Frequently Asked Questions about Psychoanalytic Psychotherapy

Here are just a few of the questions prospective patients might have about psychoanalytic psychotherapy.  Many patients consult a psychoanalytic therapist after having first tried other therapies, with limited success.  I am happy to arrange a consultation if you are interested in talking further about embarking on this challenging and rewarding type of treatment.  I am very interested in being of help to you.

What is the goal of psychoanalytic psychotherapy?

Is psychoanalytic psychotherapy a painful experience?

Can I expect to receive advice and guidance from the psychoanalytic therapist?

Can I afford psychoanalytic psychotherapy?  How much does it cost?  Will my insurance cover it?

How will we know if I am a good candidate for psychoanalytic psychotherapy?

How is psychoanalytic therapy different from cognitive behavioral therapy (CBT)?  Is it better than CBT?

What about medication versus psychotherapy?

What is the goal of psychoanalytic psychotherapy?
I believe the primary goal of psychoanalytic therapy is to make the unconscious conscious.  Here is what I mean and why this goal is so important and useful: Think of the mind (not the brain) like an iceberg where, say, one-third of it is above the surface of the water and two-thirds is concealed below.  It is the hidden part of the iceberg that sinks ships.  In another words, to mix metaphors, you cannot overcome or avoid an enemy you cannot see.  The unconscious contains buried thoughts, emotions, memories, fears, desires, conflicts, worries, etc.  So long as these remain hidden, they cannot be responsive to the powers of rationality and reason.  We might believe we know why we think, feel, perceive, and behave the ways that we do, but very often we do not really understand it.  Exposing the unconscious to our awareness gives us the opportunity, flexibility, and freedom to understand, manage, and sometimes resolve or eliminate our troubling symptoms and maladaptive behavior patterns.

Is psychoanalytic psychotherapy a painful experience?

I am not a member of the “no pain, no gain” school of therapy.  I like to compare myself to a good dentist – a good dentist does not think “great! now we are getting somewhere!” if the patient cries out in pain.  My goal as a therapist is to minimize pain while still making progress.  And I believe it’s the therapist’s responsibility to manage the patient’s anxiety within the therapy session.

Can I expect to receive advice and guidance from the psychoanalytic therapist?

Keep in mind that graduate schools and psychoanalytic institutes and training programs do not teach their students how to lead happy, successful lives.  Therapists have no particular expertise in having joyful marriages, raising outstanding, brilliant children, making wise investment decisions, finding rewarding and lucrative careers or any of the many other challenges that life throws our way.

If I feel that I occasionally have some particular piece of wisdom to offer you, I will do that.  But advice and guidance play a very minimal role in the psychoanalytic psychotherapy experience.

Can I afford psychoanalytic psychotherapy?  How much does it cost?  Will my insurance cover it?

I have always accepted and filed most types of insurance for patients and I still do, with a few exceptions.  I have a strong belief that therapy should be available to as many people as possible.  Most health insurance plans do cover psychotherapy.  Fees are set by the individual insurance company; most plans require a co-pay and nowadays a great many plans have out-of-pocket deductibles which must be met before the plan will pay anything.  We will discuss the fee in detail during the introductory phase of therapy.  Co-pays typically are in the $20.00 to $40.00 range but of course fees vary.  I customarily bill monthly.  You will certainly want to investigate your mental health insurance coverage and I can advise you on how to do that.

How will we know if I am a good candidate for psychoanalytic psychotherapy?

Every therapy starts off as a trial.  In my experience 4-6 sessions is generally enough time to discover if you and the therapist are a good fit.  Sometimes you can tell much sooner than that.  I’ve told people before that finding a good therapist is a little like dating, in this respect:  When you’re dating, you can’t always tell on the first date if it’s going to work out.  But you can practically always tell immediately if someone is not right for you!

Certainly, you will have thoughts, feelings, questions and concerns after the initial therapy consultation and those need to be discussed but trust your gut feelings.

Besides feeling comfortable with the therapist there are other important answers to the question of suitability.  The ideal candidate for this kind of therapy is someone who is interested in other people, who wonders “what makes people tick?”  Optimally, the patient should be curious about what drives them to do (or not do) and think and feel the way that they do.  So a certain degree of “psychologically mindedness” is important.

Good candidates for this kind of therapy may feel “stuck” in their lives” They may have trouble finding rewarding careers or not work up to their potential.  They may have a pattern of choosing unsuitable romantic partners over and over again.  They might lack self-confidence, have low self-esteem or have a feeling they are “holding themselves back.”  Commonly, they feel overly sad, anxious and worried.

How is psychoanalytic therapy different from cognitive behavioral therapy (CBT)?  Is it better than CBT?

The question of whether one type of therapy is “better” than another type should only be answered by saying “It depends.”

To illustrate, consider the question “Which vehicle is better – a Camry or a Jeep?”  The correct answer depends on whether you are driving across the country or going off-roading.

Cognitive Behavior Therapy is the most popular type of therapy in the United States these days and has been for several decades.  It has much to recommend it (though I don’t practice it myself).  It’s brief, efficient, focused, and comparatively inexpensive.   But I think those qualities make CBT better suited for more specific, clearly defined symptoms versus the more widespread, diffuse, and more deeply entrenched problems mentioned above.

As an example, a prospective patient called me once and reported having suddenly developed an intense fear of flying.  “I travel a lot in my work and this is causing me a big problem,” she said.  After asking her a few questions, I referred her to a local practice that specializes in CBT–oriented brief treatment of anxiety disorders.  I thought to myself – but did not say it to her – “If you come to see me, after a year you will have discovered some very interesting and useful things but you probably still will not be able to get on a plane.”

What about medication versus psychotherapy?

Psychiatric medication and psychoanalytic psychotherapy each has its pros and cons.  Medications work fast – often within a few weeks; occasionally in an hour or so.  The kind of psychotherapy we are discussing here takes time – usually months, sometimes even years.

Medication offers exclusively symptom relief and only works while you take it.  Therapy, on the other hand, aims to produce long lasting results.  Successful psychoanalytic therapy strengthens one’s ability to be self-aware and introspective, to develop and reinforce what is called “the observing ego.”  The ultimate aim is to help the patient become one’s own therapist.  Therapy is not, after all, supposed to go on forever.

However, objecting to psychiatric medication for offering “only” symptom relief is just silly: plenty of fantastic medications only work while you take them: insulin, antibiotics, and statin drugs are just a few examples.

Nowadays more and more patients are finding optimal relief through a combination of therapy and medication.  In fact, there is a substantial body of research which convincingly confirms that a combination of medication and therapy often works better than only one or the other form of treatment alone.

And then there is the fact that medication can manage some conditions that even the best therapy might not be able to make a dent in.  Severe mood disorders are one such example, in my experience.

To those patients who refuse to even try medication when it is indicated, I say to them: “If you try medicine and it doesn’t work, you haven’t lost anything – you are just back to square one.  But if you don’t try it and it would’ve worked, you have lost a very great deal.”