Psychoanalysis/Psychotherapy

How Therapy Works: working with the unconscious

When particular emotions and needs are not responded to in a supportive enough way (this could happen from lots of reasons; whether that’s: abuse, chronic lack of acknowledgement, chronic criticalness or dismissiveness, strong limits without acknowledgment and validation of a person’s emotions and needs, neglect, etc.) they go underground. Meaning, they become something we try not to feel or show. The current understanding of this is also that whatever developmental level our needs were at when they went underground is the level they stay at while dormant. Meaning, if they get a chance to come out again later in life they are usually messy in the beginning because they are still at the level they were when we were younger, other parts of us matured but not that part because it didn’t get a chance to be inside of relationships out right. 

How Therapy Works: Connection

Connection is a concept put forth by Dr. Richard Geist. It is the idea that when a person feels connected with it allows them to feel more real, whole and alive and that over time this causes positive emotional growth and change. Connection has three parts:

1. Empathy: when the therapist puts themselves in the patients shoes consistently over the course of a treatment they allow the patient to feel deeply understood especially in moments and parts of themselves where they normal don't feel understood (e.g. like in conflict). This allows the patient to slowly connect to their unconscious thoughts and desires and reveal to themselves and their therapist.

2. Unmet needs being noticed and responded to: over time as unconscious feelings/desires/needs are noticed, validated and responded to parts of the personality that are stuck emotionally become unstuck and begin to grow again.

3. Authenticity: Even though the therapist is striving to respond from within the patient's world they are still trying to do so authentically. How they respond, the words they use, how they communicate all display the therapist's personal subjectivity. This is important because it allows for an authentic relationship to build. So that even though the relationship is focused on the patient, the patient still comes to know the therapist at some level; making it a real human relationship.

What is a psychoanalytic treatment?

Our current mental health culture is a skewed to far to the side of the medical model. Meaning, it reduces mental health to science alone (i.e. we have a brain but no mind or heart). Mental health is more the just the sum of its parts. Helping people get better requires science, yes, absolutely. Evidenced based research and neuroscience greatly informs any clinician who takes their job seriously. That said, helping people get better also requires art. Being with people in a way that feels healing, that feels human and not just like the zeros and ones of care requires an art form of “being with”. Psychoanalysis and psychotherapy hold the dialectic between science and art form more than any other theory I know. Today probably the most common way of doing supportive psychotherapy is through utilizing attachment theory. Many who do this do not readily recognize or identify with being psychoanalytic but guess what? Attachment theory came from a psychoanalyst (John Bowlby was a card carrying member of the London Psychoanalytic Society to the day he died)! 

Why what you struggle with may need to be the last thing to go.

Affect or self regulation is a slow thing to master and requires committed and relentlessly understanding relationships (like a psychotherapeutic relationship) because we will never unconsciously trust ourselves to another without that and therefore won't move from self protection to relational protection (the thing we need to gain self regulating capacity). We need relationships that understand the health inside our problematic behaviors and respond to that over the problematic behavior chiefly. We need less focus on behaving right and more on what behavior means.

Compensatory actions (like anger, shutting down, feeling numb, addictions, anxiety, etc.) often are the last thing to go because the "self" needs to grow enough to be ready to replace the compensatory thing. We need to keep compensations in place until we have the replacement ready.

Chronic Guilt

Evan was a hard worker. Ever since he was young Evan never settled for less than excellence in whatever he did.  When he did not feel he could be  excellent in something he would often lose interest in it or disengage. This strategy for life served Evan very well in many respects. After all, people respond well in our society to excellence. However, Evan's emotional state was a fragile one. He was terrified of feeling he was underperforming but also simultaneously over burdened. He struggled to allow himself to relax. In fact it seemed the only way he could feel good was by achieving something or doing something or by totally numbing out (an act that left his wife and friends feeling ignored).

Emotions Revealed: Taming Your Triggers II

This is a process I've developed based on Ekman's and other's research on emotions. Taming triggers begins with reflecting on triggered moments.

Step One: What triggered you?  

It's important to reflect on the particular moment of flipping your lid and losing control. What pushed you over the edge? Was it a look, a tone, a movement, a phrase, something physical like getting pushed or touched. Or was it an environment, a situation that you didn't expect.

Emotions Revealed: The Nine Causes Of Emotion

Continuing the series about Paul Ekman's book, "Emotions Revealed" this post will highlight his research conclusions of the nine ways emotions get turned on in a human. Ekman points out that most of the time we can't control or predict becoming emotional but that one of these nine are most likely to leave us feeling regret.  

Your fight is about sex...and it's NOT about sex.

Often a couple will come in and talk about a fight they're having. The problem usually is, they are talking about the issue but they're also not talking about the issue. Our fights, I mean our repetitive deeply felt fights, are about more than what's one the surface (unloading the dishwasher, helping with the kids, making plans, cleaning the house, sex, in-laws, etc.). The surface issues are really houses for the core issues. They do matter, otherwise you wouldn't be triggered by them, however just talking about the surface issues will never solve the problem.  

Why do I do what I do?: Attachment Styles Explained

All of these styles are not good or bad, they are amoral and simply the ways that our young minds devised was the best way to get our needs met in our initial environments.  Problem is, these schemas (attachment theory calls them, Inner Working Models), become outdated as we grow up and encounter new environments but because we operate out of them unconsciously we continue to react to our world as if it was the same as the one we grew up in (an act that tends to turn our current environments into our initial ones). 

How trauma keeps our relationships crappy

Trauma is a word that probably gets thrown around too much. When that happens words often lose their accuracy and impact. So what is trauma and what does it have to do with repetitive relational struggles? 

What makes psychoanalysis different from other therapies (and so valuable)?

Psychotherapy (a word which means “healing of the soul”) and psychoanalysis (a word which means “an examining of the soul”) are methods of talk therapy designed to help people identify feelings and thoughts and needs that they have hidden from themselves explicitly (often during session people remark that they now have words for what they have known only by feeling or gut). This is helpful because it allows people more freedom of choice in life. They are less prone to repeating patterns of relating that keep them feeling stuck, dissatisfied, depressed, anxious, etc.