A Brief Description

Psychoanalysis is a descriptive science. The task is to put words to how the patient's mind is functioning moment by moment. The treatment is given a certain structure which involves frequent and regular meetings and a relatively neutral stance on the part of the analyst. In a way that's always attuned to the safety of the patient, the analyst doesn't share much about themselves. The focus stays on how the patient's mind is working moment by moment. All of this is for a good clinical reason: it makes the clinical situation ambiguous to the patient in a relative and controlled way (just like a Rorschach test). When this is done with skill, care, and attentiveness the effect is quite powerful. Because the patient's mind will have no choice but to make sense of or organize the clinical situation (this is just what minds do), they'll tend to impose a structure onto the ambiguity. In other words, the ambiguity will be made meaningful. This puts the analyst in a position to watch those meaning making processes. Of course the patient will be attuned to real aspects of the clinical situation and not all of how they organize their experience will be a function of factors internal to them and them alone, but much of it will be and it is possible to separate these aspects out in a way that's clear to both patient and analyst. This is one meaning of 'truth' in psychoanalysis - the clear recognition of what belongs to the patient and what does not. This creates a powerful learning experience, one that's not didactic or based on encouragement but experientially immediate. And because these meaning making processes are the same whether the patient is in a therapy session or not, the effects generalize automatically; they're the same ones that drive the repetitive patterns in the patient's life. This fact is what makes recognition possible in the first place and it's what generates a sense of conviction.

Unlike a Rorschach, though, this meaning making isn't momentary and isolated but general and ongoing. It binds the patient to the analyst in a certain way. The experience for the patient is that the analysis becomes more and more a part of their inner world and they feel compelled to return, sort of like a feeling of having unfinished business there. This happens in every kind of talk therapy, but in psychoanalysis it's recognized and worked with intensionally and consciously. This is what makes psychoanalytic treatment unique.

More Of The Details

When I talk about psychoanalysis I'm referring to a treatment that consists of 4 or 5 sessions weekly and that unfolds over the course of several years. When I talk about psychoanalytic psychotherapy I'm referring to a treatment that consists of 2 or 3 sessions weekly. Working once weekly is often not enough to establish an analytic process which is necessary to create the deep sorts of changes that only psychoanalytic treatment can produce. Often, patients are unable or (understandably) unwilling to enter a treatment this intense. There are times in my practice when I am more open and other times when I am less open to working with patients once per week or even even twice per month. Should you enter treatment with me with me at a frequency of once per week or even less, it's important that you understand that while something helpful may accrue to you through these meetings it will not be the sort of thing that a fuller psychoanalytic treatment can offer. There's nothing wrong with this per se, but unless this distinction is understood then the risk of feeling dissatisfied with the treatment results is high.

This raises the question of what the difference is between an analytic treatment and one in which an analytic process has not been able to be cultivated. Somewhat oddly but not starkly, analytic treatments do not consist of a discussion between you and I, necessarily, but of you asking me to speak to you about the aspects of yourself that you can't see because of your position in your own mind. It takes time and frequent meetings for these aspects to manifest clearly enough that I'm able to put them into words for you. This is what 'unfolds' through the treatment process. You come to treatment hoping to make visible (and tangible) for yourself the invisible engine powering the unwanted patterns in your life. I concern myself with the mechanics of the engine. All of this tends to make more sense after we're able to meet a couple of times. It's pretty clear to people pretty early on in the process that this is a different sort of therapy than they've had in the past, and that strikes a certain sort of person as curious enough to investigate.

In a non-analytic treatment, on the other hand, this unfolding doesn't have a chance to happen, leaving us without much to work with. In scenarios like this, it's not more substantial changes that we're working toward, but something more like helping you to maintain a reasonably comfortable mindset and offering some protection against slipping into the more pernicious and destructive patterns that bring some people into treatment. In this mode any understanding to be gained is much more likely to remain generalized, intellectual, and therefore superficial. Again, there isn't anything wrong with this per se, it's just not all that I can offer as a clinician and patients often wish for more substantial returns on their investments of time an money.

