A Microscope Look at Depth Psychotherapy

Two Angles on These Complex, Personal Transformation Processes (Vol. 3; Issue 28)

For more than a decade, I’ve been on a scholarly and political mission to clarify how depth psychotherapy works. These transformational processes (synonymously called psychodynamic or psychoanalytic psychotherapy) are poorly understood by the public. They still imagine patients lying on couches four times a week, while doctors furiously scribble notes or smoke cigars while seated behind them.

As my friend and colleague Nina Savelle-Rocklin (2023) proclaims, viewing psychoanalysis as involving couches, notepads, and cigars is like comparing Ford’s Model T to a Tesla Model 3. In some of my first newsletters—easily found in the volume one archives—I laid out how the more contemporary perspectives work.

In the way of an extremely brief overview, psychoanalytic clinicians frame their professional relationships, meaning they create safe, private, and bounded environments for regular meetings; they bring their emotional presence to their patients, e.g., they pay careful attention, show respect, and remain intensely tuned-in to whatever patients say (or how they behave), and; they engage their patients in a variety of verbal and nonverbal ways. Engagement processes include focused empathy, confrontations, dream interpretations, analyzing recurrent themes tying together current relationships and childhood situations, and more. They might simply help those consulting them to clarify or understand confusing feeling states.

I return to my status as a self-appointed union organizer for psychoanalysis, and write this week’s missive specifically because of a situation with a patient in the last week. I mean, this is LIVE. Per usual, I essentially anonymize patient information to protect privacy and confidentiality. That being noted, this young woman, Christina, asked at the end of an intense and rather painful session last Monday,

Just how is this supposed to help me with the ways I hate myself?

As I specifically answer her question, I will microscopically examine two specific transformational features.

The first intervention—excuse the lousiness of that word—surrounds recovering archaic memories and emotional states in the safety of my presence. While not the originator of the idea, Phillip Bromberg (2013) has such a poetic way of explaining this process. Before including a few excerpts from his prolific scholarly work, these details of Christina’s current life, and her early childhood experiences, bear mention:

Christina was the only child born of an alcoholic father and a high-achieving mother. Her parents divorced when she was five. Christina spent the next ten years visiting her father on weekends and living with her mother during the week. Although no overt sexual abuse occurred, her father asked her to sleep with him in his bed until she entered puberty. She “offered comfort to him,” he often told her. He rarely dated. His apartment grew increasingly disheveled. He lived on spousal support which the court ordered his wife, a tenured anthropologist at UC San Diego, to pay him. As Christina grew older, she increasingly held her father in contempt. He remained “needy” of her; she did not know how to effectively respond to his calls for visits.

Christina entered young adulthood as a brilliant visual artist with some minor successes. A few of the galleries on Main Street in Santa Monica exhibited her works. Like most young artists, she struggled financially. She rented a small apartment in West Los Angeles, on Barrington Avenue—meaning the sound of traffic often distracted her and kept her awake at night. However, it was a bright two-bedroom, two-bathroom unit. Christina “intended” one of those rooms to serve as a studio. Meanwhile, she littered it with unpacked moving boxes and the like (a pattern obviously resembling her father).

Christina sought my help for several reasons. Most prominently, she had “no idea how to deal” with her alcoholic father. She felt responsible for him because she had unwittingly become his sole source of emotional support; on the other hand, she felt rage, a sense of “burden,” and most significantly, guilt. Christina honestly did not know how to respond to him, and who could blame her? She also wanted to break out of internalized self-hatred. She said, “when I’m alone, which is often, I can hear myself telling me what a terrible failure I am, how I lack talent, and how I’ll come to nothing.”

Likely because of the bizarre situation with her father during her early childhood, and her mother’s frequent absences doing field work in Africa, Christina felt isolated and alienated as a child. She struggled to make friends. She dyed her hair bright orange starting when she was 13. Most of her fellow students in her conservative middle school shunned her as a “weirdo.” Not unsurprisingly, Christina sought refuge in alcohol herself, and also in cocaine and weed. She left high school in the 9th grade when her mother “had her committed” to a rehab facility for one year. That year on the East Coast managed to get her off these substances, but it left her feeling even more of a “loner” and an “outcast.” As noted above, she had intense dialogues with herself of a hateful nature (Karbelnig, 2018, 2020).

I imagine my more empathic readers cannot help but feel the pain emanating from the written page. And so I return to Bromberg with only ONE key, wonderful citation:

To know an “other,” a person has to loosen her hold on the self-state that defines the truth about that person as she already experiences it. But to do this, a person has to temporarily loosen her hold on the cherished rationality of that truth—a rationality afforded mostly by left-hemisphere functioning. In the analytic relationship, the collision between adversarial realities held by the patient and analyst enter a process of negotiation that allows what had been subjectively incompatible “truths” to coexist in a shared intersubjective space. Simultaneously, and arguably of greatest importance, the dissociative gap that isolates the individual self-states of each partner is reduced. Why? Because in each person, any given self-state is less rigidly protecting its own boundary in order to keep itself immune from the input of otherness.

