Damon Linker has a piece up at The Week that – uncharacteristically for him – is all about . . . him. And, more specifically, his nine-year exploration of self through psychodynamic psychotherapy:
Most of my experience with therapy has been with psychodynamic psychotherapists who’ve had psychoanalytic training but who tend to sit face-to-face with their patients, talking things through an hour at a time, once or twice a week, for months or years on end. For about six months out of those nine years, I’ve also tried Cognitive Behavioral Therapy (or CBT).
As Oliver Burkeman explains in a wonderful essay for The Guardian, CBT has been on the rise over the past few decades, with analytical approaches to therapy under relentless critical assault. Therapy in the Freudian tradition is supposedly unscientific, interminable, and expensive. Worst of all, there’s no proof that it works. CBT, by contrast, is in most cases quick, easy, and “evidence based.”
Or so we’ve been told for decades. But as Burkeman also notes, this has begun to change. Recent studies have cast doubt on the effectiveness of CBT while also raising the possibility that Freud-inspired talk therapy may work much better than once seemed to be the case.
This shift in the consensus jibes quite well with my own experience. Which is to say, CBT isn’t the panacea its boosters like to think it is, and psychodynamic therapy is far more efficacious than its detractors claim. Each has its place. Each is well-suited to certain kinds of people and problems. I’ve had positive experiences with both myself. Yet the psychodynamic model of the mind ultimately comes much closer to making sense of my psychological experience.
As he goes on to explain, CBT isn’t trying to “make sense” of anyone’s psychological experience – it’s trying to give you tools to assert control over that experience, or over the behavior that you habitually turn to in response to that experience:
Say I’m unhappy about something in my life: Whenever something surprising or unexpected happens in my daily routine I grow agitated, anxious, and angry. So I sit down with a CBT therapist and begin to problem-solve. She might explain that these negative emotions arise because I irrationally presume that things will always go badly, maybe even catastrophically, when I’m forced to think on my feet and make a last-minute change of plan. This inference triggers a panic response in my amygdala, the part of the brain responsible for emotional reactions — the one that might lead me to leap out of the way of a truck bearing down on me at high speed when crossing the street.
If I’m about to hit by a truck, such a panic response is good, and rational, since it might save me from a mortal threat. But why does my brain treat a minor last-minute change in my schedule as the equivalent of a life-threatening injury? There are all kinds of possibilities, many of them rooted in my past. But it doesn’t really matter for CBT. What does matter is that I recognize the response as irrational and seek to short-circuit the invalid inference. I might do this by keeping a diary in which I record every time something unexpected happens in my life, and the outcome. Before long, I’ll notice that most changes of plan don’t lead to catastrophe, and some of them actually make my life more interesting and fun.
And that’s the point: teaching myself to adjust my irrational associations.
Psychodynamic psychotherapy, meanwhile, grasps the other end of the stick:
But . . . [w]hat if I don’t have the foggiest idea of why I’m unhappy?
Unlike CBT, the psychodynamic approach to therapy sees human beings as strangers to themselves — unsure of what they want, self-subversive in their actions, and opaque in their motives. It therefore presumes that the obstacles to achieving rationality and happiness — which involves determining what we truly want and taking reasonable action to get it — are far greater than CBT presumes.
This means that psychodynamic therapy involves not simply listing problems and troubleshooting solutions, but making a concerted effort to achieve self-understanding — a process that takes time and often an enormous amount of work (and courage). Only then can we know what the true problems are and determine what kind of enduring solutions might be possible.
Though few psychodynamic psychotherapists these days accept Freud’s conclusions in all (or even most) of their details, they do affirm his overall model of the mind as containing sedimented layers of thinking, including a subconscious teeming with repressed images, desires, fantasies, hopes, and fears that can affect conscious thinking, acting, and feeling in strange, unpredictable ways. The mind does this by way of pre-rational forms of archaic thinking that take shape in childhood.
. . . [A]rchaic thinking can’t be changed or stopped just by pointing to surface-level behavior and feelings and labeling them “irrational.” The only way to change them is by working through the subconscious associations, emotions, and conflicts over and over again at the conscious level — in conversation with an analyst trained to look for clues of archaic thinking at work below the surface.
Three thoughts about this.
First, I’ve spent a number of years in psychodynamic psychotherapy myself, and I’ve found it enormously rewarding, both in that I feel in the sessions that I’m having an important experience, and that I feel I’ve taken from the sessions important understanding that has shaped and improved my life. I feel guilty, sometimes, about lavishing so much attention on my inner life – embarrassed, sometimes, about paying someone to listen to me. But it doesn’t feel like morbid self-absorption, not usually. It feels – when I do it “right” – directed at genuine understanding.
On the other hand, I notice that I can still be thrown off by the very sorts of mental habits that Linker highlights as the focus of cognitive-behavioral therapy. I’ve often asked my therapist whether it’s the little things – the bad mental habits and the behavior that results – that lead to deeper problems in one’s life, or whether it’s the deeper problems that lead to bad habits. The answer, of course, is, “yes.”
Which means these approaches are not competing, but complementary. You might say that cognitive-behavioral therapy aims at achieving self-control, while psychodynamic psychotherapy aims at achieving self-understanding. But what the ancients aimed for was self-mastery, something that encompassed both concepts and transcended them.
Second, I want to thank Linker for “putting himself in the frame,” something I often encourage opinion writers to do. There’s a tendency, in this business, to strive for a kind of objectivity or an Olympian perspective that is frankly and obviously nonsensical. An essential predicate – I’m absolutely convinced of this – to thinking clearly about any subject is understanding what you are bringing to the table that makes you, specifically, care. Because if you don’t see that, you can’t see around it – nor can you understand how your ideological opponents might be similarly affected by what they bring to the table, and get inside their heads.
As a culture, we’re comfortable doing this by identity category. We’re allowed to say: I feel this way because I’m a woman, or Jewish, or Hispanic, or deaf, or because I was abused as a child – and you don’t understand because you aren’t. The categories can be inherent or experiential, but they are asserted as a way of forcing somebody else to pay attention. Which, often enough, is very much merited. But it’s only a first step, because everybody brings something to the table, not just people who fit into trendy ideological boxes. And, more to the point, getting other people to pay attention is political and instrumental. Getting yourself to pay attention is the way to thinking, and writing, with greater clarity.
So I’m inclined to say that a lot more pundits would benefit from the kind of exploration Linker describes.
Unfortunately, as my final point, I have to point out that this kind of trip is really, really expensive. It is, for that reason, not scalable. It will only ever be available to an elite – and that elite may be shrinking because of Baumol’s cost disease, which makes anything labor-intensive more expensive over time as automation makes capital-intensive activities cheaper. That’s one reason CBT is so popular – it’s also not really scalable, but it’s more scalable by far than the psychodynamic approach. It’s a form of therapy perfectly suited to a society that finds the inner life to be a bit of a nuisance, but demands every-increasing organizational competence of its monads.
It is depressing to think that there are good economic reasons why an affluent society can’t afford to incubate very many mastered selves, but I don’t think the ancients would be surprised at all.