Is psychoanalysis for me?
January 11, 2012 6:14 AM   Subscribe

[TherapyFilter] Could you tell me about your experiences of psychoanalysis please? I am trying to decide if it would be helpful for me to begin it.

I am a late-twenties British woman who recently moved abroad to start studying for a doctorate. I have had periodic problems with depression, anxiety, self-esteem and procrastination since I was a teenager, and had counseling from a psychotherapist for about a year during my first degree. This helped a lot to get me through my studies and up off my bedroom floor.

Over the last few months, I have felt these old problems returning to a certain degree, presumably prompted by the change of job and country. Things got pretty bad over December, to the point where I was avoiding my colleagues and supervisors and had a couple of panic attacks at work. I saw someone at my university's counselling service and was referred to an outside psychotherapist, who happens to be a psychoanalyst.

I've had two appointments with the psychoanalyst now, one before Christmas and one yesterday, and am seeing her again next week to decide what I want to do. I get on all right with her and she feels that my problems would be amenable to help from psychoanalysis. If I decided against it, though, she would be happy to recommend me to another therapist -- I don't feel pressured at all. She works in a practice with a psychiatrist, so there would be the possibility of starting some kind of medication if I wanted to try that too.

My question to you, MetaFilter, is: what can I expect from the process of psychoanalysis and how much might it help me? The psychoanalyst has explained to me that it is a gradual process, a sort of journey of self-discovery, that doesn't involve her explicitly giving me advice. It sounds like it could take a while to be really helpful. Other than that, I don't really know a lot about it apart from the stereotypes in films and books.

I would really love to hear personal experiences of psychoanalysis, as distinct from other talk therapies. Is it worthwhile? What sort of effects does it have? I am considering trying medication to deal with the anxiety etc. in the short term, and psychoanalysis to sort myself out in the longer term. Does that sound like a workable plan?

Throwaway email:

Thank you!
posted by anonymous to Health & Fitness (11 answers total) 6 users marked this as a favorite
I found Cognitive behavioural therapy to be more effective than psychoanalysis. I knew what my problems were - I needed effective strategies for dealing with them.
posted by jb at 6:22 AM on January 11, 2012 [2 favorites]

CBT or DBT first with or without medication, fiddle around with psychoanalysis later. Treat psychoanalysis as a growth tool, not as treatment for a specific condition.
posted by Lyn Never at 6:38 AM on January 11, 2012

Mod note: We have switched out the email contact as per OP
posted by taz (staff) at 6:45 AM on January 11, 2012

Yeah, I haven't found psychoanalysis to be too much use at all, at least in the depths of things. Too much talking and too little action. CBT on the other hand has done wonders. At least in my case, specific advice tuned to correcting what I'm doing "wrong" that creates anxiety, et. al. works a lot better than a series of conversation about how growing up was hard.

Now, that's a bit of a facile take on things, but, generally, if you want things to be better, do the CBT until you feel like you're in a place where you are comfortable -- CBT is, from the get-go, a process with a concrete goal you work to reach -- and then go into analysis.
posted by griphus at 7:01 AM on January 11, 2012

Is analysis worth trying? is a short video of the blogger Andrew Sullivan talking about what it personally is like for him and what the results of the process are.
posted by Paquda at 7:30 AM on January 11, 2012

I went to a psychoanalyst for a few months then returned to a regular therapist. I found the lack of input kind of frustrating plus we also just didn't 'hit it off'. Your case may be different if there is a psychiatrist nearby to prescribe meds if necessary. Maybe go a few times and see?
posted by bquarters at 7:32 AM on January 11, 2012

I have had amazing results with psychodynamic therapy, as distinct from classic psychoanalysis and CBT. I had one major short-term success with it and I have chosen to continue with it beyond my 'acute phase' of needing it. You can memail me if you want a full discussion of what my therapy has been like, and I also have a friend in Lacanian therapy who is willing to talk about it, but neither of these are strict psychoanalysis.

