that cognitive behavioral work can do, as far as I know.

    Bill, Yes, thank you for saying that no one therapy is good for everyone. That is part of the reason I created this site: to introduce ourselves to other ways of working and to find the powerful elements in different kinds of therapy. However, I do believe that some models and their theoretical foundations lend themselves better to collaborative and nonpathologizing work than others. Some models are too stuck in the head and miss the relationship. Indeed, it is the relationship and the amount of Self the therapist holds that makes a difference too, but the theoretical orientation becomes like a filter through which we see our clients and this can limit and interfere with doing good work. So this is part of the reason I posed the questions about psychoanalysis.

    Hi Murray, Thank you for also emphasizing the wisdom that, “for all types of therapy, each is done a little differently depending on the therapist’s approach.” I’m sure this explains my unfavorable experience with the object relations consultation group I took part in.

    Dyan, thank you for boldly pointing out something that I too have been concerned about. My experience is similar. Until I learned how to help people to heal trauma and release burdens stored in the body, many of my clients understood their problems better, but didn’t really feel better or change their automatic responses to triggers. What I believe now is that healing takes more than cognitive insight and more than emotional insight. Healing requires releasing the extreme beliefs and feelings stored in the nervous system. I think that many of the body approaches to psychotherapy are truly on the cutting edge. For more info check out IFS, hakomi, and other somatic approaches.

    Jason,
    I like your initial answer to the question: let the clients of psychoanalysts decide… And thank you also for pointing out, as many others have, that it is the therapists who will meet the conditions of good therapy, not the particular approach. I agree, but do believe that the model is a filter which influences and perhaps sets up certain limitations for the therapist… Thank you for also speaking to the fact that there exists a segment of the therapeutic community who have not done their own work, that as you say, work out of the shadow. This is a big part of why I was motivated to create this site. I wanted to highlight the universal principles of good therapy in part so that therapists might have another chance to check in with themselves about the way they work. I’m aware this is very optimistic of me when we consider how powerful some of these defenses which keep therapists from seeing themselves with clarity can be. But it’s worth the try!
    In regards to your answer to question 1, my experience is that all people, even those with very fragile borderline constellations can access the Self. I disagree with developmental psychology that if one didn’t get what they needed by a certain age he or she will remain deficient or flawed until they have some sort of re-parenting experience. My experience is that healing is instead a process of removing the constraints that cover and hide the Self and that this Self is intact the same way that the eye of a hurricane is calm and sunny. Nonetheless, it’s good to know that psychoanalysis meets me half way. In regards to number 2, I agree that I should I use a different word instead of unwavering or at least more clearly define what I mean by unwavering, as I mentioned above. I really appreciated your response to question 3. I too would hope that most analysts would “see this question of irreparability as a mystery that is affected by context, opportunities, and other complex factors that in the worst case would not be known until the end of life rather than as determined a priori by diagnosis or the analyst’s narcissistic position that if s/he can’t help then the patient can’t be helped.” And I also appreciated very much your response to question 4 about there being two people in the room and finding a balance between relying on the client’s intuitive wisdom as well as the therapists. In my work I tend to rely more on my clients, but will, when it is useful, help a client to become conscious of something that he or she might not otherwise see. And I know from my past work with addictions, both physical and emotional, that there are a great deal of folks who have difficulty tapping into their own wisdom at first and, because of their defenses, really benefit from a nudge. And lastly, your answer to number 5 is similar to what I was hearing from others. Thanks for your lengthy and thoughtful response.

    Marion and Barbara, I totally agree with you both.

    Garth, I love when I hear stories about folks with severe and chronic schizophrenia improving as result of therapy.

