Dr. David Van Nuys: Welcome to Wise Counsel, a podcast interview series sponsored by CenterSite, LLC, covering topics in mental health, wellness and psychotherapy.
My name is Dr. David Van Nuys. I'm the clinical psychologist and your host.
On today's show, we'll be talking about the question: is psychoanalysis dead with my guest Dr. Fern Cohen. Fern W. Cohen, Ph.D. is a psychoanalyst and psychotherapist in private practice in New York City. She has long been committed to conveying in every day language what the psychoanalytic process is about and how it works.
She's the author of the 2007 book "From Both Sides of the Couch: Reflections of a Psychoanalyst, Daughter, Tennis Player and Other Selves." She's also a graduate of Radcliff College. Dr. Cohen earned her Ph.D. in school psychology from New York University and completed her analytic training at the NYU post-doctoral program in psychotherapy and psychoanalysis, as well as the Institute for Psychoanalytic Training and Research of which she's a member.
When she's not playing tennis, hanging out with her grandchildren or mastering music for two pianos, she is practicing psychoanalysis in New York City. Now, here's the interview.
David: Dr. Fern Cohen, welcome to Wise Counsel.
Fern: Thank you I'm happy to be speaking to you.
David: Yes, you and I have spoken twice before on my other podcast at Shrink Wrap Radio. I really wanted my Wise Counsel audience to have the exposure to you, as well. In our previous conversations, we spoke about your book: "From Both Sides of the Couch." On another occasion we shared our reactions to the HBO series "In Treatment."
Today I would like us to focus on the state of psychoanalysis. I have kind of titled our session, I framed it: Is psychoanalysis dead? Which maybe is a little extreme. So, I'd like us to focus on the state of psychoanalysis: past, present and future.
Fern: Well, remembering that I'm just an N of one.
David: OK. [laughter] One person, one psychoanalyst's perspective. Well, let's start with the big question and then we can maybe slice and dice it.
David: ...which is, is psychoanalysis dead?
Fern: Well, I think it depends who you speak to. I certainly don't think its dead. I still think of it as do my colleagues who are analysts as a very viable, in some ways essential process. However, we are small in number and growing smaller. I think many in the rest of the world certainly would suggest we think that we're dying or if not dead, on the way to.
Some of that actually I think is cultural. I think we live in a society where so many things are approached as a quick fix, medication. We have the insurance industry, which really doesn't reimburse the psychoanalysis because it's consuming and takes a long time.
So we are less recognized as a discipline in other parts of the health field. So I think that doesn't help. But I think, as a process, it still has enormous value. I think there are people who continue to study it to become analysts. And people who do undergo it, who also find it valuable but certainly a lot smaller number.
I don't know what that number is, relative to when psychoanalysis which was really in it's heyday in this country. This would be in the 1950s and the 1960s.
David: Right. Right. And maybe I should back up just a little bit and maybe go into your past a little bit. Let me remind you not to hold the phone too close to your mouth.
David: I'm hearing some of those applausive sounds.
David: So, let's back up a little bit and let me ask you about what drew you personally to psychoanalysis?
Fern: Well, as I've written about in my book and one of the reasons I wrote the book, it was my own personal experience. As an adolescent, I was in college. I describe it falling part. I never left college, but I had broken up with my boyfriend. I had become somewhat anorexic. I was weepy. My parents took me to somebody, Felina Deutsch who was then one of the doyens' psychoanalysis.
David: Sure, I recognize the name. One of the big names.
Fern: Yeah, she was one of the people who had immigrated just before the war and practiced in Boston. She had been in that early circle or close to that early circle, following Freud. And I ended up with somebody in psychotherapy and then he suggested an analysis.
In those days, it lasted from four years, which in those days was about the average length. And it really changed the direction of my life. I had known nothing about the unconscious. I grew up in a family where the conviction was that you just figure out your problems. You can solve them with reason.
I had no idea about the universe that controlled so much of what we do. So, it's really a personal experience, although it took me many years before I decided to become an analyst.
