Sybil Houlding practices psychoanalysis, psychotherapy, and couples therapy in downtown New Haven, and is an assistant clinical professor of psychiatry at the Yale School of Medicine. She is currently the president of the board of the Western New England Institute for Psychoanalysis. This week, Houlding sat down with the Herald to discuss her work and psychoanalysis at large.
YH: Why did you pursue the extra training to become a psychoanalyst as opposed to just performing psychotherapy?
SH: One of the hallmarks of psychoanalysis is the opportunity to have a relationship where people come in three, four, five times every week and typically, you know, lie on the couch, and there’s something about the intensity of that kind of rapport that gives you much greater access to the inner world. I think psychoanalysis places a much higher premium on unconscious fantasy, unconscious parts of the mind that might express themselves in character or in symptoms. It just seemed like the deepest, fullest way.
YH: Why is there such an usual density of psychoanalysts in New Haven?
SH: It has to do with the fact that we have an institute to train them. There’s the Yale Medical School, the Yale Child Study Center, and the Yale Department of Psychiatry, which all have deep roots and connections with the Western New England [Institute for Psychoanalysis]. We have a very long and established presence, as there are a number of very famous analysts who trained here. The Yale Child Study Center was really one of the most important centers for psychoanalysis, particularly of children, for many, many years, and it had a direct connection to Anna Freud, Sigmund’s daughter. So New Haven has a long history of involvement with psychoanalysis.
YH: What does a typical session look like? What sort of issues are you working with, and what sort of people come to you for psychoanalysis?
SH: I think people get to a place in their own development where they can really feel the obstacles that are keeping them from realizing themselves, and that are causing intense distress. I think that’s a very significant moment in a person’s life, realizing that. What kinds of things? Maybe long-standing issues of depression, maybe profound anxiety, maybe early trauma that makes it impossible or difficult to create sustaining or lasting meaningful relationships, and that’s very important.
And in a way there is no typical session. That’s not to say that there aren’t certain recognizable qualities, like that the patient talks more than the analyst, but really each person is unique and each relationship is unique. I think what we’ve come to realize is how much the analysand affects the analyst. An important source of data is some mutual recognition of what’s going on between you. It’s a different sort of relationship, when we can begin to notice what happens in an intense way. So if you come in and tell me, “This happens again and again and again with my roommate,” we can go over how you feel, but when it happens between us, then it comes really to life. I think that is one of the most powerful things that psychoanalysis has to offer.
YH: How long do you typically see a patient?
SH: My sessions are 50 minutes, typically four or five days a week. How many years, now that’s a good question. How big is the problem? What the clinic would say is we wouldn’t accept someone for an analytic experience for less than two years. It’s not a fast process. And therefore it’s not for everybody—not everybody needs analysis. But for the people for whom it can make a difference, it’s probably true that nothing else will make that kind of difference. I think four years would be the short end, four to six maybe, and in some situations it can go on eight, nine, 10 years. It really depends: how entrenched are the things you’re working with? How far are you each capable of going, this analytic pair?
YH: Is there a point for you as the analyst or for the patient where you feel like the problem is solved? How does the relationship end?
SH: That’s the question everyone is asking. Here’s someone who knows me better than anyone has known me, and who I feel so comfortable with, and what do we do now? Termination is what we call it, which some people think sounds sort of brutal, but it is really one of the most important parts of analysis. Because being able to work through, in a meaningful way, the ending of an important relationship onto which you’ve projected or transferred so much of your whole history, and then to be able to end it or say goodbye with a fuller understanding of yourself, to mourn and to relinquish, is an incredibly important part of the work. And some people with early losses I think come into analysis in order to terminate, in order to find a way to mourn the earlier loss, but also to have a different experience of ending a relationship. I feel like mourning is one of the central parts of the human mind; it helps to build structure in the mind. I don’t just mean mourning in the layperson sense of mourning a person, but in terms of accepting the limits of reality and being able to bear it, without either denying it or sinking into depression.
YH: Is it difficult for you, being so intensely engaged in these people’s lives, to leave the office and carry on with your personal life?
SH: It’s a very strange profession. It’s very rich and very privileged to be so intimate with people in that way. And you do carry it with you on some level, but I think with time and experience you get better at either just tolerating it or moving away from it, or finding some way to have an internal balance. I mean, you’re yourself, in all situations, and it finds its place inside you.
YH: I’m struck by the nature of that relationship, and I can’t think of another relationship in life besides maybe with a spouse, where you find that kind of closeness and trust.
SH: Yes. And I think with a spouse there’s a lot of reciprocity, there, for better and for worse, but in psychoanalysis what protects the treatment and makes it a treatment is that it’s all about you. So your fantasies about what I might be doing when I’m not here, and your wish to know, and your envy of my privacy, and all those things, form a part of the treatment, because being excluded from a relationship is central to the human psyche, and so it is actually from that point of view a very unique relationship.
YH: How do you think psychoanalysis is going to fare in the coming years?
SH: I wish I knew. That’s very much at the heart of the international discussion about psychoanalysis. There are, on the one hand, the people involved in it with so much passion, and at the same time, abroad, an awareness that the world is moving faster. There’s less value placed on the inner life; there’s more emphasis on a quick and speedy gratification. It makes us wonder how we can continue to flourish and be relevant. But I do know that something this valuable to humanity isn’t going to go away.
YH: Your job is to listen to other people for hours and hours and to always be actively engaged. Do you ever find it boring or frustrating?
SH: Well, if it weren’t in every treatment sometimes boring or sometimes frustrating, I would wonder why someone was working so hard to entertain me!
—This interview was condensed by the author