    Natasha, Thank you for reminding me about how it can be a discredit to exclude an approach. I want you to know that I have been greatly aware of all these moral questions that you point out to me and that this is why I brought this dilemma of mine to the group. It’s all in an effort of doing the right thing and knowing that I don’t always have the right answer or solution. I too believe in the power and wisdom of people to choose the therapy and the therapist that is right for them. This is why I’m trying to include as many therapies and therapists as possible into my site. I also agree with your statement, “Good therapy is not about one’s philosophical approach as much as it is how human and compassionate the therapist is in action.”

    Patti, thanks for admitting that you, like me, have had antiquated ideas about psychoanalysis. I was surprised to not here from others with this same slant. My feeling is that there are more of us out there than have been represented in these comments.

    Arnold, Yes, thank you. Good therapy, as I think everyone who has posted would agree, is about how it’s defined operationally not about which particular model is used.

  • Jim Moyers

    Jim Moyers

    March 18th, 2007 at 3:07 PM

    For more on what contemporary psychoanalytic psychotherapy looks like, I highly recommend “Psychoanalytic Psychotherapy: A Practitioner’s Guide” by Nancy McWilliams.

  • Derby Stewart-Amsden

    Derby Stewart-Amsden

    March 19th, 2007 at 3:03 AM

    Hi Noah and all,

    Fascinating blog! As a born rebel who began in the traditionalist camps, my personal take on whether psychoanalysis is “good counseling” could be easily ascertained by whether the counselor is humanistic in their approach or not. For me that is the dividing line. In so much of Freudian and other proscriptive views (but not all), the patient simply is not given the respect that they need to grow and develop and learn.

    I feel very positive about the wealth of diversity around these days. However, I did think it might be useful to share a recent discovery. One of my regular clients in a student of art therapy, and coming to see me is part of the requirement of her course. One of the things that seriously concerns both of us is the nature and attitudes of some of the counselors that her fellow students are seeing.

    What I would really love to see you add to your wonderful site is some guidance on finding the right counselor, but far more important an affirmation that every client must first find someone they trust, feel comfortable with and enabled by.

    It always seems to me that having identified that they need help, a clients next most important step is to respect themselves enough to find someone they can work with effectively. I am very careful to make this point with anyone who comes to me, and yes I do lose the occasional client, but the ones who come back do so because they know this is right for them now.

  • John Rhead, Ph.D.

    John Rhead, Ph.D.

    March 19th, 2007 at 7:03 AM

    I am impressed with the thoughtful answers that have been given to Noah’s inquiry. The one that really sounded like what I would wish I had written is Jason’s.

    Clearly we are almost all in agreement that it is about the person and style of the therapist, not about the label given to the modality. The one thing that I would add to the definition of a good (or “good enough”) therapist is his or her own extensive, if on ongoing, experience in being in therapy. One who sees therapy of an instrument of growth needs to be on his or her own personal path of growth.

  • Don Williams

    Don Williams

    March 19th, 2007 at 10:19 AM

    As a Jungian psychoanalyst, I know that Jungians, too, can be as detached as you describe traditional Freudian analysts–even though Jung emphasized relationship in the face-to-face analysis. It’s my impression, however, that the growth of “intersubjective” psychoanalysis, of the importance of attachment theory, and of more skilled attention to relationship among Jungian analysts, has led to the gradual transformation of analysis today, both Freudian and Jungian.
    Finally, I’m more concerned about clients/patients being able to respect and skillfully exercise their own distrust of a therapist side by side with their impulses to trust…we all need both. And as many have said here, the therapist is not the theory–there will always be good, good-enough and not-good-enough therapists in any theoretical persuasion.
    The topic and comments here are thoughtful, candid, and vulnerable–a good compliment, Noah, to the site and the blog.

