Dr. Lynn Friedman
Washington DC Psychoanalyst and Psychologist
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Dr. Lynn Friedman answers these questions about psychoanalysis:
- What is psychoanalysis?
- For what kind of difficulties is psychoanalysis helpful?
- What is the patient's role in psychoanalysis?
- What is your role as a psychoanalyst?
- What is, "free association"?
- What about "slips of the tongue"?
- Doesn't psychoanalysis take a long time? Like many years?
- Does psychoanalysis entail 4 or 5 visits a week over a period of many years?
- I like the way that psychoanalysts think but I don't think that I want the full monty. Are there other alternatives?
- I think that I want a psychoanalysis but how do I know for sure that it is what is best for me?
- I am honest working stiff, how can I afford a psychoanalysis?
- I'd like to explore the possibility of psychoanalysis (or psychotherapy) with you. How do I go about doing that?
- Tell me about your background.
- What sorts of people do you see in psychoanalysis?
- Nowadays, does anyone really use the couch?
- Is there a community of Washington DC psychoanalysts?
- Why is there little federally funded research on psychodynamic psychotherapy and psychoanalysis?
- Didn't Time magazine declare psychoanalysis dead?
- Didn't the New York Times declare psychoanalysis, "alive and well and living in Argentina?"
- Didn't The Guardian declare psychoanalysis, "officially resurrected"?
- Are you a Supervising and Training Analyst? Are you a Board Certified Psychoanalyst? Can you tell me what these designations mean?
1. What is psychoanalysis?
Psychoanalysis is a theory, a research method and, most importantly, a psychotherapy designed to help people to understand those parts of themselves that are outside of their conscious awareness.
2. For what kind of difficulties is psychoanalysis helpful?
Psychoanalysis can be helpful in addressing and resolving longstanding difficulties.
For example, consider the very bright man whose relationships have repeatedly failed again and again and again. During years of weekly psychotherapy. he has come to understand himself intellectually, BUT, he keeps repeating the same self-destructive patterns over and over. He's successful at work. He has longstanding friendships and interests. He has some interpersonal strengths: He's able to tolerate disagreement and confrontation without abandoning his friendships. He has a nice sense of humor. He's reflective. And he's serious about overcoming his difficulties.
Psychoanalysis may provide him with the continuity and sense of safety that allows him to form an attachment to his psychoanalyst so that he can plumb the depths.
To tolerate a psychoanalysis, you must be sturdy though many people do not feel sturdy upon entering psychoanalysis. Yet, often, "analysands" (patients in analysis) have an underlying sturdiness. They have a stick-to-itiveness that allows them to remain in psychoanalysis when the psychoanalytic waters become turbulent (and, they do in every good psychoanalysis).
So, to have a useful psychoanalysis you must be able to tolerate some conflict in relationships without taking flight. That is, you must have the capacity to stay around when the going gets tough - and, to work things out. Also, although in the heat of the moment it is easy for any of us to lose perspective, in psychoanalysis, it's important over time to be able to step back and get perspective. And here's a seeming contradiction, you need to be able to take your psychoanalyst in and react to her in the heat of the moment and not keep her at a distance.
Of course, most people don't enter psychoanalysis with all of these capacities. They develop them more fully during psychoanalysis.
3. What is the patient's role in psychoanalysis?
Unlike medical treatments where we report our maladies to our physicians and they prescribe treatment, in psychoanalysis, the role of the patient, or analysand, is far more active.
Psychoanalysis is a collaboration. Analysands are asked to report their thoughts and their feelings. We ask them, "Say whatever comes to mind." This might include fantasies, daydreams, "flash thoughts," the events of the day, and the internal events in their minds. We want to know: What happened? What did it make you think? How it did it make you feel?
Although today's psychoanalysts are still interested in the early years, we are also very much interested in the present - and, in the future. So, while we view your early beginnings as very important, we believe that your current life is important, too.
Your psychoanalyst's task is to learn as much as she or he can about you and your inner world. Just as fantasies and private thoughts play a crucial role in psychoanalysis, so do dreams. In fact, Freud called dreams, "the royal road to the unconscious."
As an analysand, the most vital aspect of your role is to be as open and as honest as you can. Of course, this takes time. When you find yourself unable to be candid with your psychoanalyst, it's important to say so and to try to talk about why. Psychoanalysts use the relationship between psychoanalyst and analysand as a way of deepening their understanding of the analysand's inner and outer worlds. The relationship between you and your psychoanalyst is the vehicle for change. For this reason, we invite our analysands to report their feelings towards us without fear of reprisal.
4. What is your role as a psychoanalyst?
Contrary to the stereotype of the silent psychoanalyst, the analyst's role is actually a pretty active one. As an analyst, I listen attentively to my patients. Understanding the manifest content of what they tell me is important. But, the unique and essential element of my role is to understand the unconscious meaning of their concerns.
Most of us get into psychological trouble not because of what we know about ourselves but because of those forces that operate outside of our awareness. That is, we get into trouble because of what we don't know about ourselves.
