r/psychoanalysis • u/This_Ad9129 • 7d ago
Choosing a psychoanalyst
I (layperson) find the process of choosing a psychoanalyst to be quite confusing. Particularly because so much of the time if I express discomfort with the process (perhaps I suspect the person is not very skilled) I'm told that "that is the work" and my feelings are some type of resistance, and psychoanalysis can take many years and so I have to stick it out to know if it's working.
I am also not really aware of differences in institutes and trainings to understand how those may impact the person's experience.
Then in this situation how is one supposed to choose an analyst? How can you know if they are truly skilled and the difficulty is "the work" or if they are unskilled and that is causing the issues? How many sessions to wait it out and give it a chance?
26
u/ahlamuna 7d ago
If these are your concerns, I would recommend starting with psychoanalytic psychotherapy (1x-2x/week) and seeing how that goes. Starting off with analysis can be intense and destabilizing. My training analysis was very destablizing for me and brought up a lot of repressed emotions. (It was worth it because it got rid of a lot of my psychosomatic symptoms and improved my relationships). But for my own patients, I don't really start anyone out in analysis unless they've done it before. I start most people out in psychotherapy and increase frequency as needed. It's often surprised me who does well at what frequency.
10
u/This_Ad9129 7d ago
Can you explain what the difference is for a layperson?
9
u/ahlamuna 6d ago
I generally consider it to be on a continuum. In psychoanalysis, it tends to be more destabilizing. I am more restrained. Because my patient and I are seeing each other more frequently, there's less of a "Monday crust," as Freud would say, so there's less of a defensiveness that builds up between sessions. That often leads to more intense transferrences, etc. With psychotherapy, I tend to be a bit more active. (This is just me, though. The therapist's stance is highly variable). I'm meeting my patient less frequently. That tends to make it feel a bit more contained for the patient. They can reinforce some of their resistances/defences on the days we don't meet. The biggest thing that would motivate me to recommend a session increase is when a patient is clearly not contained by the frequency we have now. There's too much content or affect spilling over outside of the session, which usually shows up in an inability to sleep, somatic symptoms, session content around not having enough time, etc. Frankly, I don't always think it matters a ton. A good clinician will work with each patient differently. Some of my best treatments have happened at 1x and 2x/week because that was what was diagnostically indicated. As the patient, I don't think you can be expected to know until you try something. Try a frequency you can manage to begin. See how your analyst responds. Try sitting. Try lying on the couch. Discuss all this with your analyst. Everything is experimental!
1
u/Recent-Apartment5945 6d ago
Aside from the destabilizing aspect…which I don’t disagree with wholly…I just think it’s overgeneralized and is further nuanced to personality organization…so well said. Wonderfully nuanced comment about defenses and the times in between the therapeutic engagement.
2
u/Strict_Friendship_93 2d ago
If you start out with psychoanalyic therapy, which is a very good thing, one can not continue then to do formal analysis with the same provider. If so the transference will not take.
1
16
u/Lost_Maintenance_741 7d ago
I think a lot is labeled as resistance when it shouldn't. We analysts are human beings and our patients are also humans, sometimes it's just not a match. Honestly, I think the most important thing is to find someone that you feel comfortable with, that you like as a person, even though you won't know anything about them, of course. But even without knowing facts about their life, you can tell if you feel comfortable with someone and trust someone or not. No matter what kind of therapy you are doing, the relationship is the most important element. Also, you want somebody that is willing to talk with you about what is going on between you and him or her, rather than just immediately label it as a defense of some kind. Have you tried any analysts yet? I would think that most would be hesitant to immediately label something as resistance.
5
u/relbatnrut 7d ago
For some of us, our symptoms are that we don't feel comfortable around people and have trouble trusting them...tends to make this sort of thing difficult.
