What is Psychoanalytic Psychotherapy?
Psychoanalytic Psychotherapy is a once-and-for-all process dealing directly with what causes suffering. At a practical level Psychoanalytic Psychotherapy listens out for two distinct messages from the patient: one is directed at the interlocutor or audience, the other is addressed unconsciously to the speaker himself. In other words
‘What are we telling ourselves when we speak to others?‘
The gap between what we tell each other and what we ideally want to convey constitutes our Desire. When frustrated this Desire turns into anxiety before producing symptoms such as those listed below; they are ‘substitutes’ for something else that did not happen (Freud, 1916:280). Crucially for Psychoanalytic Psychotherapy this Desire guides the clinic – see Ethics. In this unique arrangement the patient’s speech is the only available means of access to the truth of this Desire, a speech known as ‘free association‘.
Why do I Feel So Anxious?
Anxiety denotes a whole range of affects and phenomenon. Those include panic attacks, vertigo, a general sense of worry, uncertainty and doubts regarding which direction to take in life. Bodily phenomena often include breathlessness, palpitations, muscle tension, fatigue, dizziness, sweating and tremor. If we can never be sure of the reasons behind our feeling, say, happy or sad (happiness can cause sadness or guilt) anxiety has an overwhelming certitude attached to it – it is real, something in front of which all words and categories fail. Anxiety happens when our place in the world and how we used to see ourselves in it suddenly changes, when we can no longer rely on the Other and use his desire as a compass to orient ourselves in relation to it. Instead, we are left suspended in a moment where we no longer know where our place is, and a future where we will never be able to refind ourselves. For the existentialist philosopher Jean-Paul Sartre, anxiety is evidence of our freedom. For Jacques Lacan there exists a relationship between anxiety and desire. Anxiety is a way of sustaining desire when the object is missing and, conversely, desire is a remedy for anxiety, something easier to bear than anxiety itself. Psychoanalytic Psychotherapy approaches it from the fundamental notion of an absolute loss, a ‘lack of a lack’ and sees desire as its remedy.
Am I Depressed?
Do you find yourself eating or sleeping too much or too little? That you are pulling away from people and activities because of low or no energy? Some of us may feel like nothing matters anymore. We are left confused, isolated, angry, worried or scared, perhaps even having suicidal thoughts. In those cases where all seems well and ‘perfect’ this feeling of disillusionment is quite baffling to understand. One way of looking at depression is as a force or movement driving our lives. Like a heart that has stopped beating, depression marks a stop to this vital movement. Given the set of circumstances and how long things have been kept this way unaddressed, it may be challenging for some to regard this issue as worth investigating. Often placated by feelings of shame we tend to fall back on the basic assumption that us alone can change our situation. Unsurprisingly, questions of anger, frustration and isolation are often central to the experience of depression. In Psychoanalytic Psychotherapy, I approach this issue with the view to reintroducing a movement using the element of surprise.
Relationship fall-outs are expressions of a toxic form of aggressivity between partners. Typical signs include living in tension and mutual rejection, jealousy, passive aggressivity, denial and in some instances verbal or even physical abuse.For example in the act of blaming the other personal criticism is expelled by projecting it onto the other. Referring himself to the master-slave dialectic by the German philosopher Hegel (1807) Lacan argues that a fraught relationship is ‘imaginary‘ in nature, a life and death struggle for ‘pure prestige‘. In this context the other is seen as a rival, whose elimination seems to be the safest option. Generally speaking, aggressive attacks are a form of response indicating that one’s defense mechanism is somehow stuck in overdrive. The ego is felt to be under constant attacks and threatens to collapse. Those are moment of great vulnerability and risk in which retaliation is seen as an attempt to protect oneself against the anxiety that the threat of disintegration immediately poses.Jealousy is experienced when the ego concludes that the other with whom one is competing has the advantage. Feelings of jealousy reflect the desire to have this advantageous position for oneself, and the wish to eradicate this frustrating other.Psychoanalytic Psychotherapy sees working with issues in relationships as one of ‘un-knotting’ the multiple threads that have led to this situation. Its goal is to try and dislodge the frozen and stereotyped perceptions and evaluations at play.
One avenue of exploration may for instance include exploring those significant previous relationships in the patient’s life.
Why am I Angry?
