Goals in Psychotherapy: Freud’s Request

One of the main goals of Modern Psychoanalysis, if not all good psychotherapy, is the ability to put thoughts and feelings into words.  When we can do this — put thoughts and feelings into words — then we can choose to behave in a way that is in our best interest, and best for our relationships; we have a choice.

I’ve written a poem, posted below, that I hope captures what might have been Sigmund Freud’s take on this therapeutic goal.  I welcome all reactions, poetic or prose.

Professor Freud’s Request

I have explained the cost
of desires denied, put out
like the candle at your bedside.
Does the room cease to exist
when the flame dies?
But I insist: denied in thought!
Only barbarians, smelling like pigs,
burrs in their unwashed hair
and their animal-skin tunics —
only barbarians and babies
demand immediate gratification of dreams.
So, perhaps we start there?
You will tell me your dreams?


Change in Psychotherapy: Neuroscience and Relationship

Welcome to the LICMPS blog.  Here I’ll share some of my ideas on topics relevant to our clinical work — or, really, anything relevant to our professional life.  And I hope you’ll fee free to comment on my ideas — agree, disagree, expand; it’s all good.  I hope to get a conversation going, and all who’d like to join are welcome.

For some time I’ve been intrigued by the evidence that, while genetics determines the limits and possibilities of how an individual’s brain can develop, still, the brain ultimately develops in the context of relationships.  The social environment can turn genes on or off and plays a huge part in determining how the brain develops; how it’s wired.  And the brain is plastic into adulthood; it changes in response to new experiences even in adulthood.  Even more, many studies provide evidence that effective psychotherapy leads to positive changes in the patient’s brain.

So when a person comes to us for help, his or her problem is never only a biochemical imbalance, only relational, or only intrapsychic.  Instead, the problem is always all three.  And while medication can often help, psychotherapy can and does address the biochemical contribution to psychological problems.

A few months ago, in an article in the New York Times Sunday Review, Richard A. Friedman argued that adolescents are more vulnerable to fear and anxiety, when compared to younger children and adults, because the amygdale, the “brain circuit for processing fear”, develops “way ahead of the prefrontal cortex, the seat of reasoning and executive control.”  A letter printed in the next week’s Review, in response to Friedman, suggested that there are cultures where anxiety is not the typical adolescent experience.  Therefore, the letter’s author continued, it is societal factors, not brain development, that lead to either a calm or anxious adolescent.

Rather than the either/or of brain development versus societal factors, I would suggest that, given the evidence that the brain develops in a social context, social factors in interaction with genetics will influence brain development, leading to an adolescent who is either more or less vulnerable to anxiety.  While we never have a thought or feeling without our neurons firing, our neuronal pathways develop and can change in the context of relationships.  This is why, as psychotherapists, especially as analytic psychotherapists who are particularly concerned with the therapeutic relationship, we can help our patients change.