Are you a good candidate for psychoanalytic treatment?

Love and hate: Why do some relationships fail?


      As we enter into the new year and make our resolutions, I wanted to go back to the beginning and answer the question, "Are you a good candidate for psychoanalytic treatment?"
    Whether you've never been in any form of psychotherapy before or you can call yourself a therapy veteran, by the end of this post I hope that you'll be able to answer the question, "Is psychoanalysis right for me?"
    Not everyone is a good candidate for psychoanalytic treatment. Some people are looking for symptom relief - they just want to be rid of what's happening in their body, i.e. the symptom of anxiety, insomnia, difficulties focusing, depression, whatever the case may be. This is typically done through medication that is prescribed by the treating psychiatrist. Many forms of psychotherapy also fall under this category.
    In psychoanalysis, however, we look at these reoccurring psychiatric symptoms as manifestations of the unconscious in the body. Simply, what cannot be expressed through language finds its way into the organism in the form of a physical, behavioral or psychosomatic complaint - "I can't sleep at night," "I can't focus," "I have difficulties with relationships," etc.
    To enter into the psychoanalytic journey of self-exploration, people need to be prepared to take responsibility for what is happening in their body, thus accepting the existence of the unconscious mind.
    Rather than trying to find an outside solution to an internal problem, people who are good candidates for psychoanalytic treatment want to find the answers within themselves.
    When you think about it, this isn't such a bad thing after all - to take responsibility for your psychological state of mind means that you have control over it, which in turn means that you can change it if you choose to do so.
      Why do I say, "if you choose to do so?" Because, in psychoanalysis we don't necessarily assume that the person undergoing psychoanalysis is going to change. In fact, change is not our primary goal in psychoanalytic psychotherapy, which is why we don't typically give homework assignments, teach techniques, or pursue goals. It's understanding that we are after in psychoanalysis.
    It usually happens that people do change as a result of the psychoanalytic treatment, however, sometimes, they choose not to. They gain a certain awareness and understanding of their symptoms, take responsibility for them. and may even continue the same patterns. The difference is that it becomes a conscious process as opposed to an unconscious one.
    Yet, the symptoms that originally brought the person to treatment usually disappear as the individual no longer "needs" them. I say "need" because in psychoanalysis, we believe that the symptom is a form of coping mechanism, a defensive strategy, or a survival tactic created by the unconscious as a solution to a problem that is otherwise too overwhelming, painful or threatening to handle.
    Which is another reason why we don't always want to get rid of the symptom; we welcome it as a form of communication from the unconscious. We listen to what people say in psychoanalytic psychotherapy with a different set of ears, trained by our own experience of listening to our own unconscious in psychoanalysis.
    So, the question that we ask prospective clients during the initial sessions is what is it that they are hoping to get out of the treatment. And the answer that we are looking for in the majority of cases is the desire to know what within themselves is causing them to be the way they are. And then the journey begins...

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When it comes to the matters of the heart, we can easily become irrational, impulsive, crazy and stupid as the saying goes. Love can turn into hate as quickly as it sparked and what was once a beautiful, blissful romance shifts into a dark and messy break up. 

I see this daily in my practice - parents, who were once happily in love, grow to hate each other; children of divorcing parents, disillusioned with dreams shattered, all hopes for happily ever after vanished in an instant. Divorce lawyers, mediation, separation, arguments, fights…

How is it that something so special like the love between two people can so easily turn into a black hole of hatred, anger and despair? Isn’t love supposed to conquer it all? 

There is a lot that goes into the psychology of love and when it comes to relationships no one-size fits all. People come to counseling to try and work things out but by the time they make the first appointment, it’s sometimes way too late to salvage the relationship. I wish I could sit here and write that counseling can solve it all and make things all better but unfortunately relationships do not always end with “they lived happily ever after.” 

In fact, making a relationship work is precisely that, work. A willingness to look into oneself and one’s flaws, past and present; one’s fears, hopes and feelings in the presence of another, and forgive, accept, embrace and trust this other for who they are and for whom they want to become. 

Lucie Cantin, a psychiatrist and teaching psychoanalysts at the Freudian School of Quebec in Canada, says that “when you are in love, you are in love with the image you think the other has for you, the image reflected by the other. When you are in love, you have found someone to reinforce the good image of yourself.” 

What Lucie Cantin is talking about concerns the first stages of being in love - that wonderful, euphoric feeling of happiness, jittery butterflies and excitement during the first couple of years of a relationship. As time goes by, people get to know the real person in front of them, not the idealized, wonderful man or woman you first met.

Eventually, “when the image (the image that you think the other has for you and vice versa, the image that the other has for themselves in relation to you) is broken, and you encounter the real other, sometimes there is divorce” or a break up. 

