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Treating People, Not Symptoms

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LEXINGTON Oft misunderstood, psychoanalysis is a viable and vital option for Kentuckians who seek lasting relief from their neuroses. At The Lexington Center for Psychoanalysis, Drs. Jeff Tuttle and Beth Housman facilitate patients’ close examination of their own stories to help empower them to deeper understanding of the causes of plaguing stress and uncertainty. Unlike Cognitive Behavioral Therapy (CBT), psychoanalysis is cause, not symptom, focused, so revelation of personal stories, and patient understanding of them, is integral to the treatment. It is a highly collaborative, and usually gradual, process in which, as Housman says “Patient and doctor work together to find the best course of therapy.” For Tuttle, the goal of psychoanalysis is simple: “To make people less vulnerable to stress in the future.”

Why Practice Psychoanalysis?

Both Tuttle and Housman began training as psychiatrists without plans to practice intensive psychotherapy, but each found that the limited doctor-patient interaction precluded the familiarity and understanding they needed to best serve patients. Having observed the shortcomings of the trend towards medication management, their revelations were fundamental for their career paths. For Tuttle, “the value of getting to know patients was lost when I was limited to 15 minutes per patient. This led me to consider training in psychotherapy.” Housman, who planned to be a family practice doctor when she started medical school, observed that “During my outpatient rotations in psychiatry, I became frustrated very quickly with just a medication approach – and noticed that my patients were also. I found that I was drawn to their stories, so I did more training in psychotherapy.”

Their inclinations led both to the Advanced Psychotherapy Program at the Cincinnati Psychoanalytic Institute. The two-year program is available to medical professionals who have an advanced professional degree in their field, a minimum of two years supervised clinical experience, and a valid license to practice in their state. As part of their training, all psychoanalysts maintain a long-term relationship with an experienced analyst who regularly sees them as a patient. For Tuttle, “A psychiatrist’s experience in their own therapy has probably the most profound impact on the direction of their practice.”

How It Works and For Whom it Works

Psychoanalysis is a gradual, but intense and dynamic, process. Doctor and patient typically meet one-to-five times per week, as Housman says, “to work together to determine the best course of therapy.” Although many psychoanalysts are psychiatrists, medications are not always incorporated in the treatment. Nor is psychoanalysis focused on symptom management, as CBT is. Rather, Housman continues, “it is focused on where symptoms are coming from and why they exist, because the symptoms are there for a reason.” Thus, looking closely at stories – one’s past and how it is understood – is key.

The general population’s conception of psychoanalysis is rife with outdated clichés. While some patients do take their therapy in a reclined position, most converse face-to-face with the analyst. Rather than explaining how archetypal relationships and neuroses are manifest in a patient, modern psychoanalysts spend abundant time getting to know specifics of the individual life being examined. Tuttle finds that many people do not know what to expect when they first come to see him. “I am yet to have a patient come in asking for psychoanalysis. Most people come looking for a combined treatment – therapy with the availability of prescriptions,” says Tuttle. So there is a “getting to know the therapy” period. Housman notes, “The first few sessions are spent trying to get a feeling for what the problems are and what kind of treatment will be most helpful.” Tuttle estimates that, “About a quarter of patients decide this long-term approach is not for them.”

With its time-intensive demands and self-exploratory nature, psychoanalysis is not for everyone. Housman says that many people who end up in psychoanalysis “feel guilty about feeling depressed or anxious because they ‘have it all.’ These are people who are not satisfied emotionally and cannot seem to understand why – despite their success in other realms of life.” Tuttle summarizes typical psychoanalysis patients as “functioning neurotics, who have significant problems or frustrations related to work, relationships, or sex.” Another group ends up in psychoanalysis either by choice or requirement: people with characterologic problems and multiple severe symptoms for whom CBT has failed. Housman says, “These are challenging patients, but it is very rewarding to see them change.”

Value Added for Lexington

Tuttle opened his Lexington practice in January of 2010, and Housman joined him that October. They work out of a discrete office near downtown with separate entrance and exit that keeps patients from crossing paths. Their patients range in age from 18–75, with most referred by their GP or word of mouth. Their services work best for people who want to take an active role in the understanding and resolution of their mental and emotional misgivings.

Housman and Tuttle are excited to be part of this dynamic field. Psychoanalysis is seeing increased interest due to abundant disappointment with pharmacological results for emotional and mental health issues and some ebbing of the immediate-gratification culture. There is available data about psychoanalysis’ effectiveness, despite it being so highly personalized. While both Housman and Tuttle are certified by and members of the American Psychoanalytic Association, there is no formal maintenance of certification, so self-regulation is encouraged in the field. Both doctors note the culture of mentoring, professional support, and self-awareness as integral to this self-regulation. A strict code of doctor-patient conduct is also advocated.

The Lexington Center for Psychoanalysis offers an enduring form of therapy that has been extremely valuable to many individuals. It’s predicated on the type of doctor-patient interaction both Tuttle and Housman long sought. As Housman says, “People come to us because they are struggling, they want help. They are not sure just what kind of help they want.” Tuttle concludes, “Our goal is to collaboratively foster positive psychological development in our patients.”