David: Actually, I know from reading your book and speaking with you before that you ended up going into analysis on three different occasions.
Fern: Yes. This is a horrifying thought to many people. [laughter] But it wasn't horrifying to me. I had four years of analysis when I was a college student and then I stayed an extra year and my analyst agreed that I was "finished." I put that in quotes.
Also, I was offered a job teaching in New York. So I came to New York. After about a year, I discovered that some of the patterns that I had started to learn about, like getting involved with very distant men, who represented different versions of my father. The emotional distance that there was with him. I was still getting involved with them.
So, I went back into analysis again in New York for another four years. Although I consider those two analyses, like one; continuing with a different person.
Fern: And at the end of that time, I had married. I was pregnant with my first child and I really felt quite prepared and not finished. I don't think you ever feel finished.
But in some ways naively I would never need to be in analysis again since I had acquired such good tools. I am not sure how much detail you want.
I had been a teacher and then decided to stay home when I raised the children. But I had been doing part time work as a therapeutic tutor. One thing lead to another and I realized I did not have any of the credentials.
So I went back to graduate school to get my Ph.D. When our youngest child was three, we have three kids and discovered the whole world of psychology and worked as a school psychologist, had a small private practice. And when our kids had really started leaving the nest and I was becoming more and more involved in my work, I began to feel that I was becoming a workaholic like my father. And I really couldn't control it.
I also kept discovering things that came up in my work which suggested that I should think about doing a little more work on myself. So I decided to start therapy twice a week. And the next thing I knew, and it was very dramatic, and I have tried to describe it in the book. I just fell into this rabbit hole with analysis where all the things that I hadn't touched about my relationship with my father, my sense of self-worth, my need to prove that I could be good enough, just erupted. So I ended up in another very long analysis.
And as long as I was doing that, I decided I was a psychologist. I had my Ph.D. I had been a therapist, so maybe I should become an analyst myself. Now that takes a very intensive training. You have to be in your own analysis. You do clinical work under supervision. You take courses. So that took a while.
So I'm a rather late to the scene analyst. But I have absolutely no regrets that I finally got to it. And I think that it's lucky that age is not necessarily a detractor.
David Van Nuys, Ph.D.: Yeah. Right.
Fern: I think in other fields I'd be in a lot of trouble. [laughs]
David: I think we hope for some wisdom from our therapists and our analysts, so age should be an asset I think. Now as you mentioned, you're a Ph.D., and aren't most analysts M.D.'s, or is that changing?
Fern: That's a good question. That's really changing a lot, particularly in this country, in America. The medical analysts formed the first institutes. There are other institutes, but when I refer to an analytic training institute, I'm referring to ones that were recognized by the International Psychoanalytic Association in Europe, which is the umbrella group of people who have been trained in the Freudian tradition.
And in those days, they would only accept a medical doctor to be an analyst. Now it must be that 15 or even 20 years ago, some people managed to form institutes that they weren't recognized by the IPA, because they had psychologists and social workers. But then some psychologist initiated a lawsuit against the medical exclusivity.
Fern: And we won the lawsuit, which meant that the classical training institutes had to accept psychologists and social workers as long as they were qualified and had the prerequisite background. So nowadays, there's been a real turnaround. Because I think in the 50's and 60's, almost all the psychoanalysts, trained ones, were medical doctors, although there were always a few exceptions.
And nowadays I think psychiatrists are not really studying analysis. They have no exposure to dynamics in medical school. They're exposed to medication. And I think their whole orientation, as with the rest of the culture, is to medicate people.
David: Yeah. I seem to recall that even Freud himself was opposed to requiring that analysts have an MD, even though he had one.
Fern: That's true. In one of his papers, "The Question of Lay Analysis", he argued quite cogently on not having people be medical doctors, because he felt there was a lot about their training that precluded the kind of thinking that an analyst should be capable of. And he felt the arts and people who have studied other areas of learning and creativity might be just as effective if not more so.
