Over the past three decades, I have dedicated myself to working in various mental health settings, engaging in psychotherapeutic work with individuals from diverse backgrounds. While you can find my formal credentials elsewhere on this site, here I aim to provide insight into my educational and clinical experiences that have shaped my professional growth and continue to influence my practice.
Following the completion of my residency training at Georgetown University in 1986, I had the privilege of serving as a staff psychiatrist at Chestnut Lodge Hospital in Rockville, Maryland. Known as "The Lodge," this private psychiatric hospital, established in 1910, provided a remarkable environment for learning and work. Situated on a vast, serene 100-acre property, it was dedicated to the intensive, humanistic, and psychoanalytically-informed treatment of individuals grappling with severe mental illnesses. Patients sought our help as a "last resort," often after being unresponsive to treatment elsewhere, and they came from various regions of the country and the world. The time I spent at Chestnut Lodge exposed me to invaluable lessons about therapy and the complexities of the human condition, and I am immensely grateful for that opportunity.
In 1990, I transitioned from Chestnut Lodge and established a private practice. My experiences during psychiatric training and subsequent work at Chestnut Lodge solidified my conviction that the psychoanalytic perspective offered the most profound and comprehensive understanding of the mind. Consequently, I pursued further training at the Washington Psychoanalytic Institute, from which I graduated in 1995. While I strive to stay updated on developments in psychiatry and neuroscience and leverage that knowledge in my practice, my approach to treatment—whether conducting psychoanalysis, psychotherapy, or prescribing medications—is fundamentally rooted in the insights provided by the psychoanalytic perspective.
What exactly does the "psychoanalytic perspective" entail? Psychoanalysis, both a theory of the mind and a therapeutic method, originated from the work of Sigmund Freud in the early twentieth century. It has deeply permeated Western thought and become ingrained in our cultural consciousness, to the extent that many of its assumptions are now taken for granted. Psychoanalysis has faced criticism, some of which may be warranted, while some may not. Like any theory, especially one attempting to elucidate the complexities of the mind, psychoanalytic theory is imperfect.
I am frequently asked whether I am a "Freudian." In one sense, all psychoanalysts can be considered Freudian since he is the progenitor of the theory. However, in another sense, no one today strictly adheres to Freud's methods, as his practices have evolved significantly. In his book "Open Minded: Working Out the Logic of the Soul" (Harvard Univ. Press, 1998), Jonathan Lear aptly stated: "Freud is dead. He died in 1939, after an extraordinary productive and creative life... it is important not to get stuck on him... either to idolize him or to denigrate him."
For any scientific theory to endure the test of time, its adherents must continuously question its tenets and, when necessary, discard components that no longer align with ongoing observations and discoveries. Since the inception of psychoanalysis, our understanding of the mind and brain has expanded significantly, and numerous scholars have refined, expanded, and improved upon psychoanalytic theory and derived treatment methodologies. It would be an oversimplification to attempt to summarize the vast literature in this regard. However, in my view, the essence of a modern psychoanalytic approach can be distilled into a few fundamental statements:
1. Every individual is unique.
2. A significant portion of our mental activity operates outside of conscious awareness. These "unconscious" thoughts, feelings, fantasies, wishes, and conflicts exert a continuous influence on our conscious mental lives and interpersonal relationships.
3. Our personalities, relationships, and life choices are influenced not only by genetic inheritance but also by past experiences and relationships. In simple terms, our past serves as a prologue to our psychological and interpersonal selves.
These seemingly straightforward statements hold profound implications for our comprehension of the forces that drive and motivate us. Psychoanalysis and psychodynamic psychotherapy, which delve into the exploration of unconscious forces and conflicts underlying psychological and emotional distress, aim to help individuals gain awareness of these hidden dynamics. Modern psychoanalytic therapy revolves around exploring one's past and present relationships, including the therapeutic relationship that develops over time. The insights gained through therapy enable individuals to perceive themselves and the world from fresh perspectives, fostering mental flexibility necessary for constructive personal growth.
If you are interested in delving deeper into the current state of psychoanalytic therapy, I recommend reading two papers by Jonathan Shedler: "That Was Then, This is Now: An Introduction to Contemporary Psychodynamic Psychotherapy" and "The Efficacy of Psychodynamic Psychotherapy." (see below).
While psychoanalysis primarily focuses on the psychological aspects of the mind, it does not deny or exclude the fact that we are biological and physical beings. Research on the brain has made remarkable strides over the past several decades, significantly contributing to our knowledge and understanding of ourselves. The application of such research to the clinical realm has led to the development of medications that can alleviate the pain and suffering caused by various psychological conditions such as anxiety, depression, panic disorders, bipolar disorder, schizophrenia, and many others. Brain science also offers fresh perspectives to our work as therapists, either confirming or challenging psychological theories.
Dr. Louis Cozolino's books, "The Neuroscience of Psychotherapy" and "The Neuroscience of Human Relationships," provide excellent examples of integrative work that incorporates neuroscience into psychotherapy. The emerging field of Neuropsychoanalysis, spearheaded by Dr. Mark Solms and others, aims to integrate neuroscience findings with all levels of the mind, proposing that "The brain is the organ of the mind. If we want to fully understand mental life, we must integrate the findings of neuroscience with all levels of the mind." Dr. Solms' 2021 book, "The Hidden Spring: A Journey to the Source of Consciousness," is a fascinating read.
My consultation process begins with a discussion of your current difficulties and a comprehensive review of your life history. After conducting a thorough assessment, I will provide you with my impressions and recommendations, and collaborate with you to determine the most effective form of treatment. If it becomes evident that you would benefit from a type of treatment outside my area of expertise, I will make a suitable referral.
Marc S. Levine, M.D.
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