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."

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.

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?