What Makes a Psychoanalyst? — A Dialogue Between Patient and Analyst

[Written in 2008.]

(Note:  Although I am aware that this does not apply to all psychoanalysts, it sure does apply to a lot!)

Patient asks:  What’s the difference between a psychoanalyst and an average therapist?

Psychoanalyst replies:  I have studied the most modern, sophisticated theories of human dynamics, and thus have the tools to understand and unravel the motivating roots of human endeavor…

Translation:  Don’t you know that I spent seventy thousand dollars going to psychoanalytic training after I got my Ph.D.?  Do you deign to suggest that I wasted the money I struggled to earn spending thousands of hours not listening to mere mortals like you?!

Patient asks:  As an analyst do you have higher rates of success than average therapists?

Psychoanalyst replies:  Yes, because I focus on catalyzing permanent, deep change and cure in my patients, which is a long and arduous process that sometimes lasts decades.  Most therapists just effect temporary, surface change – if that.

Translation:  Don’t even try to back me into a corner, peon!  It takes a damn long time to bamboozle you into integrating my denial-laden psychological interpretations into the fabric of your soul, and don’t expect one ounce of my approval until you start making some real headway.  Getting well?  Pfaw!  That’s for the lesser therapists.  I’m here to rework your soul in my image, thank you very much!

Patient asks:  Out of curiosity, do you believe psychoanalysts can help a patient with psychotic issues?

Psychoanalyst replies:  Although Freud would have answered “no,” modern psychoanalytic theoreticians postulate that a patient’s success at utilizing the analytic framework depends on his degree of insight into the nature of his problems, and lack of insight is not necessarily concomitant with psychotic mental process.

Translation:  That would depend on the patient’s ability to pay.  Look, I’m working with you, aren’t I?  Christ!

Patient asks:  Can you explain to me what exactly is the Oedipus complex?

Psychoanalyst replies:  It’s the inherent crux of all the motivating forces that give you a disturbed template for engaging with others in the way you do.  In essence it’s you converting your ambivalent wishes and desires for and about your parents, sexual and otherwise, into the defensive fantasy that those wishes and desires actually manifested in your childhood, and then attempting to replicate those fantasies with others in your present life.  Didn’t you read those articles I suggested?

Translation:  Listen, we all know that little boys inherently want to pork their mothers, and that the more I reject you emotionally (like your sick, beleaguered mother rightfully did) the more you’ll want to pork me, which frankly makes me happy because not only does it gratify my narcissism but it allows me to charge you more.

Patient asks:  Hmm.  I did read those articles, and I found them kind of confusing.  The thing is, I think I really was sexually abused by my parents as a child.  I really remember it.  Do you think that’s possible?

Psychoanalyst replies:  The key is not whether they did abuse you or not, but your fantasy about it.  So let us focus there.  What is your fantasy?

Translation:  Are you deaf, bozo?  I just explained the Oedipus complex in terms a retardate could understand!  Your parents were not the problem.  You were!  Anyone who sits with you for five minutes could figure that out!  You had a DEEP NEED to have sex with them, but they didn’t meet your need, so your memory now manipulates reality into the fantasy that it happened.  Don’t you get it?   This is like a textbook case of Oedipal denial.  God, I can’t wait to share this one in supervision group!  I wish I didn’t have to wait till Thursday.  Crap.  Maybe I should email them all beforehand…

Patient asks:  Hmm, maybe it is my fantasy…  I guess I just keep picturing that sexual abuse really did happen.  I even dream about at night.  It’s so painful.  But I do have a question for you.  Why do you have patients lie on the couch?

Psychoanalyst replies:  Although I will take note of your abrupt changing of the subject, I will answer your query.  Lying on the couch gives patients greater and freer access to explore and express their spontaneous, unconscious thoughts and fantasies – without having to be so focused on projecting their own internalized judgment onto an analyst looking at them.

Translation:  You sniveling ball of defenses!  Clever – switching topics and putting the focus on me!  You’re terrified to lie on the couch and be honest, and so you sabotage the whole process.  Don’t even try to undermine my right to yawn, pick my nose, and doodle in my notepad.  You think it’s easy to sit behind your dandruffed head and tune out your prattle?

