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Psychoanalyst Erica Komisar on Dad Saves America podcast

Read the full transcript of Psychoanalyst Erica Komisar’s interview on Dad Saves America podcast episode titled “Childhood Isn’t Supposed To Be Stressful. Here’s How Parents Can Help” with host John Papola. (Feb 23, 2024)

Listen to the audio version here:

TRANSCRIPT:

JOHN PAPOLA: Erica, welcome to Dad Saves America.

ERICA KOMISAR: Thank you for having me.

JOHN PAPOLA: I’ve had a lot of conversations with people that are working in the mental health space. And it’s because this show, in a lot of ways, is inspired by the challenges our kids are facing psychologically. And you are among many things a psychoanalyst. So I wanted to start with the question, what is that? What is a psychoanalyst? Is this Freud? Is it all about mommy and daddy issues?

ERICA KOMISAR: Well, a psychoanalyst is someone who thinks about not just the present, but also thinks about how the past influences the present. So, you know, we say if you don’t know where you come from, how can you know where you’re going? And so a lot of therapies today are very cognitively or behaviorally oriented. It’s very much on symptom relief and very much on the present. But you can’t really get under the issues unless you also understand them in context, and the context is also the past.

So the myth is that psychoanalysts focus on the past, and at least good ones don’t. Good ones help you understand the present by understanding the past and, therefore, helping you to get to a better future.

Cognitive Behavioral Therapy vs. Psychoanalysis

JOHN PAPOLA: I want to jump right into what I thought was an interesting thing when we met because we’ve had some folks on who are really practitioners of cognitive behavioral therapy and will say things like, this is the evidence-based proven treatment and that it is the most scientific thing we have for treating things like anxiety and depression and post-traumatic stress disorder. And you push back on that. So I want to hear what’s wrong with cognitive behavioral therapy.

ERICA KOMISAR: It’s not what’s wrong with it. It’s that its use is limited, meaning it was originally designed to help people with things like PTSD or OCD or if they had habits that they were trying to stop. It’s a very symptom-oriented relief. And, by the way, psychoanalysts do use cognitive behavioral therapy in small doses when necessary, at least, again, good ones. I do.

Meaning, I can work with a patient where I can also uncover what’s happened to them in the past. But if they need some symptom relief, can also do some mindfulness training or some breathing. CBT therapists don’t have the equipment or the training to go farther back in the past and help patients understand what is underneath those issues. So, it’s not what’s wrong with it. It has a limited use, but the problem is it’s being applied widely.

The best way I can describe the difference between depression and anxiety is that depression is a preoccupation with past losses. Anxiety is preoccupation with future losses that haven’t occurred and may never occur. What they have in common is loss.

So if you’re treating a patient who has anxiety, there’s always loss involved, and losses relate to the past. And so if you’re not dealing with the past at all, then you’re not really getting under the problem.

And so you might have some quick symptom relief, some immediate gratification, but it’s not sustainable. And a lot of the research is showing that people that go for CBT therapy, a lot of them get immediate relief, but it’s not sustainable. It basically believes that you can heal people’s anxiety and depression by just getting them to think about it differently. It’s using your cognitive skills to think your way out of what are emotional issues. And so what I always say is you can’t think away something that is an emotional issue.

You have to examine it on an emotional level.

JOHN PAPOLA: So we had a cognitive behavioral therapist, Doctor Ortiz, on the show, and he talked about how, you know, a big part of it is the experiential part, which is, let’s say, I’m afraid I think an example he uses, I’m afraid of being in elevators.

ERICA KOMISAR: Phobias. It’s very good for phobias.

JOHN PAPOLA: It’s like, okay. Here’s what we’re going to do. We’re just going to go to…

ERICA KOMISAR: Conditioning. Yes. Oh, yeah. Yeah. It’s very good for phobias. And does it have more sticking power for that? So think about the fact that if you break your leg skiing, you’ve had the experience of breaking your leg.

And so when you go to ski again, you’re scared that you’re going to break your leg again. And you can develop a phobia around, you know, breaking your leg skiing. And so what it does is it deconditions you. And that’s why it’s good for things like phobias, OCD, PTSD. What it’s not so good at is if the thing that you’re frightened of has nothing to do with an experience you’ve had, meaning I’m scared of elevators, but I’ve never had an incident in an elevator, that means it’s not about the elevator.

That means something is getting projected from the past. That’s a loss that has nothing to do with the elevator, but it’s getting projected onto the elevator. So if you get the person to not be afraid of elevators, you might as well just, it’s a little bit like what I call plowing snow in the winter. You push it from one place to another. And so now you don’t have a fear of the elevator, but you may have a fear of something else.

Evolution of Psychoanalysis

JOHN PAPOLA: And so psychotherapy and psychoanalytics, like, what… I think, you know, Sigmund Freud is probably the most famous name in psychology. Right? To what extent, is that work an extension of him? Where has it evolved past what he developed?

ERICA KOMISAR: Truth in advertising, I was trained as a Freudian, but I’m not a strict Freudian.