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Random Thoughts On Psychoanalysis vs. Psychotherapy…

It was a grey, humid, rainy morning in my new neighbourhood and psychoanalysis was on my mind.

Among other things.

Why psychoanalysis? Simple. I spent 40 minutes reading Daphne Merkin‘s engaging lead New York Times magazine feature on her 40 years in psychoanalysis.

I’ve been in psychotherapy for 50 years.

We were both considered “difficult” children…

There is no comparison, though…

Daphne and I have some strong similarities. We’re both writers. Both Jewish. Though I was not raised in an Orthodox home. We both were considered “difficult” children. She was sent to her first psychiatrist at age 10. I was 12. But she went the psychoanalytic route. I did not.

10 Comments to
Random Thoughts On Psychoanalysis vs. Psychotherapy…

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  1. Unfortunately old school Freudian psychoanalysis is a dying breed… EAP and managed care have taken care of that in short order. We can all long for the days when clients got the help they actually deserve (the kind of help you describe above).

    I also liked your admission at the end that “nobody’s perfect.” Hopefully we learn and grow from our mistakes and setbacks!

    Phenomenal post Sandy!

    • Hi, Kent ~

      Thanks for the kind remarks. I know that “old school Freudian psychoanalysis” is not as prevalent as it used to be but I don’t think that necessarily has to mean that long term psychotherapy has to die out in favour of all the short term therapies. From what I read, they are simply not as effective for all people, especially those of us with serious long term psychiatric conditions ~ like bipolar disorder or schizophrenia.

      Have you read the memoir of Elyn Saks titled The Center Cannot Hold?

      This is an excellent book. A real eye opener.

      Good Talking Therapy ~ more than 15 minutes and a prescription ~ even if it is not exactly as Freud imagined it, is still immensely healing especially in combination with carefully monitored medication.

      In Canada, a psychiatrist or medical practitioner practicing psychotherapy is covered by our healthcare plan. This does not apply to social workers or other non-medically trained therapists ~ so money need not always be an issue, here. Perhaps the same will hold in the U.S. when your health care reform is in full swing and more developed and when the knowledge that one’s mental and emotional health and well-being affects all aspects of our health, especially our physical health.

      We’re package-deals. Feeling good is complex. We can’t be compartmentalized.

      I appreciate your comments enormously. Thanks for joining the conversation.


  2. Here, the flick of today (or rather a while) has been cognitive behavioural therapy. You attack issues and alters your way of thinking around them.
    It’s a short therapy (read cheaper) with maybe ten therapy sessions. This is what I was initially referred to. The cognitive approach was a dead end. I didn’t have any specific issues per se. There was nothing concrete, nothing you could say that THIS is what we need to approach. We agreed, me and the therapist, that this was not the way to go.
    I began seeing a “regular” therapist after that which was far more helpful and ended up seeing her for 5 years before ending it. When I ended it I felt somewhat finished. I had talked about what I needed to talk about and the particular therapist no longer had anything to really offer me. It was a very profound feeling.
    I’m now searching for another therapist with another spectrum of expertise since I have new stuff I need to sort out. I hope the new therapist can offer me more than the other one could at the end.

    My therapist was, too, only human. Unfortunately it became a little too apparent that my needs and her abilities had grown apart and, equally, short circuited. It was a strange experience, taught me a great deal but was also a source of pain.

    You can be offered therapy on your social insurance. It has become increasingly more rare since clinics are looking to cut costs even at their patient’s expense which is why the shorter therapies (such as cognitive approaches) have grown in popularity. It didn’t work for me, I know of others it didn’t work for either. If I hadn’t been offered the therapy on my social insurance, I would have been unable to do it. I saw the therapist weekly for a long time. Without insurance it would have been, AT LEAST, 150 – 200 dollars per session. The cost alone would have provided more anxiety than relief and I wouldn’t have pursued the idea at all.

    It taught me alot. In the end and when I summed it up. It might have had more to give me but my therapist really couldn’t give me what I needed.

    • Hi, Jessika…

      Good to hear from you.