  • Pam Castillo

    Pam Castillo

    March 19th, 2007 at 4:30 PM

    Modern ? psychoanalysis learns it’s skills from the study of broken people.
    That’s like going to a junk yard and looking at a bad carbeurator to learn how to put together a new efficiently running car. Where else does that model in life. If you want to help people work effectively ie, in a state of whatever their desires are, then how will it help to study the “broken” ones. People are NOT broken. They have all the necessary resources already inside to change. A modality to help the client become aware of their natural resources is far more effective, permanent and quick. Besides, how many people do you know that have gone through psychotherapy and come out in a few weeks “all better”. It’s based on the false belief that if a person becomes aware of how they got the way they are, they will surely change. It doesn’t happen that way. The past is only mildly interesting however it does not bring about change in any way close to a reasonable amount of time. 10 years to bring a client to terms with the fact that their mother or father did not do such a good job, is NOT helpful. And don’t even get me started on the drugs.

  • Marjorie Rand

    Marjorie Rand

    March 19th, 2007 at 5:29 PM

    I didn’t have time to read all of these postings, but I’m pretty much agreement with the ones I did read. I would consider Contemporary RELATIONAL Psychoanalysis (based on updated Kohut’s Self Psychology) a good psychotherapy.

  • Therapist American Fork

    Therapist American Fork

    March 21st, 2007 at 6:54 AM

    Noah:
    Thanks for what you started, a meaningful dialogue on a worthwhile subject. I could write in response bjut I’ve done it so in my book THE SYMPTOM IS NOT THE WHOLE STORY: PSYCHOANALYSIS FOR NON-PSYCHOANALYSTS (Other press, 2006, $27). By no means the last wors on the topic it responds to your questions.
    Last, note that we call it psycho-ANALYSIS, sort of the Zen of the Western world.
    Thanks again.
    Daniel Araoz, Ed.D., ABPP, NCPsyA

  • Chris Hartwell

    Chris Hartwell

    March 25th, 2007 at 7:22 AM

    My supervisor during my internship had been through years of psychoanalysis and was still going 4 times a week while I was her intern. She was anything BUT cold and detached. She is one of the more insightful therapists I’ve ever met.

    My therapist is also an analyst, and although I’m not in “analysis,” she is also one of the more insightful clinicians I’ve met, and again, very warm and supportive while maintaining healthy boundaries.

    Analysis is something I’d love to go through one day. All of my experiences regarding it have been positive so far. The only thing preventing me from doing it at this point in my life are time and financial constraints.

    Best Regards,

    Chris Hartwell, MSW

  • Ron Kimball, PhD

    Ron Kimball, PhD

    April 3rd, 2007 at 2:59 PM

    Just a quick comment. Among the more “modern” schools of psychoanalysis is that of relational psychoanalysis. I know it has taken the analysts a long time to get here, but basically it acknowledges that what happens in therapy is a function of BOTH the therapist (and all his/her history, feelings, implicit models, etc) and the patient. It makes them sound a bit like humanistic therapists in the emphasis on the curative relationship. In that sense, your view of analysis is a bit dated (not that there aren’t still “blank screens” around to make some patients feel even more deprived than their families did! The School of Modern Psychoanalysis in New York City (Louis Ormont) is a fine example of where analysis has come in more recent years.

  • medizin-im-text

    medizin-im-text

    April 17th, 2007 at 10:49 AM

    It’s great that this issue is discussed so lively at all. On my Blog (German) I listed a few studies that examined the effectiveness of psychoanalysis: medizin-im-text.de/blog/?p=28.

