© 2017 by Dr Olli Anttila
A lot about psychoanalysis has been written over the last 120 years, and you can go to Wikipedia and Internet to find some of that information. There are even almost thirty dictionaries to describe just the terms used in psychoanalysis, and the last one, Professor Salman Akhtar’s ‘Comprehensive Dictionary of Psychoanalysis’ (Karnac 2009), has over 300 pages. Psychoanalytic education takes a long time. The main parts of it are a compulsory personal analysis 3-5 times weekly and attendance at clinical and theoretical seminars over several years and treating 2-3 ‘training cases’ (tightly supervised psychoanalytic treatments of patients).
I can only answer what I do. I work in my own private office in Auckland City and see patients according to their needs. Most patients come to see me regularly for a relatively long time, from several months to several years. Optimal frequency would be three times weekly but in our time most patients come less frequently, 1-2 times per week. I have a couch in my office and some patients prefer the use of the couch, which gives them more internal space and helps them to be more attentive to their own inner world. For some people sitting in an armchair feels more suitable and some people use the chair and the couch at different times in their therapy, depending on their inner mental state. The fee varies depending on the patient’s own financial status and the frequency of the sessions.
My work is not only doing psychoanalysis. I do also individual and group supervision for doctors and mental health professionals; both face to face and by Skype. Another area of my work is to help patients or couples/families, who are in an acute crisis and this kind of work is often quite intense and usually of short term duration. In couples work I often work together with another therapist. I also often provide second opinions to my psychiatrist and psychotherapist colleagues. I am a New Zealand registered medical doctor and psychiatrist, however, I tend to refer patients to another psychiatrist, should they require medication.
In terms of my personal experiences as a practicing psychoanalyst I would like to tell something about what have learnt over the last few decades:
Psychoanalysis has moved a long way away from Freud’s original idea of a mirror-like analyst, who just observes the patient and is unmovable and detached from the process. The reality is that even Freud himself never worked that way either; he was a warm human being who really cared for people. Over the last decades the psychoanalytic movement has become very fragmented into many different schools and appears to be going further that way. The general tendency seems to be towards a more relational approach and a deeper understanding of the therapy/analysis process itself and what happens in the room.
The analyst himself is very much an active participant in the process and his own learning process is in many ways parallel to what the patient goes through. Theoretical knowledge only increases the knowing of information and data; it does not bring you any wisdom. True knowledge and data are two different things and wisdom can only grow from getting to know your own inner being. Most of our conscious knowledge is only a small part of what really is inside us. Freud used to say that our mind is like an iceberg and we only see the top 15% that floats above the surface. The invisible part, the so- called unconscious, is the dominant part, which we can only learn to know a bit better by undergoing psychoanalysis or psychodynamic psychotherapy.
Psychoanalysis is a confidential process where you can learn about what you really feel and how your past seems to limit and impact on your current life. This process of learning from experience is painful because it means that we have to change. There are forces in our psyche that resist all changes and therefore we don’t really want to know what went wrong in the past and is still not quite right. The psychoanalyst or psychotherapist is there to work as your helper, or midwife, who facilitates your own self-discovery and makes your journey to true knowledge about yourself safer and more tolerable.
The result of the therapy is an increased sense of freedom and joy. In the therapy sessions, the therapist keeps an eye on what is currently going on in the room, in the patient, in himself and between the patient and himself. Before long the patient’s past experiences and relationships, and his ways of relating to other people, start to be transferred to the therapy situation itself and then they can be explored in the here and now situation in the session itself.
Some permanent patterns of our behaviour that have been there for a long time but have never been noticed, now become the subject of examination and often it is quite liberating and easy for the patient to see how the past patterns are casting a shadow on his current life and his relationships with his loved ones. Also, the relationship with the analyst/therapist becomes a focus of attention because that relationship seems to repeat some of the patient’s earlier experiences and feelings of his past relationships, which could never before be properly seen or openly talked about. The most helpful observations are often related to feelings of hatred and enviousness or jealousy, but loving sentiments and unrequited love are also common subjects of the explorations in the therapy sessions.
Also, Napoleon's dictum that ‘to understand the man you have to know what was happening in the world when he was twenty’ often becomes very obvious in the psychoanalytic process. We can never overestimate the impact of the period and environment of our formative years and it is worth re-visiting our childhood passions and disappointments, and the ideals of our youth to understand ourselves better in the current life.
The physicist Albert Einstein said that in the centre of universe is a great mystery and from that mystery everything comes. (“The most beautiful thing we can experience is the mysterious. It is the source of all true art and all science. He to whom this emotion is a stranger, who can no longer pause to wonder and stand rapt in awe, is as good as dead: his eyes are closed.” Albert Einstein) It also implicitly means that the mystery of life can never be rationally understood. This was very different from Sigmund Freud’s belief that everything in the human mind could eventually be understood, which was very much according to his own epoch of Enlightenment and Newtonian knowledge.
It was only in the 1950’s that Dr Wilfred Bion brought the mystery of life back to psychoanalytical thinking. His work reconnected psychoanalysis with the spiritual and mysterious. He used the concept of ‘O’, or Godhead, or ultimate truth, to describe the centre of life and the aim of psychoanalytic therapy. He saw the psychoanalyst more as a mystic than a scientist. In a way, he brought psychoanalysis into the quantum age. Bion also expressed a new idea of our main longing or desire. For Freud, it had been pleasure seeking. Bion thought that the deepest desire in us is to grow and to understand more. I personally resonate with that. We humans are ready to tolerate a lot of pain to understand more about our personal lives, about the purpose of our lives and the life around us. Ultimately it leads to wisdom and an increased sense of freedom and devotion.
I would like to finish with an extract from a poem by T. S. Eliot. (The poem, East Coker, the second poem in Four Quartets, discusses time and disorder within nature that is the result of humanity following only science and not the divine. He wrote this poem in February 1940; in the early days of gloom and menace of the WW II. That time had unfortunately some similarities to what seem to be unfolding in our own time This extract is from the third part of the five-part poem). This extract describes well the importance of tolerating the mental state of not knowing and being able to wait. In psychoanalytic treatment, the so called ‘negative capability’; an ability to stay and tolerate the slowly unfolding truth, is very central. Eliot’s lines go like this:
I said to my soul, be still, and let the dark come upon you
Which shall be the darkness of God. As, in a theatre,
The lights are extinguished, for the scene to be changed
With a hollow rumble of wings, with a movement of darkness on darkness,
And we know that the hills and the trees, the distant panorama
And the bold imposing facade are all being rolled away—
Or as, when an underground train, in the tube, stops too long between stations
And the conversation rises and slowly fades into silence
And you see behind every face the mental emptiness deepen
Leaving only the growing terror of nothing to think about;
Or when, under ether, the mind is conscious but conscious of nothing—
I said to my soul, be still, and wait without hope
For hope would be hope for the wrong thing; wait without love,
For love would be love of the wrong thing; there is yet faith
But the faith and the love and the hope are all in the waiting.
Wait without thought, for you are not ready for thought:
So the darkness shall be the light, and the stillness the dancing.