Mind as system, world as representation

Part of what makes psychoanalysis so difficult to describe is that it's based on the idea that the mind is a complex system. Complex systems consist of parts that interact with one another to produce something greater than its parts alone. This is hard for most people to conceptualize because it implies a view of 'a person' as an emergent property of semi-independent but interacting parts, and this flies in the face of more religious or spiritual views of the person as a soul or more neo-liberal views of the person as the product of pure self-creation. Some people feel that to think of 'a person' in these terms is to mistreat them by discounting their personhood. The trouble with that position is that it binds would-be helpers to the structure of the currently operating 'self' which works against the larger effort of a more dispassioned understanding of any operating mechanics. From the perspective of psychoanalysis, none of us can know ourselves fully because 'we' are creations of mind the vast majority of which remains inaccessible to introspection. We require outside information about ourselves to be psychologically healthy.

Another part of what makes psychoanalysis so difficult to describe is that while it is a theory of how the mind is composed and operates, so too is it a theory of how the mind builds up an understanding of and ability to contact and therefore to know the external world, and this implies that there IS an external world to understand. In other words, psychoanalysts, at least in the traditions I'm most aligned with, are realists. We believe there really is a reality out there that exists independently from anyone's perception or interpretation of it. This is, after all, the going understanding of every other scientific discipline on earth. This means that there is such thing as truth. It may be hard to get to, and we may never be fully without doubt as to whether we have fully understood a particular phenomenon in the world, but there is something out there to be known.

From a psychoanalytic perspective, because our minds are a product of evolution they are designed to detect certain truths, this is what makes it possible for us to navigate the world around us. But so too do we have the ability to ignore or deny those truths in various ways, and this is what leads to dysfunction. What allows us to correctly perceive the external world has a lot to do with what the psycholinguist Steven Pinker calls "the language of thought" and what psychoanalysts call "unconscious phantasy." Essentially this is the raw material our minds use to construct meaningful experiences. Grasping this is the key to understanding central psychoanalytic concepts like projection, introjection, and transference. Pinker uses the analogy of language to connote that this raw material has a particular organization or structure. When deformations or inefficiencies or areas of immobility occur in this structure one result is that we lose the capacity to perceive and relate to some portion of the world around us. This is what brings people into treatment.

But the really hard part to capture in written form is the way the process is simultaneously abstract and concrete. You talk about the present day events of your life or whatever feels important to you, and the meanings that animate those issues begin to stand up on their own in the very moments of the session; they find an expression in the quality of interaction between patient and analyst. The analyst's job is essentially to translate these meanings into words. This makes the problematic areas of one's 'language of thought' or 'unconscious phantasy' visible and accessible to intervention and all of this happens in a clear, observable, and factual way. This is what makes things concrete and evidence based.

First description

Psychoanalytic treatment is the slow work of watching how the mind transforms information from both inside and outside, creating particular experiences of self and other in the process. There are no ready made answers or directions about how to live or act. There is only the psychoanalytic method which we do our best to follow during each session and that, when practiced consistently over time, allows for something real and effective and meaningful to happen. It's a bit hard to describe this from the outside, but it's not magical nor mystical nor necessarily mysterious.

It's something like: What happens in your life begins to happen in the treatment. Your mind works the same whether you're in a therapy session or not. That's the point. Yes, in a way, you're interested in learning how to be different somehow. The trouble with that is, "but how?" The paradox of this way of working is that different comes from getting more clear on what already is. If you think about it, how could it be otherwise? I can't tell you how to be. Anything I could say to you would land only intellectually and would be nothing more than you could read on the internet or in a book. No, the work is in diving into each individual moment and getting hold of how your mind moves and shapes experience 'behind the scenes' so to speak. To practice this is to come to realize how difficult it is to be honest with oneself. The treatment just acts as a viewing instrument of sorts; it concentrates the otherwise diffuse patterns of your life, the ones you live through but only tend to recognize in retrospect, or the things you know about yourself but try not to for various reasons.