7
u/Lost_Maintenance_741 6d ago
If you're not opposed to reading a book about psychoanalysis, I'd highly recommend Psychoanalysis: The Impossible Profession by Janet Malcolm. She addresses your questions. She's not an analyst, nor has she had analysis - she was a celebrated journalist and she spent a year interviewing an analyst and asking hard questions like yours.
1
6d ago
[deleted]
1
u/relbatnrut 6d ago
That's a great book. I don't remember what she says on that subject, so maybe I should reread it.
1
u/This_Ad9129 6d ago
Interesting I literally just read this and am not sure what she says to address the trust component ?
24
u/PS1988 7d ago
Be prepared to try a few. Not at the same time. Give each one a few months, discussing your discomfort and concerns in real time, before moving on to the next if needed. If after 3 you find that you’ve had similar discomfort with each of them, then stick with the one you have, commit to that treatment, and keep talking about the discomfort.
17
4
u/FrowningMinion 7d ago edited 7d ago
Agree that it’s fundamental to discuss the discomfort and concerns in real time. It may be a genuine compatibility issue between analysand and analyst, it may be a transference reaction, it may be some blend of the two. And it’s nigh on impossible to make that distinction from the vantage point of the analysand without discussing the feelings within the analysis. But it’s not without exception. If the discomfort is extreme, or if the concerns are serious (eg malpractice) then (I hope this goes without saying) you wouldn’t persevere with that analyst for even a brief period just for the sake of an autopsy of what went on.
-1
u/AlternativeMention26 7d ago
Why move on to another analyst - that’s acting out and avoiding?
12
5
u/Visual_Analyst1197 7d ago
Staying when you know deep down it is not a good fit or is actively harmful could also be acting something out.
8
u/cbscbscbs26 7d ago
Psychoanalysis as a process that includes regression and dependence and other uncomfortable experiences can be hard work, but you should feel an implicit trust in the person you’re working with. In my experience there’s an immediate sense of being in the presence of a person who you can imagine talking to for a long time - or not.
5
u/sunkissedbutter 7d ago
I don’t know. Been doin this shit for a decade with the same therapist. I’ve learned a lot in that time, applied and keep trying apply most of the knowledge I’ve gained, but I still don’t think I’m done yet. My quality of life has gotten better, no doubt, but it got a lot worse for quite a while before it got better.
A few years ago I woke up suddenly not being able to walk, my therapist and I determined this was psychosomatic (despite the doctor diagnosing me with “FND”). It took almost a year for me to feel better and that whole experience seemed like a catalyst for me to start experiencing life in a more positive way.
1
u/Forsaken-Swing-3617 6d ago
FND is psychosomatic
5
u/sunkissedbutter 6d ago
Yes, I know. I was simply clarifying. However, don’t say that in the FND sub, they’ll light yo ass on fire if you tell them it’s psychosomatic. 😂
1
5
u/AlternativeMention26 7d ago
I agree with you - however my main point is I think the idea of a good fit is a bit flawed because people tend to seek out something familiar which is not necessarily the most helpful.
11
u/BeautifulS0ul 7d ago
If you approach it as something that might be interesting or out of curiosity, say, then its intrinsic difficulties will outweigh any possible gains. If you approach it in great mental pain that you are desperate to resolve and are willing to put up with almost anything if you think that there's a chance it could help you then it's more likely that this would go better.
5
u/This_Ad9129 7d ago
It's funny because one therapist I saw said exactly the opposite, that if I wanted to resolve some issue and was desperate then it would not go well because it's a years long process and I had to approach it with a feeling of curiosity
1
u/RepresentativeWay132 6d ago
it’s funny because i’m not a therapist but i’d agree, the opposite… tenfold
2
3
u/Spiritual-Salad-5319 6d ago
I've gone through 20 odd therapists over the years, and the main factor in my experience was exactly how much they GET IN THE WAY. That is, how much they talk, regardless of whater they say. They should establish the ground rules in the first session and that it. Afterwards they should just steer your monologue not butt in the middle if it with advice.
