The most classic intervention of psychoanalysis—to give the patient an intelligent, well-thought out interpretation of why he does what he does—is depressingly ineffective in resolving a patient's self-destructive repeating. This is because an interpretation speaks to the patient's cerebral cortex, where cognition, logic, reason and ethics reside. But the cerebral cortex is also the smallest part of the human brain—it has practically no influence or control over the more primitive parts of the brain where the repetition compulsion is created.

The repetition compulsion is established in our infantile brains before the cerebral cortex has developed enough that we can remember, or even think.  Long before a baby can speak, his brain is very, very busy learning about the way the world works. Neural pathways are being established that will affect how he sees the world for the rest of his life. 

The child won't remember these impressions. He will just experience them as reality; i.e., I must get a dangerous man or a woman who is incapable of love to love me.

Meanwhile, the psychoanalyst’s interpretation and explanation of the patient’s compulsion is almost always experienced as an attack—especially if it is correct. Defenses fly up, and the explanation is rejected. 

But modern psychoanalysts have developed techniques that can break the back of the repetition compulsion. They direct their patients to "just say everything," and then they speak only when spoken to while the patient tells his story. This encouragement and acceptance of talking without intruding creates a safe environment where the patient has no need to mobilize his defenses against a brilliant interpretation.

Language resides in the cerebral cortex, and so while the patient is putting everything into words, he is strengthening this most evolved part of the brain—thus giving it increasing control over the primitive parts of the brain where the repetition compulsion resides. When a modern analyst does speak, he doesn't make an intellectual interpretation, but a well-timed emotional communication. So instead of saying, “Your relationship with your boyfriend is just a repetition of your longing to get your abusive father to love you,” a modern analyst might say, “I want you to get rid of that guy and find a kind, loving man who thinks everything you do is wonderful!” 

This kind of intervention, delivered after trust has been established in the analytic relationship, is laced with powerful feeling, and so it speaks to the deeper parts of the brain where feelings are generated.  It deactivates the neural pathways that created the repetition compulsion, and activates new neural pathways which will allow the patient to make better choices in his life. 

The repetition compulsion may be remarkably immune to reason and insight, but emotional communication has the power to rewire the brain.

To learn more about the repetition compulsion, 
read Dr. Holmes's latest book, Wrestling With Destiny,
and watch her presentation at the 2013 CMPS Annual Conference:
"The Role of Free Association in Resolving Repetitions."

Psychoanalysis is the best solution to this problem. A good analysis can literally rewire the brain in a way that can help the patient learn to make better choices in their love life. A patient of mine, who is going through a painful divorce and who has been talking about how she has chosen the wrong partners again and again, said this about it: 

This woman is ready for a new kind of relationship.

For those who don't have the inclination or the money to begin a long term analysis, there are several things to keep in mind to help a troubled marriage:

• Work on improving your fights with your spouse. Only one person is allowed to shout at any given time. If your mate is screaming, try to listen till he or she is finished. Then repeat what your partner has just said without screaming. 
  
  

• Forget being honest. I shudder when people tell me they are always scrupulously honest with their marital partner. A long term marriage is going to produce plenty of feelings that should not be communicated. You can know that you feel bored with your husband or wife, that you don't like that he or she is older or fatter than they used to be, but nothing good can be gained by being honest about it. Know what you are feeling at all times, but only communicate what will be good for the relationship. 

And yet, for all her hard-won liberation, the contemporary woman is still constrained. 

In the twenty-first century, female shackles are extremely subtle, and often disguised as “choices” or “control.” Today, the war on women is fought on the battlefield of the female body. And sadly, most of the combatants are women themselves.

In Wrestling with Destiny, I explore why so many women are willing to attack their own bodies with starvation diets, elective Caesarian sections, hormone replacement therapy, and face lifts.

There is power in femininity—it contains an innate reminder of infancy, that vulnerable time when a woman had all control over food and shelter, over the line between life and death.

Because it is women who preside over our infancy, we associate women with our earliest, most primitive anxieties. This anxiety drives us to diminish and control women—even if those women are ourselves.

Female flesh reminds us all, men and women, of our vulnerability and our most primitive fears; and we all, men and women, have an unconscious need to attack and control the female body. Women must be mindful of the power embodied in their femininity, and mindful of the fact that it needs protection not only from our sexist society, but also from our own self-contempt.

Someone once said to me that psychoanalysis and group therapy are “apples and oranges.” I thought about that and then thought, “I think it’s more like apples and apple pie.” First you have to grow the apples in an individual analysis, but at a certain point, you are ready to go into group to learn how to make something delicious with them. 

To use a different metaphor: 

Most of the patients who come to me for an individual analysis are not ready to be in a group; they are just too young, emotionally speaking, and they need to spend time in a dyad before they are ready to play. Unless you are a person who has a very strong ego and is coming to therapy to tweak a few personal problems, I think it is a mistake to go to group first.

But a person who has done an individual analysis but never been in a group is incomplete. Psychoanalysis gives people tremendous insight about themselves, but to really change and be attracted to people who are nurturing rather than pathological, a person needs to practice with real people in a group.

Psychoanalytic patients have explored and understood their obsessive repetitions, but now they need practice in trying something new. Group is the perfect place to practice all sorts of new relationships. Group is a lab for life.

In a good group, rather than monologuing about sad childhoods and unhappy love affairs, members are encouraged to work in the here and now with others in the room. 
                                                                                                   (Image via Joris Louwes on flickr.)
For example:

Group helps people become interested in other people’s feelings, and develop the skills to be genuinely empathic and intuitive. As that begins to happen, the world goes from black and white to technicolor.