In other words, the analyst does not preach, condone, teach, encourage, coach, judge, criticize, or persuade. We do our best simply to describe particular sorts of processes occurring during the session. These processes are ways that information from the session is given specific interpretations and leads to particular sorts of mind states and experiences. This means that what the analyst says is empirically verifiable to the patient themselves. Not only should it sound true, but once seen the truth itself should be self-evident. When these truths are struggled with as such, the mind is freed of the work of avoidance and so begins to function better. The resulting clarity gives the therapeutic process meaning, structure, and directionality, and helps the patient to tolerate the pain and difficulty that are also part of it.

In still other words, you're asked in each session to speak as freely as possible about whatever feels important to you. The direction is to do the best you can to allow your mind to work and to say your thoughts outloud as they occur. The experience at first is awkward and difficult, but soon one begins to understand that to speak freely in this way (and free is always relative and meaningfully constrained) is to say things that feel true and alive and meaningful to us and we register that as vulnerable somehow. To share thoughts in this way is to put the analyst in a position to see something real about us, and this risks painful feelings. Conviction about and trust in the process is generated from an experience of the analyst as relatively neutral, which makes it obvious that the painful feeling is not being inflicted from without but freed from within, and recognizing this initiates growth promoting processes related to mourning, repairing, and forgiving.

Second description

Each of us lives within a model of the world that the mind creates for us moment by moment. We look out from within it onto a 'world' it is representing. Our perceptions and experiences are structured by this model, and the limit of our ability to sustainably change ourselves is set by it. In other words, while we do perceive and interact with a world that does indeed exist outside of ourselves, we never have direct access to it. We reach it only through the representation we make of it, that our minds make of it for 'us'. But in bridging the gap between outside and an inside it is also charged with organizing, the mind leaves an uneven seam. Bits that really belong to 'us' get mixed into the representation we make of the outside world. These facts are both widely accepted and ubiquitously under appreciated.

Psychoanalysis, as a theory and a practice, is built on this understanding of things. It itself is a model which aims to make the mind’s component processes observable as such and in real time. These processes amount to the activity of meaning making. They are what the mind does when it organizes raw stimuli, i.e., when it constructs its representations. They are bits of "us", and "we" exist always in relationship with the surrounding world. The bits gotten hold of in analytic sessions are those uneven points in the seam (the points where our model of the world has, without our realizing it, ceased to faithfully reflect the world itself). Identifying this allows for a mechanism of action (a way of helping) based on something other than education (as in cognitive therapy), "exposure" (as in behavioral therapy), or reconstruction (i.e., as in "dynamic" therapy). To get hold of these processes is to be able to see how one's models of self, other, and world have come to distort more than reveal the realities they intend to represent. As a result, one comes to understand how, in an important sense, they have been creating their own version of the world as opposed to struggling with the one given to them.

Importantly, the power of psychoanalysis does not hinge on the external definition of Truth. The analyst does not act as an arbiter of Truth, but as an observer in the position to watch the mind construct it's version of reality from a perspective inaccessible to the patient themself (we are all bounded in this way). In a way that's difficult to describe but straightforward to show, what gets talked about in psychoanalytic sessions is how this process of construction happens and why. Speaking to these processes as they occur has a powerfully sobering effect. These are moments when we know ourselves more completely and therefore see the world around us more clearly. It's the state of mind restored in these moments that implies the abatement of symptoms and increased ability to productively engage the world and people around us. These are moments when one learns that how the world looks and feels to us has a lot to do with how the line between self and other gets drawn, and when the opportunity to understand why the line gets drawn like that in the first place opens up. Helping the mind to draw the line between self and other more accurately greatly improves its efficiency. Our ability to think gets a lot better. Importantly, this does not eliminate suffering but makes it more meaningful and hence productive.