Yes, Sigmund Freud is back in the forefront thanks to the brouhaha over Frederic Crews’ The Making of an Illusion, a title that speaks for itself. A host of commentators' pro and con have been either countering Crews’ muckraking and celebrating the self-styled professor as an icon on par with Shakespeare and Jesus or joining him in debunking a persistent charlatan who did more harm than good for his beguiled patients. The upshot seems to be that the practice of psychoanalysis was and is a sham even as its founding father changed Western culture for forever and a day.

Many months before all this flurry of intellectual opining, this author, who spent many of his 72 years as a clinical psychoanalyst and educator, came to the unequivocal conclusion that so-called “classical analysis” had become an anachronism. How then, I asked myself, might clinicians salvage its demonstrable “truths of the human heart,” which remain buried in solipsism, ideology, and self-deception, and make of it more than it had been? Luckily, it was patients themselves that over the course of nearly two decades had led the way in pointing their doctor toward a new and more effective treatment modality.                  

No doubt when they read this, colleagues will chide me for breaking time-honored boundaries by plunging in as an active agent in a patient’s real world in what they call an “enactment.” But I would rejoin by saying that our paramount responsibility is not to a procedure but rather to a person seeking our services and to the well-being of those who depend on us. “Necessity is the mother of invention,” and I can’t help but suspect that more than a few analysts are doing on the sly something analogous to what I’m about to come clean about. Perhaps like me, they, too, stumbled along a circuitous path into new unhallowed but pragmatic ways of conducting psychotherapy.

Part One: An Old Dog’s New Tricks

I was 25 years into my career at the new millennium, when a well-known actor who a year earlier had begun an analysis with me five days a week (when not on location) sought my professional expertise in assessing the veracity of the depiction of a psychopath he was about to enact. I had analyzed 50 individuals three, four, and five times a week on the couch over the course of four decades with eight to 10 of these patients in my caseload at any given time. In my writing, teaching, and supervising, I myself had rigorously fended off efforts to “water down” psychoanalysis.

Loath to seem highhanded and inaccessible, I agreed, and he brought me the script. Myself a lapsed actor/director, I found myself attentive not only to the psychology of the character in question but also to other aspects of the plot—timelines, backstories, character trajectories, verisimilitude, and the like. Wouldn’t a coroner be able to determine the time and cause of death of someone who had been strangled and then, to make her demise look like suicide, whose wrists he had slit as her corpse lay in a bathtub? And wouldn’t it be both more true to life and more dramatic if the child in danger, his daughter, ended up with the selfsame dissociative disorder as her murderous father in the film’s epilogue? And in making other things more realistic, would not the characterization of the psychopath my patient was to inhabit become more believable?

I paused. Did I dare take off one designated hat and put on another, one that I had tossed into the closet years ago? In so doing would I be breaking the golden rules of abstinence and anonymity by revealing my nonclinician self? I trusted my gut and did what came naturally. I handed in my edits, those pink and blue sides of a screenplay in process, for the patient’s and the director’s consideration.         

The results? Most of my suggestions were incorporated into the film, making this thriller more compelling and scary. Other screenplays and screenings followed. And my actor patient’s psychoanalysis, unimpeded by my screenplay editing, continued for many years thereafter with good results. Indeed, I was right and had I turned down his request in the first place, which would have seemed both silly and highhanded, I would have confused, offended, and probably lost him.

“Hmm,” I thought, “if I could do it with an actor, why not plunge into the meat of the matter at the get-go with the writer himself? Why not get real while accessing and further freeing a person’s imagination?” And so began my work as a “script doctor” of blocked writers and in time a whole new way of working with almost all my patients.

I guess that not a few of my readers who have ever written anything have at one time or another experienced writer’s block. But if you do not make your living from it, it’s not so bad. Writing is not the main event after all, not your main job.

However, for the full-time novelist, biographer, memoirist, screenwriter, or journalist, unremitting writer’s block is a nightmare. Not writing means not only not fulfilling one’s creativity and disappointing oneself but also not doing what one is supposed to be doing and disappointing others: the editors or producers who rely on getting on time what you are under contract to complete. And if writers cannot produce, they cannot make a living and provide for their family. Not everyone is a Joyce Carol Oates or Stephen King, for whom a stall is a hiccup, but a decent output is to be expected.

The trouble is, fretting over these contingencies rather than focusing on the work at hand only makes matters worse. Daunted by the specter of dire consequences, the blocked writer makes other plans—anything to avoid that laptop whose blank screen stares back at him with admonition and contempt. That is, if he doesn’t manage to lose or leave his Mac behind when headed for that special secluded spot or drag it along on vacations when it is impossible to get any work done.

Mired in conscious guilt over what is felt to be as irresponsible procrastination, he forgets that “this is life [he has] chosen,” that he wanted to write because it is pleasurable, downright fun at times, and because artistic license is also “license to kill.” Herein lies the source and true nature of that guilt. It is unconscious. It is the creating that makes creator guilty, and so he turns it into a chore, into homework. But where there’s a will, free will, there’s a way.

True or not, psychoanalysts who simply talk to such patients in the abstract about a “fear of success” and “Oedipal guilt” ignore the surface or texture of work-in-progress that remains for them sight unseen. Yes, storytellers do yearn to tell their stories but can find themselves stalled because of unconscious, irrational guilt. But it is seeing these conflicts on the printed page and helping writers reposition themselves as those of his characters that get the job done just as the writing itself becomes therapeutic.

