email page print pageAll Topic Reviews
Maximizing Effectiveness in Dynamic Psychotherapy Self-Compassion in Psychotherapy101 Healing StoriesA Clinician's Guide to Legal Issues in PsychotherapyA Map of the MindA Primer for Beginning PsychotherapyACT With LoveActive Treatment of DepressionAffect Regulation, Mentalization, and the Development of SelfAlready FreeBad TherapyBecoming an Effective PsychotherapistBefore ForgivingBeing a Brain-Wise TherapistBetrayed as BoysBeyond Evidence-Based PsychotherapyBeyond MadnessBeyond PostmodernismBinge No MoreBiofeedback for the BrainBipolar DisorderBody PsychotherapyBoundaries and Boundary Violations in PsychoanalysisBrain Change TherapyBrain Science and Psychological DisordersBrain-Based Therapy with AdultsBrain-Based Therapy with Children and AdolescentsBrief Adolescent Therapy Homework PlannerBrief Child Therapy Homework PlannerBrief Therapy Homework PlannerBuffy the Vampire Slayer and PhilosophyBuilding on BionCare of the PsycheCase Studies in DepressionCaught in the NetChild and Adolescent Treatment for Social Work PracticeChoosing an Online TherapistChronic DepressionClinical Dilemmas in PsychotherapyClinical Handbook of Psychological DisordersClinical Intuition in PsychotherapyClinical Pearls of WisdomCo-Creating ChangeCognitive Therapy for Challenging ProblemsCompassionConfessions of a Former ChildConfidential RelationshipsConfidentiality and Mental HealthConfidingContemplative Psychotherapy EssentialsControlConversations About Psychology and Sexual OrientationCoping with BPDCouch FictionCounseling in GenderlandCounseling with Choice TheoryCouple SkillsCrazy for YouCreating a Life of Meaning and CompassionCreating HysteriaCritical Issues in PsychotherapyCrucial Choices, Crucial ChangesDeafness In MindDecoding the Ethics CodeDeconstructing PsychotherapyDeep Brain StimulationDemystifying TherapyDepression 101Depression in ContextDialogues on DifferenceDissociative ChildrenDo-It-Yourself Eye Movement Techniques for Emotional HealingDoing CBTE-TherapyEarly WarningEncountering the Sacred in PsychotherapyEnergy Psychology InteractiveErrant SelvesEssays on Philosophical CounselingEssentials of Wais-III AssessmentEthically Challenged ProfessionsEthics and Values in PsychotherapyEthics in Plain EnglishEthics in Psychotherapy and CounselingExpectationExploring the Self through PhotographyExpressing EmotionFacing Human SufferingFairbairn's Object Relations Theory in the Clinical SettingFamily TherapyFavorite Counseling and Therapy Homework AssignmentsFear of IntimacyFlourishingFolie a DeuxForms of Intersubjectivity in Infant Reasearch and Adult TreatmentFoundations of Ethical Practice, Research, and Teaching in PsychologyFreud and the Question of PseudoscienceFrom Morality to Mental HealthFundamentals of Psychoanalytic TechniqueGenes on the CouchGod & TherapyHalf Empty, Half FullHandbook of Clinical Psychopharmacology for TherapistsHandbook of Counseling and Psychotherapy with Lesbian, Gay, and Bisexual ClientsHandbook of Evidence-Based Therapies for Children and AdolescentsHealing the Heart and Mind with MindfulnessHeinz KohutHelping Children Cope With Disasters and TerrorismHigh RiskHistory of PsychotherapyHow and Why Are Some Therapists Better Than Others?How Clients Make Therapy WorkHow People ChangeHow Psychotherapists DevelopHow to Fail As a TherapistHow to Go to TherapyHypnosis for Inner Conflict ResolutionHypnosis for Smoking CessationI Never Promised You a Rose GardenIf Only I Had KnownIn Others' EyesIn SessionIn Therapy We TrustIn Treatment: Season 1Incorporating Spirituality in Counseling and PsychotherapyInside the SessionInside TherapyIs Long-Term Therapy Unethical?Issues in Philosophical CounselingIt's Not as Bad as It SeemsItís Your HourLearning from Our MistakesLearning Supportive PsychotherapyLetters to a Young TherapistLife