Psychoanalysis

As a member of IPSO (the International Psychoanalytic Studies Organization), Cara Goubault is qualified to provide psychoanalysis in English and French. International Psychoanalytic Association guidelines specify that the length of sessions is 45 to 50 minutes (as opposed to other schools where the length of sessions can vary, though the session fee remains the same). IPA guidelines also require that the analyst has many years of their own psychoanalysis, as well as weekly supervision and clinical seminars. These guidelines guarantee that the person undertaking psychoanalytic treatment can be confident in the competence of their analyst, and are quite different from many French analytic schools where the analyst is required to have neither analysis nor supervision.

What is Psychoanalysis? 

Psychoanalysis is the most in-depth and intensive of any psychotherapy. Its goal is to help you gain a deeper understanding of yourself. Many patients that enter psychoanalysis have first tried other types of therapies, medications or used other strategies towards self-awareness without adequate success. Traditional psychoanalysis is generally conducted at a frequency of 3-5 times per week with sessions that are 45 to 50 minutes in length. Psychoanalysts believe that through intensive work and a deeply introspective process, most people will begin to realize that their previous experiences have greatly influenced who they are today—the positive and satisfying aspects, but also the problematic parts that they wish to change. Being aware of your problems is only the first step.

Psychological change requires breaking patterns of being that are often repetitive, pervasive, and unconscious. People often think they know their issues but find themselves unable to change. This is due to something called “resistance”, and it is one of the reasons that many Cognitive-Behavioral therapy approaches fail. If it were easy to change simply because we want to change, then many of us would have opted to change already… however we resist our own efforts at changing. Psychoanalysis will help you understand why you resist change that you consciously desire, through recognizing unconscious motivations that keep one stuck in patterns of unhelpful behaviors, thoughts, and feelings.  Psychoanalysis and psychoanalytically oriented psychotherapy can offer more than just insight: it works towards real-life transformation, from the inside out.

The only “tools” used in psychoanalysis are the words, images, and sensations that come up for you during a session, and your analyst’s attentive listening and interpretation. This way, analysis ensures that the change you seek won’t come from applying a certain method or mode of thinking that is foreign to you but uses your own power to create resilience and evolution. This means that your analysis will have an enduring impact in the years to come.

Because there are so much confusion and misinformation surrounding people’s perceptions of psychoanalysis, here is a FAQ dispelling some of those myths.

  • What typically happens in a session?
    Patients are encouraged to speak freely about whatever comes to their mind (free-associate) and refrain from censure or editing (even things people may feel are inappropriate, offensive, silly, embarrassing or crazy). They talk about important daily events, significant interactions with others, feelings about themselves and what troubles them, memories, dreams, etc. Psychoanalysts believe that our defenses, inhibitions, anxieties, and capacity for self-deception create invisible barriers that keep us from seeing things about ourselves, others and reality that we don’t want to see – but need to see. Dreams, fantasies, and reverie are also important tools in psychoanalysis and they can sometimes reveal deeper preoccupations, internal struggles, desires, and conflicts that our mind is trying to keep from our consciousness.

  • What is the relationship between patient and therapist? 
    The popular media caricature of an old bearded man asking you about your mother is just that, a caricature. Analysts as ‘blank screen’ sound like a scary movie where you are pouring your heart out in front of what is made to look like an un-empathic, cold and unfeeling stranger. That is absolutely not true. Your analyst may take on different roles during the course of your treatment: as a mentor, a life coach, a parent, a confidante. Remember, the focus of treatment is YOU. Contemporary psychoanalysts are interactive and are focused on using the therapeutic relationship in the service of your recovery.

  • Do I have to lie on a couch? 
    The couch is not mandatory. It is, however, a useful “tool” for some patients. In traditional psychoanalysis, patients recline on the couch and the analyst sits slightly behind them just out of view. Lying down is a more relaxing position, and can often allow a more open, free-flowing and less intellectual stance. With the analyst out of sight, they can often have a clearer image of what they imagine or fear their analyst is thinking/feeling. This provides information about the kind of expectations of others you unconsciously hold because observing other people’s faces and body language is a way of reassuring one’s self of one’s “place”. The couch helps one to become more aware of this process, facilitating more authentic communication not based on the expressions or movements of your interlocutor. Patients that are not comfortable are welcome to move back to the chair and to face-to-face therapy.

  • Why more frequent sessions? 
    Frequent sessions help deepen the process and address core issues. Whereas a 45-minute session held once every few weeks can be rapidly filled with updating the analyst about a patient’s current life, more frequent sessions create more intensity and intimacy.  A patient might share not only important daily events but also significant interactions with others, feelings about themselves and what troubles them, memories both small and significant, their dreams – whatever comes to mind. In time, the analyst and the patient begin to notice patterns in thoughts, feelings, and behaviors that are unconsciously repeated. Simply becoming conscious of this is a way of breaking free of repetition, and developing curiosity about why these patterns exist.  A deeper understanding of what situations a person avoids, and how the past is influencing the present develops.

  • Does psychoanalysis take the place of medications?
    Medications are not an impediment to treatment, nor is psychoanalysis a replacement for medication. Medicine can help to alleviate the intensity of psychic suffering, thus enabling the treatment to proceed more easily. Some patients can lower their dosage or stop their medicines after time in analysis, but this is a decision between the patient and the prescribing doctor.

  • Does treatment go on forever?

  • No. The basic goal is to resolve as soon as possible the problematic emotional issues that bring a patient to therapy. At the same time, emotional difficulties that have a long history and have led to dysfunctional and repetitive patterns of behavior can sometimes take time to change in meaningful ways. The goal is to make new patterns of thought, feeling, and behavior automatic. That is to say, with time it becomes much easier to no longer engage in destructive patterns, and eventually old ways of thinking and behaving no longer even occur to you. You feel calmer, more authentic, happier, and more creative. Your current life will reflect your inner desires more clearly.

  • Are Psychoanalysts obsessed with Freud and the past?
    Contemporary analysts draw from a multitude of psychoanalytic theories (yes, Freudian school of thought is just one of many) and can fluidly change gears and modes to best suit what technique and intervention would be best suited to you in any given situation. 
    And while psychoanalysts believe that an understanding of the past can help identify problems in the here-and-now, they view the past as a path to the present (and future).

  • Will I become dependent on psychoanalysis?
    Dependence and intimacy are issues that are universal and often evoke anxiety, concerns, and questions in people. Some people cannot allow themselves to feel that they need anyone and often have difficulties forming close, intimate relationships. Others feel that they need someone upon whom to be totally or largely dependent in order to function in life. They panic if threatened with the loss of that someone. Psychoanalysts are acutely aware of these issues and try to help people overcome these problems, not take advantage of them. If an individual becomes overly dependent on the analyst, it becomes an issue to be resolved within the analysis. Likewise, if an individual needs to keep a “wall” up in their relationships, that too, becomes an issue to be worked on.

I hope that these questions and answers have provided you with a better understanding of what psychoanalysis and psychoanalytically oriented psychotherapy is and isn’t. Normally we take a few sessions in psychoanalytic psychotherapy to decide whether psychoanalysis, the next level of treatment, would be beneficial to you. Sometimes people decide to “switch up” to psychoanalysis after a bit of time in psychoanalytic psychotherapy. There can be flexible, and this can be talked through in your sessions.