Psychoanalysis stirs the emotional pot, bringing to the surface a patient’s unconscious feelings that Sigmund Freud, a Viennese specialist in nervous disorders, likened to “summoning the demons from below.” Freud’s idea was that symptoms are rooted in underlying, often longstanding, psychological conflicts that can be discovered in part through close examination of the patient-therapist relationship.
Although the use of psychoanalysis has waned since Freud’s day, it has proven to be an effective treatment for people who struggle with depression, anxiety, relationships and personality difficulties. The intensity of the psychoanalytic process allows people to make far-ranging improvements in their sense of well-being and in the ways that they relate to the world.
One of its adherents, Lynn Friedman, a clinical psychologist in full-time private practice in Chevy Chase, Md., and a member of the School of Education faculty for 19 years, teaches two courses for the Clinical Mental Health Counseling Program at the Johns Hopkins School of Education: the one-credit “Psychodynamic Psychotherapy” and “How to Build a Private Practice.”
“People are driven by things outside their awareness,” said Friedman, who works with individuals and couples and specializes in relationships, work-life concerns, anxiety and depression. “People come for psychodynamic psychotherapy and psychoanalysis because they recognize there’s a gap between what they want for themselves and what they have. For example, they may consciously wish for a mutually satisfying, intimate relationship, but they may find they repeatedly end up with unreliable partners. Or they may notice they’re always in trouble with the boss. They want to learn more about themselves so that they can stop repeating these self-sabotaging patterns.”
By establishing a trusting and nonjudgmental atmosphere, Friedman encourages her patients to say whatever comes to mind without fear of reprisal. “It’s easier said than done,” she said. “Growing up we learn politeness and tact. Few people go around sharing all of their thoughts—the good, the bad and the ugly. In psychodynamic psychotherapy and psychoanalysis, we are asking people to do just that.”
Friedman and other psychoanalysts use many methods to help people access their unconscious, including asking them to say whatever comes into their minds, report their dreams and attend sessions several times a week. Freud called that stream of consciousness “free association,” and dreams “the royal road to the unconscious.” He believed that seeing patients nearly every day led to a deepening of the “transference,” which for Freud and most modern-day psychoanalysts is a cornerstone of psychodynamic psychotherapy and psychoanalysis.
Transferring expectations, based on our early experiences with key figures in our current lives, emerges the most profoundly in intimate relationships with our partners, children and close friends.
“In our first years, we develop a sense of how the world works based on how we are treated by our parents and primary caretakers,” said Friedman. “This is not a conscious process. As we go out into the world we anticipate that others will treat us as our parents did. If our parents were warm and loving, we expect that others will nurture us. If they were critical and hostile, we anticipate harshness — in fact, unconsciously, we may even provoke it.”
Psychoanalytic treatment makes use of transference as a vehicle of change. In treatment, individuals begin to anticipate the same reactions from the psychoanalyst as they experienced in their formative years. It’s the psychoanalyst’s task to point out these early patterns as they recur in current relationships—with friends and lovers, in school, at work and, most important, in the relationship between the individual and the psychotherapist.
The concept of transference is useful for any therapist irrespective of their theoretical orientation. “It can be puzzling when clients sabotage their therapy,” said Friedman, “but the notion of transference helps us to recognize that it’s not personal. Rather, the individual may be driven by early experiences that are outside of their conscious awareness.”
Friedman pioneered a psychoanalytically informed approach to career counseling, developing the Psychoanalytically Informed Career Assessment Model. During an evaluation, she determines what keeps people from being successful in their careers.
“Often, people with workplace unhappiness have an internal conflict that is out of their conscious awareness,” she said. “For example, they may be afraid that if they succeed they will outshine their spouse and that’ll threaten the marriage. Or, they may harbor unconscious resentment toward their parents for emphasizing achievement over happiness. Unconsciously, they may be retaliating by being unsuccessful at work. My task is to figure out what has led to their career dissatisfaction and to assess how it can be most effectively resolved. I evaluate whether they need career counseling, therapy or psychoanalysis.”
Norma Day-Vines, director of the Clinical Mental Health Counseling Program, said that because Friedman was originally trained in cognitive behavioral therapy and family systems, she appreciates the usefulness of all of these approaches.
“The mental health counseling program is predominantly cognitive-behavioral,” said Day-Vines, “however at Hopkins we are committed to scholarly inquiry. Therefore I think it’s important to expose our students to a diverse array of theoretical perspectives.”
In an era where there is a devaluation of time and an overemphasis on speed and efficiency that discourages many people from engaging in a deeply introspective process, Friedman treasures the opportunity to create a safe place for her patients—a place where they can acknowledge things about themselves that they don’t like or are ashamed of.
“I really love the fact that psychoanalysis is transformative,” she said. “I love the relationships—knowing another person really well. Getting to the real essence of the person, that’s when the work gets done.”