We all have things about ourselves that are puzzling to us. For example, the man who consistently chooses unreliable woman may be puzzled by why he keeps repeating this pattern despite his conscious wish to have a relationship. Similarly, the talented female attorney who keeps alienating her bosses despite the detrimental effect that it has on her opportunities for promotion may be confused about why she sabotages herself.
It's my job to try to tune into that channel and share what I learn with the analysand so that they can understand and overcome these difficulties.
Of course, I have more mundane but essential obligations, too. I need to show up, on time, keep a consistent schedule and be prepared to listen and think about what I am hearing.
5. What is, "free association"?
Free association is another path to the unconscious. It's a lot like brainstorming. It entails saying whatever come into your head. Psychoanalysts encourage patients to free associate as a way of gaining access to unconscious thoughts and feelings.
6. What about "slips of the tongue"?
Slips of the tongue come straight from the unconscious. They have meaning. Therefore, when you have a slip of the tongue, hopefully, you and your analyst will try to make sense of it. Slips of the tongue are yet another window into your unconscious.
7. Doesn't psychoanalysis take a long time? Like many years?
Yes. Psychoanalysis does take a long time.
Beyond time and money, the work of psychoanalysis can be daunting - though, at times, liberating. We all have longstanding, often, deeply entrenched ways of being in the world. While these ways may lead to unhappiness or dissatisfaction, they are often our best compromise for navigating unconscious, internal conflict. This is because these conflicts operate outside of our awareness.
The aim of psychoanalysis is to help you to develop a better understanding of your inner world; an internal blueprint of sorts. It takes time to become aware of our inner conflicts and to work through these conflicts in an enduring way. This understanding often leads to significant change.
Also, during the process of psychoanalysis you develop your own capacity for "analytic reflection". In this sense, although you, and your psychoanalyst, terminate; the psychoanalysis continues with you as your own psychoanalyst.
The silver lining: as noted earlier, research shows that unlike many psychotherapies, psychoanalysis and psychodynamic therapy can have enduring effects long after the treatment has terminated.
8. Does psychoanalysis entail 4 or 5 visits a week over a period of many years?
Yes. There are many benefits to frequent meetings.
First, they promote an atmosphere of safety and continuity. You get to know your analyst and she gets to know you. As the relationship deepens you become comfortable thinking about, and bringing up, difficult topics. Knowing that you will return the next day makes it easier for you to talk openly about difficult material.
Second, the consistency of the sessions allows you to remain in touch with the feelings and thoughts that get evoked and to work on them. Deeper topics emerge and frequent meetings keeps these important topics close to the surface. In this way, you can work through your difficulties more consistently and thoroughly with less intrusion from current events.
9. I like the way that psychoanalysts think but I don't think that I want the full monty. Are there other alternatives?
Not everyone wants, needs or can make use of psychoanalysis. In addition to training in psychoanalysis, all psychoanalysts are trained to provide psychodynamic psychotherapy (aka psychoanalytic psychotherapy).
Like most psychoanalysts, I am committed to providing psychotherapy in those situations where I feel it is more appropriate than psychoanalysis.
Some difficulties can be effectively addressed in psychodynamic psychotherapy, and/or short-term, even very short-term, psychotherapy. Psychodynamic psychotherapy uses many of the techniques and methods employed in psychoanalysis with some modifications.
10. I think that I want a psychoanalysis but how do I know for sure that it is what is best for me?
This is an important question. It's a little bit like going to the doctor complaining of a stomach ache. You can report your pain and your symptoms but, unless you are a physician yourself, you likely have little idea about how to evaluate and address your difficulties.
To truly assess whether psychoanalysis or psychodynamic psychotherapy are warranted, seriously consider a psychological evaluation with a psychoanalyst. Only a psychoanalyst is trained to assess whether or not a psychoanalysis would be optimal for you.
11. I am honest working stiff, how can I afford a psychoanalysis?
Virtually all psychoanalytic clinics have sliding scale clinics. Here's a list of psychoanalytic institutes. Consider calling the one in your locale.
12. I'd like to explore the possibility of psychoanalysis (or psychotherapy) with you. How do I go about doing that?
I'd be happy to talk with you. Feel free to give me a call at: 301.656.9650. To streamline things, please leave me your day and evening numbers and the times that it's best to reach you. I welcome your call
13. Tell me about your background.
I am a Washington DC Psychoanalyst, Clinical Psychologist and Master Career Counselor (MCC). I practice on the Washington DC border, in Friendship Heights, one block from the red line (actually, in Chevy Chase, MD). I help adults, adolescents and middle schoolers. Also, I enjoy working with couples and families.
Beyond helping people with anxiety, depression and relationship difficulties, I have a special niche in psychoanalytically-informed, career assessment. I teach at Johns Hopkins University and I've written on psychodynamic career assessment for both the professional and lay literature.