Patient asks:  And free association?  What exactly is that?

Psychoanalyst replies:  It’s a way to get you to speak about what’s really happening in your unconscious, and not get lost in the mundane, defensive talk that characterizes most human interchange – and can easily derail good analysis.

Translation:  Actually there’s nothing free about free association at all, nitwit.  I’m charging you four dollars a minute to go off on pointless tangents that heighten your sense of powerlessness and inferiority, which render you optimally marinated to accept my speculative interpretations…  Pucker up, ’cause I got more where this is coming from.

Patient asks:  Can you explain to me the difference between transference and countertransference?  They confuse me.

Psychoanalyst replies:  The mechanism of transference involves all the things from your past that you unconsciously project onto me in an attempt to avoid the recognition of your core issues – like a lens clouding reality.  Countertransference, on the other hand, is a theoretical construct that considers the possibility that the psychoanalyst might be projecting unconscious material onto his patient in return.

Translation:  God, wasn’t my reply brilliant?!  That little rat tried to trap me in his cage, but I gave him a good flick in the snoot!

Patient asks:  Have you been in psychoanalysis yourself?

Psychoanalyst replies:  What is your fantasy about that

Translation:  Screw you, buddy.  Don’t even try to suggest I don’t know what I’m doing.  You’re the one who’s dumb enough to come here four times a week and pay the king’s ransom to have me do to you what my prick of an analyst did to me.

Patient asks:  Are you still in analytic training?

Psychoanalyst replies:  It seems you are questioning whether or not I can be of psychoanalytic use to you to help you resolve your neurotic complexes.  The key here, again, is that we explore your fantasy about my degree of training.

Translation:  Being halfway through analytic training is none of your damn business, blowhard, but trust me, when I get that institute certificate your fees are going up, up, and up, and if you can’t pay, well, tough luck, ’cause I got a waiting list!  Hopefully by then I’ll have some supervisees of my own who I can pawn you off onto…  Kill two birds with one stone!

Patient asks:  Do you love me?

Psychoanalyst replies:  What is your fantasy about me loving you?

Translation:  Jesus Christ, I should have been a banker.  At least then I would have gotten to spend my days hanging around normal, healthy people, not whining psychological cripples.

Patient asks:  Well, I don’t know, it just seems odd to me that you, as a psychoanalyst, would suggest I go on antidepressants.  May I ask why you suggested that?

Psychoanalyst replies:  What is your fantasy about why I suggested that?

Translation:  Oh, don’t start that crap with me!  We both know this whole process is a sham and that no one really changes.  Listen, I took the meds.  You can too.  Grow up, sniveler.

Patient asks:  [taking deep breath]  I have to admit, I am considering quitting analysis.  It’s very expensive and it’s making me feel worse.  And it doesn’t seem to be helping me at all.  What is your opinion on this?

Psychoanalyst replies:  [silence]

Translation:  Don’t even try to manipulate me into begging you to stay, Weasel.  We’ve been through this like forty times over the past nine years.  You know you need me and you know you’re not going anywhere, so there’s no point in me engaging in this discussion.  Besides, my supervising analyst always tells me that I talk too much in session.  For that reason I will avoid rushing to say anything, and let you do the analytic work – for a damn change.

Patient asks:  I just feel so lonely and anxious when I come here.  Is that normal?

Psychoanalyst replies:  [silence]

Translation:  Don’t try to put your feelings onto me, freak.  If you only knew how absolutely boring you were you would be better able to relate to the deep pleasure I get in watching you squirm in discomfort…

Patient asks:  Hmm….I guess it is normal…  Well, did you think this was a good session?

Psychoanalyst replies:  How do you feel it went?

Translation:  God, only two minutes to go – and then three more sessions before the day is done!  I wonder if I should pick up a bottle of Chablis on the way home – or maybe Sauvignon Blanc?

8 thoughts on “What Makes a Psychoanalyst? — A Dialogue Between Patient and Analyst

  1. I never knew that a psychoanalyst focuses on catalyzing deep change. It would be good to find someone who will focus on this kind of change to ensure that they are qualified. It would also be good to consider their past reviews too.