Anger may be categorised as any forms of violence expressed towards others or oneself in self-harm. In the former, symptoms of anger include bullying, threatening people, persecuting, insulting, pushing or shoving, using power to oppress, shouting or playing on people’s weaknesses.Psychoanalysis regards anger as a ‘passage à l’acte’: a form of ‘acting out’ with no control. We become violent when the Real has come to possess such a grip on us that the fictional character we had created of ourselves to contain it breaks down. However paradoxical this may sound, Psychoanalysis Psychotherapy understands anger as a form of ‘deadly enjoyment‘ which, in its final analysis, expresses nothing other than a rejection of what is felt to be a threat to one’s sense of integrity. For Freud, hate and anger are more ancient feelings than love. In this context, the clinical work consists of using language as a way to make something of this anger. The exercise of symbolisation realised in therapy may well be initially experienced as somehow exacerbating this feeling further, but should in due time transform itself into some useful and creative productions.
Why do I feel I can’t act?
In certain situations we may find it almost impossible to act, and instead react as if feeling self-conscious and unable to act in a natural way. Symptoms of inhibition include reticence, procrastination (delaying), reserve, wariness, reluctance, discomfort, hesitancy, nerves, nervousness.The experience of inhibition can be transitory, for instance in a surprise accident from which we eventually recover, or last some extended period of time while bringing with it feelings of isolation and anger. From another person’s perspective, it may look as if nothing is really going on. In fact, being quiet may even be encouraged and seen as a positive personality trait (especially for men), that is, until eventually some violence is done and personal ties are cut. Symptoms of inhibition include fear; being hyper sensitive to the other’s reactions; feelings of being disconnected or dissociation. In therapy, it may be useful to invoke the place and presence of the Other with its omnipotence. In Psychoanalytic Psychotherapy it is essential to help patients try to remember anything that could have been felt as particularly traumatic. It may also be useful to explore the various relationships the patient had with this so-called ‘omnipotent Other’.
I Don’t feel confident
Issues of self-confidence and/or self-esteem include shyness, embarrassment, unease, reserve, apprehension and feelings of insecurity.As a derivative of the experience of inhibition, issues of self-confidence can be usefully regarded in therapy as revolving around the notion of power, the perceived lack of which is based on an image (the ego) which is in fact deceptive. This is not to say that feeling of low self-confidence is not real. This ‘hole in the mirror‘ can have a significant impact on one’s life if left unattended. The society we live in demands that we continuously show self-confidence. The work undertaken in Psychoanalytic Psychotherapy includes encouraging patients to describe their significant relationships and identify those specific descriptions that have an alienating influence in their lives. The aim in therapy is also to help patients identify with what works for them; the Sinthome.
I Have mood swings
Moods can oscillate more or less suddenly between extremes of euphoria and a sense of invulnerability (in some cases with spending habits getting out of control) morbid, self-deprecating and suicidal thoughts.The clinical work consists primarily in first trying to achieve some form of stability, then to reduce or ‘average’ the gaps between highs and lows. Explorations to this effect are encouraged by helping patients provide some detailed descriptions of their life experience, but also to help them remember if any significant events had occurred in their past, the things they may have heard being said while growing up.The desire or willingness to become curious about those moods swings, the time at which they appear, what makes them suddenly turn into their opposites, what, if anything, could be associated when those are at their peaks, are also critical ingredients in the work Psychoanalytic Psychotherapy.
Addictions are usually recognised in experiences of dependency, craving, habit, weakness, compulsion, fixation or enslavement.From a psychoanalytical perspective addictions are regarded as a type of ‘self-medication’: a method used to evade everyday suffering. Intoxication affords not just an immediate relief from pain, it also provides a feeling of independence from the external world. At any time the addict can withdraw from the pressure of reality and find refuge in a world of his own.Addiction with intoxicating substances may draw to it an enormous amount of resources, physical and financial, potentially leaving the sufferer totally depleted or, as popular language would have it, ‘wasted’.The looming danger with addictions of this sort, besides the obvious risks to one’s health, include some potentially long-lasting changes in the person’s view of himself or herself. “I would no longer be ‘me’ without it”; “I am expected to keep achieving and could not do this without it” are only a few typical accounts therapists hear in their clinic. The combination of using substances as painkillers or as a means to sustain a particular lifestyle in which one is trapped makes it a formidable symptom to treat. The work may seem arduous, if not impossible at first, but this would be to underestimate the power of words. The patient’s understanding of the notion of ‘belief’, as well as what may have been seen and heard at the time in the past, are essential avenues to explore within Psychoanalytic Psychotherapy.
