An Analyst Questions the Self-Perpetuating Side of Therapy
from the NY Times interview with Owen Renik, 2006
As a young boy growing up in the Bronx, Owen Renik saw his mother struggle with depression, watched helplessly as she deteriorated from a muscle-wasting disease, and spent months living with relatives because she was unable to care for him. From that powerlessness grew a desire to become a doctor. By the time Dr. Renik was out of college and had worked for a time driving a taxi in New York — an immersion course in brief counseling while dodging traffic — it was clear what kind of doctor he would be.
He fell hard for Freud, and as a successful psychoanalyst who was also a prolific writer and engaging speaker, he rose quickly in the psychoanalytic establishment. He has held high office in the American Psychoanalytic Association and at the field’s premier journal, The Psychoanalytic Quarterly, where he served as editor in chief for about a decade. As an insider, he has questioned the techniques and affectations of analysis in an attempt, he says, to spare the science of psychoanalysis from those who would make it a monastic ritual, a priesthood.
His book “Practical Psychoanalysis for Therapists and Patients,” released last month, is meant to give therapists, their clients and anyone interested in therapy a sense of how to navigate the chutes and ladders of treatment, what to expect from therapy and how to know when it’s time to stop. Dr. Renik, 64, has a private practice in San Francisco and is a training and supervising analyst at the San Francisco Psychoanalytic Institute and Society.
Q. Why do you think the profession of psychoanalysis needs corrective advice now?
A. The profession is in a great decline, and I predict the decline will continue. The reason for it, and the reason a corrective is needed now, is that although psychoanalysis began in a spirit of open-ended inquiry, with an orientation above all to be helpful to the patient, it took on a self-perpetuating guild mentality that was its ruin. The possibility is still open to reverse the decline, but it will be necessary to escape the clutches of an establishment that, unhappily, has increasingly gotten away from the original scientific enterprise.
Q. You place great emphasis in the book on symptom relief as the central measure of the effectiveness of therapy. Shouldn’t that be obvious?
A. Not necessarily. There is a tendency among psychoanalysts to pursue self-awareness as a goal in itself, rather than a means to an end. Originally, the idea was that the self-understanding that arose as a result of psychoanalysis was unique and impressive and valid because it afforded relief from symptoms that were otherwise impossible to treat.
If you don’t require that self-awareness be validated by symptom relief, there are two destructive consequences. The first is scientific. You have no independent variable to track; you set up a circular situation in which it’s the analyst’s theory that determines what is found in analysis. Many critics of psychoanalysis have recognized this.
But an equally important consequence is that you relieve the analyst of any accountability. The process can go on forever, and there are all kinds of temptations to extend it, including the therapist’s vanity, his inability to admit failure, his narcissism — and nobody likes lost income. The therapy then becomes an esoteric practice of proselytizing, rather than a discipline, and the proof of that is everywhere in the world, where fewer and fewer people go to analysis at all. If the therapy worked, people would be going.
Q. How long should you have to wait before expecting to see positive changes in your life?
A. I have no precise and general answer, but there should be evidence very quickly of some progress. This idea that you have to wait around a long time for the fruit to drop from the tree is nonsense. If you don’t see progress soon, you should move on. If you don’t get better quickly with the next person, fine; you may conclude that the process will take a little longer than you expected. But nothing all that much is lost. Hanging around forever and ever with the same person has a much greater nonrefundable cost.
Q. You challenge the traditional analytic notion that the therapist should be a neutral guide. Why?
A. I think there is a tendency to confuse a nonjudgmental attitude with the psychoanalytic concept of neutrality. But none of us can help having a personal take on any issue a patient is discussing, and there is no way for us to think about any issue — let alone intervene — without that being influenced by our own very personal psychology.
Therefore, the only thing that happens when we aspire to relative neutrality is that we encourage the analyst and the patient to create a fiction of impersonal contribution. That makes the influence of the analyst’s personal assumptions all the more powerful, because they’re exempted from review, they go underground.
Q. Doesn’t psychoanalysis find that some patients deliberately sabotage themselves because, consciously or not, they don’t really want to get better?
A. Yes, and this is a species of patient blaming. It means the analyst hasn’t understood what the patient’s misguided motivations are. Everybody is trying to cut himself the best deal possible, and if it looks like somebody is trying to do himself in, it’s only because he is trying to escape greater harm by doing so. One example from the book was rather ironic: the patient was continually attacking me, verbally, knowing that his accusations would be discredited. This preserved his wishful thinking that nothing was as it seemed and that his mother was more loving and supportive than he experienced her as being. Discovering this proved to be a turning point in the therapy.
Q. If psychoanalysis is to be more practical in the ways you suggest — providing quick symptom relief, discarding the fiction of therapist neutrality, encouraging more patient collaboration in treatment — is it still psychoanalysis?
A. Yes, I think it is. There are any number of traditional concepts that remain very useful, perhaps the most familiar being unconscious motivation. The effort to reveal such motives when they’re important remains. Another principle unique to psychoanalysis is paying close attention to the treatment relationship itself, and its role in the cure.
But the point is that technique should never define a science. Psychoanalysis doesn’t mean lying on a couch, it doesn’t mean coming in five times a week, and it doesn’t even mean free association. It means applying concepts scientifically to better understand patients.
Q. When is it time to stop therapy?
A. You should have a criterion for judging whether the outcome is satisfactory, which leaves you free to judge by trial and error. If the treatment seems sufficient, you stop. You can always resume the therapy when and if there’s a need. What might also happen along the way, you might become aware of other things that then you define as symptoms, and you want to address those. Let’s say you have trouble dating, for example. We discover when we look into it that you have trouble asserting yourself, and that applies in a number of areas, including your work life. So we go on, until you are able to make progress there. If you’re not having symptom trouble after that, there’s no reason to keep analyzing stuff. That’s it. You’re done.