I practice from a psychoanalytic stand-point. That is in the tradition started by Freud and Breuer in Vienna in 1890s, but enriched over billions of client hours to the 2020’s by practicing therapists, and crystallised by writers like Jung, Klein, Bion, Winnicott, Bowlby, Lacan and Bollas.
Freud and Psychoanalysis are names that dominated mental health care in the twentieth century, but they carry a lot of baggage. Freud was a superstar and his conceptions of human nature have, by now, diffused into every part of our culture where they are difficult to see because they are so integrated. But ideas like the structure of the psyche (the Id, Ego, Super-Ego) or the Oedipus Complex – which is a very helpful and flexible framework for thinking about the family and internal dynamics that established a person’s character – were misrepresented by Freud himself who set them down as established fact, rather than ways of thinking about consciousness.
Early psychoanalysis, particularly its (now reduced) focus on sex, excited massive resistance from all but the free-thinkers of the day, and the early analysts had to fight. This made them set theory in stone rather than seeing it as a constantly evolving body of fascinating and difficult thought which the therapist keeps at the very back of their mind to help them make sense of things. Psychoanalytic theory is by far the most developed of any mode of psychotherapy, and there are many. But to my mind theory has little direct therapeutic value, beyond helping me think more deeply into the complexities and difficulties of the person I am treating. It keeps my mind sharp. But for the client, if generalisation is even possible, it is the experience of being known, thought about and held securely in the therapist’s skilled attention as they work through the incredible difficulties and complexities of their character that is therapeutic.
Working in a university town, it is perhaps worth noting before moving on, that psychoanalysis, as a huge repository of thought about how minds work has been plundered as an intellectual tool box in the social sciences and humanities. Regrettably this has largely disconnected the theory from its roots as an approach to help understand individual people and their distress. There is no heart in psychotherapeutic theory without the client, and it is practically meaningless unless you understand the link. This is why many people can’t understand theory until they have experienced being a client. I couldn’t.
The thing that survives in my consulting room almost intact from Freud is the framework for the analytic meeting. It is a confidential meeting of two people for 50 minutes governed by a private contract and fees agreed between us. It is personal. The normal noises of life come into the room, but the focus of both is on the client, taking their inner life in and gradually and gently making known the unknown/unappreciated/unconscious emotions that are driving their experience of life – getting a handle on them. With a handle on, they can be understood and reacted to by the client, sometimes mourned; and empathised with and accepted by the therapist, helping draw the poison. This is work from the heart from both sides.
Jung emphasised the point that the therapist is alive and changed by the client’s hidden love, hate, anxiety, envy, mistrust, guilt, grief… and by being alive and open to the client, makes the client amenable to change themselves. Keeping good boundaries, for instance not touching and keeping sessions to the allotted length, normally 50 minutes, allows security for the client to trust the therapist with their inner life and for the therapist to take it into themselves deeply without being overwhelmed.
Powerful emotions can come up safely in the relationship between the client and the therapist in an interaction called ‘transference’. The study of the client’s transferences, which is done less in counselling and more in my open-ended psychotherapy, is the hallmark of psychoanalytic therapy. What does it mean? Someone might be pained by the behaviour of, say, a shop assistant or a colleague toward them; or they might find working remotely unbearably lonely. The pain they feel is the action of an emotionally charged expectation learned by that person, frequently in childhood, and ‘transferred’ onto an ordinary situation. In normal life these transferences are ignored. In therapy the client’s feelings about the therapist can be discussed. Certainly the therapist is studying them because they are complex and ever changing, like sunlight on water. Transference is an immensely eloquent expression of the underlying emotion that gives character to how the client experiences their life.
Contemporary thinking about the brain – which has an anatomical form and functioning structures shared by all humanity – supports the premise of ‘transference’ although it is individual. The brain is patterned by individual experience, particularly in childhood when its plasticity is greatest. One of the main characteristics of the brain and nervous system is powerful affect, or emotion. Hunger, for example, is experienced as a physical pang in which emotion is an integral part. The human mind in its complex contemporary setting is the same mind that experiences real fear at the prospect of not having enough to sustain them for a couple of hundred thousand years, and still does. My sort of psychotherapy seeks to access this level of emotion.
In today’s intellectual environment, science and the public services demand evidence that can be generalised and made accessible to numerate analysis. ‘Transference’ is personal, or ‘subjective’, and thus impossible to pin down in this way. Fortunately Attachment Theory, pioneered by Bowlby and carried forward in academic science and in the NHS by the work of organisations like the Anna Freud Centre and Psychoanalysis Unit at UCL, is amenable to numerical analysis. This provides an isthmus between psychoanalytic therapy that is very personal and subjective and a scientific climate that requires data. Examples of the data driven studies of the efficacy of psychoanalytic therapies have been conducted by the NHS Tavistock and Portman mental heath trust
, and the University of Colorado
. I include the later because it says a bit more than I want to here to define the characteristics of this sort of therapy.
I see such studies as my profession addressing government commissioners of healthcare or insurance companies. I’m glad it is being done, but for me on the ground what matters is that my clients are using therapy as an opportunity to to work through their suffering and suppressed emotion and understand their own character; and that this deepens their potential to manage their personality and suffer what Freud called the ‘normal miseries’ of life (loss, aging, death) with greater resilience, and to reduce the amount of pain and energy expended in sometimes intricate knots of defence that they have created to protect themselves from hurt.
The last point I want to make is that this sort of therapy was designed by doctors to make people feel better, but it is not an intervention like administering a drug. It takes time and is about enlightenment regarding yourself and the way you interact with the world, other people and the frequently extremely hard realities of life. It is a privilege for both parties in psychotherapy to be part of the process.