Questions for a new psychodynamic/psychoanalytic T

I know of quite a few psychoanalysts who see clients once a week and consider that analysis, I even saw one of them (although my ex-T is definitely not an example for a great T, IMO).

I personally would tell the new time upfront what you struggle with regarding the current T and that you don't know whether it is specific to that T or something more general that will likely show up with someone else as well. Can even ask if he has productive experience with negative transference. Given that issue, perhaps it would be worth looking for someone who identifies with the school of Modern Psychoanalysis - they very much center their approach around negative transference, especially anger and are supposed to welcome it. These are also the analysts who are more likely to see clients once a week and won't have long cancellation policies although I am sure many would be happy with more frequent sessions. Many also do phone therapy if you don't find one locally and if that's something you are open to.

"My T used to interpret my requests to modify the therapy as transference wishes, but now we have a T-client relationship instead of just the transference relationship. He made a few adjustments and it works well."

Interesting. I wonder if this is what my t is doing. I've got negative transference to her and I can see how resistance from this to her may be elided into her believing that it is all resistance when I have genuine concerns over her methods. To be fair I've only recently come to this. As I said further up I was groping to it at the last session. So I've not been able to talk to her about it. But this adds an interesting element. Thanks.

Eta: sorry for hijacking your thread.

This is really interesting. Honestly, it would have been really nice to have this info from the beginning. I still need to reread and process. My T can for sure be supportive but as I’ve been in therapy longer he’s leaned away from that and more towards “expressive.” Ultimately I like the goals of that type of therapy, but only if I don’t lose my mind in the interim.

I plan to ask him if he’ll do a second weekly session at 6:00 am. I assume the answer will be no. If the new T that I meet in a week can meet me twice/week and I like her, maybe I should switch to her even though the thought of leaving my current T makes me a bit sad. I will also plan to discuss with him what the benefits might be of just meeting him once/week. I don’t necessarily want to leave, but also don’t want to stick around just to torture myself. But, as you suggest, maybe he can modify the way things work and still accomplish an exploratory type of therapy, although more slowly.

By the way-all the types of psychoanalytic therapy done these days except Freudian are considered modern (or contemporary) analysis.

Could you do a video session for the 2nd weekly session?

He doesn’t do Skype/video sessions, unfortunately.

What I am referring to is a specific school/interest, originally established by Hyman Spotnitz.

I know you were as I've read your posts about him in the past. Spotnitz is self-psychology much like Kohut. Self psychology is one of three I've been discussing:

Objection relations
Self-psychology
Relational

Those are the 3 main ones that are considered within of the modern school of thought. They all do once a week psychoanalytic therapy, but some clients need it more. This is opposed to Freudian, which is "classic"/nonmodern.

My therapist has talked about this in terms of an "uncovering" approach and a supportive approach, and has expressed that he feels that both components are necessary, and that uncovering can only happen as fully as possible if support is also given when appropriate. Therapy can't always be comfortable, but it does need to be bearable.

Honestly, I don't think even the most traditional analysts eschew supportive techniques altogether all of the time
My experience is that supporting and uncovering interventions are part of the same continuum, where the key is finding the right balance both in the moment and over time

Is "Freudian" really a separate school of thought from the others you listed, where you are? I don't know any analysts or therapists who work psychoanalytically who don't see themselves as Freudian in some sense unless they identify as Lacanian (or Jungian, I suppose, but I haven't met any of those), despite very much using object relations and relational theories in their work.

I feel like "Freudian" gets used as a specific label more as a pejorative where I am, by people who don't know much about contemporary psychoanalysis in clinical practice and don't realize that their impression is closer to a parody than to what actually happens in analysis and analytic therapy.

I agree that "modern" can refer to a broader variety but am holding that I speak about something more specific regarding working with anger and frustration. Spotnitz had specific concepts on his own that do build on self psychology but he developed his own more specific concepts and approach, originally while treating schizophrenia and narcissistic disorders. I took classes at the Center for Modern Psychoanalytic Studies and discussed theory a lot with my ex-T who followed that tradition (he is directly from the lineage of Spotnitz followers) so am pretty confident in what I am saying. It was actually part of the reason that analyst was not a good fit for me - he has that interest very strongly and wants to work with every client that way, but I did not find it useful, I don't think I have the relevant issues. Anyway, one can look up all that online.

Yes it is separate in that the key concepts are structural and drive theory. No, I'm not taking my location into consideration.

I do agree with what you're saying about dismissing Freud, it does get ridiculous and therapists get it wrong all the time when discussing. Most I know still use concepts like neurosis, hysteria, defenses, conflicts, etc. They are still useful to me too, and I know these are actively used in some way or another as all therapy is Freudian in a sense. But hardly anyone uses drive theory and psychosexual development anymore, which is why I say there really are no Freudian analysts. I still use some of these concepts for myself (and talk about them here) because I think they are still relevant.

There are so many overlapping concepts, structures, and methods which is why I've been trying to say to help Lrad, if you look it as expressive vs supportive, that's the one component that informs what to expect for the most part. I also agree ideally it is a always a mixture of both but many analysts favor certain schools of thought and although they incorporate both, they often tend to lean towards one or the other.

There's all the different classifications which can't be illustrated effectively without using a tree diagram as they are hierarchical and most are not mutually exclusive, so they cannot be categorized easily. (Interesting-this is sort of like the DSM where everything overlaps and is messy-no wonder the inter-rater reliability is all messed up. Which is another reason why I like Glen Gabbard-he includes everything from all the different schools and is very contextual.