But he lost that battle in this country. And for many years the medical model really had a strangle hold. It's sort of ironic, because while there are still some psychiatrists who become analysts, I don't know what the numbers are, but there are fewer and fewer.
David: Yeah, and for the reasons that you outlined. I think, speaking of Freud, people outside the field might not be aware that psychoanalysis has continued to evolve since the time of Freud. What are some of the major evolutionary developments?
Fern: Well there are of course many different perspectives that people have as analysts nowadays. I mean I could list names, clinician, relational, object theorist. But from my perspective the biggest change has been the idea of the analyst as a completely neutral screen, reflecting back to the patient interpretations and really a one way process, as if the patient were not an equal participant in the process.
And I think the big shift is that for most of us analysts, it's a two way process. Which means that, and it's hard to capture in words, because my last analyst who was a contemporary Freudian, was certainly silent a lot of the time. And it doesn't necessarily mean more talkative, but a way of conveying that it's about "we" as opposed to you the analysand and me the analyst who's an authority.
If one makes a mistake with analysis it...
David: You mean a therapist?
Fern: A therapist, yeah. Occasionally express an opinion. You know there used to be a dictum in the classical that the analyst never answered a question. So people would get either silence or another question. And I had found that it doesn't really matter if I tell a patient whether or not I've read a particular book when they ask me. Because invariably they go on to tell me what it was about the book that they wanted to tell me.
We're not getting into a discussion about the book, but it seems to me that it doesn't spoil anything in the transference to answer the question. So that's a small example, but I think it conveys that the analyst is more there. It's hard to put into words. And that's another thing that I tried to capture in the book so people can have this sense of what it was like in the very classical days and some of the shifts that have happened.
David: Yeah, you actually cover that very well in your book. The book is framed as a memoir, but actually, there's also a lot of solid information really about psychoanalytic thought and some of the shifts that have happened over time. And that sort of very distant stance that originally was exercised by psychoanalysts of the "blank screen", that's really been burlesqued quite a bit...
Fern: Oh, yeah.
David: ...in movies and cartoons and so on. And maybe that perception too has contributed to the decline in popularity, I guess is the right word.
Fern: I don't know if it was ever popular. I think, even in Freud's day, when the first analysts were starting to do their work and people were very excited about becoming analysts or being...
I mean, Freud was beleaguered from the beginning. I don't know what the numbers are, but I think it's always been not a popular therapy, although, certainly, in its heyday in New York or California... people still joke about - and I think its true - people in New York are still in therapy. I don't know how much in analysis, but certainly, on the coast, it's still actually flourishing.
I don't know as much as it was in the early days, because it's so expensive, it's so time-consuming, and there is no coverage. It's hard for people who don't have a lot of money, or even money to spare, to do it, although there are some very good training institutes, which is where and how people can get a good analysis without having to pay a lot of money.
David: Well, that's a good point. In a way, I think psychoanalysis has become - because of the cost and so on - and I know, initially, you said some people are horrified to hear how long you've been in analysis...
Fern: I won't even tell them how long my last one took.
David: [laughing] But, from another point of view, it's really a luxury, isn't it? To be able to afford to spend that much time with oneself, and exploring one's unconscious, and deeper potentialities.
Fern: It is, and actually, I quoted something from my book to a patient who was struggling with her analysis, and happy that she's doing it. In some ways, it's a luxury, but there's a poem from Yeats - I think it's 'Sailing to Byzantium' - where he talks about, in the first stanza, "An aged man is but a paltry thing unless soul clap its hands and sing." I do think analysis has potential to help people clap their hands and sing, and to me, that is a very valuable gift to be able to give to somebody, or to help somebody reach.
Actually, the person to whom I was referring came to me about three years ago, in her early 60s, telling me that she was looking for somebody who could do supportive therapy for her once a week. She had been on medication since she was 28, when she was diagnosed with post-partum depression - had seen one psychiatrist for a long time, but a few psychiatrists over that period, once a week, sometimes every other week. They monitored her medication, and she said, "I'm a depressive."