CoachingLogotherapy and Existential AnalysisLove's ExecutionerMadness and DemocracyMaking the Big LeapMan's Search for MeaningMetaphoria: Metaphor and Guided Metaphor for Psychotherapy and HealingMind GamesMindfulnessMindfulness and AcceptanceMindfulness-Based Cognitive Therapy for DepressionMindworks: An Introduction to NLPMockingbird YearsMoments of EngagementMomma and the Meaning of LifeMotivational Interviewing: Preparing People For ChangeMulticulturalism and the Therapeutic ProcessMultifamily Groups in the Treatment of Severe Psychiatric DisordersNarrative PracticeOn the CouchOne Nation Under TherapyOur Inner WorldOur Last Great IllusionOutsider ArtOutsider Art and Art TherapyOvercoming Destructive Beliefs, Feelings, and BehaviorsOverexposedPathways to SpiritualityPersonality and PsychotherapyPhilosophical CounselingPhilosophical Counselling and the UnconsciousPhilosophical Issues in Counseling and PsychotherapyPhilosophical PracticePhilosophy and PsychotherapyPhilosophy for Counselling and PsychotherapyPhilosophy PracticePhilosophy's Role in Counseling and PsychotherapyPillar of SaltPlan BPlato, Not Prozac!Polarities of ExperiencesPower GamesPractical Psychoanalysis for Therapists and PatientsPrinciples and Practice of Sex TherapyPsychologists Defying the CrowdPsychology, Psychotherapy, Psychoanalysis, and the Politics of Human RelationshipsPsychosis in the FamilyPsychotherapyPsychotherapyPsychotherapy and ConfidentialityPsychotherapy As PraxisPsychotherapy for Children and AdolescentsPsychotherapy for Personality DisordersPsychotherapy Is Worth ItPsychotherapy Isn't What You ThinkPsychotherapy with Adolescent Girls and Young WomenPsychotherapy with Children and AdolescentsPsychotherapy without the SelfPsychotherapy, American Culture, and Social PolicyRapid Cognitive TherapyRational Emotive Behavior TherapyRational Emotive Behavior TherapyRationality and the Pursuit of HappinessRebuilding Shattered LivesReclaiming Our ChildrenRecovery OptionsRelationalityRent Two Films and Let's Talk in the MorningSaving the Modern SoulScience and Pseudoscience in Clinical PsychologySecond-order Change in PsychotherapySelf-Compassion in PsychotherapySelf-Determination Theory in the ClinicSelf-Disclosure in Psychotherapy and RecoverySerious ShoppingSex, Therapy, and KidsSexual Orientation and Psychodynamic PsychotherapySigns of SafetySoul Murder RevisitedStaring at the SunStraight to JesusStrangers to OurselvesSubjective Experience and the Logic of the OtherTaking America Off DrugsTales of PsychotherapyTales of UnknowingTalk is Not EnoughTalking Cures and Placebo EffectsTelling SecretsThe Behavioral Medicine Treatment PlannerThe Body in PsychotherapyThe Brief Couples Therapy Homework Planner with DiskThe Case Formulation Approach to Cognitive-Behavior TherapyThe Challenge for Psychoanalysis and PsychotherapyThe Child and Adolescent Psychotherapy Treatment PlannerThe Clinical Child Documentation SourcebookThe Clinical Documentation SourcebookThe Complete Adult Psychotherapy Treatment PlannerThe Couch and the TreeThe Couples Psychotherapy Treatment PlannerThe Crucible of ExperienceThe Cure of SoulsThe Death of PsychotherapyThe Education of Mrs. BemisThe Ethical Treatment of DepressionThe Ethics of PsychoanalysisThe Gay and Lesbian Psychotherapy Treatment PlannerThe Gift of TherapyThe Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work The Healing JourneyThe Heart & Soul of ChangeThe Heroic ClientThe Husbands and Wives ClubThe Love CureThe Making of a TherapistThe Mindful TherapistThe Mirror Crack'dThe Mummy at the Dining Room TableThe Neuroscience of PsychotherapyThe Neuroscience of Psychotherapy: Healing the Social BrainThe New Rational TherapyThe Older Adult Psychotherapy Treatment PlannerThe Other Side of DesireThe Pastoral Counseling Treatment PlannerThe Philosopher's Autobiography The