In thinking through this, I came up with a few classifications though not wholly accurate unless a tree is done. I may have gotten some of the classical vs modern wrong thinking date was the delineation but it's not. It seems modern or contemporary can sometimes be the same as interpersonal or relational but sometimes not. I can't figure it out now as I have to run. I also don't see where this Spotnitz guy fits in-i thought he was self psychology but he's also under interpersonal or mostly excluded-hmm.

Key theoretical frameworks/schools of thought:
Topographical/Structural/Drive Theory (eg Freud)
Ego psychology (eg Erikson, Anna Freud)
Object relations (eg Winnicott, Klein, Kernberg)
Self-psychology (eg Kohut, Stern)
Relational/Attachment (eg Bowbly, Ainsworth, Schore, Fonagy)
There's a few more such as Lacanian; Spotnitz?

I prefer to think of it all as 'developmental'. It's also confusing since all psychoanalytical methods are considered relational, but object relations isn't really considered relational.

That's why I was trying to simplify everything in the way I was referring to it before to help Lrad see what's out there-the key differences.

Thanks for explaining. I ended up concluding he was his own thing when I was trying to sort everything out. Looking back, I think it's similar to object relations and attachment theory-sometimes attachment is part of it, sometimes it's not and is considered a separate concept. And like sometimes interpersonal is considered part of relational, yet sometimes it's not and is it's own separate thing. So I think there may be multiple ways to look at the same thing, and I'd imagine multiple professors have different ways of looking at it, depending on who is instructing the class. So I think a tree is the best way to visualize.

I'm still confused by your take on this because they all technically work with anger and frustration and negative transference, but I'll just have to read up on it more if I get the urge.

Of note, my therapist, who typically discloses nothing, disclosed that his analyst was James Grotstein and his analyst’s analyst was Bion. I think that puts him in the object relations camp perhaps. I didn’t know who either of these analysts were before I looked them up and find them both sort of hard to read.

Back to the original question of this thread. I just thought of perhaps the most important question to ask a new T:

Have you had therapy yourself?

I’m guessing the answer will always be yes for someone who practices psychoanalytically, but I’d like to hear her answer.

Yes, it can be informative to see how they answer questions about themselves even if the answer is obvious. I like Ts who have websites with a small resume about their training and experience, so I usually know that by the time I contact them. If I were to interview a T now, I would still ask them to tell me about their training and work experience a bit, to see how they describe it on the spot and what they emphasize. I would also ask them what specific concepts and theories have impacted them the most and what they consider their professional specialities.

My last T asked me to email him some text about myself, my story, issues or whatever, before our first session. I enjoyed writing that up and seeing how he brought it up and discussed it in the session. It established an immediate good connection between us because he obviously related to a lot of how I presented myself in that letter, and I clearly felt it was genuine, not just a selling attempt.

Not sure exactly where to post this, but I met with my usual T today and he is not willing to do 6:00 a.m. as a second weekly session. So that’s a bummer. Now that I’m finally open to doing 2x/week and realizing it’s not available to me is frustrating.

That's a pity but I guess these are the circumstances right now. Did he also tell you the reasons?

Anyway, I suppose in this case now exploring options with other T's is even more justified and hopefully you will meet someone who seems to suit you as well as the current T and who can provide you more frequent sessions at the times that suit you.

He said the early morning sessions have gotten harder as he’s gotten older (he’s 63 according to Google). He did offer me 7:00 a.m. on a different day which I can only make 50% of the time due to my work obligations. He said it wouldn’t work to come the the 2nd weekly session only 50% of the time which I don’t completely understand, although I do genuinely understand that it’s a business for him and not ideal to fill up a slot only 1/2 the time. Also, since he’s been so open about me seeing other T’s our sessions have been going much better. I am just more open and less tense. I do meet a new T next week and will see how that goes.

I think one has to be REALLY motivated somehow to commit to regular 6 am meetings I personally would not do that with any job even if the client paid me double fee. And I am a morning person but not for meetings

Does your work have no flexibility-even to ask for alternative arrangements?

The consistency in scheduling is important for containment when doing depth work. My T emphasizes this too.

Too bad you can't find a solution.

On second thought, perhaps also slightly adjusting your expectations may make the once a week more workable at this point? Maybe you already have since the initial dilemma...

Sorry to derail... but Bion, wow!!

I've had a 2.5 yr stand off about wanting/needing a second weekly session and not being able to have one - due to both of our other commitments. This coincided with a similar period of negative transference. For me, I think the 2 things were linked. It's ironic that now I don't feel I need a second session and I no longer feel as intensely angry towards him, I can have it due to his commitments changing.

I think it's good to look into seeing other therapists too. I wish I'd done that.

Also, who said psychoanalytic therapists can't see people once a week? Sure, it's not the definition of analysis but it's still ok in therapy terms.

Yeah, that’s fair. I would do it because it’s my therapy and right now I’m motivated to find a time that works, but I can see why he wouldn’t want to do it. Kind of a bummer because he planted the seed that got me thinking it might be a possibility. Looking on the bright side, at least I don’t have to be somewhere at 6:00 a.m. now.

Yeah, now it sort of seems like he was name-dropping which didn’t actually work since I had no idea who Bion was. Although my T knew darned well i was going to go home and look him up. Strange piece of info for him to disclose.

Since we’ve determined that we basically have the same T (seriously, do we?) what do you think he’ll say if I propose going every Wednesday as currently scheduled AND all but one Thursday/month for the second weekly session? He said no when I said I’d have to skip 2 Thursdays/month, but I think I can make it to all but one/month. Is that enough containment (assuming that’s the issue)? I’m really trying here. Isn’t there something to be said for compromise on the T’s part as well? It’s actually sort of funny that I’m basically begging for a second session because I have a history of having a very hard time making it to my weekly sessions. I always made it, but felt like there was a magnet pulling me away from his office as I was driving there. Now I’m basically pleading with him to let me come a second time per week.