I am a Board Certified Psychoanalyst and a Supervising and Training Analyst, at the Washington Psychoanalytic Institute. This means that, in addition to analyzing people in the community, I analyze psychoanalysts-in-training. Also, I supervise psychoanalytic candidates (psychoanalysts-in-training). Also, I supervise licensed, clinicians who are wishing to refine their skills in psychoanalytic psychotherapy (aka as psychodynamic psychotherapy). Also, I chair our psychoanalytic fellowship program.
14. What sorts of people do you see in psychoanalysis?
People seek me out for help with anxiety, depression, workplace dissatisfaction, relationship difficulties and an array of other concerns. I work best with people who want to deepen their understanding of themselves.
Professionally, my practice is weighted heavily toward attorneys, academicians, physicians, mental health professionals, entrepreneurs and students (ranging from doctoral students to middle school students). Beyond this, I see people with a wide array of professional backgrounds and interests, including some who are pursuing paths off-the-beaten track as well as those who are in the process of attempting to find their passions.
15. Nowadays, does anyone really use the couch?
Yes. Although the couch is not the sine qua non of psychoanalysis, many people find the psychoanalytic couch to be a useful tool. Typically, the analysand lies on the couch and the psychoanalyst sits behind him. Lying down helps you to focus inward and to reflect on your internal thoughts and feelings. It allows you to attend to what you are thinking rather than to your psychoanalyst's reactions. Free associations, thoughts, fantasies, feelings emerge. This allows analyst and analysand to deepen their understanding of your internal world.
Freud, himself, noted that having the analysand lying down allowed him to focus on the work of psychoanalysis and not to be constrained by regulating his on facial expressions.
16. Is there a community of Washington DC psychoanalysts?
Actually, there is a vibrant community of psychoanalysts in Washington DC. There are, at least, 6 institutes here. Three of the institutes are accredited by the International Psychoanalytic Association and two are accredited by the American Psychoanalytic Association.
17. Why is there little federally funded research on psychodynamic psychotherapy and psychoanalysis?
American Psychological Association leaders talk about, "evidenced based treatments." However, there are three problems with this construct.
(1) A treatment can only be demonstrably, evidenced-based, if researchers are investigating it. And, the National Institute of Health (NIH), the national, governmental purveyor of such research stopped awarding grants to investigators who study psychodynamic psychotherapy (or psychoanalytic psychotherapy, let alone, psychoanalysis) some years ago. Instead, they confined their grants to those investigating CBT and psychophamacological treatments.
(2) All psychotherapy research is hugely costly to conduct, especially psychodynamic psychotherapy research. This is because it is difficult to define research variables. As renown psychodynamic psychotherapy researcher, Lester Luborsky (1972) pointed out, patients are, of course, as diverse as all other human beings. Even people suffering from the same "diagnosis" arrive there from vastly different routes. Similarly, psychotherapists (even those operating within a theoretical perspective) are a heterogeneous group. Similarly, there is enormous variability within each treatment. Despite the challenges inherent in psychotherapy outcome research, more recent research supports the idea that psychoanalysis, and the psychodynamic therapies derived from it, has more staying power. That is, gains made in these therapies may endure years after the treatment has ended.
18. Didn't Time magazine declare psychoanalysis dead?
Yes. Indeed! In 1993, Time Magazine, with the advent of managed care, Big Pharm and a quick fix, mentality, Time magazine posed the question, Is Freud Dead?
19. Didn't the New York Times declare psychoanalysis, "alive and well and living in Argentina?"
Yup. In 2012, the New York Times published an article about how, and why, psychoanalysis is flourishing in Argentina.
20. Didn't The Guardian declare psychoanalysis officially resurrected?
Yes, according to Guardian journalist, Oliver Burkeman. Burkeman describes the rise and fall of psychoanalysis, accurately noting that in recent years, it has been displaced by Cognitive Behavior Therapy (CBT). But, CBT, he asserts is not all that it is cracked up to be.
True, an arsenal on empirical studies suggested that cognitive behavioral therapy was both efficacious and cost-effective. And, an army of insurance companies jumped on the bandwagon, quick to indict psychoanalysis and psychodynamic psychotherapy as sorely lacking. But, studies have demonstrated that these therapies have some efficacy --- and, more importantly, their benefits may endure long after the treatment has terminated.
21. Are you a Supervising and Training Analyst? Are you a Board Certified Psychoanalyst? What do these designations mean?
Yes. I am a Supervising and Training Analyst. This means that while like all psychoanalysts, I treat patients from the community, I am also qualified to treat psychoanalysts-in-training. Candidates in psychoanalytic training are required to seek out a Supervising and Training Analyst to undergo their own psychoanalysis an important part of their training. I’ve been vetted as having the very specific expertise and experience required to conduct psychoanalyses for psychoanalysts-in-training. Beyond this, it reflects the fact that I’ve been very active in the teaching and training of psychoanalysts and mental health professionals.
Also, I am Board Certified by the American Board of Psychoanalysis. This means that a panel of national experts have examined and vetted my clinical work.