      I’ve heard nothing good about the short term therapies from patients who’ve tried them. At the same time, it seems to be almost impossible to find anyone interested in a long term therapeutic relationship. I’ve had two. One lasted 16 years and the other, Dr. Bob, 20 years and counting. We’re always evolving. Patients and Therapists. I think there’s something basically wrong with the way psychiatrists are being trained. The focus is long term and the number of doctors interested in becoming psychiatrists is probably not that great. Financially, here on Canada, you can’t make a great living when you can only see eight patients a day. Given that each session is at least 50 minutes long.

      Too bad our values are so different. That the art of psychotherapy ~ and I believe it is an art. I am going to quote to you from a comment from Dr. Ron Pies, which you probably read a while back. He considers psychiatry to be “the science of meanings” ~ here’s what he said:

      “Finally, just to clarify my view of psychiatry and language. I think you were referencing a piece I wrote for Psychiatric Times, in which I argued that psychiatry is no less a “science” than physical sciences, and that psychiatry may be considered a “science of meanings”. By that, I was trying to say that psychiatry involves a systematic attempt to understand the patient’s innermost world, through a methodical approach to the patient’s “language”, both verbal and non-verbal. It is not “scientific” in the way a chemist is scientific–but there is a science to listening and analyzing meanings, nevertheless. That said, there is also a good deal of “art” to the process of psychotherapy! And, as you know, the process of understanding the patient must involve empathy, trust, and support, not just “analysis”.

      Like Dr. Bob, Dr. Pies, a psychiatrist and published writer on many subjects including philosophy, psychotherapy and he’s also written fiction and poetry, is a strong advocate for long term talking therapy and its benefits. My first psychiatrist of note, the visionary who discerned that I did not have schizophrenia, but “manic depression” as it was known in the mid-1970s, Dr. Emmanuel Persad, is currently writing a book about longterm psychotherapy ~ the real essence of talking therapy, today.

      I think it will be making a comeback and more and more drugs prove to be ineffectual or deleterious to one’s health and as the “chemical imbalance theory” of mental illnesses continues to be debunked by writers like Robert Whitaker in his latest book, Anatomy of an Epidemic. I’m reading it now. It’s not the last work, but it’s very compelling. There are medications that do work for some people. For others who have intractable depression, for instance, there’s ECT. Yes. Electroconvulsive Therapy. This piece from a recent reader of the Globe and Mail is very compelling. I’ve written extensively about the “current” therapies, too.

      There’s also peer support and all the community mental health and recovery-oriented offerings. So much, if you’re willing to make the commitment. I think that’s the problem. Too many people ~ not you ~ don’t realize how much work and time is involved and they don’t want to make the effort and commit the time.

      I really don’t know.

      Maybe you have some thoughts on this. You are so thoughtful. Share with us.

      Thank you so much for your honesty and insights. Your enrich our “community” immensely.


      • Hi, All ~

        I want to stress something here.

        Everyone needs different types of help at different stages in their lives. We’re constantly changing and growing and being bumped around a bit. We do not stay the same.

        My hope is that we can continue to find what we need in the moment ~ be it short-term or long-term.

        Making the decision to find help is huge. Too many people, I’m afraid, find solace in behaviours that may not be healthy.

        Here, at Psych Central, there are so many different resources, bloggers, patients, people, sharing so many insights on so many therapeutic issues and types of therapy. For example:

        The Therapist Within.

        Therapy Soup.

        Therapy Unplugged.

        There’s humour:

        Mental Health Humor.

        Light, Laughter & Me.

        Have a look. You won’t believe how much you can find, right here, exploring the other bloggers. I’m going to update my Honour Roll to give you a sense of the richness of this website.

        Take care and stay open to anything than makes you feel better. And keep reading and trying new approaches. Be open to new ideas. Resilient. Flexible.


  3. Hi Sandy,
    I too spent 40 minutes reading about Daphne Merkins, My life in Therapy. What a fabulous read, but what is it that she is missing out when she spends so much time therapy shopping? I agree that therapy can be an addiction like anything else, but there does come a time when you have to literally uproot yourself from your therapist’s room and start a new life somewhere else.
    Does anything really make up for what we missed out on during those early formative years?
    Should therapy be about love rather than “changing character” as she says?
    I think love is such an important part of therapy it should be taught as a mode and used when some clients display those transference dynamics that suggest they missed out on early mother-love.
    What do you think?

