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The Best-Kept Psychotherapy Secrets

How to get help with today’s “problems of living.”

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by Bruce Levin, M.D.

Keeping secrets is a central tenet in my line of work as a psychiatrist and psychoanalyst. I am intimately involved with my patients' most private experiences, behaviors, fantasies, thoughts, and desires. Keeping secrets is vital in developing and maintaining a trusting and nurturing alliance. As treatment proceeds and trust deepens, my patients reveal more, and eventually come to understand even the “secrets” they have kept from themselves. Or as one of my patients frequently liked to remind me, “You are only as sick as your secrets.”

But the profession of psychoanalysis has often had a tendency to prescribe itself too much of its own medicine. We have been so good at keeping secrets that the public does not really know who psychoanalysts are, what we do, what we treat, or how to find us.

Who are we?

We are psychiatrists, psychologists, social workers, or academicians who have five to ten years of extra training beyond our professional degrees. Psychoanalysts are educated to become experts in the “basic sciences” of talk therapy and difficulties encompassing relationships, love, and work. These difficulties can lead to a variety of “problems of living.”

This education is intense: It involves four to five years of classroom work and weekly presentations of clinical material from several cases to different senior psychoanalysts. But the most central part of the training, and what distinguishes it from all other psychotherapy education, is that we become patients in our own personal psychoanalysis. This is important, because it offers the beginning psychoanalyst an opportunity to:

  1. Gain a better understanding of their inner psychological life
  2. Work out their personal emotional difficulties
  3. Resolve therapeutic “blind-spots” when working closely with patients
  4. Gain an empathic understanding of the vulnerability of being a patient

What do we do?

We listen in a specific manner, utilizing well-honed skills from our specialized training. We also invite patients to listen and observe their inner emotional life. In a sense, it's like looking at an X-ray of your body with a radiologist. The radiologist's expert training can help them identify problems that may be right in front of your nose, but are not readily apparent. You might share discomfort in your body, and the radiologist could help you correlate this with the X-ray and vice versa. Over time, you could learn from each other and develop a good idea of what is going on inside.

What do we treat?

We treat “problems of living.” Although these struggles are a ubiquitous aspect of being human, sometimes the stresses and strains of everyday life, traumatic events, or other “triggers” tip the scales away from normal health. This can result in anxiety, depression, inhibitions, and symptoms such as anger, irritability, low self-worth, somatic preoccupation, lack of confidence, sexual dysfunction, relationship problems, obsessive thoughts, avoidance behaviors, insecurity, and not being able to reach one’s academic or professional potential.

Developmentally, problems of living often first appear in adolescence or early adulthood, as life gets more stressful with increased adult responsibilities such as independent living, marriage, children, careers, and other commitments. These struggles tend to become more entrenched, tenacious, and intricate as life goes on, potentially causing angst in an otherwise good life. As a result, I advise college or graduate students and young professionals to consider and address their problems of living early on and in a serious manner.

In a fast-paced age, many people seek a quick fix. Who could argue or disagree with wanting more for less when it is effective? But with problems of living, short-term treatments may temporarily ease acute discomfort and symptoms, but only nibble around the edges of more extensive workable difficulties. Unfortunately, unless effectively treated, these problems will likely repeat themselves over and over.

What else is important to know?

It is important to note that the profession of psychoanalysis has changed and is evolving with the times. Psychoanalysts come from all races and ethnicities. We are men and women, straight, gay, liberal, conservative, and everything in between — just like our patients.

Psychoanalysts are radical. In our action-packed, instant gratification culture, we offer the radical approach of slowing things down in a private, quiet, and completely confidential setting. We help you explore and redesign your interior emotional world, yielding freedom from inner shackles.

Psychoanalysts are “all natural” with few additives: We conduct our work through the natural use of language and a close, meaningful relationship. This is basic to being human and connects us to our humanity in a seemingly simple yet extraordinarily complex way. By using the freedom of talk, and listening in a particular way with a well-trained ear, we help work out personal vulnerabilities and bolster strengths. One occasional “additive” is the use of medication, when necessary, along with talk therapy.

Psychoanalysts offer a psychological pot of gold for those who are motivated, courageous, and have the determination and grit to take the audacious step to explore their inner life and free themselves from their restricting anxieties, depression, inhibitions, and symptoms.

Most of all, psychoanalysts care and are here to help.

Bruce J. Levin, M.D., is a Training Analyst at the Psychoanalytic Center of Philadelphia and at the Institute for Psychoanalytic Education (IPE) affiliated with the NYU School of Medicine. He is Distinguished Fellow and Life Member of the American Psychiatric Association. He practices in Plymouth Meeting, Pennsylvania, a suburb of Philadelphia.

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