Seven Questions for Warren Procci

Sometimes seven questions are just seven questions. Warren Procci, the next president of the American Psychoanalytic Association kindly shares his interpretation of the Seven Questions. The Seven Questions project asks prominent authors, theorists and policymakers the same questions about psychotherapy to help illuminate theoretical and stylistic differences between therapists. Dr. Procci concludes the policymakers portion as he joins the presidents of the American Psychiatric Association, American Psychological Association and APA Division 29 (Psychotherapy).

Psychoanalysis is the original practice of psychotherapy from which most modern therapies evolved. You know the trademark features; Sigmund Freud, lying on the couch, free association, penis envy, Oedipus, etc. Patients attend multiple sessions per week for several years, plumbing the unconscious to discover unhealthy drives and resolve conflicts while analyzing their resistance and transference. Freud's basic theory and techniques are still used today, although modern psychoanalysis is comprised of dozens of variations. Thousands of clinicians around the world pursue psychoanalytic training through a rigorous process of coursework, test cases and their own analysis. Despite significant criticism from detractors, it appears to hold up under scientific scrutiny.

Warren Procci (MD, University of Wisconsin) became President-Elect of the American Psychoanalytic Association following a decade of administrative participation in other capacities. He was President ('94-'96) and Dean ('96-'01) of the Southern California Psychoanalytic Association. He's a Trustee (1999- ) of his alma mater Wagner College, Clinical Professor of Psychiatry with both USC and UCLA and instructor at New Center for Psychoanalysis and Newport Psychoanalytic Institute. I contacted Dr. Procci because we share common ground - we both practice in Pasadena and I trained at the Southern California Psychoanalytic Institute during his deanship. Also because he had Paul Anka at his 60th birthday party, which sounds pretty cool.

Not familiar with the APsaA? This organization educates the public on the benefits of psychoanalysis and are actively involved in social initiatives including support for same-sex marriage and treatment for soldiers returning from Iraq and Afghanistan. Once considered a luxury for the rich, several low-fee psychoanalytic facilities have emerged in recent years. I've been affiliated with two such clinics: the Wright Institute Los Angeles and Rose City Center, where clients are seen multiple times per week for as little as $30 per session.

I appreciate Dr. Procci's responses that clearly reveal years of experience. It's obvious he's spent a lot of time reflecting on the therapist/client relationship. According to him, successful work comes when the client is in charge of her own insights (Q2, Q7), and problems start when therapists try too hard to help (Q3). Sit back, relax, enjoy the Seven Questions and tell me the first thing that comes into your mind.

Seven Questions for Warren Procci:

1. How would you respond to a new client who asks: "What should I talk about?"

This is a very common occurrence. While I will of course answer the patient, I think it is far more important to also deal with this through the demonstration of my own therapeutic stance. I consider it important to be calm, relaxed, and at ease and to let the patient know that if he or she just tries to relax and tell me what they have been thinking about, or what's on their mind, or what they have been worried about, then they'll find that they will talk about what it is important to talk about.

2. What do clients find most difficult about the therapeutic process?

This is not always the same for every patient or client but as general principle for many what they find most difficult is the fact that they themselves have to deal with the very things with which they don't want to deal. Specifically, they have to confront their own role in their difficulties and how difficult it is to stop doing what they've been habitually doing for many, many years and to accept that the initiative must come from within themselves. It cannot come from me.

3. What mistakes do therapists make that hinder the therapeutic process?

This is also something that differs from therapist to therapist, but in my own work I often find that it's when I'm trying too hard to help them, that the therapeutic process is hindered.

4. In your opinion, what is the ultimate goal of therapy?

I think the ultimate goal of therapy is to expand an individual's sense of freedom and autonomy and thus to help them give up stereotypical and unproductive patterns which have prevented them from achieving their full potential. They can then find ways to let themselves engage in new, different, and hopefully more creative and flexible responses.

Freudian Psychology Essential Reads

The Birth of Psychoanalysis, and the Erasure of a Life

Failed Resolutions and Broken Promises

5. What is the toughest part of being a therapist?

For me the toughest moments in treatment occur when it is necessary to maintain a constructive, helpful, therapeutic attitude while dealing with a patient's resistances and with their persistence in using self-defeating patterns. It is very important for the therapist to not behave in a way which only evokes the patient's defensiveness. It is important to be calm, even serene and, with time, to eventually help them begin to see the role that these behaviors play in perpetuating their difficulties.

6. What is the most enjoyable or rewarding part of being a therapist?

The privilege of being able to participate in a very close, highly collaborative, and deeply meaningful way with a fellow human being in a process that leads to greater opportunities for his or her fulfillment and development. If we are successful with a patient, he or she will remember us with gratitude for the rest of their life.

7. What is one pearl of wisdom you would offer clients about therapy?

It is important to find a way to take the pressure off yourself to try to make immediate or even quick changes. Instead, just attempt to sit back and observe how you think, feel and behave within the context of the therapeutic relationship. Put another way, it is important to allow yourself to trust that our therapeutic relationship will provide an environment from which relief and improvement can flow.

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My gratitude to fellow PT bloggers Jared DeFife, Michael Formica and Stephen Diamond for contributing their intriguing responses to the Seven Questions. I'm flattered they took the time to respond, each with his own unique spin. In a couple weeks I'll wrap up the project with a summary and analysis of the answers. So, if you're a therapist & blogger on PT or somewhere else, post your own responses soon and I'll try to include you in the summary. Let me know at ryan@ryanhowes.net.