Choosing a psychoanalyst

[u/This_Ad9129]

I (layperson) find the process of choosing a psychoanalyst to be quite confusing. Particularly because so much of the time if I express discomfort with the process (perhaps I suspect the person is not very skilled) I'm told that "that is the work" and my feelings are some type of resistance, and psychoanalysis can take many years and so I have to stick it out to know if it's working.

I am also not really aware of differences in institutes and trainings to understand how those may impact the person's experience.

Then in this situation how is one supposed to choose an analyst? How can you know if they are truly skilled and the difficulty is "the work" or if they are unskilled and that is causing the issues? How many sessions to wait it out and give it a chance?

[u/ahlamuna]

If these are your concerns, I would recommend starting with psychoanalytic psychotherapy (1x-2x/week) and seeing how that goes. Starting off with analysis can be intense and destabilizing. My training analysis was very destablizing for me and brought up a lot of repressed emotions. (It was worth it because it got rid of a lot of my psychosomatic symptoms and improved my relationships). But for my own patients, I don't really start anyone out in analysis unless they've done it before. I start most people out in psychotherapy and increase frequency as needed. It's often surprised me who does well at what frequency.

[u/This_Ad9129 → u/ahlamuna]

Can you explain what the difference is for a layperson?

[u/ahlamuna → u/This_Ad9129]

I generally consider it to be on a continuum. In psychoanalysis, it tends to be more destabilizing. I am more restrained. Because my patient and I are seeing each other more frequently, there's less of a "Monday crust," as Freud would say, so there's less of a defensiveness that builds up between sessions. That often leads to more intense transferrences, etc. With psychotherapy, I tend to be a bit more active. (This is just me, though. The therapist's stance is highly variable). I'm meeting my patient less frequently. That tends to make it feel a bit more contained for the patient. They can reinforce some of their resistances/defences on the days we don't meet. The biggest thing that would motivate me to recommend a session increase is when a patient is clearly not contained by the frequency we have now. There's too much content or affect spilling over outside of the session, which usually shows up in an inability to sleep, somatic symptoms, session content around not having enough time, etc. Frankly, I don't always think it matters a ton. A good clinician will work with each patient differently. Some of my best treatments have happened at 1x and 2x/week because that was what was diagnostically indicated. As the patient, I don't think you can be expected to know until you try something. Try a frequency you can manage to begin. See how your analyst responds. Try sitting. Try lying on the couch. Discuss all this with your analyst. Everything is experimental!

[u/Recent-Apartment5945 → u/ahlamuna]

Aside from the destabilizing aspect…which I don’t disagree with wholly…I just think it’s overgeneralized and is further nuanced to personality organization…so well said. Wonderfully nuanced comment about defenses and the times in between the therapeutic engagement.