Some translation is required before continuing. Bromberg here refers to the process of patients reliving past trauma within the supportive environment of their personal/professional relationship with their psychoanalysts. Self-psychologists (Kohut, 1984, 1977/2009) would call these dissociated self-states; Jungians (1915/1972) would consider them repressed parts of the personal unconscious; Kleinians (1957) might call them “unconscious fantasies” brought into consciousness, and; so on ad infinitum (in terms of endless psychoanalytic theories of mind). [Apologies for any narcissism here, but see Karbelnig, 2022 for details of why an overarching psychoanalytic theory of mind will prove impossible].

Bromberg continues, and notice how he already integrates the famously popular (if excessive) interest in the neurosciences:

As any two people do this reciprocally, a miracle of right-hemisphere “creativity” slowly emerges within and between them—a shared process that makes each person feel “larger” than before. Larger because each is less alone than before—especially at those times they would always have felt most empty and “uncreative” as a human being. Hearken back to Emerson's (excerpted from Poirier, 1990) words: “Power … resides in the moment of transition from a past to a new state. (p. 5)

In sum, and here is where the depth psychotherapy approaches become unnecessarily complex, a great deal of personal transformation in patients occurs when old memories and feelings are expressed by them to their psychotherapists. You might compare it to bringing up an old Word document, re-reading it with pain, making a few edits, and then saving it again.

That’s it.

Nothing more obscure than that.

My fellow psychoanalysts and I have these experiences with patients day-in and day-out. It is part and parcel of our work.

Returning to Christina, sometimes she sits on my couch and remembers feeling “creepy” sleeping with her father, “utterly alone” during her mother’s field trips, or “that weird kid” feeling in middle school. Every time Christina relives one of these thoughts-feelings-memories, they lose a bit of their hold on her. Christina’s self-loathing follows precisely from these experiences. As Fairbairn (1952, 1958) wisely noted, infants and toddlers blame themselves for whatever abuse or neglect they receive. They cannot blame the parental Gods for it; they can only blame themselves. I consider it a Darwinian form of adaptation. Fairbairn called this the moral defense. In any event, it is a common part of the human experience.

The second, highly specific means of transformation borders on the cognitive-behavioral (demonized in some psychoanalytic circles). In the course of our discussions, I have repeatedly pointed out to Christina how her self-care mimics her self-loathing. Specifically, the way she keeps her apartment is pathetically like her father. Were she to make singular changes in it—like borrowing some money from her mother to buy good, solid easels, new canvasses, and an array of oil paints to set up a home art studio—she might well alter part of her internal drama. Rather than looking out at her “mess” as confirming her negative self-valuation, Christina could reverse the loop. And, honest to God, since our last session, she sent me pictures of a cleaned up bedroom (now studio) along with images for a $5,000 set-up her mother agreed to buy for her!

I hope and trust I have now demonstrated, almost in real time, two specific ways that depth psychotherapists work. They recover dissociated, repressed, or disavowed thoughts-feelings, inviting patients to express them in the safety of their consulting rooms and; they alter behaviors, one little step at a time, so as to prevent their internal drama from continual reinforcement in the outside world.

Of course, facilitating these processes are not as easy as it may seem; on the other hand, there’s really nothing particularly mysterious about them.

References

Bromberg, P. M. (2013) Hidden in Plain Sight: Thoughts on Imagination and the Lived Unconscious. Psychoanalytic Dialogues, 23:1-14.

Fairbairn, W.R.D. (1952). Psychoanalytic studies of the personality. New York, NY: Routledge.

Fairbairn, W.R.D. (1958). On the nature and aims of psycho-analytical treatment. International Journal of Psychoanalysis, 39:374-385.

Jung, C.G. (1915). The theory of psychoanalysis. Psychoanalytic Review 2:29-51.

Jung, C. G. (1972). Two Essays on Analytic Psychology. Trans. R.F.C. Hull. Princeton, N.J.: Princeton University Press.

Karbelnig, A. M. (2018) Addressing psychoanalysis’s post-tower of babel linguistic challenge: a proposal for a cross-theoretical, clinical nomenclature. Contemporary Psychoanalysis, 103(1): 69-109. 

Karbelnig, A. M. (2020). The theater of the unconscious mind. Psychoanalytic Psychology, 37(4):273–281.https://doi.org/10.1037/pap0000251

Karbelnig, A. M. (2022). Chasing infinity: Why clinical psychoanalysis’ future lies in pluralism. International Journal of Psychoanalysis, 103(1):5-25.

Klein, M. (1957).  Envy and gratitude. Psyche, 11:241-255.

Kohut, H. (1984). How does analysis cure? Chicago: University of Chicago Press.

Kohut, H. (2009). The restoration of the self. Chicago: University of Chicago Press. (Original work published in 1977).

Poirier, R. (1990). Robert Frost: The work of knowing. Stanford, CA:   Stanford University Press.

Savelle-Rocklin, N. (2023). Personal communication.

HEY!! If you’re enjoying these newsletters, please consider buying my book in which I explain how psychoanalytic psychotherapy works. It is entitled, Lover, Exorcist, Critic: Understanding Depth Psychotherapy. You can read reviews and purchase it on Amazon or at https://firingthemind.com/product/9781800131965/