PSYCHIATRY, PSYCHODYNAMIC PSYCHOTHERAPY AND PSYCHOANALYSIS

OVERVIEW

Different disciplines such as philosophy, cognitive psychology, neurobiology, developmental psychology, infant psychiatry, psychoanalysis and the mindfulness/awareness traditions used to be separate, work independently from each other and believe they had nothing much in common. However, in the past few decades or so we have gradually come to appreciate the complexity of nature’s entanglements and the need for interdisciplinary dialogue. This has lead to a rich convergence and cross-fertilization among those disciplines, now called ‘the cognitive sciences’. These have increasingly enriched our understanding of the mental, first-person, subjective experiences of being alive, including the psychodynamic process in psychotherapy and psychoanalysis. Consequently, the practice of psychodynamic psychotherapy in general, and psychoanalysis in particular has gradually shifted towards mutuality, intersubjectivity, embodiment and the present moment in its view of human nature. Psychiatry, too, is being deeply influenced by these developments.

Even though there often is an unfortunate discrepancy between the vision of what psychiatry should be, and how it is practiced in everyday life, we should never lose sight of what psychiatry is all about. Psychiatry deals with the fundamental questions of what it means to be human, and as a medical discipline is particularly concerned with the alleviation of human suffering that results from dysfunctional alterations in certain domains of first-person, subjective experience, such as mood, perception, cognition and intersubjectivity. This includes the broad base of existential experiences that reaches all the way to the deepest spiritual and religious questions of human existence.

Because the field of psychiatry is so complex, psychiatrists are particularly susceptible to preconceptions arising from personal biases that color their day-to-day practice in limiting ways. Unfortunately, deep rifts result between psychiatrists, when they narrow their thinking to such preconceptions, leading to artificial boundaries between biologically, psychoanalytically, cognitive-behaviorally or otherwise oriented practitioners. These artificial boundaries within the psychiatric profession resonate with similar artificial boundaries the human mind creates quite habitually, as exemplified by the categories of experience referred to in popular language, such as body, mind, heart, soul, and spirit. Such compartmentalizations do not do justice to the fact that human beings experiencing life in certain personal ways are not split into compartments. We are whole, complex, integrated organisms with multiple, complexly interactive systems and levels of reality. For practical purposes, it sometimes makes sense to deal with this complexity as if its parts were separate, as long as we do not lose sight of the artificiality of compartmentalization.  

Psychiatry needs to have its conceptual house in order by being vigilant and always keeping the vision of coherent complexity alive. This means adherence to the following principles (adapted from Kenneth Kendler, M.D., ‘Toward a Philosophical Structure for Psychiatry’, American Journal of Psychiatry, 162:3, March 2005):

1. At its foundation psychiatry deals with the way human beings subjectively experience living. It is irrevocably grounded in mental, subjective first-person experiences.

2. To think that the psyche (mind, soul and spirit) consists of some different kinds of ‘stuff’ than the body, and that body and psyche are independent of each other, is called ‘substance dualism’. This substance dualism that was most notably represented by the philosopher Descartes, is unnecessary, confusing, and downright false. We need to reject the belief that psyche and brain reflect two fundamentally different and ultimately incommensurable kinds of ‘stuff’. The human first-person world of subjective experience emerges from and is entirely dependant upon brain functioning. Mental-psychological and physical processes are both reflections of the same fundamental ‘stuff’, a view we call ‘monism’. This means that the mental-psychological and the biological are not fundamentally different, only different ways of viewing and analyzing the mind-brain system.

3. Thoughts, feelings and impulses matter not only because they are responsible for huge amounts of human suffering, but also because they have a direct effect on the physical structures of our body. In other words, the psyche directly affects the physical body, and is not just an epiphenomenon.

4. Accepting that in psychiatry we are dealing with an integrated mind-brain system means that there is a bidirectional mind-brain and brain-mind causality. The mind deeply affects the physical organism, and the physical organism deeply affects the mind. If there is no-body, never mind!

5. Explanations in psychiatry are never simple and linear. There is never one cause or one reason for the way we feel or suffer, or for a psychiatric disorder. Etiological considerations are always complex and multifactoral. The most we can hope for are lots of small explanations from a variety of explanatory perspectives. This is called ‘explanatory pluralism’.