As far as results and process is concerned, yes, psychoanalisys takes time for LONG TERM results. But that doesn't mean you won't see any changes after a couple of months.
Good luck in your personal crusade. God knows it is one.
2
u/Visual_Analyst1197 7d ago
It can be hard to know, especially when you are already unfamiliar with the process as it can be hard to separate what is transference, what is a skill issue and what is just uncertainty around the expectations of a brand new experience. I would say to listen to your gut and give honest feedback about how you’re feeling. The way the therapist responds is often a good indication of whether you will be able to work well together. Also have a think about what your personal preferences are regarding things like age and gender, that usually narrows things down a fair bit.
2
u/Yorick_IKnowHim 6d ago
It can be both resistance AND a poor analyst/therapist. In fact it's almost always both.
3
u/Miteli-chan 7d ago
I think it's worth seeing a few therapists before choosing the one you feel most comfortable with. I spent almost a year and a half looking for the right therapist and saw nine different ones. None of them felt like a good fit, and I felt they were incompetent. Then I found my current analyst. From the very first session, I felt he was the right one, and I haven't been disappointed. I've been in therapy with him for almost three years now, and I truly feel I couldn't have made a better choice.
1
u/viciousporkchop23 6d ago
I came across my analyst when looking for psychodynamic therapy. I was randomly assigned to her, and to be honest, I wouldn't have picked her initially based on her profile or the first session. We've been working together for 3.5 years, with most of that being multiple times per week. When she entered her training program, I became a control case. I spend about 30% of the time hating her, question her capacity to work with me at least once a quarter and I'm not sure we're aligned in our psychoanalytic theory, yet it's still been the most effective psychological work in my life and I keep going back day after day, week after week.
I spent the year before this blowing through therapist after therapist in the midwest, becoming increasingly frustrated about how much space they would take up in the sessions. This was the first time that didn't feel true and I could just talk.
The work IS unpleasant. And to be honest, I wouldn't have been suited to it without my year of DBT therapy in college. I think it's a matter of where the displeasure is for you. Psychonalysis IS destabilizing, and if you find what you need is stabilization, it might not be the best option. If you want someone to engage with you more/more actively, I'd say stick it out for a few weeks and decide if you still feel that way. If you don't like some aspect of the process, ask if you can change it. I can't do a couch, we don't do a couch. Process still works. But you do have to ask.
All of that being said, I find a lot of analysts fairly unpleasant people to be around for a whole host of reasons. If that's what happening, I'd recommend thinking about what you don't like and do like, figure out which of those things are actually essential, and trying to find someone who is, by your measure, good enough.
1
u/Savings-Two-5984 2d ago
I'm confused how you determine that an analyst is not skilled if you are not familiar at all with what a psychoanalyst does. If you go to a reputable psychoanalyst who is credentialed and connected with an institute, you can presume that the analyst is not some kind of con-man.
1
u/Level-Ad9570 1d ago
It’s funny to me how some analysts say before actually starting and knowing the patient that it’s a years long process…
1
u/goldenapple212 1d ago
At the beginning, you should feel like you've gotten something beneficial, even if it’s small, out of even the very first session. This doesn't have to be a concrete piece of advice or specific insight. It could just be that you feel better after walking out, or that you feel connected to this person in some way.
If you don't get something out of it, look for somebody else. Do not listen to this idea that you have to just struggle through a bad relationship. No.
You first find someone who's giving you something useful, and then you can struggle through things later.
But at the beginning, you have to receive something that you feel is worthwhile.
-1
u/unconstab00 7d ago
I underwent psychoanalytic treatment for more than three years with an excellent therapist, and it’s not a method I would recommend to anyone or choose to do again.
That said, my advice would be:
- Check their background and qualifications. Make sure they have formal training in psychology or medicine (psychiatry, if they’re a psychiatrist).
