that Was Then, This Is Now: Psychoanalytic Psychotherapy For The Rest Of Us

Abstract

Psychoanalysis has an image problem. The dominant narrative in the mental health professions and in society is that psychoanalysis is outmoded, discredited, and debunked. What most people know of it are pejorative stereotypes and caricatures dating to the horse and buggy era. The stereotypes are fueled by misinformation from external sources, including managed care companies and proponents of other therapies, who often treat psychoanalysis as a foil and whipping boy. But psychoanalysis also bears responsibility. Historically, psychoanalytic communities have been insular and inward facing. People who might otherwise be receptive to psychoanalytic approaches encounter impenetrable jargon and confusing infighting between rival theoretical schools. This article provides an accessible, jargon free, nonpartizan introduction to psychoanalytic thinking and therapy for students, clinicians trained in other approaches, and the public. It may be helpful to psychoanalytic colleagues who struggle to communicate to others just what it is that we do.

Keywords:

• psychoanalysis
• psychoanalytic therapy
• psychoanalytic education
• public perceptions

Notes

1 The full document is available at jonathanshedler.com/writings. The interview that prompted Philip Bromberg to contact me (“Interview with author-journalist Oliver-Burkeman”) is available online in both video and audio format. Links to both can be found at jonathanshedler.com

2 For readers who may have been taught psychoanalytic approaches are relevant only to the privileged or wealthy, Luepnitz’s book also provides moving examples of psychoanalytic therapy with diverse and marginalized patients.

3 Note the word unconscious has a specific meaning in psychoanalytic theory. Many mental processes occur outside awareness, but we generally reserve the term unconscious for thoughts, feelings, and behaviors we actively repudiate and that actively seek expression. Thus, the word unconscious really means dynamic unconscious. Psychoanalytic theorists generally use other terms (such as non-conscious) to refer to mental processes that take place outside of awareness but are not conflictual or actively defended against.

4 A patient of mine was once deeply struck when I pointed out a repetitive pattern in his life. In a moment of soul-rattling insight, he realized he had repeated the same mistake in his life time and again. He was highly intelligent but not terribly psychologically sophisticated. With the shock of recognition he blurted out, “It’s true, it’s true! I do exactly what you say, I see it!” And then, with consternation: “Why do I do this? Why do I keep doing it? Is this just the way I am?” I answered, “It’s the way you’ve been.” It was one of my favorite moments in therapy.

5 I am inclined to think the best psychoanalysts never practiced this way, but certainly there were mediocre ones who did. In the past decades there have been sea changes in psychoanalytic theory and practice. Thankfully, this phase in the development of the profession is behind us.

Additional information

Notes on contributors

Jonathan Shedler

Jonathan Shedler, Ph.D., earned worldwide acclaim for his paper, The Efficacy of Psychodynamic Psychotherapy. Hailed as a contemporary classic, it established psychoanalytic psychotherapy as an evidence-based treatment. A leading expert on personality styles and disorders, Dr. Shedler is also the author of the Shedler-Westen Assessment Procedure (SWAP-200) for personality diagnosis and clinical case formulation, and coauthor, with Nancy McWilliams, of the Personality section of the Psychodynamic Diagnostic Manual (PDM-2). He has authored over 100 scientific and scholarly articles in psychology, psychiatry, and psychoanalysis, and his blogs reach audiences in the hundreds of thousands. Dr. Shedler teaches and provides clinical consultation to clinicians around the globe. He is a Clinical Professor in the Department of Psychiatry at the University of California, San Francisco (UCSF) and a faculty member at the San Francisco Center for Psychoanalysis.