Toronto Psychologist and Psychoanalyst

If you want to get an idea of what psychotherapy s all about, watch an episode of the television series The Sopranos. Tony Soprano is a mafia don in New Jersey who is in talk therapy with Dr. Jennifer Melfi. He has panic attacks, loses consciousness, and has slipped into a depression. All of this seems irrational to him, but he can’t help it. He has some hidden agenda lying just outside his awareness that is controlling his feelings and behavior. He doesn’t believe in therapy at the start, convinced he cannot talk about himself and that it won’t help anyway. He resists, evading Dr. Melfi’s questions, withdrawing, and even walking out. But eventually he is intrigued.

Aspects of his unconscious experience expressed in his dreams and in the triggers of his panic attacks come together. For Tony, ducks and their babies stir up a deep-seated dread having to do with his tortured relationship with his malevolent mother. He begins to have some conscious awareness of what is really bothering him in his depths. And he begins to feel better. This is what psychotherapy is about – an exploration of one’s internal world, conscious and unconscious, played out in the relationship between the patient and the therapist, designed to alleviate pain and suffering.

Psychotherapy is a conversation, a two-person enterprise in which both participants contribute to an evolving relationship. The therapist’s task is to create a safe atmosphere in which the patient can open up and express feelings he may have repressed his entire life. She analyzes his defenses against these feelings – his joking, forgetting, intellectualizing, rationalizing, denying, avoiding, and withdrawing into silence. And she offers ways of understanding his experience, leading him toward self-awareness.

The patient’s task is to open up as much as possible, say whatever comes to mind, note whether the therapist’s attempts to understand him click at a gut level, and tell her the reactions he has to what she offers. Together they uncover the meaning of the patient’s words and deeds. Therapy sessions are emotionally rich and alive, full of moments of tenderness, closeness and intimacy, anger and hostility, silence and withdrawal, dead ends and moments of insight and even epiphany.

One of the ways in which therapy works has to do with the concept of transference. Freud discovered transference when his female patients regularly fell in love with him. He came to understand that patients experience their therapists like important figures from their infancy and childhood, unconsciously transferring intense feelings and needs onto the therapist for satisfaction. In this way, the patient relives and masters unresolved conflicts or developmental steps from childhood, so that he can progress in life with greater freedom and security. Furthermore, old relational scripts developed in early life are unconsciously repeated in the therapeutic relationship and are relinquished in favor of more adaptive ways of relating.

The process is often heated and painful, but endlessly rewarding. Symptoms, inhibitions, relationship problems, feelings of hopelessness or futility or purposelessness or despair, all improve or disappear as a result of treatment. Therapy is not an intellectual exercise. It is not advice. And it is not a quick fix. But given sufficient time, intensive psychotherapy can transform your personality and your life, allowing you the freedom to be yourself.