Pornographer's GriefThe Portable CoachThe Portable Ethicist for Mental Health Professionals The Present Moment in Psychotherapy and Everyday LifeThe Problem of EvilThe Problem with Cognitive Behavioural TherapyThe Psychodynamics of Gender and Gender RoleThe Psychotherapy Documentation PrimerThe Psychotherapy Documentation PrimerThe Psychotherapy of HopeThe Real World Guide to Psychotherapy PracticeThe Schopenhauer CureThe Sex Lives of TeenagersThe Talking CureThe Therapeutic "Aha!"The Therapist's Guide to PsychopharmacologyThe Therapist's Guide to Psychopharmacology, Revised EditionThe Therapist's Ultimate Solution BookThe Trauma of Everyday LifeThe Trouble with IllnessThe UnsayableThe Way of the JournalTheory and Practice of Brief TherapyTherapy with ChildrenTherapy's DelusionsTheraScribe 3.0 for WindowsTheraScribe 4.0Thinking about ThinkingThinking for CliniciansThinking for CliniciansThoughts Without a ThinkerThriveToward a Psychology of AwakeningTracking Mental Health OutcomesTrauma, Truth and ReconciliationTreating Attachment DisordersTreatment for Chronic DepressionTreatment Plans and Interventions for Depression and Anxiety DisordersUnderstanding Child MolestersUnspeakable Truths and Happy EndingsWhat the Buddha FeltWhat Works for Whom?What Works for Whom? Second EditionWhen the Body SpeaksWhispers from the EastWise TherapyWittgenstein and PsychotherapyWorking MindsWoulda, Coulda, ShouldaWriting About PatientsYoga Skills for Therapists:Yoga Therapy
Often psychoanalytic theory, as interesting as one may find it, seems to be unable to prove itself to be effective therapy. It is true that therapy is difficult to measure and patients demand privacy, but the wealth of psychoanalytic books which are devoid of contemporary examples (and instead rely solely upon Freud's rich but outdated case studies) makes one wonder if psychoanalysis is its own worst enemy. Since therapeutic practice is under greater demands to prove its value to insurance providers with ever-tighter belts (many HMOs provide little to no allowance for therapy), psychoanalysis seems destined to end up as something of arcane interest to academics and absent from its therapeutic birthplace.
Errant Selves: A Casebook of Misbehavior is a counter-example to the reification of psychoanalysis. The book, edited by Chicago psychoanalyst Arnold Goldberg, is a timely and fascinating collection of case studies of contemporary patients undergoing psychoanalytic treatment. The majority of the book describes eight case studies by various psychoanalysts. Each case study is written by the analyst and followed by a discussion in the group of the case. The setting in which the various analysts come together to discuss their patients is a worthwhile model to follow since it provides a place where the therapists can achieve a more objective view of their own behavior.
The first study in the book "The Case of John Alter: To Catch a Thief or Two" describes a lawyer who suffers from a variety of symptoms. The most interesting aspect of this case is the clear articulation of the therapist's own difficulty in properly approaching Mr. Alter's request to sign off on disability payments. Although John Alter has ceased to practice corporate law, he still makes a good living in law and thus is not truly disabled from his career. The therapist, until later reflection, does not realize what a great role his ambivalent feelings about the insurance payments ends up playing in the therapy. The discussion that follows the case study begins, "This case shows that an analyst functioning with an unrecognized vertical split in his psyche cannot hope to heal a similar split in a patient." (17) The case book presents not only the contemporary problems (obtaining insurance payments) but also the importance of the therapist's own feelings toward the therapy.
