Myths About Couple Therapy

by Marilyn Dawson-McCarthy on 2013-11-11

MYTH #1 Many therapists operate with hard and fast rules about doing therapy with couples. One of them is "Never see members of a couple in individual therapy while you are conducting marital therapy with them." The belief derives from the notion that one's individual work will be compromised by focus on the marital relationship. In some instances, especially if members of the couple are in serious conflict and have widely differing goals for the therapy, individual work might be best.

BUT it might not. We have found that many individual therapies are greatly enhanced by helping each member of the couple understand the impact they have on one another. In helping spouses understand their blind spots towards their partners, each individual's life can be greatly enhanced.

Sometimes individual therapy can become stalled until the individual grapples with the aspects of the marriage in which they take part, but to which they are blind.

Our Manifesto: Pragmatic Psychoanalysis

by Eric Kulick on 2013-11-08

Pragmatic Psychoanalysis is a rubric under which we refer to multiple ideas. It is a description of our approach to psychoanalytic therapy in which we utilize psychoanalytic theory to help patients achieve practical goals and go deeper into the unconscious only as necessary. We also mean to emphasize a convergence between our practical approach and the philosophy of pragmatism, which tends to be non-ideological. It is a philosophy that is of maximal use to understanding everyday life.

Additionally, it is meant to be a critique of psychoanalytic practice and particularly of psychoanalytic education. We feel strongly that psychoanalytic practice and education have veered into stultifying blind alleys. Education such as this interferes with the potential inherent in the powerful and radical insights that psychoanalysis has provided.

We also believe that the mainstream approach to ethics in psychoanalysis and psychotherapy has engendered rigidities and orthodoxies that are constricting and unproductive. It is our intention to elaborate these ideas in future blogs.

Can Psychoanalysis Be Practical?

by Eric Kulick on 2013-09-20

Pragmatic Psychoanalysis sounds like an oxymoron. Can psychoanalysis be practical? The surprising answer is "YES!" Practicality in any endeavor is relative. The problem with psychotherapy is that there are no shortcuts. Why is that? A very wise psychologist and psychoanalyst, David Rappaport, defined psychological structures as processes with a very slow rate of change. This is a most subtle truth. Our attitudes, inclinations, and approaches to life are all guided by underlying psychological paradigms that are intangible yet they are often pictured as concrete structures, although they are not. As Rappaport says, these structures or underlying attitudes, appear quite stable over time. This appearance is deceptive.

Our psychology is not permanent, it is not unchangeable. Indeed, nothing human is unchangeable. Inevitably we are either growing, regressing, or taking a side trip. We are never absolutely standing still. Change occurs slowly, and requires repeated attempts to challenge and resolve the powerful obstacles to change, especially to positive change, also called growth. Freud called this prolonged process "Working Through," which entail the idea that a single insight, no matter how spectacular, rarely is effective in producing significant and stable change. Insight must be rediscovered and repeated dozens and dozens of times before change actually occurs. In each repetition a new, subtle addition to the original insight is achieved.

People often say to me, "But we've already talked about this before! I've known this, and so why talk about it again?" The answer is that one knows something, but not enough to change. Working through requires patience, courage, and entails a deepening emotional understanding of oneself.

Through psychoanalysis we have come to appreciate the complexity of the human psyche and the difficulty of trying to achieve enduring change. Many behavioral and cognitive techniques can achieve temporary results, but when used without attention to the unconscious, they do not last. Psychoanalysis offers the most honest and direct approach to human psychology that we have available.

The first step towards change always involves looking at a problem as realistically as possible. Psychoanalysis is the most practical psychological approach available precisely because it it approaches the mind with a realistic appreciation of its complexity.

Freud was surprised that America took so readily to psychoanalysis. Why? This was because he thought that America was too simplistic, impatient and was a nation of doers rather than thinkers. Indeed, America was less interested in the philosophical and metaphysical implications than Europeans, however it was America that appreciated the practical power that was potential within psychoanalysis.

Americans are interested in what works, and in the hands of dedicated and flexible practitioners psychoanalysis works.

How and Why We Deceive Ourselves

by Marilyn Dawson-McCarthy on 2013-09-20

One of the most frequent experiences people experience is, "Why couldn't I see that coming?" "How could I have fooled myself?" This is one of the best questions we can ask ourselves. All too often we do not have the courage to take these questions seriously and to pursue answers. Pursuing these questions involves a curiosity about oneself, a willingness to learn something new about oneself. This does challenge the status quo and our pre-conceived views of ourselves. This is unsettling and often frightening.

There are good reasons why we engage in self-deception. There are always aspects of ourselves that are painful to recognize. Why are these aspects frightening? There are multiple reasons, such as beliefs that if we feel a certain way, this is wrong or hurtful to others or oneself. Many people believe that some of our feelings are wrong or bad. People can feel ashamed if they were to realize that they feel envious of someone, if they feel hateful at someone we love, for instance. Sexual desire can be unruly and unpredictability and therefore difficult to acknowledge.

