The Practice of Therapy

Gordon Brewer: Well, hello everyone, and welcome again to the podcast. And I'm happy for you to get to know today, Nicholas Samstag. Welcome, Nicholas. Glad you're here.
Nicholas Samstag: Thanks very much. Thanks for having me.
Gordon Brewer: Yes. And Nicholas is in New York and as we're recording this, we were just commiserating about the heat that we're all enduring this summer.
But Nicholas is a start with everyone. Why don't you tell folks a little more about yourself and how you've landed where you've landed?
Nicholas Samstag: It's always a privilege to be able to tell my story and I'm, I'm always a little surprised that it took me as long as it did to get here.
Started off as a, as a very young person being very interested in the theater, which I pursued in college. But when I was in college pursuing the theater, I read, I read this wonderful Russian dramaturge named Stanislavski who talked about Freud and how Freud Freud informed him on how he might better help his actors by, By requiring that they develop a, a, a psycho history from, of their character, and I was very intrigued by that, and I started reading for it, and I, I got out of I got, I, I graduated college, and I thought, you know, what I really want to do is study literature.
So I went to Columbia and I studied Greek and Latin. I got a master's in Greek and Latin. It sounds, it sounds so strange to say that now. But I'm glad I did it. And I wrote advertising for a while. I didn't really know what I wanted to do. I was all over the place and I got into my own therapy. Girlfriend of mine at the time was in it and she seemed to be really helped by it.
And I thought, you know, I, I need to do this. I was having trouble with authority figures. I was being promoted. I was sabotaging myself. And so I thought, okay, so, so I'll get into therapy. And then I did it for a while and I thought, you know what, this is really cool. I could probably do this too. So I then went back and got a I got a PhD in clinical psychology.
And I still wasn't satisfied. So I thought, you know what, these analysts seem like they're really smart and they do really interesting things and they get to read a lot of interesting stuff. So I went and I did that. And then that's what brought me here. So I've been, I've been in private practice for.
about 30 years and taught at university for 20 some odd years. And I love what I do. I get to see a wide, wide variety of people and, and help them in some, in some very difficult and often profound human situations. Yeah.
Gordon Brewer: Yeah. Yeah. That's, that's, that's really interesting story. And you know, I guess I'm curious is at least in my training, I always think of, psychoanalysis as being kind of the maybe the bedrock or the beginning of our professions as psychotherapists and that sort of thing.
And then, yeah, and maybe this is incorrect, but also think of, you know, oh, well, there are better methods than psychoanalysis and that sort of thing, but it's something that you have stuck with and what was it that has drawn you to it and kept you with it?
Nicholas Samstag: Yeah. I think I, I, I think when, when one talks about psychoanalysis.
Not unlike when one talks about Freud, one has to be clear about the time frame that one's really interested in. Whenever someone says, Freud this, Freud that, my back goes up, it's very rare that people actually have read enough of him to know the arc of his intellectual journey. And to your question, you know, if you psychoanalytic colleagues what psychoanalysis is, you're going to get a lot of different responses.
And I think it's, I think it's, you know, we could say it's unfortunate, but it's also a testament to how I think diverse and rich psychoanalysis is and can be. So it can't reasonably be compared to other modes of treatment unless you're really defining your terms. The, I, I studied at the William Allenson White Institute, which is one of the, one of the big old ones.
Contemporary psycho, contemporary psychoanalysis and contemporary psychoanalysis is not your grandmother's psychoanalysis. So these are you know, one, one reads contemporary authors, one reads queer theory, one reads all kinds of things that are very much about present day. And the techniques, the so called techniques that one use.
uses really differs from practitioner to practitioner. When people ask me what a psycho, what my version of psychoanalysis is, I say something like, okay, so I believe that human experience necessarily comes from two realms. It comes from the supposed, the so called real world, I say so called because we don't often agree on what that means.