When I began to talk to her, it was so clear that she had had a traumatic childhood, which she had survived and really done enormously well. She was educated, she had a family, but she lived on the surface of her emotions. She had absolutely no tools for dealing with conflict, with issues of separation, things that were coming up with her husband and her children. She very skeptically agreed to see me twice a week, and we began to work. She had never acquired tools about herself. When she was feeling stressed, she'd take her medication.
A year later, she was off medication. She agreed to be in analysis. She's in the middle of a very intense analysis, and she is really dealing with the kinds of injury that had kept her, in some ways, very distant from people and frightened of her emotions. In terms of the world, I don't think anybody would notice very much the changes in her, but she has actually started writing. There's this amazing outpouring of writing as she describes some of her early experiences, heals them, and is really growing past them.
I don't know how you weigh that. I mean, its one person. I'm not out there making a contribution to large groups of people, and God knows that they need it, but I do feel that psychoanalysis has the power to give people back to themselves what they were not able to do, for one or another reason.
I don't know whether that answers, but it's as close as I can come to an explanation.
David: Yeah, well, it really helps to illuminate that beautiful line that you quoted from Yeats, and let me remind you about the phone mouthpiece again.
Fern: OK, sorry.
David: But I really appreciate that case history that you shared, and I think one of the things that it underscored is maybe not as much of an emphasis on the symptoms as on the quality of the inner life and the experience.
Fern: That's actually putting it in a much more encapsulated way, because, for all intents and purposes, looking at this woman, everybody would think she had had a very successful, satisfying life, and there were real pockets of omissions and losses. She's also recently become a grandmother, and I think that whole experience - it's opened her up, to that experience with her kids in a very different way than she would have been able to do or to share.
David: Yeah. Another thought that I haven't really shared with anyone before is, as I think about the decline of psychoanalysis in terms of the image of it - I'm going on the basis of contact with students, having been a professor for a long time, and so I've seen the way they think about different approaches evolve over time - I think that the feminist movement dealt a big blow with all the mocking the idea of penis envy and so on. What do you think of that?
Fern: Well, I think it did for a while, but there was a really interesting response on the part of a number of woman analysts who began to write about the female experience and some of the psychological differences that were embedded in the gender differences - women's greater vulnerability because of things like penetration as opposed to having a penis, which predisposes men to a different kind of activity.
I don't know, today, whether that still holds true. It certainly did for a while, but I think there's been a very big shift in understanding about female development, and also really early. I mean, now we know one thing that Freud is certainly open to criticism about - after all, he analyzed himself. He really never analyzed his relationship with his mother; he focused on his father, and while he did recognize the mother as the significant love object for the child, he really didn't know much about early development, and he postulated that little girls developed sexually the same way that boys did until they reached genital phase. He was really off about that. I mean he called women the-was it the "Dark continent" or something like that?
Fern: So I mean he was wrong, and he certainly was easy to take on from that perspective. But I have always felt that you don't throw out the baby with the bath water, and there's so much of Frued that continues to be relevant today-- not all of it.
I do think he gave us a way to try to understand unconscious mind, and to recognize the ways in which it affects us, and sometimes help us grow past the extent to which it can be throw us.
I think a lot of what he has theorized certainly about the clinical material holds quite true, although a contemporary analyst going back to some of his cases would probably diagnosis them of much more severely disturbed like borderline and narcissistic, but that isn't where Freud started from, he really focused on hysteria.
I don't know what the numbers are, but I don't think it has had a lasting impact-the feminist downplaying.
David: Yeah. To spite all the critique of Freud we do live in a Freudian culture kind of in the way that they say that, "The fish is unaware of the water that it's swimming in," because it's such a pervasive medium.
Fern: That's right.
David: Americans and most of the world in general just assumes unconscious motivation, that some of the things that we do, much of what we do that we're not always conscious of the reasons why we're doing things, and we take for granted defense mechanisms, and so on. Movie and novels revolve around these ideas in ways that are just absolutely taken for granted.
