Why psychoanalysis? #2

A second instalment.

Before I began training as a psychoanalytic psychotherapist, I wrote something on here in answer to the question, ‘Why psychoanalysis?’. Now well into clinical training, I want to consider the question again. And I’ll do so again and again. I think it is only possible to answer this question iteratively, forever, until I can’t anymore.

Often, when people approach me for therapy, in an initial consultation, I offer something of a précis of psychoanalytic psychotherapy. I do this because sometimes people are seeking something very different when they are seeking therapy - which isn’t to say that psychoanalysis might not turn out to be just what they didn’t know they wanted. In offering this précis, I have realised that psychoanalysis is a hard sell and that this is one reason why I love it.

Increasingly, prospective patients know something about different therapeutic modalities - especially cognitive behavioural therapy (CBT), the main therapy available on the NHS, and sometimes those that garner attention on social media, such as eye movement desensitisation and reprocessing (EMDR), family systems, and exposure, response and prevision (ERP). People have less frequently come across psychoanalysis, even though it is the precursor of talking therapies of all kinds.

When I say psychoanalysis is a hard sell, I don’t mean to suggest that I try to sell it, as such - more that, if I were to try to, it would be difficult, under predominant terms of sale. To be marketable, commodities are sold using words like ‘efficient’, ‘optimised’, ‘fastest’, ‘evidence-based’, ‘guaranteed’. Where many other therapeutic modalities attempt to market themselves along these lines, psychoanalysis generally does not. Perhaps more so than a hard sell it is a strange sell, under capitalism - which, again, is why I love it.

There is plenty of 'evidence’ that psychoanalytic psychotherapy is effective, if you’re into that kind of thing. But unlike some other therapeutic modalities, its evidence isn’t really its point. Certainly, alleviating suffering could be taken as the hopeful destination in any psychoanalytic treatment - but it is taken as given that the road to get there might be bumpy, winding and long. And that each patient will have to tread their own path.

It is difficult to market psychoanalysis, in part, because it is not one thing anyone; depending which theoretical orientation you ask, it has a different flavour, different aspirations. Freud suggested “ordinary unhappiness” as a good outcome for psychoanalysis; Lacan thought it was about facing up to one’s desire; Winnicott wanted to facilitate play and surprise; Klein believed that patients might aspire to the depressive position; Ferenczi proposed that patients were ‘cured’ when they were able to free associate - to speak their mind in analysis truly, freely. Adam Phillips writes that “Psychoanalysis is about what two people can say to each other if they agree not to have sex."

What psychoanalysis is depends on who you are speaking to - which is also to say, which analyst, and which patient. The constants are few and vague: it is dependably a slow process, sprawling, unpredictable, weird. It is often an experience that can be better understood, as a whole, in retrospect.

In one sense, psychoanalysis is less something to be pre-determined, and more about waiting and seeing what happens. In this sense, it demands that we find a patience within ourselves that our culture at large has not cultivated in us. I notice this impatience in myself as much as I do in patients. And in this sense, too, it can demand a kind of faith, the kind you choose to have.

It is difficult to market this kind of thing - and even though the psychoanalytic relationship too often involves monetary exchange, the experience is, I think, less something bought than something that each patient can only find, of their own accord. It might be found early on in the work, or years in (or of course, never). This is one reason ‘Why psychoanalysis?’: in a culture that all too often asks us to swallow whatever is being sold, instead psychoanalysis is about finding, unearthing for ourselves.