I teach classes on clinical theory and practice, and many of the students I teach are interested in becoming psychotherapists or psychoanalysts I’m often asked about my own practice. The text on this page is designed to give students (and anyone else who might be interested) an idea of how I practice, and the reasons why I have chosen to practice the way I do.
I’ve constructed this text as a result of the most common sorts of questions I get, and I continue to expand and revise the text as I get new questions. I hope that you find something informative and useful as you read it.
The way I tend to explain this is to compare therapy to food. There is “fast food” that is available in many places, and it does not cost very much, and you don’t need to wait long for it. Fast food tastes great, and tends to make people feel a sort of satisfaction, but that satisfaction is very short lived. Additionally even though fast food can create a sort of short term enjoyment, it does not really offer nourishment.
To my way of thinking there are lots of “fast therapies” that are similar to this sort of “fast food”. These therapies tend to be:
The therapy that I practice is “slow therapy”, which I compare to a big Thanksgiving meal that takes a longer time to prepare, but is also (I hope!) far more enjoyable than fast food that people pick up via a drive-through.
Another comparison I can make is to fashion. There is “fast fashion” which is used to describe clothing that is mass produced and sold for little money in big box stores. This type of clothing is designed to be appealing the the largest number of people, and is not tailored or unique.
“Slow fashion” on the other hand is clothing that tends to be produced in small batches. The material and the labor the make the clothing is high quality. Another example of “slow fashion” would be getting a suit tailor made just for you. The result “slow fashion” is low supply but high quality.
The type of psychoanalytic therapy I provide is more similar to slow food and slow fashion than it is to fast food and fast fashion.
Make no mistake, digging into one’s unconscious is not an easy process! It’s a longterm process that requires a high level of commitment and perseverance. However, for those who undertake the rigorous project of gaining self-knowledge are rewarded with the increased freedom that comes from achieving insight.
It’s important to state that psychoanalytic therapy works very well for individuals who are very motivated in investing the necessary time and energy into coming to know and understand their unconscious. This tends to be longterm project as opposed to a fix, cure, and/or different way of behaving, that is arrived at quickly.
While individuals who engage in psychoanalytic therapy do tend to feel better, and behave in ways that foster more personal freedom with less anxiety, those feelings and behaviors are the byproduct of the long term project of gradually increasing one’s understanding of their unconscious.
In other words: Psychoanalytic therapy focuses on generating insight. This is done because real meaningful change grows out of insight. While other therapies will try to take “short cuts” by skipping the process of generating insight and going directly to a behavioral changes, psychoanalytic therapy prefers the “long way” of generating better ways of living.
If you only put in a little bit of time working out, or eating well, what sort of results do you get? Not very good ones. On the other hand, if you work out and eating well for a long time what sort of results do you get? Better longer lasting results!
Another way to describe the benefits of longterm work comes from something I heard at a conference. A psychoanalyst said, “Sometimes you can’t microwave change.” To me this short sentence shows how longterm psychoanalytic therapy is more like a meal that a person spends a long time preparing, and less like a microwave dinner. The well prepared meal does take longer, and it costs more, but it offers a satisfaction that the microwave meal won’t be able to provide.
I also believe that the patient has to experience the process of therapy as something that is manful and valuable to them.
This means that I work only with patients who want to receive the therapy I provide. Being committed working only with patients who want to be in therapy has not always been easy, and truth be told it has meant that I work with far fewer individuals than other providers.
Be that as it may, because the patient I’m working with are intrinsically motivated the work we do together tends to be extremely generative for both me (as a provider) and them (as a patient).
During the intake session it becomes clear that the child does not want therapy, and is only in the room because their parent is “making” them be there. When this happens I ask for child for five sessions (the intake session which is usually done with the parent there as well, and then four sessions without the parent). If at the end of those five sessions the child does not want to continue withe therapy I will tell the parent that the therapy (with me) is not an option. I can’t predict how things will be at the end of the five sessions. I’ve had people who were not interested become interested, and I’ve had people who were uninterested remain uninterested.
For me the bottom line is this: For therapy to work the person who is receiving the therapy has to want it. If that condition is not meet then the therapy will (I think) be a wasteful use of time and money. I don’t want to waste my time or anyone else time. I also don’t want to take money from people if I’m not going to be able to provide something that is valued.