WWhen I imagine what a good life means to me, I feel a tension in my chest. I see my daughter and husband and feel deep satisfaction that I am exactly where I need to be, shackled by the horror that life is so fragile and I cannot protect them from this reality. Then a memory: I was lying on my analyst's couch and describing the feeling of emptiness inside that I was very ashamed of, and the way she listened, thought and understood – and I noticed that although I felt horror and disgust, she did not seem to feel it. Next: different walks in different parks with different friends, each with the same feeling of being warmed from the inside; I also run into neighbors at the playground and feel part of my community. I remember vivid moments with my patients who felt understood by me and within themselves. And I think about moving messages from readers who got in touch share precious stories from their lives.
People often think that psychoanalysis and its NHS-friendly grandchild, psychodynamic psychotherapy, are about looking inward. And it’s true—good therapy should give us the time and space, the boundaries and constraints, to look within and listen to ourselves.
But it doesn't end there.
Some of us don't understand what it is inside of us that means we can't be in the outside world or be with other people in the usual way. We have not yet overcome those traumas or unconscious conflicts that keep us trapped in the past. We don't have the ability to process our own feelings, so we can't tolerate, let alone relate to, the feelings of others. Sometimes, if we cannot tolerate any emotions that spontaneously develop within us, we reflect these feelings through screens, drugs, sex, gambling or other self-harm, work, work sabotage or abuse of loved ones, and things become much more dangerous.
Without psychoanalytic help, many of us remain stuck in our habitual and destructive narcissism, unable to relate meaningfully to ourselves or others. If we are blind to what is happening inside, we will not be able to look outward to find solace and meaning in society, in the natural world, in work and love. Meaningful therapy does not condone narcissism; it lights the way out of it.
I am sometimes criticized for writing about psychotherapy because it is perceived as being for the privileged few. And it's true that I'm proud that I can afford it. But that doesn't mean it's only for the rich – or that I shouldn't write about it. Reputable clinics and training organizations have low commission schemes. British Psychoanalytic Council websiteGPs can now indicate on their profile when they are offering low paying jobs. But not everyone can afford these low-fee schemes, which is why my colleagues and I believe in and fight for the provision of sustainable psychodynamic psychotherapy on the NHS. Unfortunately, we are losing this battle; Service provision has been in constant decline for decades, and currently available psychodynamic psychotherapy is very limited.
Every time the NHS is forced to cut the provision of psychodynamic psychotherapy – that highly effective, evidence-based treatment that helps people improve mental health and live better lives – it is forced to act against any values ​​of equality, quality of care, respect, diversity, inclusion and patient choice that it seeks to uphold. These cuts make a mockery of equal respect for mental and physical health. This is an unacceptable state of affairs, and we must not remain silent about it. We should march in the streets. Who will join me?
Because it shouldn't be about who can afford this treatment. I have treated patients from all different backgrounds, some of whom can use therapy to build a better life, and some of whom cannot. It has absolutely nothing to do with how much money they have, how well educated they are, or what they do for a living. While it is true that when a patient has a particularly sophisticated education and is stuck for a long time in using his intellect to try to navigate the feelings that need to be felt, it can be very difficult to work through this to the deeper emotional currents and needs that lie underneath. But it’s worth persisting – at least that’s how it was for me as a patient.
If it weren't for psychoanalysis, I don't think I would still be married or have a daughter. I would not be able to see my role in the difficulties in the relationship or listen to my partner so that we could grow together despite the storms of married life. I couldn't process my own feelings, let alone try to help my child deal with hers. I couldn't do the work I do, shackled by an intellectual defense that was as fragile as it was superficial. I couldn't build a better life on the emptiness I felt but couldn't turn to. I would not have been able to discover that there was anything there after all – the rudiments of man.
I don't know what a better life means to you. And often when my patients come to therapy, they don't know either, and it becomes part of our job to find out. But now I know something about what it means to me. I feel it inside – and I am very lucky that I can afford therapy that helps me. If we want to build a better life and a better society, it must be available to everyone who needs it and can use it.