And, and the other, the other realm of experience is unconscious. Which has been proven over and over again, not the unitary unconscious of Freud, but the, but the, the the variable unconscious processes that we all, that we all have. So when someone comes into psychoanalysis I am interested in hearing about both of those realms of experience.
I'm not disinterested in the here and now and the what's actually happening. But I'm, I'm, I'm, I'm primarily interested in the, in the integration or conflation of, of unconscious and conscious realms of experience. And I'm very active. I ask a lot of questions. I'm very present. I don't give advice typically because I don't think it does anything to give advice.
As a, as an old professor of mine once said, you can give anybody all day, but why aren't they interested? So anyway, so that, and then of course dreams, you know, working with dreams and not working with dreams in a formulaic robotic way, but actually in a heuristic fashion where you You know, you're, you're asking, you're asking the patient and yourself to associate the material in ways that hopefully resonate.
Yeah, that's, I think what I, yeah.
Gordon Brewer: Well, it's a, you know, I think as I think about this you know, I think at least in my own practice, there are elements of psychoanalysis that we really, All probably use. I mean you know, the in particular when people come in and start talking about maybe a dream that they had and really just kind of helping them kind of break down and make connections with things, is there a, is there a particular kind of method or whatever you, you use when you're just thinking about dream work, for example?
Nicholas Samstag: Yes, absolutely. Great. Wonderful question. And it's something that I think about all the time. If, if Freud only gave us the notion of free association, we'd be forever in his debt. So the difference between an association and a thought is that a thought is deliberate. It's deliberate. I ask you to go think about, you know, think about, think about urban planning and what you would do.
All right, so you're going to go away and you're going to think about this and you're going to research it and it'll be deliberate and conscious and, and all that. Free association is simply what comes to mind. Carl Jung was the first one to develop the free association test. You know, you give people, these are wonderful tests, I think.
You give people words, arbitrary words. If I say, you know, if I give you the word duck and you say yellow, it's like, okay, that's not a thought, that's an association. If I say duck and you give me an exegesis on the history of ducks, that, those are thoughts. And so in, in DreamWorks, Not unlike in other aspects of psychoanalysis analysts are, are, are interested in the free associations of their parent, of their parents.
That's a good slip, of their patients. What are the, what are the associations? And, and, and, and the, the goal there is that we don't know what the meaning is until we associate. And it's often, it's often the case, unfortunately, that clinicians tell the patient what the dreams mean, and they read these ridiculous dream books, you know, if you dream that your teeth fall out, that means you think you're a baby or something.
It's just ridiculous. Freud didn't talk about that. You know, you want, there, there's no answer to the dream. There's no right answer. There's no answer, but there is the capacity to expand you, your, your, and the patient's awareness of what's going on. So. It's, it's an extraordinary use and benefit if the, if the two people involved can do it.
I, I have some of my best, my best moments in, in, in my work are just that. And I'm not the answer man. I don't tell them what I think it means. I simply associate with them. And if it doesn't resonate with them, it doesn't resonate. So it's much more heuristic, you know, it's a, it's, it's a heuristic approach.
It's an approach that's interested in a continual expansion of associative material, not, you know, this is the answer and this is what you're supposed to do now. And this is up for
Gordon Brewer: everybody. Yeah, right. But what do you think of the, the notion that when we have recurring dreams, in other words, dreams that are kind of the same kind of dream or theme or whatever, that that being something that we're still trying to work through within ourselves?
Nicholas Samstag: Yeah, I think that's, I think that's absolutely true. And, and, and so elegant that the mind brain can do that. Right. It's like, you're right, that there's something, there's something in the material there that you on a certain level really want to get into and engage with and maybe solve. But there's another part of you that doesn't want to be be anywhere near it.
So yeah, those are those are great dreams. And that's, you know it's also important to note that, you know, the more, the more analytic I suppose one is, in a way, the more one is looking for symbolic, symbolic significance. It's like, what does it mean? So if you have a dream about actual people in your life that's a relevant, that's relevant to inquire about, but it's also, it's also interesting and fun, actually, to wonder what the symbolic value is of those people who appear.