And again as luck would have it, several patients came my way and moved me to start systematizing my inchoate ideas about treating writing blocks and, later on, other work inhibitions.

A couple of these people had had prior analyses with me at the conclusion of which they achieved many of the goals they had initially set for themselves. Facing new life crises, milestones, and opportunities, they returned after a hiatus of several years. With the rebooting of their analytic engine, they settled back in, and we began meeting face to face for one hour weekly and in and between sessions reading, critiquing and coediting what they wrote. In doing so, I was to discover for the first time artistic gifts and achievements above and beyond the hard-won but unwritten recollections and reconstructions of their psychoanalyses. So much so that upon reading one patient’s memoir, I exclaimed,

“B, I never really knew who you were after all those years not so long ago. You are a true artist—an extraordinary writer, activating all the reader’s senses—sight, sound, touch, smell, blending them with a painter’s palette and bringing your people to life.”

For many years I had told my students that when it came to people’s real lives, they didn’t “know the half of it.” Paradoxically, the more experienced the therapist, I continued, the more he sees each patient as a unique and multilayered individual, the more open he is to surprises, and the more exciting the therapeutic process becomes. With these inhibited artists, I had unearthed a further and more thrilling variation on this theme, which I would keep in mind with all my patients. Unlike narcissists who predictably fail to report the negatives, guilt-driven and diffident “anti-narcissists” are reluctant to bring their strengths and successes into the consulting room.

My experience with returning patients primed me to look for similar lacunae with a filmmaker who came to me for the first time. Reluctant to show off and thus to show up his defensively idealized father, he acted as if he himself had never made his six movies nor written a screenplay in years when in fact there were three more workmanly scripts tucked away in his files. Watching and reading these attested to his proven competence and promise at the same time that the stories’ denouements, the endgames, revealed his hesitance and that of his protagonists to “go in for the kill.”

My effectively collaborating with these people on the hitherto elusive memoir, screenplay, or novel shortened the time of period before the patient could see tangible results after what felt like a losing battle with an excruciating paralysis. Starting to write again under my watchful eye was a process akin to an “exorcism” in which the therapist helps the creator free himself from and turns the tables on “his demons,” ghosts of the flawed and often immature adults on whom he had been abjectly dependent as a vulnerable child. No longer its victim, he takes possession of his past.

I wonder whether others can appreciate the healing power of the creative process itself, the sheer necessity of an artist’s practicing his art. No matter how he may thrive in other pursuits, no matter rich his personal life, there will always be the sense of an unfilled void, of being haunted, and of guilt and shame for failing to give his audience what his uniquely his to give.

Life and art imitate each other. For the artist, the interplay of the creative and therapeutic processes enhances the healing effects of each exponentially. Fictive storytellers tap into the fluid worlds of childhood in which under the worst of circumstances they could find refuge in imagination. Hence the imperatives for storytellers, both wounded and enthralled as children, to make of their struggles sublime dramas whose truth as beauty others can share and which defy the inexorable passage of the life cycle.

In film and in the theater—and in contrast to most literary fiction, which need not adhere to the unity of time and place—heroes and heroines accomplish in a few weeks for them and two hours for the audience what their creators, like most of us, have taken decades to attain. Consider a fifty-year-old filmmaker and his eighteen-year-old alter ego.

Almost without the filmmaker’s or even my knowing it until seeing it on the screen, the movie turned out to be a modern-day rendering of the myth of Oedipus and his filicidal father Laius. A late adolescent basketball star repeatedly turns a blind eye to the misdeeds of his pernicious father because of his guilt until he is forced to abandon him so that he can get into college and proceed with a hard-won life of his own. In the movie’s final moments, our hero hobbles onto the court with a knee crushed by his father (“accidentally on purpose”) in a one-on-one fiasco the day before, echoing the piercing of the infant Oedipus’ ankles by Laius’ servant and the resulting club foot for which he was named. Undeterred by his injury like Oedipus at the crossroads, he wins the game which his father had bet against, “casting him to the wolves”—the bookies who lead him to his death.

Ironically then, it was the imaginative work of the creative artist that first set in relief pressing realities of an individual patient’s actual life and led me to focus on the interplay of long-term as well as more recent memories for all sorts of patients, writers and otherwise, in my practice. Those positive and immediate results that ensued as opposed to the vagaries of psychoanalysis made for what the philosopher of science, Thomas Kuhn, identified as an unanticipated anomaly in the data that has impelled me to formulate a psychotherapeutic paradigm shift.

Indeed, I have concluded that psychoanalysis, as clinicians and consumers have conceived of it, is an anachronism in today’s world—outmoded, impractical, inefficient, and often ineffective. Making psychoanalytic psychotherapy work, I now believe, means dispensing with most of its cornerstones and hallmarks, among them a relentless focus on transference in the consulting room in an arduous process that usually takes a year to unfold and many more to undo.

Instead, patient and doctor, meeting once weekly with texting between sessions, home in on those issues already in play in everyday life. Delving into the telling details of a patient’s current reality along with the overt actions and more subtle communications on the part of childhood caretakers clears a person’s head and allows him to factor in other people’s transferences toward him. The fact that bosses and spouses are not acting in loco parentis but are people with life histories and conflicts of their own makes immediate sense to the individual and induces him to grasp at the get-go what William Faulkner, echoing Freudians, once said: "The past is not dead, it’s not even past."

Like an old-fashioned psychoanalysis, reality and remembering it are what this psychotherapy is all about. But I guess you could say that it turns memory’s face not to the moonlight of the murky consulting room but to the sunlight—of the day, every day.

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