My Thoughts

A teacher and supervisor of mine, Robert Winer wrote on his website (I encourage you to visit) about differences between psychotherapy and psychoanalysis. I liked what he wrote so much I decided not to reinvent the wheel. He has generously given me permission to use his thoughts here. My thoughts align with many of his below:

Psychotherapy

First and foremost, it’s an open and honest conversation, a good talk. I feel it’s been a useful hour if we’ve been able to say the things worth saying to each other. And it’s not so easy to do that – we’re used to keeping our guard up for compelling reasons, because of our experiences of being hurt and used and misunderstood in the past. So it takes a while, and sometimes a substantial while, for us to build trust, to negotiate ways in which we can be really candid with each other. Our past experiences shape us, and sometimes they take their toll. But it’s a great misunderstanding about therapy that the work is all about rummaging through the attics of our past. Therapists are only interested in the past as it is alive and kicking in the present. The ways of negotiating the world that we learned in childhood often became addictive. For better and for worse we connect in the ways that worked for us as children, even at great price to ourselves. That’s because the opposite of being loved isn’t being hated – it’s being treated as nonexistent – and so we accepted connection on the terms we could find. Therapy is about putting in question the roadmaps we’ve followed without hesitation and taken as set in stone. In a good-enough therapy, more than anything else, we come to know ourselves better. Which can be extraordinarily useful. We don’t become different people, but we can develop second opinions about things we’ve taken for granted. (An example: It’s not just that I’m afraid of being embarrassed if I speak up. It’s also that I’m afraid of hurting you, and losing you.) Being able to entertain a second possibility offers us a measure of freedom, the chance to make a different choice. At least some of the time.

Psychanalysis

The real difference between psychotherapy and psychoanalysis is how often we meet. Conventionally, being in psychoanalysis means having sessions four or five times a week, and being in psychotherapy means coming less often. Once-a-week treatment does run the risk of becoming the “news of the week in review.” By meeting more frequently, we can move beyond surface concerns and work at the underlying problems which interfere with connecting, loving, working, being expressive and creative, feeling better. It becomes safer to reveal yourself when you know that we can pick up the conversation tomorrow. There’s a popular notion that more frequent treatment is for those who are more disturbed, that coming often must mean you’re “really sick.” But it’s actually the other way around. It takes a measure of personal strength to engage in a substantial treatment. Most of the people I’ve seen in psychoanalysis have been students or professionals with fully engaged personal lives. For stubborn inner problems, which have been years or decades in the fashioning, it may be that nothing less than an intensive treatment will make a difference. A maladaptive way of negotiating the world fashioned over a lifetime can’t be shifted quickly or easily. “So am I signing on to do this for the next ten years?” I might be asked at this point. “Am I surrendering my life? Am I another perpetual patient like Woody Allen?” might be the private thought. (My first thought is: But think of all the great movies he made during those years of treatment.) What I’d say is this: You’re not signing on for life, you’re going to give it a try. If it doesn’t seem useful you’ll move on and try something else. And if it does feel helpful, it folds into your life like other useful activities which take time (working out at the gym, practicing at the piano, participating at the church, and so forth). Analysis makes heavy demands in time and money, and you’ll only stay with it if you sense that it’s become worth doing.”