Shirah Vollmer MD

The Musings of Dr. Vollmer

Free Association: Making Meaning Unconsciously

Posted by Dr. Vollmer on January 30, 2017

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What has meaning in our lives? Why do we make the decisions we do? How do we choose our friends, our lovers, our jobs? When we lie to ourselves, how do we get at our authentic “truth”? The answer, according to psychoanalysts, is straight-forward: Free Associate! This means exercising the mind in an unrestrained way to determine what pops in and out at any given moment. For example, sitting in traffic, it is curious what thoughts arise to consciousness? Frustration, anger, acceptance, or imaginative thinking? Thinking about thinking takes time, and effort, and in the presence of a therapist, can present issues of shame and guilt. Sexual thoughts, greedy thoughts, competitive thoughts, can all bring a sense of unworthiness to the relationship, and as such, those thoughts can be suppressed leading to feelings of conscious anxiety without known antecedents. The hallmark of psychoanalytic work is allowing time, and openness to see what the patient brings to the relationship, which is in stark contrast to the “T” therapies (such as CBT, DBT, IPT) in which the therapist has an agenda. The lack of an agenda is KEY to understanding the meaning that patients’ assign to the experiences in their lives. The other KEY is time and patience. For patients to free associate, they must  speak without fear of judgment, and this can only happen in the context of a trusting and reliable relationship. This “frame” as you will, provides an opportunity for patients to feel safe to “free associate” since free associating is a scary activity. Being afraid of one’s own brain is the hallmark of anxiety disorders, and as such, to make friends with one’s thoughts is a journey of self-discovery and self-acceptance. The length of this journey is not knowable from the outset, and hence restrictions on the number of psychotherapy visits is simply absurd. Thought suppression, the hallmark of Cognitive Behavioral Therapy (CBT) is antithetical to thought acceptance in that thought suppression might provide temporary relief, in the longer term, buried thoughts resurface in ways that can be more disturbing and more unpredictable, whereas free association offers the promise of a more sustaining treatment in that the technique helps the  patient cope with whatever uncomfortable thoughts come to mind. The point here is not to say that CBT is bad for everyone but rather to say that it is not good for everyone, and should not be a one size fits all approach to anxiety disorders and/or depression. Psychopharmacology is another intervention for anxiety/depression, and as such, medication can facilitate free association in that the patient may feel more relaxed in order to allow his brain to connect seemingly unrelated ideas. Hence medication can be a tool which eases the psychotherapeutic process, a benefit of medication which is usually not touted. In summary, it is the loss of free association in psychotherapy which saddens me. The restriction of thought takes away both a deeper relief in patients and a deeper sense of work satisfaction in the provider. Superficial treatments bring superficial results and thereby superficial feelings of job satisfaction. Deeper treatments bring the opposite. We have deeper treatments to offer patients, but as I have said many times, as a field, we have lost our way and forgotten about that.

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6 Responses to “Free Association: Making Meaning Unconsciously”

  1. writingsfromthecouch said

    To free-associate on the couch can be a life-changing experience, over time. It takes lots and lots of time and lots of faith in the process. I am experiencing it and I consider myself very fortunate. It is a huge commitment. And, in my opinion, it is worth every moment. That said, one must be willing to explore one’s own unconscious mind. And like free association, understanding what that means happens only through experiencing psychoanalysis oneself.

    • Hello Writingsfromthecouch..thanks again for chiming in, but I am not sure I agree that the only way to experience free association is through psychoanalysis. I think being attentive to one’s own mind can enlighten the free associative process…or stream of consciousness, as they say in the literature world.

  2. writingsfromthecouch said

    I am afraid I did not express myself clearly. Yes, my final sentence makes it seem that that’s what I mean. I free-associate all the time, no matter where I am. I was trying to make the point that for me the experience of free association on the couch has been different than when I’m not in the consulting room. Of course, psychoanalysis is not the only way. For me it has been a unique way of experiencing it.

  3. Shelly said

    Don’t people free-associate while they drive, while they shower, while they do their hobbies, meditate, hike and bike ride? The only thing missing is the therapist or friend in the room with them, right? There is nobody there to help interpret the thoughts or give them their opinion or show them patterns that may be negative or be their guide. Nobody to listen, if you will. Yes, of course I understand that you mourn the loss of free association in psychotherapy, but that doesn’t mean that free association is gone forever in life.

    • Absolutely true. In life, people call it “stream of consciousness”. It is a very valuable exercise which, as you say, is one of the many great pleasures of being human. It can also be a therapeutic tool, and as you also say, this tool is not being sharpened by many. Thanks.

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