When Understanding Is Not Enough

Michael Bader, D.M.H. has written a column in Psychology Today entitled "We Need a Practical Psychoanalysis." Here are the first few paragraphs:

I'm a psychoanalyst. So it was with great interest that I read Daphne Merkin's New York Times Magazine article about her forty-year history of psychoanalysis and psychoanalytic psychotherapy. Merkin is a terrific writer, a brave observer of her inner life, and a lively critic of the professional cultures devoted to studying and healing inner lives. She found the New York psychoanalytic culture reassuring, even if not always helpful. She says:

"...aside from the fact that the unconscious plays strange tricks and that the past stalks the present.....[there is] a certain language, a certain style of thinking that, in its capacity to reframe your life story, becomes--how should I put this?--addictive....Whether [it does] so rightly or wrongly is almost besides the point."

For decades I've heard that it doesn't matter what theory a therapist holds, what his or her formulation about the patient might be. What matters, the cliché goes, is simply the presence of an attentive relationship. Merkin's variation on this theme is that her idealization of her analysts' wisdom and the rhythms and imagery of a psychoanalytic conversation have been more comforting than anything she's been offered in the way of interpretation and insight. The process, in other words, was more important than the content or outcome.

Now, my psychoanalyst colleagues certainly don't think this is true. It's important to them -- to us -- that our very extensive training (6 - 8 years after we get our professional degrees) has given us access to a special knowledge (transference, unconscious conflict, defenses, primitive mental states, etc.) about the human psyche that is vital to the success of our treatment. Unfortunately, psychoanalysis has unwittingly colluded with the caricature that its practitioners don't really help their patients, but instead foster 40-year treatments more akin to addictions than cures. I thought that Merkin's essay hoisted us on our own petard. And this petard is a big reason why I left organized psychoanalysis....