Should I Enter Psychoanalytic Psychotherapy? If So What Can I Expect?

Entering psychoanalytic psychotherapy for the first time can be a daunting prospect

It is understandable that you may be dreading the initial encounter. What is necessary in making a commitment to an in-depth therapy, in sitting with a psychotherapist and examining one’s life? Coming to terms with certain realities that were previously avoided is emotionally challenging, and may feel scary. At times extremely painful feelings, embarrassing or shameful fantasies, and troubling memories will arise, all demanding the courage to confront, explore, understand, and resolve them.

The foundational elements of a successful psychoanalytic psychotherapy include persistence, the development of trust, feeling understood and cared about, feeling emotionally “held” through difficult and painful moments, mutual respect, a high level of technical skill on the part of the therapist, and a shared optimism regarding the outcome.

A 50-year-old biology professor in a suicidal crisis

A number of these principles are illustrated by the story of Bob, a 50-year-old biology professor at a local university who had previously been in psychotherapy with me. He returned in a suicidal crisis precipitated by an extremely uncomfortable experience, where he became visibly aroused in a classroom setting as he was teaching biology graduate students. Bob had been staring at an attractive graduate student, sitting about ten feet away from him, who was wearing a sexy outfit. A week before she had come on to him in his office. Being a happily married man, he had turned her down, yet in the interim had vivid sexual fantasies and dreams about her. Bob’s depression began to get worse, as he had no explanation for this embarrassing event where he had become aroused in front of his students. He just felt so confused and out of control of his sexual impulses.

As we began to explore his early childhood relations with his mother, Bob began to recall something insidious. She had fancied herself “progressive” and “a free spirit.” Not infrequently she would walk around the house naked, and would explain that “bodies are meant to be shown to others in their natural state.” Beginning when Bob was about four years old, his mother also began to touch him in places and in ways that made him feel very uncomfortable. This included giving “cleansing enemas.” And when he was about eight years old, she would massage Bob’s legs after he came home from playing ice hockey, and at times her hands approached his genitals. Ostensibly, this was to work out the knots in his leg muscles, which would “make him a better player.”

Bob had largely repressed many of these experiences until they began to emerge in his psychotherapy. At first Bob denied that he had any feelings at all about his mother’s behaviors (the feelings were just too emotionally threatening). Yet persistently and courageously Bob began to explore these memories along with their corresponding feelings. He recalled feeling humiliated by his mother touching him near his anal region, and inserting the enema tube into his rectum. The more he remembered, the angrier he became. He felt that his mother had no right to invade his body, and began to feel enraged at her, yet wondered why he had never protested out loud. Later he realized that his feelings of powerlessness related to fears that if he objected, his mother would complain to his father, who then might hit him with a belt in the same region of his body. Either way it would feel horribly humiliating, so he simply submitted.

I asked how he felt when his mother rubbed his legs and placed her hands near his genitals. At first he was horrified, then ashamed of the fact that he began to feel sexually stimulated by her actions. He had similar feelings when she walked around the house with no clothes on. In recalling his arousal Bob was filled with deep shame, couldn’t look me in the eye, and described a fear of going any further, and wanting to leave therapy.

I then asked Bob if he had any ideas regarding what was scaring him to the point of wanting to leave. He initially believed that it had to do with facing his feelings of shame and guilt over getting aroused by his mother’s sexual provocations. Over time, he began to realize that it was also something else – feelings of rage toward her that felt boundless – and were terrifying. He had felt a murderous rage toward his mother for what she had done to him; having felt betrayed, sexually aroused and overstimulated, guilty, and humiliated. These events had also filled him with deep feelings of self-hatred which had haunted him his entire adult life, yet whose origins had remained elusive until now.

Our work took place over several years’ time. My caring and empathic support enabled him to leave behind the highly destructive effects of his mother’s abusive treatment, and the failure of his father to protect him.

We finally began to understand why Bob became so highly aroused by that female graduate student. She bore a striking resemblance to his mother when he was a boy. Her physical appearance, manner of dress, body movements, and even her voice evoked memories of his mother as a young woman. And both women had behaved in a sexually provocative way toward him. In one session he suddenly exclaimed, “And my mother was even studying for her Ph.D. when I was a boy.”

At the time of this publication Bob is still in therapy. He is no longer depressed, and hasn’t had any suicidal feelings for over a year. He and Karen are happier together, and their sex life has become more pleasurable. Bob is gradually beginning to feel lighter, as if a great burden has been lifted off his shoulders. His self-hate has given way to emerging feelings of self-love for the first time in his entire life. Bob feels proud that he’s had the courage to stick with psychotherapy in the face of so many frightening and confusing emotions. I told him that I feel proud of his courage as well.

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