What Is Psychoanalysis?
Psychoanalysis is a type of treatment for emotional or personality problems. The treatment aims to help people get a better understanding of both their own thoughts and feelings and their relationships with other people.
Treatment focuses on understanding minds, looking at how thoughts, feelings and other mental processes interact to generate problems of experience and behaviour. This includes wishes and ideas that the person is not aware of, which we describe as unconscious. When unconscious thoughts and wishes come into conflict with conscious wishes and intentions they may cause emotional difficulties and/or behaviour problems.
Psychoanalysts also help their patients to think about how different people's minds can affect each other: how our own ways of thinking and behaving may affect others, how other people's thoughts and feelings may lead them to behave in particular ways and how other people's actions and assumed motives make us feel, think and behave. We call this capacity to think about our own and others' thoughts and feelings the capacity to mentalize.
It is particularly important to be able to mentalize in our closest relationships, which we call our attachment relationships, because sometimes the strength of our feelings in these most intimate bonds can cloud our judgement, leading to misunderstandings and mutual distress.
Rob's story
Rob's story is a very simple example of how problems can arise and be resolved.
Five-year-old Rob caused great distress to his parents by insisting on putting several scarves around his mother's neck because he was terrified that she would catch a cold and die. His obsessive preoccupation grew more and more severe over the months before his parents brought him to the Anna Freud Centre. During the consultation his mother was wearing at least a dozen scarves, shawls and wraps so she could hardly breathe.
The therapist talked to Rob and tried to explain how little boys could sometimes feel very frightened of being angry with their mums, particularly if a boy was frightened that if his mum noticed him being cross she might pack up and leave. Rob admitted that he was very frightened that his mum might leave one day.
When the therapist talked with Rob's parents, he learned that their marriage was on the rocks. Mum was having an affair with a colleague at work and there were frequent arguments - which they assured the therapist that their child had never witnessed.
The therapist said that he understood how difficult things were for them, but that perhaps it was better to be honest with Rob rather than "trying to protect him" if their protection generated more anxiety than it alleviated.
Rob's parents took the therapist's advice, spoke honestly about their marital difficulties to Rob, and reassured him that even if they did decide to separate they would still live close together. Within a few weeks Rob's problems had completely disappeared.
Rob unconsciously, but mistakenly, believed that his anger with his mother had caused her threat to leave, which he had overheard and (mis)understood. He did not know why he felt that he had to keep putting scarves around her neck. Yet, when the therapist helped him to understand that maybe he only wanted to protect her from his anger and that her wish to leave would not mean that they would be separated for ever, his anxieties became conscious and more realistic and possible to talk about; they stopped disrupting his relationship with his parents.
Unfortunately the problems of most of the children we see at the Centre are not as easily resolved as Rob's. Rob and his parents were helped with a brief consultation and advice. Often this in itself can be enormously helpful for families. We all sometimes miss the obvious and need someone else to point it out, but once we see it we simply reorganise our thinking, feel less frightened, angry or ashamed and are enabled to carry on with our lives. Many of the cases that need the Centre's assistance are far more complex.
Sally's story
Sally, a seven-year-old little girl, had seen her father murder her mother. She too had terrifying thoughts and fantasies about what had happened and why. But in her case her fear was so intense that she could no longer think clearly, she couldn't fantasise or play and she was so terrified of adults that she sometimes without warning attacked those who tried to help and look after her, kicking and biting viciously so that she had to be forcibly restrained.
She needed many months of patient, sensitive contact with a highly trained adult before she could gradually begin to think about what had happened, who and what she was and how she could possibly dare to make relationships again. Like many of the other children whom we meet, even before the terrible event that she witnessed her life had already been very difficult - she suffered severe neglect, frequent humiliating criticism, beatings and many other forms of emotional and physical abuse.
Working with children such as Sally is highly specialised. This is not just because of the traumatic experience of her mother's death but also because her early experiences had not given her the chance to develop the capacities she needed to cope with the terrible emotional turmoil that followed. Psychoanalytic therapy, for Sally, was about helping her to build and rebuild her mind to learn that life was not too dangerous and it could be safe to think and feel.