Impotence or obsessive thoughts of a sexual nature, porn addiction or excessive masturbation unavoidably distract from having an intimate relationship.To make sense of this situation, the other may conclude that he or she is no longer attractive, that some extramarital affairs must be going on or that the other must have fallen out of love altogether. In any case, the end is devastating in the emotional distance this lack of intimacy create. Conversely, sex may be taking place not because of any sexual desire per se, but solely with the purpose to sustain this emotional bond.In Psychoanalytic Psychotherapy the French psychoanalyst Jacques Lacan claimed that ‘there is no such thing as a sexual rapport’. If each of us have our own and very specific way to reach sexual gratification, then how can we ever be exactly ‘on the same page’ with each other?Now what may also be at play for some men is an anxiety about being ‘swallowed up‘, being under the stress to perform. At times some inhibition may take place because of something felt to be too close for comfort.
After finishing a degree in Applied Mathematics at the University of Paris X (Nanterre) I decided to go and discover something else. London presented itself as an attractive choice; it was there that I would develop a lifelong interest, not just in the language, but of the English culture as a whole. My initial intention was to combine a background in Mathematics with a degree in 3D graphics and build a career in film visual effects (VFX).
I subsequently worked in the film industry in London, Soho, for a few years, that is, until my interest in human sciences caught up with me. Thus, I first enrolled with the Metanoia Institute where I certified in Transactional Analysis. Feeling at home in this field, I continued and was awarded a diploma in Psychodynamic Psychotherapy from WPF, London. A few years later I would eventually graduate in Psychotherapy with a Master of Science (MSc) from Roehampton University.
Today I am a fully accredited member of the British Association in Counselling and Psychotherapy (BACP). Practising privately in the UK since 2010 has provided me with a unique experiential understanding of language, at the heart of talking therapies. My sustained interest in psychoanalysis in particular, with the significance this field attaches to the structures of language allows me to conduct Psychoanalytic Psychotherapy with equal clinical efficiency in English and French.
“Stephane Preteux’s clinical skills are very advanced. His work is fully in accordance with the highest standards in the profession and bears witness to excellent reflexivity. His professional conduct with clients with a wide range of presenting problems is exemplary”
– Dany Nobus. Professor of Psychoanalytic Psychology at Brunel University London and Chair of the Freud Museum London
Fees – Budget Conscious Help
The initial assessment is £60 and is an opportunity for us to clarify the issues that have led you to consider psychotherapy, as well as your expectations as to its outcome. It may also be a chance for you to ask questions about me, my background, clinical work and qualifications as well as make your mind as to whether you feel confident that we can work together.
By the end of this session, I aim to discuss therapy options with you, including other services if for any reason therapy seems unachievable with me. If we agree to continue, we will discuss availability and fees as based on a sliding scale ranging from £60.00 for individuals who meet specific financial criteria to £75.00.
Coppergate House, 10 White’s Row, London E1 7 NF. See map here
To book an initial appointment you can contact me directly by phone: 07921 860498 or by email: email@example.com
Psychoanalytic Psychotherapy, Ethics and Confidentiality
There exist many different therapeutic approaches guiding the clinic, but none have to-date kept so faithfully close to the scientific rigour first applied to his discoveries by the founder of psychoanalysis Sigmund Freud, than the French psychoanalyst Dr Jacques Lacan. My approach to Psychoanalytic Psychotherapy is therefore guided in principle by Lacanian tenets and regards questions of ethics to be at the core of the analytical work itself. If guilt is seen as a direct result of conflicts between our most authentic and most profound desires and the societal demands of a ‘civilised morality’ then how does the analyst work with it? It is important to stress here that psychoanalysis rejects all ideals, including ideals of ‘happiness’ and ‘health’. It sees its role as one of encouraging patients to explore the relationship between their actions and their desires. For Freud “The analyst respects the patient’s individuality and does not seek to remould him in accordance with his own personal ideas; he is glad to avoid giving advice and instead to arouse the patient’s power of initiative” (p251).
Confidentiality in therapy is paramount and may be of significant concern for some clients. For my part, the handling of confidential materials between sessions is rigorously bound to the Ethical Framework for Good Practice in Counselling & Psychotherapy as elaborated by the BACP (British Association for Counselling & Psychotherapy). Issues of confidentiality, as encapsulated in the list below, is for my practice a matter of:
- Being trustworthy: honouring the trust placed in the practitioner (also referred to as fidelity): Practitioners who adopt the fundamental principle of being trustworthy regard confidentiality as an obligation arising from the client’s trust.
