The magic of psychoanalysis is in how it happens.

(Published on May 5, 2014 by Lawrence D. Blum, M.D. in Beyond Freud)

Psychoanalysis has been pronounced dead so many times that many people don’t realize what a rewarding career it can offer. I’d like to tell you why I love being a psychoanalyst and why you might, too. If you study psychoanalysis, you may even have more company than you imagine: as psychiatry and psychology begin to draw back from biological and behavioral reductionism, as neuroscience increasingly recognizes that experience influences neurophysiology and neuroanatomy, and as cognitive-behavioral therapy takes more notice of both feelings and the therapeutic relationship, the contributions of psychoanalysis may again attract attention. Throughout its history, psychoanalysis has steadfastly kept its focus on mind, feelings, and the therapeutic relationship. Not only is psychoanalysis as relevant as ever, it also can be magical, fun, suspenseful, challenging, and rewarding. Let’s start with the magic.

A patient starts by telling a psychoanalyst a story, the story of his life, or of his suffering. Gradually, as the sessions progress, the analyst becomes important to the patient, and the patient then incorporates the analyst as a character in the story. The story, remarkably, is suddenly taking place in the office as it is being told! This occurrence can have a quite magical feeling. The analyst’s presence in the story offers a unique opportunity to help people figure out what their stories (their lives and relationships) are all about, and then to “write” better outcomes than would otherwise be possible.

This is serious business and challenging work, but also a form of play. Instead of reading about or hearing about someone’s struggles, to some extent one participates in them. It’s intimate. The analyst has to be curious, to want to know the patient’s mind (and heart), and to want a relationship. He (or she) has to be ready to participate in the story as it takes place, yet also be able to observe and comment. The central, difficult, task is to allow the patient to form a relationship with the analyst that is determined as much as possible by the patient’s needs and inclinations, and at the same time to observe and narrate the relationship as it develops. Together, the analyst and patient can then examine and learn from this process. If you’ve read, or been taught, about analyzing transferences and resistances, the process just described is most of what it’s about. Psychoanalysis thus provides an opportunity to be deeply involved with other people in a way that is careful yet also spontaneous, caring, and respectful, even as it is asymmetrical, and certainly non-physical.

One of the things that helps patients most in psychotherapy is the opportunity to distinguish the ways they view other people (and the world) that are distorted by fantasy from the ways in which they are realistic, in other words to get the past out of the present. Looking at the ways the patient treats the analyst, or to put it in terms of the idea described above, how the patient brings the analyst into the story, provides the best opportunity for this work. This is why intensive treatments are helpful; they facilitate a more involved relationship with increased opportunities to look first-hand at more intense feelings and fantasies. In less intensive, less frequent psychotherapies, the psychoanalyst brings the same set of skills and can often foster a helpful analytic process in those therapies as well.

It is a major challenge for the analyst to truly allow the patient to make the analyst whatever kind of character in the story that the patient needs him to be, and to facilitate the expression of any and all feelings that the patient may have toward that character. The analyst has to be willing to be loved, hated, envied, desired, condescended to, avoided, mocked, or criticized – and at the same time to maintain his composure, along with his observing, narrative, and interpretive faculty. The analyst also must be alert to the inevitable evidence for, and to help bring into focus, those difficult feelings, especially the anger and hate, that the patient (or analyst) may attempt to avoid, or to express only very indirectly. These difficult feelings are often at the center of the patient’s struggles. Bringing them to life in the relationship, so they can be understood directly, there and then, is typically a high-challenge, but high reward, proposition.

Another part of the interest and fun should now be clear: while the work is necessarily deliberate and patience is required, there is always suspense. One can never know how things will turn out. How many of the hurdles will be cleared, which ones, how, and when? This is a sort of theater in which no two performances, no two plays, are the same. At times things may appear similar, but the next act, or the ending, may not be what one expects. Stay tuned! Perhaps this is why so many psychoanalysts work well past the time when colleagues in other fields have retired – the work stays interesting and fun.

What helps prepare a psychoanalyst for this? Everything! Psychoanalysis lives in a great intellectual neighborhood, with stimulating interactions with many nearby disciplines. Anything you’ve learned about people in an English course, in art, history, sociology, anthropology, psychology, and psychiatry applies. So does neuroscience, which has a greatly increasing exchange with psychoanalysis. With its attention to drives and biology, psychoanalysis connects with the natural sciences; with its focus on interpersonal relationships, it engages with the social sciences; and with its emphasis on individual subjectivity, it is squarely in the humanities.

If your interests are broad, if you are someone who was drawn to the mental health professions because you really want to know what makes people tick, you may well find a career in psychoanalysis to be remarkably fulfilling.

(This article was originally published in Clinical Psychiatry News, April, 2014 - and reposted on the San Diego Psychoanalytic Centre website.)