Psychoanalysis is the process by which unconscious dynamicis that make us unhappy with our selves and our relationships are made conscious so that healing and growth can occur. As treatment unfolds you will come to understand yourself and your relationships better and experience more freedom to make choices about how you want to live your life.
Psychoanalysis is based on the idea that our adult personalities are the result of many developmental stages -- what happens first to the infant and then to the child shapes the way we see the world, the kind of relationships we form, the way we feel about ourselves in relation to others and the needs we seek to have fulfilled. Through the process of psychoanalysis we can get in touch with the past in order to re-experience and re-examine the formative and sometimes painful experiences we have had. Psychoanalysis helps us come to terms with the relationships we had during the growing up years -- both the good and the bad.
The concept of the "repetition compulsion" is a central idea in psychoanalysis. The compulsion to repeat is curious because what is repeated is not pleasurable. On the contrary, it is usually a painful and destructive pattern of feeling and behaving. A common refrain of my patients is: "Why do I keep doing this?"
Different "brands" of psychotherapy explain the causes of repetition compulsions in a variety of ways. For example, behavioral therapists treat the repetitions as bad habits that can be changed by conditioning. Cognitive therapists view the repetitions as irrational ways of thinking that can be changed by rational thinking. The psychoanalytic perspective, in contrast to the cognitive or rational approaches, views the repetition as unconscious. The concept of the unconscious is a cornerstone of psychoanalytic thinking.
Freud believed the repetition compulsion was an unconscious drive toward self-destruction -- a reflection of the "death instinct." Most psychoanalysts have rejected the concept of the death instinct and believe these repetitive feeling states and behaviors were originally adaptive and necessary for a child's psychic survival, but in adulthood they are self-destructive.
Many contemporary psychoanalysts understand the repetition as an attempt at mastery -- the hope that this time the mother or father or grandfather (or their stand-ins) will behave differently. From this perspective, the woman who tries to seduce her male analyst by dressing seductively and making seductive remarks unconsciously wishes the male analyst (father) will not act out his sexual feelings toward her as her father did.
Although I often find the notion that repetition is an attempt at mastery useful, but sometimes I cannot see it -- I only see self-defeating behavior. For example, after a half hour of work in a group therapy session that leads to an important insight, my patient, Bettina, inevitably says: "But what difference does it make?" It makes the group members feel frustrated that no matter how hard they try they cannot affect Bettina. She undoes the group's work. After discussing it several times, Bettina realized that's how she felt about her depressed mother when she was a child. No matter how hard she tried to make her mother feel better, her mother remained depressed. Bettina makes the group feel the frustration and anger she felt as a little girl. In trying to understand self-defeating repetitions like Bettina's, I find the object relations approach most useful.
Object relations analysts understand a repetition as some unconscious aspect of a childhood relationship (with a significant other such as a parent or sibling). From this perspective, a dynamic only becomes a repetition that is compulsively acted out if it was negative. The interaction gets internalized and becomes part of the self. It isn't all of the relationship, nor is it a perfectly accurate version of it because it was subjectively experienced and transformed. Whatever brand of psychoanalysis we practice, we believe that unconscious fantasies, prior experiences and constitutional make-up filter external reality and transform it into psychic reality. It is not the relationship as it was in its entirety or exactly as it was in reality. Bettina's feeling about her mother may not be objective reality, but it is her experienced reality and has become part of her psychic reality. It is a connection to her mother, albeit a negative connection. Although the dynamic is painful for Bettina as well as the group, she experiences giving it up as a loss -- a loss of connection to her mother.
The repetition compulsion is acted out through the processes of displacement and projection. Displacement involves experiencing and treating one person as if he were someone else. For example, my patients often experience me as if I were their mothers or other significant others in their early lives. Projection involves experiencing another person as if she feels what you feel. For example, the patient is feeling guilty and experiences me as thinking she is bad. In psychoanalysis, the feelings and experiences that the patient has toward the analyst is called "transference" and the analysis of the transference is at the heart of the psychoanalytic process. The kind of change we try to facilitate in psychoanalysis is not simply a behavioral change or a cognitive change, but a change in the experience of the self that results in behavioral and cognitive changes. Of course, this is a difficult level of change to achieve and for those willing to spend the time and money necessary to achieve it, the results are profound.
Copyright © 2004 Roberta Satow. All rights reserved.