I mean, yes, it was your father and your father and your, and your uncle. That's great. But what else can that represent? And that's an often very powerful journey for both parties.
Gordon Brewer: Yeah. Yeah. And so outside of dreams you know, when, when we, you know, that's how I think about psychoanalysis is that we help people make associations between maybe their behavior.
How they do something and then, you know, then maybe, and you correct me if I'm wrong of then once they're, once they're aware of those associations, and they can make a choice about how they want to proceed with things moving forward. Is that, am I, am I in the right ballpark there with that?
Nicholas Samstag: I think I, I think most contemporary psychoanalysts would agree that, you know, our bias, I'm not going to speak for the field, my bias is.
is to help the patient make their own choices.
Ask me what I think, you know, I will, I will usually, I will usually tell them, but it's very much their show, not mine. I think, I think, I think, I think, I think most of us and myself included, I think we talk too much. I think, I think we talk too much and don't allow for silence, not, not silence, but silence.
You know, people can actually, they can actually do something other than recite things. You know, patients come in, I had a supervisor a hundred years ago and said, patients come in to have their symptoms blast. Which I always loved, you know, so it's, it's, it's, I think psychoanalysis is unique in that it really doesn't have any dog in the race in terms of who you, who you are or what you're going to be.
As long as you're not hurting anybody, you know, I don't tell people how to think better or feel better. I don't believe in good feelings and bad feelings. I believe that, you know, introducing them to themselves, really, that's my job.
Gordon Brewer: Yeah. I like that. I like that. So maybe take us through maybe a kind of a typical session.
I know everybody's different, but when you, when you think about starting with a new patient, what is it that you're, You're focusing on or trying to get to with him. I, and I know a lot of it's going to depend on what their goals for therapy are. But yeah, can you kind of walk us through that?
Nicholas Samstag: Sure.
I'm I'm first session and every session after I'm interested in what the person's experience is. So I'll say something complicated, like. How's it going?
Gordon Brewer: Yeah.
Nicholas Samstag: Yeah. How's it going? Huh. And, and often, often patients want me to engage in their recitation of why they think they're here. You know, my, my, my job, my, my lover, my this, my that.
And I'm, I'm interested in that of course, but I'm much more interested in what their experience is. What's it like to be in here? What's happened to current, why, why did you call me when you did? I think that's always a great question, why are you coming into the hospital. And and, and to be where the patient is, I always try to just be where they are and use what they're saying to me as a, as a way into their difficulties. But I think, I think I do my best work when I say the least.
Gordon Brewer: Yeah. Yeah, teach it. Maybe is it a way of maybe saying, or maybe teaching people how to kind of sit with, with the feelings and emotions that they're experiencing in that moment?
Nicholas Samstag: Yes, absolutely. That's absolutely right. And I also think it's one of the things that I enjoyed doing this.
One of the things I enjoy about this work so much is that I don't have to abide by the sociocultural rules of discourse, right? I don't have to, I don't have to put it on. I don't have to do things like, so how are you? Right? I don't have to do the baloney stuff that we typically have to do out there.
You know, I don't have to answer questions, you know I, I silence. And I think, I think that's it. I mean, that's the answer you gave me the answer that I think people don't sit with their experience much, especially today. When we're multitasking, all our gizmos are going off and we're, you know, we're so externally engaged.
And some, some patients, you know, they really, they can't do it or they, or they really resent doing it. It's like, you know, I had a patient years ago who said to me, Dr. Samstag, at the rates you charge, you should be talking a lot. Yeah. Yeah. Yeah. That's funny. I said, it's not the word count that counts here.
Gordon Brewer: Yeah. Yeah. Yeah. One question that I always tend to ask people early on and when I do sessions with, you know, start working with folks is I asked them, you know, I I'll say something along these lines. And obviously you've thought a lot about what's going on with yourself. And it's something that brought you here.
