It's a new year folks, and many of you are thinking about looking into your long-standing problems in relationships, depression, anxiety, and of course the list goes on as does the unique story of each person's life.

There are generally two ways to find a therapist or doctor: a personal or professional referral, or a web-search. I'd like to talk a little about these options, and I am starting with a bias. I think you should be looking for people who have trained at a Psychoanalytic Institute, such as the San Diego Psychoanalytic Center, and I hope to convince you as to why.

From either referral source (website or personal), the message to you is: "this person is the best," so to speak. Friends, colleagues, or other doctors may provide the referral in a way that suggests you are receiving a special password. Many providers present themselves as "evidence-based," using "proven" methods; with the implication being that other (usually psychoanalytic therapists like me) are doing this confusing labyrinthine work that they cannot understand. Still others present themselves to be essentially spiritual healers and sort of zen-masters in a nutshell (no pun intended).

So how do you navigate the referrals and web-searches well enough to avoid unhelpful docs and to find someone useful?

First, I am interested in you developing an understanding of "psychodynamic" or "psychoanalytic" therapies. These forms of treatment work from the assumption the you have an unconscious part of your mind, and that understanding the unconscious part of your mind is crucial in symptom relief or depression and anxiety and in forging a path into more enhancing relationships. In order to understand that the unconscious exists, you only need to think of confusing patterns in your own life. People find themselves in dysfunctional relationships, attached to incompatible partners, engaging in self-defeating cycles at work or in love, treating loved ones harshly when they do not actually want to, and much more. Most people, when they think about it, do not imagine patterns like the ones above are helpful and would like to change them.

A cognitive therapist (someone who does not acknowledge that we have an unconscious) believes that you suffer with "distorted cognitions" or "maladaptive beliefs" and supposes that you need to learn different ways of thinking.  The idea is that you will recognize better or more healthy ways of thinking and that you will then correct problems in your life.

…I have many problems with the notion of cognitive helping above. The cognitive therapist seems to think you have an error of intellect, because the absence of cognitive networks is an intellectual deficit. I make no such assertion. Most people come in to my office with the full knowledge that some things are real problems, and that for some reason they cannot bring themselves to behave or feel differently. If I could simply say “well, you just didn’t recognize that your thinking is inaccurate and that you can just think this way,” I think I would wave that magic wand many times. But, that’s not how therapy works, because it’s not how the mind works. You hang around in troubling relationships, or you co-create troubling patterns in an otherwise viable relationship not because you are making intellectual errors, but because there is something happening in a deeply complex pattern of unconscious networks, which all add up to a belief that you should be treated or should treat others a certain way. Feelings of a void in one’s self and a confusion and anxiety pertaining to one’s identity is far more complex than a set of cognitive gimmicks can solve.

One metaphor may help illustrate my point. A CBT or cognitive therapist might say, “some people just need help putting a new tire on the car, and can be on their way.” My response is, then that person is in for some real problems if the car’s alignment is the problem because they will continue crashing into the guardrails.  

How do I think change works? I believe, and research studies by some of the most prominent scientists in the field agree, that attention to unconscious processes and a focus on the therapeutic relationship in all of its complexities will help you. Forget about studies for a moment, and let’s just think together. Doesn’t it make sense that if you develop a deep and strong relationship with your psychologist, that understanding your self in the context of that relationship will be the most helpful? If you could talk about a moment that just happened with me in session and draw upon the feelings that arose, wouldn’t we be able to ascribe meaning and understanding about how your mind works with much more weight that talking about some distant, historical, or intellectual error in the past?

If you agree with me that it is most helpful to assume you have a part of your mind that is unconscious and works in irrational ways, and that it is helpful to comprehend the therapeutic relationship with the unconscious in mind, then you are still left with one problem. How do you go about finding someone who is actually trained well enough to work with you on these deeply complex matters? is the most popular way of searching for therapists, followed probably by These are basically online phone books where therapists can put in a short bio and pitch their shtick, so to speak.  The problem is this: it is a fact, not just my opinion, that in order to specialize in “psychodynamic therapy,” “psychoanalytic therapy,” and certainly “psychoanalysis” where unconscious processes can be understood, a therapist needs to have gone to a Psychoanalytic Institute for certification after they have their graduate degrees and are practicing, and only a tiny minority of my colleagues ever enter such training; this field is in a sort of crisis for that reason.

The problem for you is that the web-searches offer you no good way of knowing who’s who….who has the training versus who is just claiming they work in a “psychodynamic” when in fact they are just using a label. There are over 10,000 different forms of “therapists” in San Diego county, and only 127 people who are active members of the San Diego Psychoanalytic Center, the only place in town where one can receive this form of training. I do not have the numbers tallied yet, but the amount of providers claiming to work in “depth-oriented” and “complex” ways are making claims that may be true, but that are not verifiable by you. 

Rollo May talked about the crisis of untrained therapists in this video. 
Note: while the video lists Rollo May as an "existential" therapist, he was a trained psychoanalyst. 

For a useful article on choosing a therapist, click here. 

I hope that this article has helped you understand something more about searching for therapists, and the importance of your therapist having attained verifiable psychoanalytic training from an accredited regional institute.


Lucas Klein, Ph.D.