  2. Daniel’s “Dialogue…” I find hilarious & v entertaining. There seems to be a myth that one has to have a “broad based liking for people” to be a psychotherapist – I suppose that differs from a psychoanalyst? (I think that was Anthony Storr). I’ve encountered many analysts in the UK both on courses and personally, I have encountered the odd kindly training student and analyst, but I stress “odd” due it’s rarity, as I was ultimately alarmed by the unpleasant characters floating about, many employed intimidation on courses which I found alarming, many did not want anything they said questioned and could not tolerate humour, some seemed close to psychopathic, and it really made me wonder what is going on.
    So I’m still sitting here wondering what is going on…

  3. This saddens me actually. Psychoanalysis has taken enough punches to the gut in recent decades to ACTUALLY marginalize it. I study it, practice it, and feel that it has so much to offer my patients. The real crime is nobody in the general public (or a miniscule proportion) has ever heard of profound thinkers that followed Freud – such as Melanie Klein, Donald Winnicott, Heinz Kohut, or more modern geniuses such as Stephen Mitchell and Jessica Benjamin. There are countless others. I don’t know why we are so bent on discrediting an intellectual tradition that has clearly made mistakes along the way, but continues to be vibrant and passionate about exploring the human condition. Somebody please explain this to me.

    • i just re-read the piece you’ve commented on and, while i think it’s a bit harsh (i must have had some anger when i wrote it) i still stand by it. i think the punches to the gut that psychoanalysis has gotten should be wake-up calls for the profession. like i said in the essay (or the intro), not all psychoanalysts are bad. but i think the better ones are going to ditch a lot of that foolish theory. incidentally, i’ve read a fair amount of all the writers you mention, except jessica benjamin — her name doesn’t ring a bell to me. the rest, well, i probably like winnicott the best, though i have some pretty strong criticisms of him (and i’ve explored them on this site). i really don’t like melanie klein at all, and i’d be very hesitant to promote her work. i wrote about her some in my book “toward truth.” she analyzed her son in therapy when he was a teen, if my memory is correct (and i believe it is) and analyzed his masturbation fantasies, which he shared with her at her behest. talk about HORRIBLE boundaries on her part (not just a little error) that i could label as sexual abuse. he later died under mysterious circumstances in his 20s that many said was suicide. i put some of that responsibility on her. and her daughter, who became a famous analyst too, hated her and wrote horrible things about her publicly. to me that really calls into question that “profound thinker.” not saying she may not have had some unique ideas, but god, what a sick woman! anyway, thanks for commenting — daniel

      • Well if you are open to it, I would like to continue this dialogue, I find it stimulating. I will restrict my comments to a few key things and ask one question.

        Melanie Klein. MOST analysts at that time had strange histories, difficulties with boundaries (including our beloved Winnicott). Psychoanalytic thoery has contributed to our understanding of boundaries in fact and could be seen as a linchpin in improving our understanding in this area. Consequently if you judge the writer soley by their personal life, it is easy to discredit many influential writers from early 20th Century.

        In short, ALL of the most influential modern psychoanalytic writers (Winnicott included) were MOST influenced by Klein’s work (this includes Bion, Ogden, Kernberg, etc). In essence she founded the object relations school (the central theoretical advance in psychoanalytic theory post Freud). She made seminal contributions in our understanding of painful primitive affect states, her concepts such as projective identification, splitting, depressive position, paranoid-schizoid position, plus her contributions to our understanding of destructive envy, and it’s opposite, “gratitute” are timeless.

        A lot of that “foolish theory” has been borne out by empirical research time and again (See Westen, 1994) but I agree that a lot of psychosexual theory is dated, sexist and should be discarded. By and large it has. The VAST majority of analysts do not see the oedipal myth as the core of psychoanalysis. An inlfluential textbook by modern freudians called “a new synthesis” makes this crystal clear (even the freudians dont think mostly about oedipal stuff). NONE of the many analysts I know and work with (all under 60 years of age) think in this way.

