I have a specific issue. Can we work on this?

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In all likelihood, yes.

People come to psychotherapy for many different reasons. Many are worried about relationships with other people. Some may feel hopeless or lost, anxious or angry, bored or desperate, or they may feel nothing at all. They may believe that they eat too much or too little, that they are unworthy of love or boring, that they have strange compulsions or obsessive thoughts, that they desire sex too much or too little, that they have disturbing fantasies, panic attacks, addiction problems and so on and so forth. Some counsellors and therapists specialise in certain problems. But this suggests that one person’s compulsion is like another person’s compulsion, or that there is a standard for what is “normal” sexuality or “healthy” behaviour. Is this really the case? And who would be the judge on this?

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We can work with your “issue” because an issue is never just an issue. Your issue is your issue and no one else’s. There are as many reasons for addiction as there are addicts. There are as many reasons for being bulimic as there are people who are bulimic. Your issue is your issue in the context of your personality and your history. It is intimately connected with who you are, who you have become, and who you think you should be. Your issue, then, is a starting point for us, a crucial piece of information, a signal pointing to something that matters fundamentally. Psychoanalysis is about paying attention to this signal and taking it seriously.

In psychoanalysis we are not in the business of working with issues or symptoms or psychiatric labels. We are working with individuals who have found ways of bearing unbearable pain, who have found solutions to insolvable problems and answers to unanswerable questions at a time in their lives when they were so overwhelmed that this was the only way to keep going. Issues are survival strategies that are, perhaps, failing you at this point in your life. But trying to get rid of them without understanding why they are there in the first place is at best naive and at worst dangerous. Our minds are very good at protecting themselves. And they are even better at coming up with all sorts of new symptoms when we fail to address the core of the matter.