Everyone comes to group therapy wanting to be loved, but they soon discover that the real joy is learning to love other people. New skills learned in group become available a few months later outside the group room in real life; those who are successful in group soon become successful in life.

All patients, sooner or later, need to be in a group if they want to achieve their full potential. 

Freud famously asked, “What do women want?”

He never really answered that question to his satisfaction, and toward the end of his life, he described his theories about women as “fragmentary and incomplete,” and left it to younger female analysts to expand on his ideas about women.

How do you feel about Freud? Do you agree with feminists in seeing him as a male chauvinist? It is true that Freud’s theories about women were a product of the sexist Victorian culture in which he grew up. He described women as “little men,” as “organless.” He believed that women suffered from an envy of the penis that left them passive, masochistic and narcissistic. He thought this penis envy drove female development, and beyond that, he had little to say about the female mind. Should we give up on Freud as hopelessly old-fashioned and Vistorian? Or can we use Freud’s theories as a starting point to expand his ideas about women?

Seventy-five years after Freud invited younger female analysts to deepen our understanding about women, I responded to his challenge.

I knew that explaining women as “castrated” was overly simplistic, but also believed that most of Freud’s theories, particularly his theory about the unconscious, were very helpful in my work of trying to understand female human beings. After studying women for almost ten years, I introduced my first book, The Internal Triangle. Using Freud’s theories about the unconscious and penis envy as a springboard, I offered new and expanded theories about women and their emotional development. These ideas present a much richer picture of the female mind. 

After studying women---particularly pregnant women---I found that they have a very lively internal fantasy world. The female mind is full of ghosts. Many women’s own parents are very active in their minds, and often, on a fantasy level, a woman’s sense of herself is somewhat oppressed by the mother and father within her own mind.

I called this very common mental situation the "internal triangle".

Women’s tendency to internalize their mother and father has some positive consequences: Because women are able to see things not only from their own perspective, but also through the eyes of the mother and father within, they can display tremendous empathy for and intuition about other people. The internal triangle also enables women to sacrifice themselves for others, which is what enables them to mother and to marry.

But if the triangle of mother, father and self is too oppressive, with the internal mother and father controlling and subjugating a woman, she can demonstrate some of the negative qualities we associate with femininity: passivity, masochism and narcissism.

Do you know any women that are so bogged down in their impulses to care for and understand others that they hardly know what they themselves think?

The physical crises in female development---the beginning of menstruation, pregnancy and childbirth, and menopause---are dramatic milestones. At each of these milestones, if all goes well, the internal triangle gets reworked. Childbirth in particular can empower a woman in a unique way and free her from the subjection of the mother and father within.

However, many people think of these physical milestones as “illnesses” and try to treat their symptoms with drugs. Have you ever thought of them as opportunities to grow and evolve?

For more of Dr. Holmes's research into the psychology of women, read her first book, The Internal Triangle.

Yet after working with psychoanalytic patients for many years and carefully studying my successes and my failures, I can say with some conviction that saying everything is the key to a successful analysis and a satisfying life. Patients who are good talkers are the ones who get better.

Does this idea ring true in your own experience? Does talking with others about a problem you have, rather than impulsively going into action to solve it, improve your chances of finding constructive solutions to life’s challenges? If, on reflection, you find that talking things out, inserting words between your impulses and your actions, helps you make better decisions, why do you think that is so? Why is talking such a useful tool?

Most people who are unhappy with their lives are being controlled by their own primitive impulses and feelings. They get angry or anxious or sexually attracted to the wrong person, and that causes them to go into action which is self-destructive. They make a bad marriage, lose a job, destroy their relationships with their children because they are being ruled by their own out-of-control feelings.

In these unhappy people’s lives, there is no real thought or consideration between the impulse and the action. This makes for a life that is unsatisfying at best, and, more often, bleak or chaotic. Do you know people like this---people who don’t really talk very much, but instead take drugs, kick the dog, indulge in self-destructive sex, disappear from relationships? People like that are compulsive. They’re not steering their own ships but instead are being controlled by their primitive impulses. 

Talking about things in therapy disrupts that compulsive process. It delays going into action which may be self-destructive. It puts the higher levels of the brain, where logic and reason reside, in control of the more reptilian parts of the brain, where our sexual and aggressive drives are created. Talking actually strengthens the higher levels of the brain in a way that begins to give the talker control over his life. He (or she) may still have primitive impulses and feelings, but they no longer control his life.

And as he strengthens the more evolved parts of his brain by putting all thoughts and feelings into words before making any decision or taking any action, he actually takes charge of his own destiny.

Freud famously said that anatomy is destiny.

Much of Freud’s writing was devoted to the idea that the penis, or the lack of one, shapes the minds of human beings. He associated masculinity with activity and femininity with passivity.

There are good reasons, having to do with the possession of a penis, that men are associated with individuality, active phallic energy, and a strong and rather rigid sense of rights and justice. The lack of a penis in women demands that they have to compensate by creating mental structures which encourage feminine attributes like empathy, intuition, nurturance, and even passive masochism.

Freud thought that part of good mental health was accepting and embracing our anatomical destiny and the sexual roles it demands. But I don’t want to be boxed in, and I don’t want my clients to be limited by their gender identity. When I meet a person who feels trapped and depressed in a rigid masculinity or femininity, I want to help them play with gender roles a little. This means encouraging women to think “like men” and helping men behave “like women”.

What do you think? Am I wrong not to guide people to accept their anatomical destiny? Or would the world be a better place if there were more competitive, ambitious women and empathic, nurturing men?