6. Explanatory pluralism also means that in psychiatry a battle of paradigms is futile. For example, the medical medication approach is not any more or less valid and valuable than the systemic, cognitive-behavioral or psychoanalytic ones. They all represent different levels of reality that correspond to the extraordinarily complex and multileveled causal networks within the mind-brain system. To use a famous metaphor, every paradigm is like one of the blind men that describe an elephant through touch. The one that touches the tail will find the elephant to be like a brush; the one who touches the ear, like a cabbage leaf, and the one who touches the leg, like a tree trunk. Psychiatric wisdom lies in the psychiatrist’s ability to see the whole and work with all the different elements and paradigms in a non-ideological fashion, in order to do justice to the complexity of the human beings they treat. This means that psychiatry has to be open to and draw from the experience of a wide spectrum of disciplines that span the gamut of the cognitive sciences. This is called ‘integrative pluralism’.

7. In summary, developing a grand theory of psychiatry and subscribing to one particular school of thought are the greatest pitfalls a psychiatrist can encounter. Instead, to understand and be able to treat human beings efficiently, we have to do justice to the human organism’s complexity with humility and perspective. This means applying the principles of bit-by-bit efforts of integrative pluralism, allowing for only very limited and patchy reductionistic explanations.

THE PRACTICE - Back to top

Dr. Treyvaud’s approach to mindfulness and mindfulness-based psychoanalysis reflects these developments. Mindfulness means experiencing wholeness and interconnectedness directly, a seeing that individuality and totality are interwoven, that nothing is separate or extraneous. Everything is whole in the deepest sense, but you have to be there for it to experience it. All else is mere thinking. Psychoanalysis seen in this light is not an analytic discipline based on rational thought or ‘analysis’ alone. It is on the contrary a narrative-based process of discovering one’s embodied truth of ‘being-with-an-other’ through mindfulness. Thus mindfulness in psychoanalysis brings awareness to the stories we tell ourselves, their meanings in the field of intimacy, the fine filaments of the relationships we engage in, and the embodied manifestations of our being in the world. In-depth self-discovery through this kind of mindful ‘analysis’, which in fact is more like a contemplation through an intimate dialogue, helps one achieve deep and lasting changes that allow for a more fulfilling and successful way of life.

The services that Dr. Treyvaud specializes in are covered by OHIP and include:

• Individual, psychodynamic and psychoanalytic psychotherapy for adults and adolescents

• Psychodynamic group therapy for adults

• Couple therapy

• Assessments and consultations

Individuals seeking these services may face psychosomatic or physical pain, or psychological distress in many different forms including: stress, depression, anxiety, obsessions, tiredness, sleeplessness, unhappiness or a sense of meaninglessness in life. They may feel confused as to who they are, or what they want existentially out of life, or may experience family conflicts, marital discord and difficulties in relationships. Some people may have to face traumas like the death of a loved one, a severe illness or dying, past sexual and physical abuse, the loss of a job or a separation and divorce. Others face a spiritual crisis or a religious conflict.

Dr. Treyvaud’s psychotherapeutic practice focuses on meeting the needs of those people who want to deal with their suffering by way of an in-depth transformative approach that leads to lasting psychological changes. Since psychological changes are only lasting when they are embodied by having achieved transformations on a cellular level, this journey is intensive and long-term, in the order of at least one or two sessions per week for usually in the range of a few years. Decades of a life lived cannot be permanently changed in a few weeks or even months.

Two paths can be taken, which intertwine and both lead to the same results: Individual and group psychodynamic psychotherapy. Depending on several complex factors, some individuals will engage in one or the other, or in both, either sequentially or simultaneously.

Entering psychodynamic psychotherapy means entering an intense journey into the unknown, yet intuited landscape of one’s own being. The stakes are high as the most difficult landscape in the world beckons to be explored.  The human soul’s depth is unfathomable and the mind’s deceptive maneuvers countless. It takes great patience, skill, tenacity and courage to recognize and unmask the mirages we so ignorantly follow. It also takes practice and staying power to slowly but surely effect the changes we so deeply desire, in order to lead lives with less suffering.

Even though this work is the hardest journey through peaks of happiness and valleys of sorrow one will ever engage in during one’s lifetime, participants typically experience a deep sense of relief from the strain the unexamined life caused, thus strengthening their sense of self. In the psychodynamic groups, where participants get to know each other intimately in ways not possible anywhere else, they experience a deep sense of belonging and grounding, a sense of unshakable trust in each other and the wisdom of the body and mind, and an atmosphere of profound freedom and honesty of inquiry, exploration and dialogue that is rarely found elsewhere in society. As these qualities of experience are deeply internalized, the fundamental personality structure is altered in positive and healing ways that allow for greater freedom, less suffering and a more present, creative and successful everyday life.

When an interested person is assessed for psychodynamic psychotherapy, a collaborative decision is made with the individual regarding the best therapeutic direction to take. Because of the powerful synergistic effect of meditation and psychoanalysis, many patients decide to combine psychodynamic psychotherapy with mindfulness meditation by simultaneously taking the Mindfulness-Based Stress Reduction Programs.

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