- Autonomy: respect for the client’s right to be self-governing: Practitioners who respect their clients’ autonomy protect privacy; protect confidentiality; normally make any disclosures of confidential information conditional on the consent of the person concerned; and inform the client in advance of foreseeable conflicts of interest or as soon as possible after such conflicts become apparent
- Providing a good standard of practice and care: All clients are entitled to good standards of practice and care from their practitioners in counselling and psychotherapy. Good standards of practice and care require professional competence; good relationships with clients and colleagues; and commitment to being ethically mindful through observance of professional ethics.
- Keeping trust: The practice of counselling and psychotherapy depends on gaining and honouring the trust of clients. Keeping trust requires careful attention to client consent and confidentiality.
- Respecting privacy and confidentiality: Respecting clients’ privacy and confidentiality are fundamental requirements for keeping trust and respecting client autonomy. The professional management of confidentiality concerns the protection of personally identifiable and sensitive information from unauthorised disclosure. Disclosure may be authorised by client consent or the law. Any disclosures of client confidences should be undertaken in ways that best protect the client’s trust and respect client autonomy. – Communications made on the basis of client consent do not constitute a breach of confidentiality. Client consent is the ethically preferred way of resolving any dilemmas over confidentiality. – Exceptional circumstances may prevent the practitioner from seeking client consent to a breach of confidence due to the urgency and seriousness of the situation, for example, preventing the client causing serious harm to self or others. In such circumstances, the practitioner has an ethical responsibility to act in ways which balance the client’s right to confidentiality against the need to communicate with others. Practitioners should expect to be ethically accountable for any breach of confidentiality. – Confidential information about clients may be shared within teams where the client has consented or knowingly accepted a service on this basis; the information can be adequately protected from further unauthorised disclosures, and the disclosure enhances the quality of service available to clients or improves service delivery. – Practitioners should be willing to be accountable to their clients and their profession for their management of confidentiality in general and particularly for any disclosures made without their client’s consent. Good records of existing policy and practice and of situations where the practitioner has breached confidentiality without client consent, greatly assist ethical accountability. In some situations the law forbids the practitioner informing the client that confidential information has been passed on to the authorities; nonetheless, the practitioner remains ethically accountable to colleagues and the profession. I will do my best to answer any questions you may have regarding this particular code of ethics during the preliminary session.
Psychoanalytic Psychotherapy / Frequently Asked Questions
If help is available it may not remain an easy process to go about deciding to find the right person to talk to. Below is a list of the most frequently asked questions around starting psychotherapy ‘on the right foot’.
What is psychotherapy?
Psychotherapy is an opportunity for you to talk safely in a confidential place about your life and all that may be confusing, painful or uncomfortable. The therapist is someone who is academically trained to listen attentively so as to help you cope better.
How therapy will make me feel?
Therapy is a process which is personal. Going through painful experiences may feel as if things are worse than when you started. In the long-run however therapy should help you feeling better. If it doesn’t after a while you should let your therapist know that things are not improving.
Will I feel better straight away?
Apart from rare occasions where a single session is enough it usually takes a number of sessions before therapy starts to make a difference.
Does it work for everybody?
No. Because everyone is different (therapist included) everyone will feel the therapeutic process differently. Some therapy are successful, others are less. The relationship with the therapist is central to any progress.
Will I be able to have therapy that understands my cultural background?
It is important that you find a therapist you find yourself comfortable with, which could mean that you want to search for someone who is aware of your cultural background. Having said this it should not matter for the therapist.
Are therapy all the same?
No. There exists different methods and approaches in therapy and you might want to discuss the various modalities with your therapist so as to be sure his or her way of working will be all right with you.
What types of therapy are there?
Many different types of therapy are available. However it is often found that your relationship with the therapist is central to the progress of therapy.
How long does therapy take?
Sometimes only one session is enough to feel better. However, as the therapy progress it may be the case that sessions continue over several weeks or months. It is common practice after 6 or 12 sessions to review how therapy is going for you, and discuss whether you feel it is important for you to continue or not.
How long is a session?
Sessions usually last fifty minutes to one hour. However it is also the case that some modalities extend or shorten this time
How often will I see my therapist?
Usually people see their therapist once a week. However this frequency can change if you wish a more intense therapy. This should be made clear from the start in the initial session with your therapist.
What questions should I ask the therapist before therapy begins?
The following are a list of recommended questions, however do also ask your therapist any others that you think of: – How many sessions will I have? – What type of therapy do you offer? – How much will it cost? – What happens if I miss a session? – What happens if I want to take a holiday, will I still have to pay? – Will the counselling be confidential? – Will you make notes during the session, and if so, what happens to these? – Can I contact my therapist in between sessions?