  • Therapist Austin

    Therapist Austin

    April 21st, 2007 at 4:35 AM

    Thanks for this interesting discussion. Good site too.
    I know a reasonable amount about psychoanalytic psychotherapy as a client and some things about cognitive behavioural therapy through reading and because it seems (to me at least) a very clear, efficient ‘technique- based’ therapy. Over here it is far more popular than psychoanalysis – in part because it is more economically viable from the Australian government’s point of view.But there are other reasons from the College of Psychiatrist’s point of view, I dare say.
    I personally lean towards psychoanalysis because it allows one to engage in interesting discussion- it is emotional and intellectual and if one needs that well it’s great. Also, memory and how it forms us must surely be terribly important and I can’t understand at a cognitive level why it gets so side-lined in CBT. But I am sure they have their rationale which I am not well informed about. Perhaps memory is an over rated tool? I dont know. Time will tell for me.
    From my point of view,analysis is far more convoluted, magical and amorphous than behavioural therapy and as much I would support the idea of including all the variants of psychoanalysis in a forum like this one,(simply because it is so interesting) I would issue a warning that even at the level of discussion ABOUT it, it gets quite intense, so is not for the faint hearted!
    When Geoffrey Steinberg states above that the relationship between analyst and client can be a crucible for change and that it tends to generalise to other relationships-yes, perhaps , but I will comment that in my experience at least, that can be a double- edged sword – this constant awareness that the relationship is ‘useful’. There is a certain coldness in that and it is one of the hallmarks of many forms of psychoanalysis- the primacy of the relationship . ( Strict freudian analysts are few and far between – here in Australia at least).
    It is so paradoxical. That the relationship exists specifically for some special purpose -instead of for the fact of its own beauty- is hard, really hard after youve been there for a while no mattrer how rational and well put together you are.
    The paradox is that in order to get deep trust there, you have to bond with your therapist and if you bond with your therapist, you have trouble with the ‘usefulness’ angle and so therefore how useful is the relationship if this realisation strikes you? How can you do therapy to make you more conscious if you become conscious of the ‘wrong things’ ?. It can be a bit confronting to have a dual relationship with the therapist and one ALWAYS has a dual relationship with the therapist (which doesn’t imply being friends outside of the room or any of that stuff). The reason it is confronting is because the therapist has to at once get close to you and then say that he/she is in a ‘useful’ relationship with you- can anyone see how potentially undermining this becomes when one is conscious of this element of the therapy? I dont mean to sound aggressive about it, I just see it as a pertinent question to ask.
    However, for CBT- the paradox for them perhaps is this- that if you have a crisp short- lived CBT relationship, then do you ever get to the point of really deep change or are you simply more adept at crisis managing yourself?

    I would suggest that cognitively based and analytically based forms of therapy have much to learn from one another. A half- way balance is probably sensible. Having said that, if one can find a well -trained psychoanalyst it is a fantastic, if difficult, inner experience to give oneself even given the paradoxes.
    cheers
    Lesley

  • Noah Rubinstein

    Noah Rubinstein

    April 23rd, 2007 at 2:40 PM

    .

  • Therapist Belleville

    Therapist Belleville

    June 19th, 2007 at 4:40 AM

    This is a great discussion. I wonder why so many have a problem with the idea of the couch? I think it is just this – the IDEA of the couch. From my experience of 3 years of psychoanalysis, the couch has been a very important, supportive, and changeable – dynamic factor in my analysis. It is an experiential thing, and hard to describe. I accept people’s comments about the importance of speaking face to face with someone, and especially, as someone noted, the importance of this vis a vis mirroring and early attachment. But even when we are speaking face to face, we are not always so aware of who we are (unconsciously) speaking to, the couch helps me clarify this, and I feel that now I see others and myelf in greater depth and relief. The couch also has something to do with the love inherent in the treatment, and I think this has to do with attachment theory. One can be held, and freed.
    Thanks for the conversation,
    DF

  • Vicks

    Vicks

    June 30th, 2009 at 3:15 AM

    good work, hope you make more related posts! will keep an eye on this blog ;)

  • Sue

    Sue

    March 10th, 2010 at 5:19 PM

    I went to three therapists: Dr. Disdain, who viciously tore me down as I tried to terminate his incompetent treatment, (he said it was “to challenge me,” shades of Alice Miller), the infantilizing, simplistic Dr. Syrup, with her self-image as a magic lady who “fixed” her patients during their brief treatment period, and Karen Horneyan psychoanalysis.

