Isak de Vries, LCSW | Psychoanalyst & Psychotherapist in New York City, New York

Severe Psychological Distress

There are times when the mind becomes a frightening place to inhabit. Thoughts turn against us, feelings become unbearable, perceptions betray what we once knew to be real, and our sense of who we are begins to come apart. The familiar world becomes unfamiliar. We may withdraw from others, lose ourselves in states of confusion or despair, or struggle to hold together the ordinary demands of living.

Psychosis, bipolar disorder, dissociative disorders, and other forms of severe psychological distress can profoundly disrupt our relationships, identities, and experience of reality. Even when the most acute symptoms subside, the fear of losing ourselves again can remain.

Yet even the most troubling psychological experiences are not without meaning. Psychoanalytic treatment offers a sustained relationship in which what has become fragmented, overwhelming, or impossible to think about can gradually find expression and understanding. Sometimes the work begins simply with finding enough stability to bear being oneself. From there, other possibilities emerge.

Addictions, Substance Abuse, and Compulsions

What begins as pleasure, relief, or escape can gradually become something we cannot seem to live with, yet cannot live without. Alcohol, drugs, sex, gambling, and other compulsive behaviors may promise freedom from whatever troubles us, only to leave us increasingly captive to them. We make promises to ourselves, break them, and return again to what we know may be destroying our relationships, health, work, and sense of ourselves.

The strange thing about addiction is that knowing what harms us rarely seems enough to make us stop. Something persists beyond reason, intention, and even our strongest wishes to change.

Psychoanalytic treatment offers an opportunity to explore what draws us repeatedly toward these experiences, including the unconscious conflicts, desires, and forms of suffering that may sustain them. The work is not simply about giving something up, but discovering what has made it so difficult to relinquish. It is especially about what else become possible in its absence.

 Depression and Anxiety

We worry endlessly, anticipate the worst, replay conversations, dread what might happen, and struggle to find relief even when nothing seems particularly wrong. Or the world loses its color. Things that once brought pleasure become burdensome, getting through the day takes enormous effort, and we withdraw from the very people and experiences that might make life feel worth living.

Depression and anxiety can leave us painfully at odds with ourselves. We may know our fears are unreasonable, that our lives are not as hopeless as they feel, or that something needs to change. Yet knowing rarely seems enough. The same thoughts, feelings, and familiar patterns return, sometimes with a persistence that makes them feel like an inescapable part of who we are.

Psychoanalytic treatment offers an opportunity to explore what lies beneath these experiences, how they have come to shape our lives, and what might become possible when their hold on us begins to loosen.

Relationships, Sexuality, and Intimacy

Times have changed when it comes to love and relationships. Wives used to be shamed for divorcing their cheating and insufferable husbands; today, they are shamed for staying with them. Once, we believed intimacy and satisfaction resulted from time together; today, we'd better provide both if we want a relationship that stands the test of time.

All our stories are about what happens to our desires: the world as we wish it were, and the world as it actually is. Relationships are no different. Communication sinks into discord; what was once easy trust fragments into bitterness; sex becomes troubled by conflict, boredom, or disappears altogether. One partner wants independence while the other wants to depend; one wants separateness while the other wants closeness.

Add our unruly tendencies toward jealousy and righteous indignation, our differences around sex, parenting, politics, and money—not to mention our own psychological struggles—and a happy, thriving relationship begins to sound like the definition of a miracle.

And yet, that happens...

Adolescence and Identity

Adolescence can be a bewildering time. The person we once knew ourselves to be begins to feel unfamiliar, our bodies change, desires awaken, and the world suddenly demands that we become someone we have not yet figured out how to be. We want independence but still need to depend; we long to belong while desperately wanting to be different. Parents become impossible, friends indispensable, and questions of identity, sexuality, love, and belonging can take on enormous urgency.

For some, these struggles become overwhelming. Anxiety, depression, isolation, self-destructive behaviors, conflicts at home, or difficulties with peers may emerge as adolescents struggle to make sense of themselves and their changing world.

Psychoanalytic treatment offers a space apart from the expectations of parents, peers, and the outside world, where adolescents can begin to discover something of their own thoughts, feelings, conflicts, and desires. Not simply to become better adjusted, but to find greater freedom in becoming themselves.

Trauma

Deep lines cut by trauma provide access to depths that are otherwise unreachable. When the unimaginable becomes real, disarray and scrambling result. Our bodies become discordant, our minds scramble, symptoms scream what we cannot silence or make sense of, and dreams wake us catastrophized. We wish things could be otherwise, easier. But trauma imposes itself, wounding every dimension of our lives regardless of how hard we try to contain it or make it go away.

The confusion, rage, panic, nightmares, flashbacks, intrusive thoughts, and even the fog of deadness and numbness can leave us feeling estranged from ourselves and the world around us.

Yet the other side of trauma can hold a kind of deep nourishment not found elsewhere. Psychoanalytic treatment offers an opportunity to approach what has become unbearable, to give meaning to experiences that may have remained beyond words, and to discover how even the deepest wounds can be transformed. Symptoms can change. Relief happens.