On Suicide

by Marilyn Dawson-McCarthy on 2013-07-02

In the May issue of The Daily Beast an article on suicide presents alarming facts that indicate that suicide is a worldwide epidemic, worsening each year. In examining data on suicide, Dr. Steven Joiner, of Florida State University, found:

... the world’s most depressing spreadsheet. There are as many intentional ways to die as there are people to imagine them, and we saw more of all of them: an almost 20 percent rise in the annual suicide rate, a 30 percent jump in the sheer number of people who died, at least 400,000 casualties in a decade—about the same toll as World War II and Korea combined.

Throughout the developed world, for example, self-harm is now the leading cause of death for people 15 to 49, surpassing all cancers and heart disease. That’s a dizzying change, a milestone that shows just how effective we are at fighting disease, and just how haunted we remain at the same time. Around the world, in 2010 self-harm took more lives than war, murder, and natural disasters combined, stealing more than 36 million years of healthy life across all ages.

He proposes that there are three conditions that must be met in order for an individual to commit suicide:

  • Low belongingness to others, to a community
  • A perceived burdensomeness to others
  • The lack of fear of death

Interestingly, Joiner believes there is another surprising contributor to the desire to commit suicide: altruism. He believes that there is a degree of “altruism” in people’s desire to commit suicide, the desire to rid others of a burden.

The most striking aspect of Dr. Joiner’s research is that we are effective in fighting disease and inadequate in addressing severe depression, aloneness and alienation.

There are social and psychological aspects of our modern era that contribute to this increase in suicide. Family and community are diminished in their ability to create a fabric of meaning and belonging. Few people continue to live in the same city in which they were born. Most family members in our culture are separated emotional and physically. What’s more, the popularity of the euthanasia movement may decrease the former taboo against suicide.

As interesting and important as these ideas are, as psychoanalysts we believe that there are emotional and unconscious dimensions that must added to the understanding and prevention of suicide. In our clinical experience, serious suicidal intention is associated with rage, hatred, and vengefulness, in other words, the more savage aspects of the human mind.

In Man Against Himself, Karl Menninger spoke to this dimension in the triad of factors he considered necessary to commit suicide. These include:

  • The wish to kill
  • The wish to be killed
  • The wish to die

Sigmund Freud cast doubt on our capacity to make a rational and honest choice to commit suicide. Freud believed that as living organisms we cannot really conceive of what death is. For Freud, death can only be understood in terms that we can understand and experience. We project experiences we are familiar with onto death.

Fantasies of suicide often include a wish to rid oneself of unwanted aspects of ourselves and may include fantasies of rebirth and resurrection. Willie Loman in The Death of a Salesman imagined a glorious funeral before he committed suicide. The key to the realization of Willie Loman’s wish would have to involve Willie Loman being present to enjoy that funeral. He has a fantasy of finally being admired, valued and loved. What is the point if he is not there to receive it? Mark Twain took the fantasy one step further in Huckleberry Finn, by having Huck actually present at his staged funeral. Huck was very moved by the eulogies he heard, in other words Huck felt appreciated and cared about. Huck was far wiser than Willie Loman. He realized that he had to stay alive to achieve his wish.

Clinical Implications

As with all of our work, we believe in integrating formulations from all pertinent fields. In keeping with the triads of Joiner and Menninger we propose a new triad for treatment:


Acute and imminent suicidality is typically a transient phenomenon. It is first and foremost our obligation to keep the person safe and protected during this brief but very dangerous time. Hospitalization may be necessary. Family and/or close ones must be mobilized and engaged. Medication is often an important tool for stabilizing mood.


We have found that suicidal individuals are feeling profoundly disconnected from important others in many ways. Psychotherapy is a treatment that occurs through the medium of a relationship. Thus the relationship with a therapist is a very important means of preventing suicide. We believe that any individual who is truly and deeply connected to another human being cannot commit suicide as long as that connection remains strong.


This is the province of psychoanalytic psychotherapy. It requires a therapist who is able to form deep and trusting relationships with their patients. It also requires an honest and open exploration of the patient’s reasons for suicide, in all the conscious and unconscious aspects. Such work requires a high tolerance for difficult and anxiety-provoking discussion. We must be tolerant of the more savage side of human nature: the wishes mentioned by Karl Menninger of wanting to kill and be killed. We must work to help the patient come to an acceptance of these feelings and find ways out of helpless rage.

A therapist must be able to tolerate a patient’s belief that suicide is an answer, and also understand that suicidal thoughts may provide a needed sense of hope that suffering will not go on forever. We must be patient as the suicidal individual works through this false belief and comes to find hope in life. The strong bond with the therapist can make this possible.