When this shift happens, people change the way they see themselves in the relationship and consequently, they change their behavior towards one another - love can easily become hate, indifference, sometimes even disgust. Keep in mind that a relationship between two people is never just between those two people - each one brings with them their history, their family, their past relationships. Counseling can sometimes help, but sometimes it doesn’t.  It’s sad, especially when there are children involved…

I wish I could say otherwise but the truth is, we can’t always make it work. We can only move forward and hopefully, we are not alone. 


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In the therapist's office: 
What to expect?

By Mihaela Bernard, MA, LCPC

Have you wondered what it might be like to go to a therapist? Do people really lay on the couch; how long is it going to last; how much does it cost? Maybe your child needs help but you are not sure what to expect at the therapist’s office. Read along for some answers.

I remember making the phone call - I had the name of a therapist that came highly recommended. I knew I needed to talk to somebody. I was nervous, had no idea what to expect and was worried about whether I could afford it. She sounded nice on the phone; I had also seen her picture on a website and read a little bio. We scheduled an appointment and I made my way to the office. The hour went by in a flash - I was not used to talking about myself but she asked questions, made comments, explained the process and seemed to understand where I was coming from. We agreed on a price I could afford and set up a session the same time every week. I worked with her for close to two years; my issues resolved and I felt much more in control of my life. 

The truth is that there are many different kinds of therapeutic approaches and every therapist has their own style, theoretical orientation and length of treatment. Psychoanalysts still use the couch but most clinicians are not psychoanalysts. Depending on your problem, therapy can last between three to six months or even a year. 

Typically, all therapists recognize the importance of the therapeutic alliance with you, the client. Depending on whether your therapist is in or out of network, you will probably have a copay or agree on a reasonable price that you can afford. The therapist listens, asks questions, does not judge and accepts you for who you are with your pain, symptom or problem, and guides you to a solution. If you are a parent, bringing your child, the therapist will interview you as well, get your perspective and hear your concerns. Many therapists collaborate with parents when working with their children, while maintaining a safe place for their kid to work on their struggles. The therapist will maintain confidentiality and everything you say remains between the two of you, unless you make a specific threat to harm yourself or somebody else. In that case, the therapist is required by law to ensure your safety. 

Everything can be spoken about in the therapist’s office; there are no taboos on your thoughts, feelings, questions. It is your time to use. The therapist is there to listen, guide, offer new perspective; some offer suggestions, others do not. If talking is not your cup of tea, and especially with young children and adolescents, art, spontaneous play and games are ways to communicate as well. The therapist may collaborate with other professionals such as psychiatrists, psychologists, teachers, pediatricians or school social workers to ensure quality of care. 

More often than not, the therapist becomes a part of your life, a professional confidant, a life compass, pointing in four different directions. Which way you will choose to go will be up to you!


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The power of superheroes 

By MIhaela Bernard, MA, LCPC

Do you remember when you were a kid and fantasized about possessing superpowers? It can be quite empowering for a young boy or girl to dream about being a superhero(ine), especially when feeling small, helpless or inadequate. And haven’t many of us felt similar ways as children, surrounded by what seemed like super powerful adults, bigger kids or bullies?

Spiderman, Superman, Batman, Captain America, Catwoman, Wonder Woman, Invisible Woman...the list goes on. Between DC and Marvel Comics, there are over two hundred superhero characters to choose from. Some are more popular than others, some fight crime, others fight supervillans of supernatural sorts. But they are all unique and vulnerable in one way or another, and share common human faiths that children can easily identify with.

Spider-man was bullied at school, Superman was adopted, Batman’s parents were killed when he was a kid; Catwoman’s childhood was tragic too - her mother committed suicide when she was a little girl and her father drank himself to death shortly afterwards. They all have experienced a human hardship and find strength in their supernatural powers to fight against it.

In therapy, in order to get to know a kid, I often ask them who is their favorite superhero. Then, I ask them who is their favorite supervillan. We spend time talking about or playing with superheroes. See, there is a certain power to superheroes in therapy - they occupy a special place in the fantasy world of children, particularly of pre- adolescent boys, and create the playing field for the therapeutic relationship. We talk while playing, if that makes sense.

Superheroes embody strength, resilience, wits, power and charm - all qualities many boys would like to possess. Play comes spontaneously to children and is often a way for them to speak about their internal hopes and wishes. As therapists, we know to listen to this play and to treat it similarly to the way we listen to adult patients’ associations.

Children’s fantasies serve as ways to cope with the challenges life presents them with - dealing with evil, battling crime, winning the heart of the loved one, growing up as a hero versus villain. All important skills to have not only for children but also for adults. 


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Psychoanalysis versus Psychotherapy: What's the difference?