So why do you think you are like you are? And so that they always get kind of a surprised look on their face. And I think I don't know if that's, if that would be considered a psychoanalytic technique, but it does, I think, help them kind of get into what they are what they're doing. I mean get into what they're, what they're experiencing in that moment.
Yeah,
Nicholas Samstag: I think that's a great, I think that's a great question. I mean, I think, you know, this is a huge subcourse, but the notion of technique. Is always a head scratcher, unless, unless you're talking about, I think, you know, manual driven therapy or behavior therapy or cognitive therapy in which, you know, people will tell you what to do technique and psychoanalysis.
I don't know. I think. We all have different ways of doing this. But anything that gets the patient curious about who they are. I mean, if you want to call that technique, I don't really see it as technique tech technique to me is applicable in engineering and, and, and medicine, you know, and, you know, when you do, it's like, this is how you take out the appendix.
This is the building, you know, mixing concrete. But I don't, I don't think there's a technique here really, I think there's a, there's a sensibility that I think you have to cultivate, where you're, you know, you're not, how would I describe it, you know, the, the analytic, the analytic attitude over the years, I always loved that phrase, which, which often meant, you know, don't, don't respond and just sort of act like a jerk, really, frankly.
But there is an analytic attitude, and I think it has something to do with respecting. The person you're not, you're not engaging as you would at a bar or a cocktail party. You're not trying to be nice. You're especially not trying to evoke any given feeling, you know, there is a kind of neutrality, I think, you know, I don't believe that analytic neutrality exists, but I think it's a really good thing to think about.
I think right. If there's anything, I don't think optimal clinical intervention exists but I think it's a really good thing to think about.
Gordon Brewer: Right.
Nicholas Samstag: Why are you, why are you saying this then? And why, you know, all of that, I think that keeps us honest.
Gordon Brewer: Yeah. Yeah. If nothing else, it helps people learn to be curious about themselves and curious about their internal world.
Nicholas Samstag: Yeah. Yeah. And, and, and hopefully, and this is, this is something that, you know, certain people can do better than others, hopefully being able to switch sets, you know, being able to talk about the here and now with you, the, the clinician, talk about what's happening in their life, have an association to the past, have an association to their dream, not be, not be on railroad tracks, you know, and which is, I mean, most of this is no news to you.
Most of, it. Most of human discourse is defensive. It's defensive for a reason, right? You can't walk into a, you can't walk into a restaurant and just start free associating. They'll call the police. It's like you're in a restaurant, you're supposed to act like you're in a restaurant. If you're in, if you're in a church or in the street and you're supposed to, and that's all, that's all.
I mean, I'm, I'm I'm milking the word defensive, but it's defensive in the sense that you don't dare not do those things. If you break those norms, people think you're a weirdo and you would be. Whereas in the, in the consulting room, you don't have to do that. You can have people, the freedom to say whatever they want to say with the cardinal rule of psychoanalysis, say whatever comes into your mind.
You don't have to make sense. Making sense is not what you're supposed to be doing in a way here is supposed to be making nonsense.
Gordon Brewer: Yeah, I love that. I love that. What, one of the things maybe to be, that I'm curious about, and maybe other people listening would be curious about, what, what do you find is the best way to help people kind of access the subconscious?
In other words I know it's a lot of it has to do with free association, but how do you get maybe people there? If that makes sense,
Nicholas Samstag: that's a great question. Yeah. Again, I, I, I think that the way you get there is you, you, you say things like what comes to mind as opposed to tell me a very, you know, thoughtful scripted, something you say, what comes to mind.
And, and I, and, and I think the most direct way that I do this, I do this all the time, pay attention to your language, hear what you're saying and wonder why you're saying it the way you're saying it. Language never lies. Language never lies. Language is. These are not my ideas. Language is necessarily saturated with psychological meaning.