        Finally, I am very curious about your training. You identify yourself professionally a “psychotherapist”. Nowhere on your website do you seem to disclose what training had to prepare for this most challenging work. I am asking you genuinely, not to one-up you. You do seem to have a very good feel for this and I am struck by that. As you know psychotherapist is an unprotected term, meaning you do not state licensure to practice as such (I am a psychologist). Would you be willing to disclose how much you formally trained for that professional role?

        thanks for the dialogue.

        • Hi Michael,

          Sure, I have a bit of time right now for dialogue. Glad you’re open!! I wish I had a ton of time to discuss this!!

          You wrote: “if you judge the writer soley by their personal life, it is easy to discredit many influential writers from early 20th Century.”

          My reply: True, but when they’re talking about theories of the human mind (not economic theory, for instance) I think their personal lives—and their relationship to their own children—count for a lot and shed light on their theories. Especially extreme stuff like that with Melanie Klein. Also, I’m not into a lot of her theoretical material that you mention, quite aside from her personal history — things like the paranoid-schizoid position. To me it’s way off-base. I admit, though, that I have found some value in the concept of projective identification.

          You wrote: “The VAST majority of analysts do not see the oedipal myth as the core of psychoanalysis.”

          My reply: good point. That’s where my essay departs from reality and gets into humor a bit — so I should watch myself. I wrote this essay, I believe, something like seven years ago. I think it was inspired by two main things: 1) having been in psychoanalysis myself (2x/week, on the couch) and finding it at first curious but ultimately demeaning and unhealthy. Was my analyst horrible? Yes. Was she extraordinary in her horribleness? No. I think she was pretty average and mild. Did she use old-fashioned oedipal interpretations with me? No, or at least very few. This dialogue here, though, is not exactly what happened in my therapy with her. It does catch some spirit of that therapy, though, or at least some of the sessions. But the content does differ, to a degree. 2) having known and spent time with so many analysts in my first few years as a therapist in New York City. (and i’ve been supervised by a few, too.) Generally an awful bunch — that’s what I found. Arrogant, not super-creative, rule-following, confident on the surface, often pro-meds, charged way too much (in general), loved following their own personal school of analysis in a sort of cult way, and often just mediocre people. Blah!!! Also, one thing I never liked is that whenever they were threatened by me as a therapist (or me as a person with my own ideas) they suggested that I go to analytic training. This is going back over a decade. They said it would help me understand people better — and help me be a more valid therapist. My reply, which I rarely said to them, was: “go back to school to become someone like you who understands people far less than I feel I do, and is a much worse therapist to boot because you’re loaded with all these half-silly and sometimes all-silly theories that you think answer the major questions to the universe? No thanks!!

          You wrote: “Finally, I am very curious about your training. You identify yourself professionally  a “psychotherapist”. Nowhere on your website do you seem to disclose what training had to prepare for this most challenging work.”

          My reply: sure — I’m an LCSW-R — I kept my license, even though I don’t practice and haven’t in five years. (you probably know this already, but that’s a licensed clinical social worker with the R-psychotherapy privilege that in NY state comes after six years of supervised clinical practice.) I worked in a bunch of settings and started part-time private practice in manhattan in 2002 and went fully private in 2004 and stayed there till I quit in 2010. I know I’ve written about this in a few places already — I just can’t quite remember where.

          As a closing thought, I do know some psychoanalysts whose work I trust more than others. I also have put some people who had analytic training in my movies — such as Ann-Louise Silver who wrote “psychoanalysis and psychosis” and was analyzed by searles, and Daniel Dorman who is a sort of star of my film Take These Broken Wings. But I think once upon a time (you probably know this better than I) for a lot of therapists who wanted more training analytic training was all there was. Actually, I think my grandfather (who was a psychologist and therapist) had analytic training as well, though that’s a whole other story!!!

          Greetings from New York City —

          • Your description of your analyst and the ones you have met closely echoes my own experiences with psychoanalysts. The longer they spend in psychoanalytic training, the less empathy they show: The more training they have, the more rule bound, more obfuscating, more patronizing and more defensive they become . I have seen it more than once – the lone psychoanalyst in an otherwise humane and functional department. Why they don’t see the worsening impact on their personal and professional lives?

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