Dr. Stanley Goldstein - Author and Psychologist

Classical psychoanalytic treatment, which utilizes long-term multiple sessions a week while lying on the couch, has declined since the 1970s. There are a dearth of analytic patients many of whom now receive treatment modifications that embrace the basic psychoanalytic concepts of resistance and transference and the unconscious but also the later developments of Kernberg and Masterson and Guntrip and Mahler and others who emphasize the critical importance of early infancy and toddler interaction with their mothering figure to the development of psychopathology, there not having been a "good enough" parenting. Harry Stack Sullivan, with his Interpersonal Theory of Psychiatry, is important too for, as has been said, all clinicians today are Sullivanian since they accept the importance to development of their patient's interpersonal relations. Sullivan died before the later (1960s and thereafter) treatment advances.

A behavior that parents find disheartening is their teenager's tendency to form rapid judgments about friends. Quickly deciding if a friend is "good" or "bad" and, if the latter, instantly removing them from their phone and online "friend" status.

Yet this behavior is analogous to that of infants who relate to their mother in black/white terms, whether or not she satisfies their momentary need. Only after maturing can a child relate to others in terms of shades of gray, understanding that one can possess both good and bad characteristics.

Similarly, the teenager whose personality is slowly developing into their fixed adult structure, requires maturing to accomplish this anew, and some with emotional difficulties never do.

A common complaint of patients during psychotherapy is wishing that they had the greater self-knowledge they now possess as a youth. This universal longing reflects both the benefit of life experience and the protective function of the unconscious mind.

The psychological damage from an unhealthy childhood can be great. Sensing this, the unconscious mind creates false explanations to protect self-esteem and avoid the despair which might cause suicide. Only after positive development has occurred can many tolerate realizing their earlier emotional deficits.

And not only of psychotherapy patients is this true. Many, at the end of their education or working career, are amazed by how they endured the difficult, painful course over which they traveled.

During my first job, as a psychologist at a psychiatric hospital, I told my psychoanalyst/supervisor my adolescent patient's statement. "That's psychotic," the doctor replied. Though able to define "psychotic," until that moment I hadn't grasped the power of this condition.

Similarly, when the latest horrors become public, the perpetrators are usually viewed with surprise since they look so normal, lacking the twisted features of horror film characters and speaking coherently though of bogus beliefs. Columnists then ask the usual question of "why," and provide their usual answer that "no one knows" but this is not true. While predicting violence cannot be certain, it correlates highly with several factors: failure in life; substance abuse; the psychological (ego) capacities governing thinking and behavior being inadequately developed; and having a fragmented "sense of self" (sense of who they are).

The killer's frequent decision, to suicide in "glory," is considered preferable to their continued painful existence.Though their act is horrendous, these individuals are not often considered "insane" which is a legal term determined by state statute. Most usually whether a person can distinguish "right" from "wrong" and, contrary to popular belief, rarely succeeds as a defense.

But to describe these individuals as sane does not imply that they possessed normal control over their behavior. Still, except for those possessing extreme psychological limitations, this should not influence their punishment. There is evil in the world and some succumb to its temptation. Yet even for others, the unconscious is very powerful and one must respect its power.

Psychologists have long known that children in every nation become capable of speaking their nation's language not by learning that one word follows another but because the mind innately inducts the grammatical structure of their nation's language. Understandably so since the purpose of all cognition is to make sense of the personal world as quickly as possible.

It is not true that autistic children avoid communication but rather that they try to communicate in their own way. Thus, treating them with the same behavior modification method that one would use with a dog is doomed to failure. Instead, one must enter their world and wean them into the larger world, one that is unproblematic unlike the unsatisfying, psychologically non-nourishing developmental experiences that drove them from it originally.

One caution: misdiagnosis of autism in children is widespread and traditional play therapy can often reduce or eliminate a few autistic symptoms in mere months.