Our work with adolescents
We see many adolescents as well as younger children at the Centre. Growing up has always been hard, but modern society makes things especially difficult for the young people who are growing up in the 21st century. On the one hand, we ask them to show self-discipline of a kind that we hardly expect of adults, telling them that every step of their progress through our educational system will have irreversible consequences for their entire life. On the other hand, we keep them dependent on us long after they have become physically mature. No wonder depression, delinquency, eating disorder, deliberate self-harm and suicide are on the rise in this age-group.
Our psychoanalytic approach to adolescents focuses on facilitating their progress towards independence and their struggle to resolve conflicts between past (childhood) and current (friends as well as family) loyalties and attachments. Adolescence is a unique period, a little like infancy, when many new connections are made in the brain but many are also lost in the process of streamlining the nervous system to deal with adult challenges. As the adolescent brain matures, suddenly the world comes to seem far more complicated than it has ever been before. Psychoanalysts working with adolescents work hard to see the world from their point of view and help them with the internal conflicts that sometimes torment them and frequently drive them to external conflicts with their parents, their school and the adult world of authority.
For example, adolescents may need help to recognise how their childhood experiences, which they are working hard to forget, still influence how they behave, not just towards their parents but also towards their peers. A child who was insecure and uncertain about whether they would be comforted when frightened or distressed may become an adolescent whose apparent arrogance thinly disguises insecurity about whether he will be accepted, he expects all the time to be criticised and is vulnerable to a devastating sense of shame.
Of course we do not always know what has happened in a young person's past. However, from the way that young people deal with us as professionals we learn what their expectations about adults who are offering assistance might be and this can tell us a great deal about their past experiences and also about their internal picture of how adults might feel towards them.
Some are anxious, expecting to be criticised or found wanting, and this tells us a lot about the critic they probably carry about inside their head, a voice who is constantly berating them and finding them inadequate. Such persecutory self-criticism can feel devastating and bring a person close to depression and despair. Others with depression come with a sense of having been let down, feeling isolated and abandoned but blaming the world for their troubles.
Often adolescents are the best people to help other adolescents and group therapy for adolescents can be very valuable. A trained and sensitive group therapist is needed to make sure that such groups function productively (encouraging, validating) rather than destructively (shaming, criticising), opening up rather than closing down thoughts and feelings.
Special techniques for helping adolescents with severe mental health problems
There are some adolescents who are unlikely to benefit from either group or one-to-one therapy, however sensitive and carefully administered. Their lives and the lives of their families are torn apart by mental disorders of the most severe kind. They may be facing hospital admission because of the severity of their self-harm and suicidality, their disruptiveness in the home, their incapacity to tolerate school and the extent to which their thinking is out of touch with reality.
For these young people we join forces with other specialists who bring different skills, working with the family, working with schools, and working with social educational systems. In order to avoid hospital admission in these contexts we have to go to the families rather than families coming to us and try to help to them understand what is happening with the adolescent and what is happening in their own minds in response to him or her.
Although this manner of delivering help is very different from classical one-to-one psychoanalysis, the principle remains the same: to achieve a better understanding, making what appears destructive and out of control meaningful and sensible.
The power of the mind
Freud's great discovery at the turn of the century was that by becoming aware of the internal and external forces that determine our actions we can acquire partial control over these, reducing their ability to make us feel things or behave in ways that are incompatible with our overriding wishes. Psychoanalysts for a century now have worked to harness the power of human consciousness to deal with its own problems and troubles.
Psychoanalysis has helped us to appreciate the awesome power of the human mind. We are able to perpetrate unthinkable damage on others and on ourselves because of what we believe, what we feel, what we experience. Opening up any history book will immediately convince the sceptic about the terrible damage that mistaken beliefs can cause. Psychoanalysis can help us to develop and enhance our capacity through conscious reflection and recognition of feelings which have been outside awareness to call a halt to an impulse, pause an action, or reverse an emotional reaction - an ability which is among the most precious of all human achievements.