I am a graduate student in a clinical psychology doctoral program where psychoanalytic thinking and technique are taught. It is rare for students these days to gain experience with long-term psychoanalytic psychotherapy. So how does a student come to understand the importance of the psychoanalytic process? What kinds of clinical experiences might motivate a student to decide that becoming a psychoanalyst — or thinking psychoanalytically — is the best way to help people? Can that motivation develop in the context of conducting the short-term treatments typically encountered in training clinics? In an exceedingly brief treatment intervention, I found compelling evidence that psychoanalytic thinking makes sense. Such clinical experiences not only provide a convincing introduction to the power of psychoanalytic principles but can also validate clinical principles of psychoanalysis.
I recently conducted two sessions of psychotherapy with a 72-year-old retired draftsman named George. In our first session, George told me with simultaneous enthusiasm and frustration that he had been struggling for many years to find an avenue for his creative and intellectual talents that adequately held his interest. He had sought help for this problem before. He had undergone two brief therapies and psychological testing. He was quite dissatisfied with these experiences, claiming that the therapists either gave him advice or argued with him.
George made very little eye contact with me as he told me in some detail about past interests that had not been able to fulfill him. They ranged all over the map. At one time, he had been deeply interested in philosophy and the relationship between mind and body. At another time, he had created a new system of musical notation and claimed that he had written three symphonies with it.
He explained his specific attraction to each of these temporarily consuming interests. He also described how each eventually proved less than fulfilling as he became distracted by other pursuits. He was beginning to worry that he would never find the one thing for him, the one way to “exercise his brain” totally. I remarked that it seemed as though the fact that he got distracted worried him greatly. He agreed, saying he did not want to compromise. He acknowledged that he was feeling worn out.
When I asked George about his family life, he told me that his wife had died 20 years ago of cancer. They had been married for 30 years and had had no children. He was sure that his wife's immune system had simply shut down after she lost her purpose in life. His sister too had died of cancer four years ago. She had been diagnosed with schizophrenia, received electroconvulsive therapy, and spent many years in a psychiatric hospital. George was certain that the fact that his sister “did not know who she was” had caused her cancer.
I told him that I could understand how concerned he was about finding his calling, given that he thought both his wife and sister had died because they lost or could not find their purpose in life. I reflected that he felt that he needed to realize an interest that was consuming in order to remain healthy. I suggested that he thought that he would become ill if he was not exercising his brain properly.
George admitted that he concentrated “24 hours a day” on doing just that, and that was why he had virtually never watched television or gone on a vacation. For the past 10 years, he had been taking a variety of classes at a local community college in hopes of finding the perfect interest for him. He described how he became disappointed in every teacher and quit each class when the teachers would not listen to him, although he had important things to say.
At the end of our first session, I suggested that psychotherapy could be helpful in trying to figure out what was keeping him from achieving what he wanted. I also suggested that psychotherapy might help him think about why it was so important to him to find the one perfect interest for his mind. George looked relieved and told me that he felt I understood him and that he had chosen the right place to come for help. As he left the office, he sighed and said that he could breathe easier after talking with me. It was probably quite rare for anyone to take him and his concerns seriously; the fact that I had done so had likely been reassuring for him.
Two days before our second session, George called to say that following our first session he found himself able to identify a problem that he thought would provide the mental focus he had been looking for. As a result, he felt he no longer needed to continue psychotherapy. I suggested that he come in at least one more time to tell me about what had happened, and he happily agreed.
In that second (and final) session, George described how studying thermonuclear radiation and “how the sun enters the mind and body” was the interest he had discovered. He told me that he was glad to be using his mind again because he liked to think deeply about things. I said that this reminded me of how we had talked about his needing to exercise his mind in order to prevent becoming ill like his wife and sister. He agreed and talked about the importance of feeling fulfilled in order to live a long life. He hoped now to live until he was 110. I cautioned him that his interest in thermonuclear radiation might wane in the future. I wondered whether, in anticipation of that possibility, continuing the treatment might be a good idea. George acknowledged that he might need to return but said that for the moment he felt fulfilled.
George then told me about a friend of his whose son was having problems. This friend was very upset because her son refused to talk to her about his difficulties. George counseled his friend not to criticize her son but to try to understand his thinking process first before passing judgment. It sounded to George as though the son had put up a wall between himself and his mother because he felt so criticized by her.
I mentioned that it seemed that George too had felt criticized when he talked to people about his struggles. George's face came alive as he concurred and said that I had actually understood his thinking process. In his opinion, understanding how a patient thinks was the most important skill for a therapist to have. He added that he had learned from his psychology courses that a therapist should be no more than a half step ahead of the patient.
As our session came to an end, I told George that I had enjoyed talking with him. I said that it can be a powerful experience when someone really listens and understands you. George thanked me and said that in fact he felt I was the only person who had ever really understood him. He parted feeling self-confident and elated — in his words, “like Julie Andrews in The Sound of Music.” Later my training clinic received a letter from George explaining how his life had been transformed by our two meetings.
Obviously, George's problems in relating to the world were far from solved. However, what had taken place in our interaction had clearly held some significance for him. After reading his letter, I wondered what had enabled George to feel so helped. While there is much that I will never know about what happened between us
J. Stuart Ablon, M.A., is a clinical fellow at Massachusetts General Hospital and Harvard Medical School. Elizabeth Lloyd Mayer, Ph.D., helped with this article and supervised the case.
and what happened in George's mind, I believe that certain central psychoanalytic principles can help explain what took place between us.
I had commented on what I perceived to be George's central anxiety (his fear of becoming ill or dying) as well as how he felt driven to defend against that anxiety (his obsessive focus on use of his brain in the “right” way). I now realize that my initial impulse was to pull away from George, given the extent of what appeared to be a rather severe psychological disturbance and his insistence that his only problem was that he could not find the one perfect interest to consume his mind. The severity of his disturbance and the irrational quality of his insistence made it difficult for me to identify with his struggles or even to experience them as potentially understandable. I needed to find a way to make sense out of what he was telling me in order not just to understand something about his dynamics but also to find some empathy in myself. To that extent, a psychoanalytic perspective helped me to recognize the psychological function and symbolization involved in his struggles. Insofar as I was able to do so, the empathic response and communicative process George found so helpful became possible.
Many brief treatments are conducted in settings like training clinics where some people believe that the effectiveness of psychoanalysis can not be tested. This unfortunate trend may limit the extent to which students make use of psychoanalytic thought and technique. I and many of my fellow interns have tended to assume that the opportunity for testing psychoanalytic ideas would have to wait until we could see long-term patients.
As a psychotherapy researcher, I had turned to quantitative data in looking for empirical proof of the effectiveness of psychotherapy. As a result of my brief experience with George, however, I became aware of the importance of other types of empirical data. One definition of empirical is “capable of proof by means of observation; taking experience to be the sole source of knowledge.” The case I have described here shows how observations made on the basis of experience gained in an exceedingly brief psychotherapy can be as empirically persuasive as quantitative data. My encounter with George taught me that thinking psychoanalytically, even in short-term psychotherapy, is always worth doing and helpful to patients.