    • Quick response, Soni~

      Just came in from a walk with Riley and Lucy and I’m hungry.

      I think therapy is about self-love. Not narcissism, but self-awareness and self-respect. Becoming whole, if somewhere along the line, you’ve been hurt in some way and feel less than whole. The window for self-actualizaion in childhood is very small. Those formative years are between ages two and 10, roughly, according to the work of developmental psychologist Jean Piaget. If you don’t get what you need, then. If a parent has neglected or abused you or been unable to help you to feel “good enough” and you haven’t a strong sense of self-identity. You can make it up later, but it takes years. I think therapy helps to heal that damage and build you back. Not short term therapy, though.

      At least, that’s what my long term therapy, now, is doing for me. It’s tough, often takes a lot of work and time and differing lengths of time, depending on how much work you wish to do or need to do. Commitment.

      We’re all different.

      I do not view therapy as a weakness, but a strength. A willingness to learn more about yourself and thus, others.

      I have never felt transference with Dr. Bob. Or if I have, it was a long time ago. I don’t remember it. Now, our therapeutic relationship is very focussed. He uses all kinds of techniques but in a long term format. That works for me and other patients of his. I recently met a woman who has been seeing him since 1984. I started in 1990. He’s unique, I think, in the psychiatric world. A leader. A whisper that should be heard around the world, but no one’s listening. Everyone is too busy writing prescriptions.

      Mother-love changes, too. I’ve found. Depending on your age and your mother’s age. Depending on where you are and your relationships. My relationship with my mother changed dramatically when my father died and when I married Marty. Roughly the same time.

      It’s still changing. I know she loves me, but sometimes I don’t feel it. Emotion versus Intellect. Always duelling realities for me.

      Hugs to you and Mikey and now I’m off to have my breakfast.

  4. No person will ever fully understand themselves. I think it’s a mistake to try. I recently read an interesting discussion on the topic “perfection” and the aim for it. They interviewed some japanese scholars on the topic. Perfection is not achievable, it is a journey. It also allows for humbleness. You ARE only human, you’re not expected to be perfect and all you can do is try to live life to the fullest. And then there’s the question of definition. What IS perfection?

    I’d hate to walk through life without any sense of my inner self. I certainly supressed who and what I was for a long time (too long). I’ve certainly run into alot of people that can’t or won’t look into themselves. This said, I’m not blaming them or marking myself as superior. Some people can’t look beyond of what they see. Psychological protective mechanism should not be underrated. We’ve got a huuuge incidence of mental illness in my family and most of them are in denial. I guess denial serves a purpose although I find it tiring when people are unhappy, yet won’t seek out what could be a path to resolution. I REALLY have a problem with complaining. We all have problems, the difference being in what you do to solve them.

    It is usually depicted that it is therapy vs. medicine, that one excludes the other. But then that has been the approach to the human being within western medical science for the longest time. You are body or soul, not both. I was profoundly stuck in some issues before I began my therapy. It was like a washing machine that had gone into a faulty mode and couldn’t stop churning. With therapy I became more self-assertive, more aware and came out of it with a more defined contour of who and what I am.

    I don’t believe that you need therapy just because everyone else does it. It really doesn’t serve much purpose to dig out stuff “just because”, nor do I believe that any sad event in life requires psychiatric intervention which is more and more taking hold. An unfortunate night spent in a psychiatric emergency room clearly proved to be a dichotomy. On the one side there was the manic, schizophrenic etc., and then there was a person whose partner had asked for divorce. For all intents and purposes, there’s something going on which tries to make normal human emotions into something abnormal. Take grief. It’s normal to grieve after a loss. It’s if you fall into clinical depression that you require medical intervention. You need to feel what you are feeling, that goes for when you’re in therapy too.
    I came to regard my sessions as a sounding board, hearing my own words made things more palpable.

