If I traveled back in time to meet with a 60-year-old Sigmund Freud, the first thing I would say to him is: “Stop smoking, and get out of Austria!”
That was my thought as I read “Tea with Freud: An Imaginary Conversation about How Psychotherapy Really Works” (Dog Ear Publishing, 2016), in which the author, psychiatrist Steven B. Sandler, MD, holds a series of imaginary meetings with Freud to discuss the evolution of psychoanalysis into Sandler’s preferred mode of short-term dynamic psychotherapy (STDP) and to present case material for Freud’s supervision.
The chapters in “Tea with Freud” alternate between the imagined meetings with Freud and Sandler’s clinical work, presented from what I assume are transcripts of videotaped sessions with some disguises and composites to protect patients’ privacy. These clinical vignettes bring the reader into the nitty-gritty of the treatment room, which may be highly instructive for a lay person – particularly one who has never been in therapy.
At the same time, the book has the potential to be quite misleading. This would not be the case if Sandler were simply trying to introduce the reader to STDP. Instead, he attempts to convince the reader, and apparently himself, that the therapy he practices is a modern rendition of psychoanalysis because it tries to access the patient’s unacceptable, unconscious feelings; encourages her to “remember with emotion” or “experience” her feelings; and leads to some sort of cathartic resolution and improvement in symptoms and outlook.
While, “Aha!” moments and cathartic abreaction were characteristic of very early analyses, modern psychoanalysis is about slow but permanent change in character structure. The unwritten message in the book is that Freud’s true heirs practice psychotherapy as Sandler does. He does not seem to consider the significance of the many psychoanalysts, myself included, practicing psychoanalysis today.
Sandler uses a (mercifully) attenuated Davanloo technique to provoke patients into dramatic enactments. He is highly directive, with statements like, “We don’t solve any particular problem if we jump around all over.” I wonder how he can possibly learn about his patients when he begins with a foregone conclusion about where they should be headed.
His treatments are very brief. During his first session with a patient named Carla, he deduces that she is suffering from unresolved anger related to childhood trauma and manifesting it in chronic anxiety with angry outbursts. He then proceeds to “cure” her in five sessions.
Sandler wonders why some of his patients relapse and decides it is because they have not explored their “positive memories” in treatment, as though memories were univalent.
And he talks way too much.
All of this is decidedly un-analytic, which, again, would not matter if he were only trying to demonstrate STDP in action. Nonanalytic psychotherapies are entitled to be nonanalytic. Sandler has Freud point out precisely these analytic errors, so he must be aware that he is making them. And, yet, he stubbornly maintains his position that his work is analytic. What a waste of time travel it would be to meet with Freud only to reinforce one’s own opinions.
“Tea with Freud” is a way for Sandler to promote STDP and his theories about “positive memories” using an established authority, Freud, to validate them. This makes the book disappointing, but fortunately, there is something more to it. I kept wondering why it was so important to the author to seek out Freud’s – that is, his father’s – approval for his work. The book never answers that question. But in his attempts to understand his motives, Sandler, who is very adept at describing his own thoughts and feelings, becomes a model for the awareness of internal states and the effects of unconscious processes. Perhaps this is the most important lesson in “Tea with Freud.”
Dr. Rebecca Twersky-Kengmana