    The first two modes were completely iatrogenic, reinforcing my tendency toward child-like dependence on a rescuer, and leaving me to sort out the therapists’ neediness and self-delusion. Both left me feeling like a self-pitying victim.

    I didn’t experience my analyst as detached (she was warm and empathetic) but I never felt saddled by her ego needs. The sessions were about digging out my experiences rather than her subbing as a parent or anyone else in my life. Of my three therapies, analysis gave me the most tools for understanding my own emotions and created, far and away, the least harm.

  • Nicolas PIneda

    Nicolas PIneda

    December 18th, 2010 at 4:18 PM

    Latin countries, by this I mean countries where english, french, italian and portuguese are speaking, thinks are extreamly different that in anglosaxon countries, especially in the matter of psychoanalysis. The fist clear difference, and I think the biggest issue is lacanian psychoanalisys, wich has almost no influence in North America, but is the dominant line of psychoanalisys in many countries.

    I even think that lacanian and other types of psychonalisys are not a therapy. Personaly I believe clasic psychoanalisys, deep jungian psychology and other orientations are not a therapy, they are more than that, they are powerful tools for personal growing and deep knowledge that´s why they take so long, and they goal is not to heal as cognitive behavior does. So when a person is engaged in a psychoanalisys should not expect healing, instead he should expect to have a deep knowledge of his self.

  • Jennifer Miller

    Jennifer Miller

    February 8th, 2011 at 5:11 PM

    I think this is a wonderfully lively discussion about psychoanalysis–an often misunderstood but incredibly valuable model of psychotherapy. Keep up the discussion!

  • george

    george

    August 13th, 2012 at 10:26 PM

    well I go to psychoanalysis now and it is EXACTLY like that, he sits behind me lying on the couch and is quite detached, impersonal in a personal kind of way etc. we have gone over the same material for 5 years, I know this is my limitation and block but he will and does not do anything to move beyond this except keep pointing it out! there are no different approaches, no attempts to try a new angle on his part. yes it is absolutely my fault in probably wanting to stay stuck but it never feels quite this clear or obviously chosen or determined to me and is possibly just frustrating for both of us. It feels very very old school and besides my part in resisting the process ( this again is unclear to me but I would say true) he seems resistant to move forward or approach the fact that I am resistant in a way that is useful. I cannot blame him but perhaps it is completely the wrong approach for me at this time? the idea of it is fascinating though!

  • mary

    mary

    November 27th, 2012 at 6:48 PM

    Hello, The Analysts I was seeing was the most self seeking self absorbed…. cold antagnostic provoking therapist I had ever been in therapy with! She wrote published and presented a paper on me without my consent… now I have to figure out how not to have a breakdown! First experience…

  • DrTCH

    DrTCH

    August 7th, 2016 at 12:37 PM

    Although I suppose there may be some exceptions—embodied by a handful of practitioners–I have found psychoanalysis–through the years–to be particularly irrelevant. Exceedingly cerebral-analytical, elitist in tone, with a more or less deterministic world-view, and little emphasis on “process,” I would say that “analysis” (and, most particularly the American variety) is more than a century behind the times, and signally ineffective in effecting behavior change. In session, the analyst is taught to maintain a very neutral, dispassionate stance, which would seem to violate the need, expressed by many in the field, for counselor engagement and authenticity. What’s more, a consultation (or cocktail party casual conversation) with one of these people will typically feature a mystifying and overwhelming body of analytical gobbledygook, based not so much on legitimate research, but on nothing more than the personal musings of Herr Doktor Freud. Freud himself admitted that he was less interested in healing the psyches of his patients, than in “plumbing the depths of the unconscious” (i.e., striking out, as an explorer). Naturally the “depth psychology” movement was important with its focus on the role of the unconscious, but psychoanalysis, not so much. And, particularly in view of the MANY alternatives coming into existence since the sixties and seventies, I cannot imagine a good reason to consult this type of practitioner.

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