    I found myself somewhat puzzled over the article and I’ve been thinking about it since yesterday. The author has taken away self-knowledge, also about transference and the coherent risks involved in a therapeutic relationship. I wonder if this academic approach to therapy is what causes the search for the “perfect” therapist. And the achievement of fully understanding yourself. I think I’d be bored if I knew all my ins and outs. I had tons of anxiety before. I know now my trigger points but I still get anxiety. I can theoritically identify what makes me anxious, but I’ve found it problematic to incorporate emotion so that I can prevent it beforehand. I don’t like public transportation, it causes anxiety. I KNOW that it does but I do it anyway. Why? Because if I don’t the anxiety will have won and I’m not going to yield. I’m not terrified and its not a hindrance in my daily life, therapy won’t help that feeling other than make it more apparent that some situations make me anxious no matter what. I’ve tried almost every medicine on the market and find that the only thing that works when it really sets off, is xanax. Therapeutic thinking and other medicines can’t remove it. Fortunately, given the the fact of xanax’ addictive qualities, I have an experienced and pragmatic psychiatrist. The over-emphasising of addictive qualities when you are just (and barely) surviving, doesn’t really help.

    I don’t believe in outright suffering, rather suffering sucks. I know only too well the emotions that made Munch paint “The Scream”. But then I don’t believe you can fully vaccinate yourself from unhappiness either. I understand that I cannot understand what drives the author to continue therapy, is it helping and for what? What is the goal, a complete understanding of yourself in this world? For perfection of the human mind and all that it entails?
    I don’t know.
    If you need to talk, you need not necessarily a therapist. I found good help from a priest. Thankfully he didn’t talk about god much, we talked about life and what life brings (and might not bring). I found it equally fulfilling.

  5. Hi, Sandy,

    Welcome back, it has been lonely here without you. I find your blog such an easy read.
    Guess what? After waiting 3 months I am finally getting to see a short term therapist. I am and am not looking forward to it. I think maybe I should send him my history prior to the appointment so I can get right down to the bones of things. When in therapy I am not one to waste too much time on talking about the weather, if you get my understanding. But, I will not be handing him my history prior to the first appointment – but I will let him know how difficult it is starting with someone new – AGAIN! It is difficult. But I need it. It is not the therapy so much, but just having someone with a different perspective to bounce ideas, frustrations, challenges off of. Someone who isn’t going to judge me for my thoughts because, unlike friends or family they are trained to know where it is all coming from. I like having a therapist in my corner if for no other reason than to just check in and get that little nod – you know the one. The nod or comment that says – I’m doing okay.
    I know that a therapist can’t cure me I have to get better on my own, it’s nice to have some guidance though. I have tried different avenues, talking to other people – but they just don’t seem to get it quite the same way as someone who is trained specifically to deal with mental illness.

    • Good Luck with your therapy, Sheila. I sincerely hope you “click” with this new therapist and accomplish the goals to choose to explore. It’s never easy, but recognizing your need to have someone listen to you is healthy. Jessika is absolutely right, though. It need not be a therapist. Any “active listener” in your life can be wonderfully helpful to you.
      Friendships can work this way, too.
      Hugs to you Sheila… I’m thinking about you.

  6. @Sheila:
    It takes me a great while to relax enough to trust someone with my inner most thoughts. I’ve been burned a bit too much and too often to just casually fling the door open to everything that matters. Which would be my primary concern if entering a short burst therapy. I’ve always been a private and guarded person, even towards people that are to help you. It comes over time. Time which noone seems to have or be willing to offer.
    Good luck with the therapist!

  7. Hi, Jessicka,

    I entered a response and ended up loosing it- naturally.
    Anyway, I too am very guarded, I greatly dislike the short term therapy – but finacially I can’t afford to pay for someone, so I have to rely on the therapist’s at the Family Health Team. The Social Worker’s that I have met through here have been great – better in fact than the psychologist that I paid for for 7 years of therapy.
    I will agree that it is most difficult to trust someone in the short term – I hate beginning the story all over again, I don’t like looking into the eyes of a stranger and wonder what they are thinking. It’s uncomfortable and I feel very vulnerable. But until my situation changes it is the best I have. I have been having a difficult time since October and need to know that I am not alone and that there is at least one objective person to vent to and help me get my head back on track. It really all comes down to me anyway – my recovery.