Psychoanalysis is not for all patients. In many of the case studies the patients were first undergoing psychotherapy before being recommended for analysis. Not only does psychoanalysis require a great time commitment, but it also requires high functioning individuals who don't need quick results. Psychoanalysis entails a long-term and intensive interaction between patient and therapist (four times a week is usually required). The therapist is not able to know instantaneously what ails the patient and what needs to be done. The work involves a constant reassessment of the goals and status of the patient. Thus, although the therapist is able to achieve a greater distance from the therapy, nonetheless his/her own attitude toward the patient is also dynamic. Mr. Alter's therapist overestimated his ability to not allow his resistance to signing off on disability papers to affect the treatment. All ambivalent feelings in the therapist must be addressed for the therapy to work.
The case study of Peter Stone ("A Case of Compulsive Masturbation") notes that the therapist had great ambitions to "show up" the famous therapist whom Mr. Stone had been seeing before beginning therapy with her. It also notes that she was under pressure to finish her training (and thus terminate the treatment). However, despite these comments that might seem to threaten the legitimacy of the "objective" analyst, they further bolster confidence in psychoanalysis' ability to effectively treat patients by emphasizing the psychoanalyst's constant self-assessment.
My favorite analyses were of Rashid ("Purloined Letters: The Psychoanalysis of a Man Who Stole Books") and Bert ("A Case of Infidelity"). Rashid is a graduate student stuck in writers block with a compulsion to steal books. Rashid benefits greatly from the analysis, even though it is prematurely terminated. He is able to make steps towards finishing his work as well as getting more control over his kleptomania. One comes away from his case feeling that he is better equipped to handle his depressions because his acknowledgment about his own internal split is not only intellectual but also reflected in his changed behavior.
Bert is a sixty year old man who has lost his wife and girlfriend to his infidelities, has a poor relationship with his children, and, due to his lack of earlier control over his finances, still needs to work long hours. Yet, nonetheless, his artistic photography (his sublimation) and his sense of humor remain and the phoniness that characterized the early sessions evaporates. The therapist notes the talent in his photographic work and the stronger sense of self "..[t]he con-artist aspect is gone." (72) Bert's case represents how analysis rarely provides a package happy solution to all of life's problems, but instead creates individuals who are able to find ways in which to channel their energy usefully instead of allowing it to divide and destroy them.
In Errant Selves, not all of the case studies end in success. Two of the patients, Rashid and Kool ("The Psychoanalysis of a Transvestite") move and thus have to terminate analysis before the analyst feels the time is proper. Kool is less successful than Rashid. Although he is often confident and happy about his "beautiful woman" side, his anxiety, depression and humiliation demonstrate that he never is able to achieve a true resolution with himself. In regard to his "beautiful woman" side Kool never comes to terms with his desire to be a woman and remain a man "He liked being a man. He wanted to be both [man and woman], so he felt despair." (32) Yet, despite Kool's obvious inability to come to a satisfactory arrangement, he remained throughout the analysis intent on running away from this split which cause him the despair, "Nonetheless it was very difficult for Kool to stay with the idea of sadness. Almost as soon as his thoughts turned to the subject, he began to fixate on sexual matters or else on practical questions of living. He was forever asking me how to do this or that and became quickly enraged when I suggested that he wasn't so much interested in where he might, for example, buy a used computer as he was in escaping painful feelings that he seemed to be on the brink of fully experiencing and sharing." (42) This inability of the therapy (most likely due to its short length) to push Kool to remain in the painful feelings and work through them results in the therapist noting "[t]he analysis began for me with a sense of disquiet and ended with one of failure." (44)
Yet, despite the failure of Kool's case, one comes away from this book with an example of a first class contemporary psychoanalytic casebook, as well as a sense of the legitimacy of psychoanalytic therapy in the contemporary world. The successful cases demonstrate amply that only by working through patterns established in childhood can patients hope to truly end their symptoms (instead of just moving from one problematic outlet to another). The focus on the therapist's own attitude helps to avoid abuses in therapy and brings more of a "peer review" into the clinical setting. These cases are suitable for demonstrating how psychoanalytic therapy can work effectively.
Talia Welsh is a Ph.D. student in Philosophy at the State University of New York at Stony Brook. She is writing a dissertation on Merleau Ponty's psychology.