By Mihaela Bernard, MA, LCPC

Psychoanalysis? Psychotherapy? Aren't they the same thing?… Not exactly. Psychoanalysis is an experience - you cannot call yourself a psychoanalyst without having done your own analysis. The same is not always true for psychotherapy - not all psychotherapists have gone through their own therapy. In order to become a therapist you need to go through years of schooling, practice for at least two years after graduate school and pass your licensure exam. Only then you can go for psychoanalytic training.   

Therapy is a rather generic term - social workers, counselors, psychologists and psychiatrists can all call themselves therapists. Before there was psychotherapy, however, there was psychoanalysis. Freud “invented” the psychoanalytic method, or the “talking cure,” together with his friend and mentor Breuer, a Viennese psychiatrist, who worked with female hysterics (an old-fashioned diagnostic term for what today is classified as conversion disorder). In his work with his patient Anna O., a pseudonym for Bertha Pappenheim, one of the first feminists, Breuer discovered that after she was able to speak about the origin of her symptoms, they disappeared. Hence, “the talking cure.” The presumption that talking has healing powers fuels many psychotherapeutic practices today. No one argues against that. What is the difference between psychotherapy and psychoanalysis then? 

First, psychotherapy deals with what we call the ego, the I or the active agency with which you make decisions on a daily basis. In contrast, psychoanalysis deals with the unconscious - those experiences that are beyond language, outside of our awareness; the part of us that was vastly suppressed by culture, social norms, rules and regulations. Second, the goals of psychoanalysis and psychotherapy are also different. Psychotherapy attempts to restore a persons relationship to the social norms and regulations, while psychoanalysis works to restore a person’s relationship to their sexuality. Psychotherapy works to strengthen the ego, while psychoanalysis works to strengthen the subject’s relationship to their own unconscious. Psychotherapists use their relationship with you, the client, to influence your decision-making, to teach coping strategies, change behaviors or thoughts, and to modify the ways you relate to others. Psychoanalysts use their relationship with you to help you reorganize the way you relate to yourself and your body with all of its human qualities. What happens with your relationships afterwards is secondary and entirely up to you! 

Many people are skeptical that such thing as the unconscious actually exists. Certainly, there is no way to physically grasp the unconscious but the evidence in support of it speaks quite loudly. Freud, for instance, discovered that he could plant a thought into his patient’s mind under hypnosis that the patient executed into an action after being released from the hypnotic state, having no recollection of the fact that Freud asked them to do the action in the first place. Instead, the patient fabricated an explanation and was convinced in its validity. Believe it or not, the unconscious does exist and psychoanalytic practice, which has changed dramatically since its invention, has proven it over and over again throughout the years. The question is, do you want to know about your unconscious? Do you wish to have a deeper understanding of yourself and your actions?

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10 Must-do's when you decide on divorce

By Mihaela Bernard, MA, LCPC

1. Sit down and have a conversation with your kids. It is very important that you and your partner find a time and sit down together to explain to your children that you decided to get a divorce. Otherwise, you may create unnecessary anxiety. It is always better to say it, even if it hurts. 

2. Explain with simple words why you and your partner made that decision, without burdening them with unnecessary details. Try and avoid blaming one another. 

3. Give the same consistent message - if you say one reason for the divorce and your partner another, you will end up confusing your children, especially if they are young. Discuss this with your partner in advance and try to agree on what you will be sharing with your children. 

4. Let them know that it’s not their fault. It is not unusual for young children to blame themselves and to associate their “bad” behaviors with the reason for the separation. Let them know that it was nothing that they did or did not do. 

5. Tell them that you love them and that you will always be there for them.

6. Speak respectfully about your ex. Bad mouthing your ex is probably the worst thing you can do for your children - they deserve to have a “good mommy” and a “good daddy” despite what went wrong between the two of you. Stress your ex’s good qualities and avoid degrading him/her in front of the kids.

7. Get along with your ex. You do not need to be going out for dinner or chat frequently on the phone to get along with your ex. All you need to do is communicate respectfully regarding all parenting issues of your children. This is often much easier said than done so if this is the case, do seek professional counseling to help you get along better for the sake of the children. 

8. Create predictability - be as consistent and as predictable as possible and establish rules that create a sense of safety and security in your home.

9. Explain your custody agreement to the kids and follow it - knowing when and for how long they will get to see you plays an essential part in the predictable and safe environment you want to create for your kids.

10. Date - the most important thing for your kids is to know that you are happy and in a healthy, loving relationship with someone, who cares about you and your family. When you find the right person and are ready to commit to them again, make them a step-parent and model a mature, loving relationship for your kids. One day when they grow up, they will thank you for taking care of yourself first and providing a stable home environment for them.

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