Fern: That's right, and it's quite disconnected from Freud, [laughs] because he has nothing to do with it.
David: [laughs] It is, right.
Fern: I also think his impact on education and the way people think about children and learning, I think it just has so permeated our culture.
Fern: What is interesting is that he is not taught so much anymore in clinical training programs. Also many of the internships, at least in New York but I have heard it's true through out the country, many of the internships psychologists undertake as part of their getting a PhD are pretty much focused now on cognitive behavioral therapy or a DBT, a dialectical behavioral therapy.
I think that's really a disaster for training for people having exposure for a variety of ways to thinking about development, because cognitive behavioral therapy is not interested in what happened in the past. It's really focused on changing the behavior, so it leaves a whole body of unconscious mind untouched.
David: Yes. It's been my experience that many of the people that I know who are trained what you and I might characterize as a more superficial approach, later on after some years of practice, some of the people that I know actually went on to seek out psychoanalysis, because they were looking for something that was deeper that could take them further then what they had been trained in.
Fern: I have heard that too. I've even heard that some cognitive behavioral people are beginning to introduce the idea of the unconscious in their work, but I think it's hard to straddle two worlds.
I think there's something about being a person who has instructs somebody in ways to deal with their feelings or their anxieties, that's a very different role from being the analyst where it's much more of an unfolding process and mutual discovery.
Actually, the analyst I think is less of an authority, because you're figuring out things as you go. I mean you hope you're a couple of steps ahead of your patients, not always, but you use ... I mean Freud captured it in that metaphor, "It's really a journey together."
It's not a process where one is a teacher and the other is a student, even though one does have a certain authority because of the training. I think it's important to have some of that, not to use it, but it is part of how the relationship gets going and grows, because it really does change.
David: OK; and I have to remind you about the phone again.
Fern: OK, I'm sulking. I realized it's a Princess phone, which is harder to hold the weight up.
David: Oh, a Princess phone!
Fern: OK, but it's too late. I don't have the other kind anymore.
David: It's probably quite valuable now; a Princess phone! [laughs]
Fern: I am a diehard. I hate using cordless phones, and people tell me they can't hear me at all on a cordless phone.
David: Yeah. Well I really want to thank you for hanging in here with me, because I know that you've been feeling a bit under the weather.
Fern: It's actually good to be talking to you.
David: Yeah, that's great! [laughs] I know it's a little hard on your voice. So we're getting near the end here, but I wanted to just have you talk a little bit about the distinction between formal psychoanalysis vs. psychoanalytically therapy. I know you do both, so just help us with that distinction.
Fern: OK. Well with the acknowledgement that the mind gets increasingly blurred, I think of the tools are the same.
I mean it's trying to get at the unconscious connection, but psychodynamic therapy can be twice a week or sometimes even three times a week, once a week.
The difference is aside from the person usually uses a couch in an analysis, that with much frequency it's harder for an intense transference to develop to the analyst. It is the transference, the patient's reactions to the analyst, as an important figure from the past that really allows the patient or the analysand to access the stuff that he or she has been warding off.
For instance when I said, "I fell down the rabbit hole" in the last analysis, my analyst immediately became a version of my father. He again recommended to me inadvertently as the best, and my father was the best in his field. So I assumed he was the best, he had much more knowledge than I.
I was just gripped by this need to be there as much as I could. As things began to spill out, the intensity of that experience wanting him to know who I was, which I felt my father never could; having a very difficult time if ever I had to talk about my work, because I couldn't believe he would ever think I was competent.
It was working through that experience of becoming really like a child in relation to him that I was able to grow into an adult self, and no longer felt that I could never measure up; I felt that I could have a mind of my own, that many of my thoughts were valuable. And to me that probably could never have happened twice a week. I think I would have done from useful work with him, but I know the things that were getting in my way as a therapist and a person needed to go back to that rock bottom time when I thought that I really could never connect with my father who was married to his work. And he was a loving father to the extent that he could be, but it wasn't enough for a child who needed the human connection.
