Aug 23

The World Capital of Psychotherapy May Be Argentina

Is Argentina the world capital of psychotherapy? According to the New York Times:

The number of practicing psychologists in Argentina has been surging, to 196 per 100,000 people last year, according to a study by Modesto Alonso, a psychologist and researcher, from 145 per 100,000 in 2008.

That compares with about 27 psychologists per 100,000 people in the United States, according to the American Psychological Association.

And that’s just the psychologists, only one of several disciplines in which psychotherapists practice. In other words, what about clinical social workers, psychiatrists, mental health counselors, etc.?

Another (now unlinkable) source gives a broader breakdown. Stating that “Argentines are officially the most analyzed people in the world,” the report says there are 15 therapists for every 1000 residents.

Psychoanalysis has apparently found much popularity ever since Freud’s ideas emigrated there in the early 20th century. However, the other end of the spectrum—cognitive-behavioral therapy and other of the shorter-term approaches—is also represented in Argentina.

Apparently high fees don’t necessarily pose a big issue. From the NY Times article: “Andrés Raskovsky, president of the Argentine Psychoanalytic Association, recently asserted that psychoanalysis had little risk of extinction in Argentina since seeing a psychologist twice a week is still viewed as being affordable for much of the population.” When people can’t afford it, sliding scale fees and other types of arrangements are often offered; also, public insurance covers it for some.

One analyst interviewed about the wide acceptance and use of therapy in Argentina says that it’s basically about their people liking to talk—as well as liking having someone to listen.

Could it really be that simple? Probably not.

Maybe Argentinians are more in need of therapy than other folks? Unlikely. In one article last year (update 2018: source no longer available), two therapists who were both originally from the U.S. but now practice in Argentina observe that people have essentially the same types of problems there as anywhere. As stated by one, Steven Nissenbaum: “It doesn’t make a difference what the culture is – people are people. Problems include life transitions, relationships, family, health or addictions.”

Therapy is also big in their popular culture, with the TV show In Treatment, starring Gabriel Byrne as a shrink, currently being quite popular. In addition, on the “Broadway of Buenos Aires” you can now find a staging of “Freud’s Last Session,” last year’s winner of New York’s Off Broadway Alliance award. It’s about the conversations that take place when the seriously ailing Freud invites writer C.S. Lewis to his home in London.

Michael Tanenbaum describes the play for The Argentina Independent:

As the two men carry on their debate – Lewis equating psychoanalysis with intellectual religion and Freud swatting away God as an infantile fantasy – the conversation and circumstances take multiple turns in subject, intensity, and competitive edge, bringing the men together at a historically fateful moment…

God, love, sex, and the meaning of life may be suitable tag words for this play, but overwhelmingly it is a display of the walls we build up and break down in dialogue with ourselves and others.

Another hit play “Toc Toc,” about six characters with obsessive-compulsive disorder who meet in their psychiatrist’s waiting room, is also currently playing.

World capital of psychotherapy? Certainly in the running.

Jun 29

Nora Ephron, Heroine Known For Her Humorous Writing

“Above all, be the heroine of your life, not the victim.” Nora Ephron

This is just one of many serious quotes that have been attributed to writer Nora Ephron (1941-2012), who died this week after a secret battle with leukemia.

But Nora Ephron was also known for her sense of humor. And one of her friends has publicly noted that even as Ephron was dying, she was still cracking jokes. Not that she wasn’t also showing sadness. She could do both.

“My mother wanted us to understand that the tragedies of your life one day have the potential to be comic stories the next.”

I don’t know if she was ever in therapy, but she did seem therapy-oriented in some ways. For example, in her first novel, the semi-autobiographical Heartburn (1983), group therapy figured prominently. The movie version, which featured Meryl Streep as lead character Rachel, contained a scene in which she and others get robbed during a session.

Actually, it’s quite possible that in real life Nora Ephron spurned shrinkage in favor of something else. According to the New York Times, she once said about her choice to engage in twice-a-week professional blow-drying of her hair:

“It’s cheaper by far than psychoanalysis and much more uplifting.”

Also on the topic of hair, she had stated:

“…the amount of maintenance involving hair is genuinely overwhelming. Sometimes I think that not having to worry about your hair anymore is the secret upside of death.”

Other Nora Ephron quotes of interest:

“Insane people are always sure that they are fine. It is only the sane people who are willing to admit that they are crazy.”

“[A successful parent is one] who raises a child who grows up and is able to pay for his or her own psychoanalysis.”

“When you’re attracted to someone, it just means that your subconscious is attracted to their subconscious, subconsciously. So what we think of as fate is just two neuroses knowing that they are a perfect match.”

“Sometimes I believe that some people are better at love than others, and sometimes I believe that everyone is faking it.”

“Never marry a man you wouldn’t want to be divorced from.”

“You always think that a bolt of lightning is going to strike and your parents will magically change into the people you wish they were, or back into the people they used to be.”

Mar 21

Should You Detach From Your Family? David P. Celani’s “Leaving Home”

Should you detach from your family?

In Leaving Home: The Art of Separating From Your Difficult Family (2005), David P. Celani, an experienced clinical psychologist, writes about a topic rarely addressed in self-help books—a topic that some therapists don’t even like to address—how to detach from your family if you so choose.

