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Let me begin with my conclusion. I believe there is an elephant in the consulting room that every analyst is aware of, some patients suspect, and few talk about. The secret is that this is no longer your mother's psychoanalysis. The psychoanalysis that patients believe they are coming for is not the one they will get. Little do they know, but it is probably kinder, gentler, far more user-friendly. But at the same time, if you listen to contemporary theorists, the naive patient enters an intensely scrutinized relationship in which the analyst's own psyche deserves as much of the analyst's interest as the patient. The history of the patient's life will not be revealed, it will be co-constructed, as will all questions of causation and meaning. The results of the treatment will be completely different than if the patient had chosen some other doctor. And, except in the case of well-published professionals, it is virtually impossible for a patient to know where an analyst stands on any of these matters.
In addition, just as patients are not clear about who analysts are and what we do, we too struggle with questions of power, authority, influence, evidence, truth, fact, and reality. We do not agree about the goals of psychoanalysis and, in any case, are uncertain how to reach them. We are no longer clear about how and why we do what we do, what we know and how we know it, and how anything we do really works to bring about transforming change.
Before someone starts throwing stones, let me state my personal convictions. I deeply, truly believe in the power and promise of psychoanalysis, and I have little doubt about its potential for healing despair and transforming lives. And carrying that conviction from my personal experience on both sides of the couch has enabled me to persevere, treating and teaching, over several decades.
But things have changed.
I started training in the late 60s, the tail end of the analytic glory days when analysts were feared and revered. Popular anal