So it's really the transference, because and another facet of it is somebody is going to undergo an intense transference, to wait from a Monday to a Thursday of when you next have an appointment can be pretty unbearable, and the separation for some people are very difficult. The woman whom I talked about had a mother who was alcoholic, never available, sent her away to boarding school when she was six. And never had the sense, (as my patient said to me not so long ago) that there was a lap in which she could sit or rest.
And I think part of her treatment has been her getting to feel that there is an available lap or a connection with somebody who is interested in her and can help her grow. And in order to do that, I think one needs a frequency to help tolerate what can be a very difficult process, because we're dealing with feelings that have been buried and put away because they felt too unbearable in the first place.
David Van Nuys, Ph.D.: OK now I'm feeling very irreverent, and I have to ask you, did you ever see the movie "What About Bob?"
Fern: Several patients have mentioned it. I can tell you I can't bear to go see movies that make fun of analysts. [laughing]
David: Oh, it's so much fun. [laughing]
Fern: All right, I will rent it.
David: Yeah, rent it. It is so funny. It's Bill Murray and Richard Dreyfuss. And it is a send up. And what made me think of it is you were talking about the way in which the patient can become, well in a way kind of very dependent and needing these frequent visits. And that's really what that whole comedy revolves around. And you've really got to see it. Let me know what you think. It will lift your spirits.
David: So one final question here, which is, and you've already made a case for how psychoanalysts aren't seeing themselves so much as experts, and now I'm asking you to be an expert. Where do you see psychoanalysis going in the future?
David: Or are there modern trends that are sort of pushing it in a different direction?
Fern: Well, you know I'm not sure I can really answer that. One trend that has happened within psychoanalysis is that there are so many different what we call orientations that there has even been, and there has always been, a certain amount of fragmentation among analysts who if they think they have the truth find it difficult to accept an alternative truth from another group. Some of that has modulated over the years. But it's even hard to think about analysis as a singular process, because there are some extreme differences.
For instance, some of the relational people believe that the process is really a co-creation between the analyst and the analysand, so that it's less about the transference that the patient brings, but something that grows between the two. So it's hard to know, I mean I do know, at NYU post-doc, for instance, where one of the institutes I trained at, although they had a Freudian track which I was in, and they had an independent track, the relational track has pretty much become the dominant one. So even within psychoanalysis there are many different orientations and approaches.
So it's also hard for me to think that psychoanalysis will not continue in some form. I think there have always been people who believe in it and will continue to believe in it. Another facet is it's hard to earn a living as a psychoanalyst. If you practice within the health care system, you really don't get much reimbursement. And if you practice without, well if you only want to see wealthy people, you have to have a scale. So it's difficult to earn a living.
But I still think there will be a core of people who will continue to practice it and people who will do it. I can't imagine it not existing in some form, even though it may evolve into a somewhat differnt form, then I would recognize the new one to follow.
At least I hope I have to hope that it continues, because I think it's too valuable.
David: Yeah, I agree. Well Dr. Fern Cohen, it's always fascinating to speak with you, and I want to thank you so much for being my guest again today on Wise Counsel.
Fern: And I thank you. I always enjoy our conversations too.
David: I hope you enjoyed this interview with New York City psychoanalyst Dr. Fern Cohen. If you're at all interested in the sorts of issues we discussed here, I can heartily recommend Dr. Cohen's book, "From Both Sides of the Couch". It's a terrific read, providing unique insights from, as the title suggest, both sides of the couch. She takes us inside her own life and personal struggles as well as illuminating the processes of classical psychoanalysis. Both in my interviews with her and in her book she really dispels the stereotype of the distant unknowable psychoanalyst. And in that she's really given us all a gift.
You've been listening to Wise Counsel, a podcast interview series sponsored by CenterSite, LLC. Until next time, this is Dr. David Van Nuys, and you've been listening to Wise Counsel.