THE ANALYTIC FIELD
A Psychoanalyst’s Experience as a Patient in an EmpiricallySupported Psychodynamic Psychotherapy William GOTTDIENER
There is a growing body of empirical research, mostly in the form of randomized controlled clinical trials, that supports the efficacy and effectiveness of psychoanalytic treatments (Leichsenring & Klein, 2014; Shedler, 2010). The now decades long turn to testing the efficacy and effectiveness of psychoanalytic treatments via empirical research methods has been controversial in some quarters within the psychoanalytic community because some people believe that clinical case studies are the best method to advance psychoanalysis (Hoffman, 2009). Arguments for the case study approach are that it supports the idiosyncrasy of each treatment, the humanity of the experience, and the focus on the individual. Arguments against empirical research are that it proscribes and prescribes treatment and therapeutic technique, eliminating the clinician’s freedom and creativity to make new clinical and theoretical discoveries and to offer the best treatment for the individual person who is before them. Are empirical research and the art and freedom of the clinician that is found in the case study method at odds? Can they co-exist or even be complementary? I am a practicing psychoanalyst and psychoanalytic researcher who has made contributions to the science of psychoanalytic treatments (Gottdiener, 2006; Gottdiener & Suh, 2015) and I am someone who has argued that the case study and empirical research are complementary and not mutually exclusive (Gottdiener & Suh, 2012). I decided to go a step further by going through an empirically-supported psychodynamic treatment, rather than solely rely on making academic arguments, when I recently decided to return to psychotherapy to continue to work on some personal problems. I had several questions about what I might experience in an empirically-supported psychodynamic treatment. Would my therapy follow a lockstep formula based on a treatment manual, lack creativity, humanity, and not offer me anything idiosyncratic that would tailor the treatment to me? Would the treatment be effective? How would it compare with my previous personal and training analyses? My Experiences as a Patient in Psychoanalysis I have been in psychoanalysis twice. Each was a classical analysis where I laid down on the couch and was seen between four to five times weekly. My first analysis began when I was 20 and ended when I was 30. My second began when I was 35 and ended when I was 39. The first analysis was a personal analysis and the second was a training analysis. I
entered each treatment with similar problems and similar goals. Both of my analysts were Caucasian males. They were psychiatrists trained at a classical analytic institute with a focus on ego psychology. My psychoanalyses helped me accomplish many of the therapeutic goals I had. I increased my capacity for intimacy, had better relationships, and was more successful academically and professionally. Importantly, both of my psychoanalyses helped me to engage in self-analysis and that helped me to better understand myself and continue to grow personally and professionally during and following each treatment. My self-analyses also helped me to realize the limitations of each analysis and to appreciate what I liked and disliked about each treatment and the treatment results. Upon reflection, I found classical psychoanalysis was limited in its attention to my emotions, especially as my feelings appeared in sessions in the transference. Although I was outwardly successful in my professional and personal life, I continued to live with attenuated forms of the same problems that originally brought me to my first analysis. I concluded that my continued problems were due to my difficulty using free-association. I realized it was a technique that I was able to use with limited success, in part, because it was too cognitively focused and did not focus on emotions and how I defended against them. Whenever I was silent on the couch my analysts would ask me “What are you thinking?” and never “What are you feeling?” As a result of the cognitive focus of free association, I never became fully consciously aware of the transference relationship with either of my analysts and, therefore, never experienced a resolution of those transference dynamics and the defenses that helped to maintain them. And, as a result, I was unable to effectively see how transference lived in my relationships outside of my analyses and never resolved the transferences in those relationships. I wanted to return to treatment after finishing my training analysis, but was hesitant to return to formal psychoanalysis because I was concerned that an analyst would use free association again and that it would have too much of a cognitive focus. As noted above, I did a lot of self-analysis and read a lot about different forms of psychodynamic therapies. Several forms impressed me: The psychodynamic approach developed by David Shapiro (Shapiro, 1989, 2000), the Supportive-Expressive Therapy approach developed by Lester Luborsky (Book, 1998; Leichsenring & Leibing, 2007; Luborsky, 1984) and the Intensive Short-Term 7
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Dynamic Psychotherapy developed by Habib Davanloo (Abbass et al., 2012; Coughlin Della Selva, 2004; Coughlin, 2017; Davanloo, 1992). I read and conducted self-analysis for nearly 14 years, influenced by my analyses and by my readings, before deciding that my self-analysis and reading were also limited in their effectiveness. I wanted to resolve my problems and I decided that I needed an emotion-focused experiential psychodynamic therapy and chose to begin treatment using ISTDP, which is an empirically-supported emotion-focused experiential psychodynamic treatment (Abbass et al., 2012; Coughlin Della Selva, 2004; Coughlin, 2017). My Experience as a Patient in ISTDP Intensive Short-Term Dynamic Psychotherapy (ISTDP) begins with a 90 minute to four-hour initial session (Coughlin Della Selva, 2004). The long duration of the first session serves several aims. First, it provides the patient and therapist with a trial therapy that assesses the patient’s psychopathology. Second, it helps both people to determine if ISTDP is the appropriate treatment for the patient’s problems by giving the patient and therapist an experience of a session and an opportunity to begin resolving the problems the patient has come to address. Third, the long session helps to establish all three components of the therapeutic alliance: the therapeutic goal(s), the therapeutic tasks, and the positive emotional bond between therapist and patient (Bordin, 1979). Fourth, the long session aims to help patients to begin to experience and resolve the complexities of the transference. This is done by trying to help patients focus on their feelings and the defenses against those feelings, especially as they arise toward the therapist. A considerable body of research shows that ISTDP benefits people with a wide range of problems and that people often make significant progress during the first session because the techniques “unlock” the unconscious (Abbass et al., 2012; Coughlin, 2017). In this model, feelings are the royal road to the unconscious. The “short-term” in ISTDP is a misnomer in that the treatment is not artificially short and limited to a specific duration. It is usually practiced once weekly, but in an open-ended manner with research showing that most patients find resolution to their problems after approximately six months of therapy while others might take as long as several years (Abbass, 2002). Feelings in the Transference One of the differences in my experience of psychoanalysis compared with ISTDP is
