Leslie Pratch on Business, Culture, and the Economy

By Leslie Pratch

A year and a half ago, I wrote about my friendship with Dr. Aaron Hilkevitch (“Premature Anti-Fascist”). Dr. Hilkevitch was a psychoanalyst. When I started graduate school, even before starting graduate school I thought the kind of work that would be most meaningful to me was psychoanalysis. I thought  I might enjoy doing what Freud had done.

But the culture changed. Cognitive and behavioral psychology came to the fore and HMOs entered the scene. It seemed to me that one had either to accept the strictures of operating within managed health care or else be independently wealthy to maintain a psychoanalytic practice. The notion that we did not know ourselves as well as we believed was threatening to many, and the climate of trust in professionals (see my entry on Sissela Bok) also eroded. It is truly unfortunate because what is most curative in psychoanalysis is to learn to trust enough to accept another person’s insights as potentially valid and to learn to analyze ourselves as we have been analyzed.

Other factors militate against entering into psychoanalysis. In the first place, it is very long, very time consuming, and very expensive. Few candidates who are young, intelligent, and insightful enough to benefit from psychoanalytic inquiry are willing to invest the money, time, and energy and accept the pain that psychoanalysis requires. If parents are wealthy enough to pay for it, boundary problems diminish the efficacy that comes when candidates take responsibility for self-awareness and self-acceptance. My own practice has emphasized insight-oriented psychotherapy, aka “coaching” for high-achieving, high-functioning professionals who want to optimize their success and happiness professionally and personally. These professionals are generally between the ages of 31 and 48 and have enough income to pay.

Why should psychoanalysis, which involves saying whatever comes into your mind, be so difficult and painful?  The short answer is that we conceal a great deal that we think and feel, not only from others but from ourselves. We do not want to admit to ourselves that we have such thoughts or feelings.

Freud, as Herman Sinaiko points out, discovered that the range of thought, action, and passion in the human psyche is far larger and far more difficult to get at than previously understood.  He also found that much human misery was due to conflicts within the self, although sufferers usually do not realize the internal sources of conflict. Normally they attribute their unhappiness to external causes they cannot control. Freud found that we are far more ignorant of ourselves than we realize.

Psychoanalysis is a slow, painful process discovered by Freud through which candidates, helped by their analysts, come to understand themselves better. But what matters for this blog is that for Freud the process of self-discovery is essentially a conversation between the analyst and the client. We simply cannot discover the truth about ourselves by ourselves; we need to do it with someone else.  This necessity for dialogue is built into the human situation. If we could admit to ourselves what we really felt and thought about ourselves and those closest to us, we would not be so conflicted that we needed to suppress and hide significant portions of ourselves from ourselves. It seems as though the human psyche is structured such that the truth about ourselves is accessible only with the direct aid and support of someone we trust more than we trust ourselves.

The privacy and longevity of the process is paramount to its efficacy. But these criteria for effectiveness cannot be met by HMOs and cannot compete with the pharmaceutical companies claiming to cure everything from obesssive compulsive disorders in childhood to bipolar disorders in children, believe it or not, soon to become a diagnostic entity in the new DSM.

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Leslie Pratch, Ph.D. is a clinical psychologist from Northwestern University Medical School with an M.B.A. in Strategy and Finance and a B.A. in Religion from Williams College. She works with boards of directors and private equity investors to select and develop executives. She can be reached at (312) 464-7919 or email her at leslie@pratchco.com or visit www.pratchco.com.