Frequently asked questions about psychoanalysis

1. How do I know if I should begin psychotherapy?


When a person is asking this question seriously, then psychotherapy
is usually a good idea. Waiting for a crisis or panic is not necessary.
Therapy is most productive when a person realizes that personal difficulties
are not going to change by repeating the usual methods.
2. What if I have been told to go into therapy?


If a boss or spouse has insisted that you begin therapy, you may
be angry and think about what you need to do to placate others and
end your treatment. After you get past this initial focus, you may
find therapy one of the most important experiences of your life.
3. Does therapy take a long time?


Often people experience a burst of growth right at the start, along
with a realization that they are still holding on to thoughts or feelings
that cannot be explored as easily as they might have wished. This struggle
toward the goal of telling the whole story, not just part, may increase
time in therapy as it increases growth.
4. If I go more often, does this mean I am sicker?


No, often the opposite is true. People who are basically healthy
but distressed by problems in living can make the best use of two or
three sessions a week. They realize that a single session tends to
limit them to talking about weekly events, whereas two or three sessions
permit genuine exploration of important ideas and feelings.
5. What are the differences among psychiatrists, psychologists, social
workers, psychotherapists, and psychoanalysts?


While most of these practitioners have probably had some training
in basic counseling methods, the differences between them are crucial
and affect the perspective from which you as the patient will be treated.
A psychiatrist is a physician and has been uniquely trained in prescribing
psychotropic medications.
A psychologist has a Ph.D. or Psy.D. degree and is uniquely trained
in psychological testing and research.
A social worker has an M.S.W. degree and is uniquely trained in the
workings of social service programs and psychosocial counseling.
In most states, the term psychotherapist can be used by anyone, with
or without training and credentials. New York State recently established
a license in psychoanalysis. Only certified psychoanalysts can be licensed.
This protection ensures that you are receiving treatment from a person
who has completed the appropriate state-mandated training.
A psychoanalyst has the most comprehensive training of all, since
this specialized training cannot even begin until the person has already
earned a postgraduate degree. A certified psychoanalyst has spent an
extra 8-10 years focusing on how to work with people one-to-one. Psychoanalysis
is the only profession in which certification requires the analyst
to go through personal treatment, averaging 5-10 years, so that the
analyst will not confuse her or his personal issues with the patient's.
6. Even when I know the differences in academic degrees, how can I
be sure that my therapist's training is relevant and certified?


Strange as it seems, you can't really be sure unless you investigate,
since most states do not pay any attention to whether or not a therapist
has been through personal analysis and completed a training program
in psychoanalysis. A true psychoanalyst will have a certificate from
a recognized institute and will be able to point you to a national
Directory of Psychoanalysts where this person's name is listed.
7. When it comes to my own therapy sessions, what difference does
training in psychoanalysis really make?


Your psychoanalyst's approach to therapy will be distinctive. Virtually
all other branches of the mental health field teach their professionals
to function as "experts," with goals, ideas or plans that
the patient is supposed to learn to go along with. Psychoanalysts consider
this approach useless and even harmful, since it falsely implies that
the patient is ignorant or wrong and that the therapist knows better.
A psychoanalyst's approach is based on a sophisticated listening process
that can identify previously unknown obstacles to growth. Resolving
these obstacles frees the person's own talents in choosing a personal
pathway to solving problems.
8. Don't psychoanalysts spend a lot of time talking about childhood?


Psychoanalysts have no special topics the patient is supposed to
discuss. Patients often bring up childhood memories and fantasies as
psychoanalysis enables the mind to expand. Life themes that previously
seemed disconnected are understood in a new light. This integration
of past and present is part of the holistic growth resulting from psychoanalysis.
9. What if I have health insurance for psychotherapy?


Many analysts are willing to cooperate with insurance companies,
but even though you pay premiums year after year, you might be surprised
to find that your policy strictly limits benefits for psychotherapy.
A summer 1996 issue of The National Psychologist reported that a whopping
99% of the consumers who actually examined their HMO's policies and
procedures are dissatisfied. Consumers found that their company expected
a detailed written report about confidential information, that they
are only covered for a few sessions, that the company wanted them to
take pills, or that they could not choose the best therapist because
the company required them to see someone who had a financial agreement
on the side that they are not allowed to know about. When your own
life and future is at stake, beware of choosing the path that looks
cheapest at first glance.
10. Does psychoanalysis curtail creativity?


Most people worried about losing creativity in therapy are inwardly
aware that they long for more productive ways to harness their creativity
and bring it to light. In psychoanalytic therapy a person's creativity
is likely to expand as inner wishes to be more creative have a chance
to come to fruition in the person's actions. Creativity actually increases.
11. Why does Managed Care try to avoid psychoanalysts?


Because managed care makes a profit by paying out as little money
as possible for treatment. Most managed care operations restrict treatment
to a specific topic (or diagnosis) that must be written down and sent
to the company. Managed care limits the number of sessions, interferes
with confidentiality and restricts the therapists who work for the
company. Psychoanalysts insist that only the patient has the right
to set the agenda for therapy, and that only the patient should have
the freedom to shorten or expand this agenda according to personal
needs.
12. Is psychoanalysis expensive?


Most psychoanalysts have a sliding fee scale, or set aside part of
their time for patients who can only afford a lower fee. Many analysts
also have a network of colleagues who can help find the right analyst
for someone in financial need. For nearly 100 years this commitment
to patient needs has made psychoanalytic therapy available and affordable.
As Freud once remarked, "nothing is as expensive as illness, or
ignorance".
13. Is treatment confidential?


If you are seeing a certified psychoanalyst—and not using Managed
Care—the answer is absolutely YES. However, under Managed Care,
no one can guarantee your privacy as information collected about you
as a patient is stored in the company's computer, and may possibly
be shared with other companies or agencies.
14. How should I go about choosing a therapist?


Two rules are fundamental: (a) the person you choose should have
advanced, specialized training in psychotherapy (not just an academic
degree or license), and (b) you should not rely on an insurance company's
list of therapists. Although it is sometimes helpful to seek a recommendation,
you must always rely on your own judgment when it comes to the "chemistry" in
the room. Avoid basing your choice merely on a convenient location,
surface similarities between you and a therapist, or even the therapist's
gender; chemistry matters most.
The Theodor Reik Clinical
Center for Psychotherapy offers 212ANALYST,
a referral service that
includes nearly 250 therapists in private practice in the New York-Connecticut-New
Jersey region who have met TRCC's advanced training standards. If no
one at TRCC is just right, the Intake Director will know whom to recommend
instead.

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