From the book description:

Giving up family attachments that failed to meet our needs as children…is the hardest psychological task an adult can undertake. Yet the reality is that many adults re-create the most painful aspects of their early relationships with their parents in new relationships with peers and romantic partners, frustrating themselves and discouraging them from leaving their family of origin. Leaving Home emphasizes the life-saving benefits of separating from destructive parents and offers a viable program for personal emancipation.

In an interview for Columbia University Press, Celani states: “Adults who find themselves living with their parents and who have difficulty in leaving their family of origin represent one of the largest groups of mental health patients in the country.”

Celani explains early in the book that he bases his beliefs on a psychoanalytic theory known as object relations, more specifically “the concept of ‘attachment to bad objects,’ which describes the abandoned, abused, or neglected child’s intense loyalty to the very parent or parents who failed him or her.”

I for one have always found “object relations” to be an odd choice of terminology. As has Carolyn Murphy, presumably, who “explains” this concept further in her satiric piece found in The Primal Whimper: More Readings From the Journal of Polymorphous Perversity:

Psychoanalytic theory postulates that psychological problems begin at a very young age. Indeed, many patients’ deficits are rooted in an early lack of healthy ‘object relations.’ Object relations theories are derived from the supposition that ‘objects who need objects are the luckiest objects in the world’ (Streisand, 1967, line 1).

Whatever you label the theory, though, one thing that’s not in dispute is that receiving love and attention is essential to healthy child development and “people relations.” A metaphor from Celani (from the same interview mentioned above) quantifies such nurturance in an understandable and helpful way:

…(H)ealthy development, which results from a supportive family atmosphere allowing the child’s personality to mature, is akin to getting 20 gallons of high test gasoline in your fuel tank, and once the tank is filled it never runs out. Parents who inadvertently stunt their child’s development through indifference, excessive criticism, humiliation, mockery, or episodes of physical abuse, stall their child’s developmental progress. The child raised in this type of family ends up with an empty emotional fuel tank, remaining close to his parents because the outside world appears to be too daunting to enter, and because he lives in the endless hope of someday receiving the emotional support that will allow him to mature.

An Amazon reader review notes that Celani’s book also helps answer the big question of Why? Why didn’t my parents love me? care for me properly? Celani states:

The question as to why we were abused is a continuation of our defenses, in that it assumes there is an inherent logic in life, and that we could have done something differently to please our parents. The ultimate ‘answer’ to the question of why we were rejected, undernurtured, or punished unfairly is simply bad luck — the same bad luck that allows innocent people to be maimed or killed by drunk drivers every year.

I bought this book from Celani at a conference he presented on personality disorders several years ago. I decided to write this post because of the impressive reviews he’s received from his readers—real people (not objects) like you, perhaps, who’ve struggled mightily with how to detach from your family or dysfunctional caregivers.

Jan 18

“A Dangerous Method”: Three Psychoanalysts Depicted

In a previous post about scary boundary-breaking by therapists, I described the based-on-a-true-story film A Dangerous Method (2011), which wasn’t yet in theaters. Now it is, and in a couple months or so it will be released on DVD.

Today’s post will use excerpts from film reviews/articles to focus on the characterizations in the movie of the three depicted analysts: Freud, Jung, and Spielrein.

Rex ReedNew York Observer

…a psychological tug of war between the father of modern psychiatry, Sigmund Freud (Viggo Mortenson), and his disciple Carl Jung (Michael Fassbender) over the mind and sex of an overwrought mental patient named Sabina Spielrein (Keira Knightley), a mad Russian with a craving for spanking. Whacking her on her naked bottom must have worked. She ended up, years later, analyzing patients of her own. Too bad she didn’t also analyze this movie. It would have saved so much wasted time.

(Ouch, Spielrein herself might have said.)

Lisa Kennedy, The Denver Post:

David Cronenberg’s elegant historical drama ‘A Dangerous Method’ begins and ends in a way that recalls one of Sigmund Freud’s better-known quotes.

‘Much has been gained,’ he told a patient, ‘if we succeed in turning your hysterical misery into common unhappiness.’

(In modern psychiatry there is no longer a diagnosis of “hysterical neurosis.” The current DSM uses “conversion disorder,” basically defined as the conversion of emotional issues into physical symptoms. For the upcoming revised edition of the DSM, “functional neurological disorder” is being considered as the next replacement term.)

J. Hoberman, Village Voice:

…The protean Fassbender plays a proper Jung, steely yet agonized; Mortensen’s self-amused, paranoid Freud is a more unusual piece of work. Mind ablaze, he sees repression everywhere. The mystical Jung believes that nothing happens by accident; for Freud, all accidents have meaning.

(And for Spielrein, her therapy is an accident waiting to happen.)

Dr. Sandra Fenster, Ph.D., psychoanalyst (from a post on Psychology Today):

…Jung lost his objectivity–something an analyst cannot afford to do. With his patient, Sabina Spielrein, Jung’s own insatiable needs got the best of him; he confused them for hers. That is what analysis is not. And, that is the danger in the method.

(And this is the voice of reason.)