The problem of help in psychoanalytic psychotherapy

As a psychotherapist I am part of what is called a helping profession. This includes doctors, nurses, physiotherapists, social workers, therapists and all those who are committed to help people develop and work through physical, psychological, intellectual and emotional problems, aiming for their wellbeing.

Psychoanalytic psychotherapy however is a peculiar helping profession, as the help someone will receive may be very different from what they wished for in the first place. I’ll explain.

I see a wide range of people in my psychotherapy practice in London, coming from all sorts of cultural, social and ethnical backgrounds. Many seek help in the middle of a crisis, some reaping the consequences of the aftermath. I see people suffering from depression, obsessive-compulsive symptoms, stress, acute anxiety, panic attacks, you name it. So it’s fair enough to assume that what every person wishes for is to get rid of what has been making them suffer. In this sense, help would consist in removing whatever symptom, issue or problem that brought the person to seek my help as a psychotherapist. Fair enough, it’s a reasonable thing to wish for.

However, a psychological or emotional problem, be it a symptom or patterns of behaving and relating to others, is not a foreign entity like a virus or bacteria, nor something that can be surgically removed like a growth or an abscess. Psychoanalytically speaking, everything that happens in the the mind and translates into everyday life is part of a complex construction of ways in which we organise our internal world, as we attempt to deal with some difficult aspects of ourselves and of life. This includes the way we handle our destructive impulses, our innate capacity for hurting ourselves and those we love and how we deal with painful experiences in life, things like frustration, disappointment, guilt and loss.

People often decide to seek the help of a psychotherapist when the way they lived their lives so far becomes unbearable, or when they realise they can no longer sustain a healthy balanced life in regards to how they feel, behave and relate to others. A lot of it has do to with the collapse of this complex mental structure that was put in place to deal with the undesirable and unbearable experiences we all face in life, be them internal or external. Nonetheless, the help that people often wish for when they first come is to actually be taken back to the place they were before the crisis, before they were debilitated by their struggle. As a psychotherapist I then meet (break) this expectation by helping the person realise that the way they were before is actually what led them to collapse in the first place.

Every symptom, conflict and difficulty that people seek help in psychoanalytic psychotherapy is there for a reason, and they all have a function and a meaning. They offer an important opportunity for the person to find out more about themselves, in how they behave, feel and relate to others. In this way the suffering that someone needs help with is not there to be simply gotten rid of or removed through a magical psychological surgery, but to be understood and worked through in the context of the therapeutic relationship. In doing so, the symptom or destructive pattern loses its functions and gives ways for the person to organise their internal world in a less defended and more conscious way.

So the help offered in psychoanalytic psychotherapy really comes through the painful process of discovering the meaning underneath the suffering, which will promote understanding, development and transformation. When what is unconscious surfaces to the conscious mind and is contained in the process of psychotherapy, the person can then become free to live a more integrated life. This unexpected help is long-lasting, as opposed to the short-lived illusion that one can simply get rid of symptoms and bypass the struggles in life without having to deal with them.









Allan Gois – Psychotherapist London BloomsburyPsicólogo Brasileiro em Londres


What’s that in the corner? On the use of the couch in psychoanalytic psychotherapy

Of all the aspects of psychoanalysis and psychoanalytic psychotherapy that people pick on as a cliché, the couch must be one of the most famous. I can understand why it seems so strange for someone to walk into a room and lie down in front of a stranger, who sits behind the couch away from their field of vision. You can’t see the analyst, but he can see you. It’s an odd way of having a conversation. Well, first of all, the psychoanalytic encounter is not a conversation. It’s an exploration. The key is in the name: psycho-analysis, an examination or exploration of the psyche, of the mind. And the couch provides an optimum position for that to happen.

The couch is a powerful tool in the psychoanalytic work, which enhances the experience of thinking freely and deeply looking at oneself, aiming to bring up unconscious dynamics in a less restricted and inhibited way. Freud came up with the idea of asking patients to talk whilst lying down as he observed that the couch liberated them to a level of free thinking that was perhaps unattainable when face to face with the analyst.

Whilst psychoanalysis is particularly characterised more exclusively by the use of the couch, psychotherapy can be experienced both lying down or sitting up, and each has a distinctive feel to it. In my experience as a psychotherapist, I see that something powerful happens when patients decide to move from the chair onto the couch at some point in their therapy. So in this post I want to explore 4 of the benefits of having psychotherapy on the couch.

1- Free-association: I normally say to my patients that in psychoanalytic psychotherapy there’s only one rule: to try and speak as freely as they can, whatever comes to mind. Easier said than done. Resistances and inhibitions will inevitably come out in the psychotherapy work, and they are not only expected, but an important part of the experience. The couch enhances the ability to free-associate, as it liberates the patient from the inadvertent control exercised by the therapist’s reactions and expressions, however minimal they may be. Free association is a technique Freud came up with as a way of bringing conflicts, feelings, fantasies, etc out of the unconscious mind onto the consciousness, so they can be analysed and worked through. And this is exactly what the couch promotes, a more instinctive way of communicating.

2- Evenly hovering attention: as the couch helps the patient to speak more freely, it also helps the psychotherapist to achieve a state of what Freud called an ‘evenly hovering attention’. This means a disposition of the psychotherapist to be open to what the patient is saying without an agenda, preconception or prejudice. What the patient is communicating is then met by an open and welcoming mind, looking evenly to everything the patient has to say, but not bound by anything in particular. This helps the analyst or therapist to have a deeper and more global view of the patient’s mind, so he can help them become aware of what may still be unconscious. So the couch helps freeing up both the patient’s and psychotherapist’s mind.

3- Introspection: Another benefit of having psychoanalysis or psychoanalytic psychotherapy on the couch is that it enhances introspection, that is, the patient’s exercise of looking deeply into themselves. I often observe that patients who lie on the couch can be more in touch with what’s happening in their minds as they talk, so feelings and states of mind in the here-and-now of the psychotherapy session become more available for analysis. This is helpful because a great part of how psychoanalytic psychotherapy works is through analysing and working through the dynamics between patient and therapist that happen in the room, so the couch is an important tool in this sense.

4- Submission and dependence: Most people who come for therapy will at some point be confronted with their own aversion to submission and dependence. It’s not easy to depend on others, as it exposes one to the possibility of disappointment, disillusion and frustration. Most of us try really hard to defend against this, and it’s partly why relationships are so complicated. Lying on the couch helps patients confront their defences against feelings related to dependence. As they go on the couch, they relinquish some control and quite physically submit to a process in where they will depend on someone for help. This will bring out powerful feelings that can be looked at and understood. It’s an intense but important experience.

In the end of the consultation process and in the beginning of the work I always explain the benefits of lying on the couch and encourage patients to do so when they feel like it. It’s certainly an intense experience, that can bring about powerful feelings. Some patients describe a sense of abandon, others feel preoccupied with being watched over as I sit behind them. Whatever sensation it elicits in the room, the couch is certainly a powerful tool that helps in the work of psychoanalysis and psychoanalytic psychotherapy.






Allan Gois – Psychotherapist in London Bloomsbury (WC1)