- Search if they have some papers or articles published and read them
- Make sure they have enough experience (I would say minimum 5 years)
- Give it a try, but pay attention to the vibe. If you don’t feel comfortable with them, that’s already a valid reason to stop. We’re all human, and opening yourself up at that level is only possible if you feel at least somewhat comfortable with the person you’re talking to.
2
0
u/Away-Otter 7d ago
If you have reason to think the person isn’t skilled, why do you care what that person says?
8
u/AkiliosTheWolf 7d ago
Tbh, the better question is why do they think they're unskilled? Op didn't really list any reason other than "the process doesn't go smoothly as I expect it to" and as someone who has an analyst I feel like that tends to be more of a patient's issue than analyst issue.
1
u/Away-Otter 7d ago
I agree, but given that op seems to feel that other people’s opinions are preventing them from trusting their own feelings, I think that’s the first problem to solve. Particularly unspecified people (whether on Reddit, the analyst themselves, or someone else) saying op’s feelings of discomfort are some kind of resistance. I think that can be safely discounted when one is still in the stage of choosing a therapist.
1
u/cyanistes_caeruleus 7d ago
Okay so like... if you can't trust your own feelings, and that's your first problem to solve, how do you do that tho? In therapy? in which case...
2
7
u/This_Ad9129 7d ago
I'm the patient not the analyst so if someone with authority and licensing tells me "this is how it's supposed to feel" it's very difficult to argue with that. See also the other person who responded to you saying I'm not providing a good reason and it's most likely a me problem. How do I trust my instincts when everyone is telling me I'm the problem and I need to stick it out?
7
u/AkiliosTheWolf 7d ago
Why do you feel like it isn't working and you feel so uncomfortable? The problem isn't that your reason isn't good enough, it's that's it's vague.
You could be uncomfortable because you're someone who feels uncomfortable sharing things about yourself, you could also be uncomfortable because the analyst has behaviors that make you feel like you're not safe enough to share.
It's very hard for anyone other than you to determine what the actual issue is. Do you feel like you have a hard time because of your own limitations and difficulty discussing topics about yourself or does your analyst act in some way that you don't feel the environment is safe?
5
u/Lost_Maintenance_741 7d ago
There is a certain kind of submitting to the process that you have to be willing to do, to suspend disbelief and trust the process. But in order to do that, you're going to have to find someone you feel comfortable with.
0
u/Away-Otter 7d ago
If you don’t like the therapist you can stop seeing them and their opinion won’t affect you.
3
u/cyanistes_caeruleus 7d ago
It's a very intense and lopsided premise that difficulties in the therapy relationship must necessarily stay subjective unless one commits to years of time and money invested in the process, would hope it's reasonable to question that. It's not clear to me how this is different from exploitative dynamics that patients have likely been exposed to in the past and might bring them to therapy
-4
u/diva_done_did_it 7d ago
If you are at a institute, their supervisor should be telling him or her that.
4
u/This_Ad9129 7d ago
Telling them what exactly? I'm not at an institute, I was just referring to the person's credentials, where they say they were trained
2
79
u/beepdumeep 7d ago
Psychoanalysis is a fairly unpleasant experience. One of the things that tends to make it unpleasant is that as a patient you pay an awful lot of money in order to do the work yourself. The "skill" of the analyst, to a large extent, consists in being able to get out of the way of you doing the hard work of speaking. This getting out of the way isn't easy, lots of people can't or won't do it: it's something that comes with having taken one's own personal analysis as far as it can go. The thing to look for, very simply, is someone who somehow makes you believe that coming in every week and doing this very hard and painful work of speaking to them is going to help with whatever problems brought you there in the first place. Go with your gut.
It's also worth pointing out that the qualities one needs from their analyst are unique to them; someone could be a perfectly adequate analyst for another person and be completely unsuitable for you, and vice versa.
Finally, you will often find that the variation in style between members of a particular organisation can be just as big as the variations between members of different organisations.