  8. Hello Sandy,

    On my parents’ graves, let me assure you that the comment from “Sonia” on August 9 is NOT from me – I was not online, as I was down with a cold, sniffles and sneezes.

    I am better today, and was just now reading your blog, only to see “me” write in a way that is not “me” … someone with a similar name, perhaps.


  9. Soni,

    Yes… now I can see that.

    Apologies to the first Sonia for misrepresenting you. Happy to have you aboard, nonetheless. Welcome.

    And Soni, my Soni ~ feel better. Soon. Marty has just come down with sniffles, sneezes and coughs, too.

    Hugs to you both,

  10. Sheila: I hear you on the financial aspect. If I hadn’t been referred to free therapy, I’d have passed. The money (150 – 200 dollars per session), would have killed me with worry. Regardless of benefits from therapy, it wouldn’t have happened.

  11. Hi Sandy,

    I enjoyed reading this.I’m also in Canada – and so cost is not consideration in seeing my psychiatrist. I also didn’t choose who I see, though I’m quite happy with him. He uses a variety of approaches and has been open to suggestions, and also able to see me in all of my strengths as well as my weaknesses. Unlike how people often think about psychiatrists – we’re not particularly medication-centred. I feel an incredible sense of gratefulness to the public system for looking after me at a time that I wasn’t sure I “deserved” it.

    It’s been about 3 years, and every so often I wonder if I should stop. Now I go sporadically, every 3-4 months, and I’m wondering whether maybe that’s okay indefinitely. I don’t need endless support, but it is helpful to have someone to check in with once in a while (though I do often feel guilty about taking time that someone in worse shape might need).

    I’d be interested in reading more about psychotherapy in our system – I worry about being a burden on the public system (occasionally, and then I rationalise that I’m more useful to this country with rather than without), and many of the issues I read about frequently on psych central (choosing your therapist, and issues around money and insurance) just aren’t factors here – or issues of choosing a psychologist, social worker or psychiatrist which are!

  12. Hi, Kaye

    Another Canadian buddy here. I am glad that both you and Sandy have found psychiatrist’s who will talk with you rather than at you. Why give up your therapist? I am going through a time which is fairly difficult – mainly because I haven’t had the on going support of a therapist. I have started back with someone now – but it is just temporary. What may be helping you to stay healthy is the knowledge that you have a saftey net in place. Sometimes that is all we need – just the knowledge that we are not alone, blowing around in the turbulance that can be our mental illness.
    Keep going – once every 3-4 months is like taking the car in for an oil change. Simple maintenance and reasurrance that “yes, I am doing okay.”

  13. ISTDP. As Malan said: Freud got the theory right, Davanloo got the technique right. Psychoanalysis as therapy allows the defense and resistances to take hold which prolong the process and prevent as efficient and as complete a therapeutic benefit.

    – An psychoanalyst who defected from orthodoxy.

    • Hi Safron,

      Thank you for your comment. In particular, I appreciate your mentions of Drs. David Malan and Habib Davanloo, two psychotherapy pioneers with whom I was not familiar. Now, I have some research to do.

      However, we will have agree to disagree on your general statement about short-term dynamic intensive psychotherapy. Although I agree wholeheartedly that psychotherapy should be “dynamic,” the issue of “time” and “term” concerns me.

      In psychoanalysis, what does “short-term intensive” really mean in terms of time? Ten sessions? Or five years? In psychiatric psychotherapy, short-term usually means 10 sessions, at least here in Canada with our overburdened “universal health care system.” In some cases, people with mental illnesses or mental health issues must wait months or even longer to be seen by a psychiatrist and in many cases, they need more time.

      I am always skeptical about sweeping generalizations, especially about mental health and mental illnesses. Every person with a mental health concern should be evaluated and treated individually.

      Take care and be well.


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