And if you pay attention to your language, and the tone of your voice, People learn a lot. Mm-Hmm. , right? Like, why did you say that? As opposed to that, you know? Mm-Hmm. . I have, I have, I have, I have PhD candidates who say that their, their, their, their patients messed up. And I say, what does that mean?
Gordon Brewer: Mm-Hmm.
Nicholas Samstag: up mean messed up means they were in the wrong relationship. They were in a difficult relationship. I said, who's not been in a difficult relationship? Why is that messing up? Is that messing up? So just, yeah, I got a lot of mileage out of that. I drive some of my patients crazy that way, but, but, you know, it's you know, Freudian slips are there for a reason, but even, even more subtly, how we speak is hugely significant.
And if the question is, how do I get to my unconscious, that's, that's one of the answers. I think pay attention, pay attention to how people are talking and what they're saying and why they're saying what they're saying when they're saying it.
Gordon Brewer: Yeah. Yeah. I think that's a, I totally agree. I know that. That words and the way we frame things is very powerful.
And just, you know, and just understanding what's underneath with people and what's, what are their internal motivations for things, which has always been, been fascinating. One little quick story I'll share with you. Going back to the dream work things, I remember Several years ago when I was in a different career, I had a friend of mine who was she was, she was trained in psychoanalysis.
Her name was Ann. And and I was just having a conversation with Ann at church. And we were just talking about dreams and just how fascinating they are. And I shared with her, you know, I keep having this, this same dream of being on a train, And just going down the track on a train, a lot of times it's a, you know, like an old locomotive or old rickety track, all of that sort of thing.
And she, she began, said, Well, what does, what is it that's characteristic about being on a train? And I, I said, Well you just have to go where the track takes you. You can't. Steer it in any way, which is how I was thinking at the time. And then it dawned on me at the time that I was, I was, I felt stuck in my career and I really needed to get on a different track.
And so, yeah, so I don't know if that's a good example of how, how all this works.
Nicholas Samstag: That's a lovely example. That's, I love that example. You know, and you're in famous company. I mean, Freud, Freud, when he, when people asked him about dream analysis, he said, picture yourself on a train, picture yourself on a train looking out the window.
and just tell me what you see. Now, my, I think that's lovely, but my only quibble with that is that it's linear. And I think what we want to do with our patients is introduce them to non linearity. It's not about being on a track free association anyway. It's about letting whatever comes into your mind, come in.
So top or the bottom, or, you know, The metaphor of linearity doesn't really work there. But
Gordon Brewer: yeah,
Nicholas Samstag: I think for your dream. Yeah, absolutely. That's great. I've had similar dreams about, you know not finding the right exit, you know, driving and looking for a way to get off the road, but not finding I mean all that stuff.
But, you know, I mean, that's, that's great and profound. And if one had time, one could probably spend a year on this dream, right? And come up with all kinds of other things that would not be arbitrary, but would be, again, based on associational connectedness. You know, this thing leads to that thing leads to that thing.
Before you know it, you're, you know, you're talking about everything under the sun.
Gordon Brewer: Right. Right. Yeah. It's it's funny how, how thoughts work that way and that you can, you know, I'm always reminded of that children's book. If you give a mouse a cookie and it just, it goes, you know, just on this, this big long tail about, you know, well, if you do this, then this will happen in this and that will happen.
And so, yeah, that's how I, how I think about it in a way. That's great. Yeah. Yeah. Yeah, that's great. Well, Nicholas, I have to be respectful of your time, and this has been a great conversation. Tell folks how they can get in touch with you if they would like to connect and talk with you.
Nicholas Samstag: Sure, sure. So you can find me at nicholas at nicholassamstag.
com. And that's my website and on my websites, you know, a bunch of stuff that I've written in videos that I've made and all that. So I'd be happy to help anybody.
Gordon Brewer: Awesome. So, well, Nicholas, it's been a pleasure to get to know you and hopefully we'll be able to chat again sometime soon.