I went into therapy actually asking for CBT because everyone here seems to love it, but my therapist wasn't a huge fan for it in my particular instance - and your situation sounds similar to mine, in the academia-avoidance-dysthymia sense. Her opinion was that CBT is more appropriate for people with specific triggers or situations. Frankly, you can do CBT online or with the workbook if you're committed, and I really don't think it is the best solution for everyone. It helped me deal with specific instances of being yelled at by customers at work, but it did not help me with the self-loathing I had from being in a job that was a terrible fit for me mentally. If your GP is willing to trial you on a med and you're willing to try out doing it on your own, that's something you can do, and you can do it independently of talk therapy.

That being said, I started therapy one month and and managed, with her help, to get myself from 'calling in sick because I couldn't get out of bed and face my coworkers' to applying for (and getting into) a program at a major university that was due three months later. I did get spurred into action by having a third party I really clicked with. I think that is the key more than any format - having someone whose methods work for you. Also, keep in mind that insurance will also only pay for so many sessions, depending on diagnosis, if that is a concern for you. (I actually pay out of pocket now because I feel like I'm getting so much benefit from it.)

tl;dr: CBT isn't the best approach for everyone; therapist fit is more important than their modality.
posted by Weighted Companion Cube at 7:39 AM on January 11, 2012 [7 favorites]

There is no such thing as "strict psychoanalysis," or at least there hasn't been for quite a while. What people mean by the term "psychoanalysis" differs widely to the point that it is a topic often discussed in my institute (NPAP, in which I received psychoanalytic training.) What this means in practice is that what analysts do differs widely and there's really no way to make a blanket statement about its value. In fact, many of the newer therapies, e.g. CBT, were originally just subsets of various techniques that some analysts found useful for particular kinds of issues which were later marketed under their own brand names. ("Talk therapy" didn't exist before psychoanalysis.)

What Weighted Companion Cube said above, especially that "therapist fit is more important than their modality" generally applies, with the additional wrinkle that evaluating the suitability of what a therapist chooses as their modality is part of that fit.

That being the case, you should present your concerns at your next session, in particular, whether it would take too long before you could get relief from your symptoms.
posted by Obscure Reference at 8:34 AM on January 11, 2012

I agree with Weighted Companion Cube. My therapist also comes from / subscribes to a psychodynamic therapy background, and she has been incredibly helpful. We also do some CBT-type work, but it's a minor component of the therapy. Please feel free to memail or email me for more details!
posted by insectosaurus at 8:40 AM on January 11, 2012

Do you like the psychoanalytic process? Because that is really the key. I honestly think that it's even more important than your connection with the therapist, because anyone who describes herself today as "a psychoanalyst"* is probably someone who is pretty rigorous about using the process.

I found it unnerving, so I switched to a therapist who worked in another modality (an MSW therapist who is more in the Rogersian "client-centered" vein). For me, being able to ask questions and get answers from my therapist--and I mean general answers, like "many people find that writing things down before a difficult conversation helps them organize their thoughts," not things like "you should dump that guy"--was really important.

*I'm assuming, perhaps wrongly, that that is her self-description. Only a tiny percentage of psychotherapists are psychoanalyists.
posted by Sidhedevil at 12:31 PM on January 11, 2012 [1 favorite]

I think psychoanalysis and CBT are different tools. An analogy would be something like this:


There is a patch of mold on a wall.

Solution: the CBT approach

You put some bleach on the wall and, going forward, keep the area well ventilated.

If the mold goes away and doesn't come back, the solution was adequate.


There is a patch of mold on a wall. Even after the bleach and the ventilation the mold keeps coming back.

Solution: the Psychoanalytic approach

You start tearing down drywall to find the source of the humidity that is causing the mold. This takes longer time and can make quite a mess, things get worse before they get better, but may be the right thing to do for persistent problems.


The building smells bad. Always has done. You take the CBT approach: empty the refuse containers, check the drains, clean the carpets, repaint the walls, improve ventilation, but if the problem persists you go for the psychoanalytic approach which is to start taking things apart to find the source.

(I am not a psychologist, this is just my observation.)
posted by y6t5r4e3w2q1 at 5:37 AM on September 20, 2012 [3 favorites]

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