What should I look for in a therapist?
The initial assessment is a chance for you to ask about the qualifications the therapist has and whether he or she is a member of a professional body such as: – The British Association for Counselling and Psychotherapy – The United Kingdom Council for Psychotherapy – The British Psychological Society You might also want to check whether the therapist has any experience and/or training in any particular area of concern important to you.
How can I be sure this particular therapist is right for me?
Trust your first impressions. If might just be that after a few minutes you feel you can trust the therapist and that you are comfortable talking. If on the other hand you feel not quite at ease, you may want to reconsider your choice of therapist.
What if I don’t like my therapist?
If after several sessions you don’t like your therapist you may want to address the matter with him or her. This might just be part of the therapeutic process iself (transference). If after a while there is still a real and long lasting discomfort then you may wish to consider seeking another therapist.
What can I do if it doesn’t seem to be working?
If you feel that after a while there doesn’t seem to be any difference for you, it is important that you discuss this with your therapist. If then nothing changes then you may wish to go to another therapist.
How do I know if my therapist is qualified?
400-450 hours college-based therapy training is the number of hours BACP recommends as a minimum. You may want to ask your therapist for the details of their qualifications. Don’t hesitate to ask questions. If you still feel unsure, do contact the therapist’s professional body in order to verify their qualifications.
Does a therapist have to be licensed?
Currently there is no legal requirement for therapists to be licensed. However, it is wise to choose a therapist who is a member of a professional body and who is insured to practice.
I want to end therapy. How can I do it?
If after a while you would like to end therapy it is preferable that you first discuss it with your therapist in order to bring things to a clean end. If this seems too difficult to do face to face, you may want to give notice of wishing to end therapy in writing. Please do bear in mind any agreement you made at the beginning of therapy with regards to ending sessions.
Will I be charged if I cannot attend a session?
It is important that you discuss this when you make your agreement with your therapist at the start of therapy. Because the rooms I am using require me to be charged on an ongoing basis unless in exceptional circumstances I am charging for missed sessions.
What if I am on holiday and so will miss a session?
This is important to clarify this at your initial session with your chosen therapist. For reasons related to hiring the rooms I personally expect payment for missed sessions including holidays.
Will what I say in therapy be reported outside the room?
What is being shared in therapy is confidential to the extent that it will not be reported to anyone except a supervisor who, for the protection of the client also offers his or her own interpretations and make sure no harm is being done. In other circumstances however, if there appears to be a serious risk of harm to you or to others the therapist should inform you of his or her intention in dealing with this situation. This is usually done with your permission. These circumstances should be explained to you at the beginning of your therapy.
How much will I have to share with my therapist?
What you tell your therapist is entirely up to you.
Will the therapist contact my doctor?
Therapists usually ask to have your doctor’s contact details in case they feel there is a serious risk of harm to you.
Is it possible to bring a friend?
This is not encouraged. The therapy is for you and is safe because what you talk about is explored in depth between you and your therapist. If there are communication difficulties, it would of course be understandable to have an interpreter in the room. If you feel you would rather be with other people in therapy you may consider group therapy.
- UKCP – United Kingdom Council for Psychotherapy – ukcp.org.uk – Tel. 020 7014 99 55
- BACP – British Association of Counselling & Psychotherapy – bacp.co.uk – Tel. 01455 883 300
- BPS – British Psychological Society – bps.org.uk – Tel. 0116 254 956
Other Useful Websites
- Department of Health – dh.gov.uk – Tel. 0845 4647
- Mental Health Care – mentalhealthcare.org.uk – Tel. 0845 4647
- Mind – National Association for Mental Health – mind.org.uk – Tel. 0845 766 0163
Psychotherapy Training Organizations and Services
- Institute of Family Therapy – instituteoffamilytherapy.org.uk – Tel. 0207 391 9150
- Institute of Psychoanalysis – psychoanalysis.org.uk – Tel. 0207 563 5002
- Westminster Pastoral Foundation – wpf.org.uk – Tel. 0207 361 4803/4
- Guild of Psychotherapists – guildofpsychotherapists.org.uk – Tel. 0207 401 3370
- Arbours Association – arboursassociation.org – Tel. 0208 348 6466
- Counselling in SW18: Equilibrium 88 – equilibrium88.co.uk – Tel. 020 8870 8761
- Check my profile on BACP
- Lacananian analysts here
- Therapy room to rent in London, see here