Psychodynamic Therapy

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lloyd-hoare

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In other words, the way in which our parents or caregivers have responded to our needs in the past, will influence the way in which we approach those we perceive as being in positions of authority in relation to us.

It is also generally true that in these sorts of relations the subject knows little about the object. In the examples I have given, the tutor or doctor, the objects, will learn a great deal about their students or patients, the subjects. This is the nature of the relationship but it is not a two-way traffic. Therefore projections (the way we assume people will react to us) although they may he modified the more contact there is, are less likely to he resolved in the way that they are in social situations where the emphasis is on interaction.

If we now move on to the specific relationship of therapist and client we can begin to see how transference feelings will he present even before the first meeting occurs. Clients will bring expectations and assumptions based on their experiences of life that will influence the way in which they perceive the therapist. We can begin to learn about these previous experiences not only in listening to what our clients tell us, but also in noticing how they relate to us, what expectations and assumptions they bring to the encounter. We do not seek to alter these perceptions but rather to try to understand them.

Countertransference

Some of our understanding will come through the feelings the therapist has about the clients, the emotions that are stirred up in the therapist in their affiliation with them: the countertransference. People all know that different people evoke different feelings, and most of us tend to avoid those who stir up unpleasant emotions, and seek the company of those who make us feel good. What is so different in the therapeutic situation is that therapists do not, or rather should not, decide to offer therapy only to those clients who elicit good feelings. They try to use their understanding of the countertransference, the feelings they have about their clients, in the service of all the individuals who seek their expertise. However, since there is a tendency to refer indiscriminately to all the feelings therapists have in their meetings with clients, and label them 'counter-transference', an area of confusion exists, that is as if the client were responsible for all feelings in the therapeutic setting. This confusion is hardly surprising since there is no agreement as to precisely what can he defined as countertransference. Some take it to include everything in the therapist's personality liable to affect the treatment; others see it as only concerning the unconscious processes evoked by the client's transference. It is somewhat reminiscent of what comes first, the chicken or the egg.

If we think about our ordinary everyday encounters we know that we have feelings about the people with whom we come into contact. We find ourselves saying things like this: 'you really irritate me when you keep on agreeing with what I say. Don't you have any opinions of your own?' Or, 'I do enjoy being with you because although we often differ we never seem to fall out over our differences.' Depending on what sort of people we are, the first statement might be thought rather than spoken. However, both statements say as much about the person uttering them as they do of the person at whom they are directed. In the first example we might expect the subject to be upset by our comment; in the second to be flattered by the complimentary nature of our words. Now it is unlikely that any therapist would interpret the countertransference in such subjective terms, but I have used these rather crass examples deliberately to emphasise the danger of using one's own feelings unthinkingly.

How does the Therapist work?

The therapist normally takes an attitude of unconditional acceptance. This basically means that the therapist holds you in high regard because you are a person, no matter what your problem is.

The therapist tries to develop a relationship with you, to help you discover what is going on in your unconscious mind. They do this partly by theoretical knowledge (academic stuff!), partly by experience, and partly through their knowledge of themselves.

We know the last part must seem quite weird, but actually it is critical. The therapist often uses how they feel in the room with you, as a guide to how you are feeling. They are, for lack of a better way of putting it, testing the relationship with you to discover more about you than you are aware of. The therapist uses interpretations, which are a way of making sense to you about what is going on, in order to help you become aware of your unconscious feelings.

So, in every session, the therapist is trying to judge, how much you are in touch with your own feelings, what feelings you are not aware of, how close are you to knowing the unconscious feelings, how painful these feelings are to you, and how well you can tolerate the pain that becoming aware of these feelings will bring.

How the therapist works is actually more complicated than I have presented here, but I hope this gives you a rough idea.

Psychodynamic Psychotherapy and Counselling

Psychodynamic therapy (or Psychoanalytic Psychotherapy as it is sometimes called) is a general name for therapeutic approaches which try to get the patient to bring to the surface their true feelings, so that they can experience them and understand them. Like Psychoanalysis, Psychodynamic Psychotherapy uses the basic assumption that everyone has an unconscious mind (this is sometimes called the subconscious), and that feelings held in the unconscious mind are often too painful to be faced. Thus we come up with defences to protect us knowing about these painful feelings. An example of one of these defences is called denial, which you may have already come across.

Psychodynamic therapy assumes that these defences have gone wrong and are causing more harm than good, that is why you have needed to seek help. It tries to unravel them, as once again, it is assumed that once you are aware of what is really going on in your mind the feelings will not be as painful.

Psychodynamic therapy takes as its roots the work of Freud (who most people have heard of) and Melanie Klien (who developed the work with children) and Jung (who was a pupil of Freud's yet broke away to develop his own theories)

Psychodynamics takes the approach that our pasts effects our presents. Those who forget history are doomed to repeat it, and this is the same for an individual. Though we may repress our very early experiences (thus we don't remember them) the theory is that the "ID" never forgets the experiences. If a child was always rewarded with sweets we may not know why we reach for the tub of ice cream whenever we are depressed and we want cheering up.

Psychodynamic therapists are taught many theories of child development (Oral stage, anal stage, latency period etc). The theory here is that if an adult has not properly progressed through all the child development stages, the therapist may identify the particular stage(s) that are missing.

Transference

If we go back to our own beginnings, we will see that all of us develop ways of relating to others based on experiences with those who cared for us in our formative years. This is something that everybody knows but rarely thinks about. Rather like the apple that fell to the ground causing Newton to ask why, Freud noticed that his patients seemed to develop particularly strong feelings towards him, and he too asked the question why. This was the beginning of his understanding of how, in the therapeutic setting, the therapist becomes a figure of overwhelming importance. Not because of any intrinsic wisdom or innate charm on his/her part but because, Freud realized, feelings previously felt in connection with parents or significant others were being transferred from the past into the present: the transference.

Why should this he so? Before I attempt to answer this question it is important to point out that all our relationships have an element of transference in them: into each new meeting both participants bring expectations and assumptions based on previous encounters. However, in most situations, particularly social ones, there is inter-action: exchange of opinion, agreement, argument, attraction, flirtation, aggression, repulsion, and so on. In this way, through interaction, our expectations and assumptions are either confirmed, contradicted or modified. We all know that after meeting someone for the first time we make a decision as to whether we will see that person again. Sometimes, consciously or unconsciously, we decide that we do not want to take the relationship further; on other occasions we seek every opportunity to renew the acquaintance.

If we move from social relations to professional ones we will again see how we bring expectations based on past experiences to these meetings. But now because there is less interaction there will not he so much room for maneuver, not so much scope for our assumptions to he altered. Two examples spring to mind: student and tutor, patient and doctor. The student who meets with a tutor will have expectations of that encounter, just as the patient will have expectations of the encounter with the doctor. In both cases the object (tutor or doctor) is seen to possess knowledge that the subject (student or patient) lacks. I am introducing the term 'object' because it is one that is commonly used in psychoanalytic literature, and although most of us think of objects as being things, inanimate things, the word object also refers to people.

This situation in which one person seeks something from another involves particular sorts of emotions: most of us feel small and powerless in relation to someone who has something, in these examples knowledge, that we do not think we possess. Because the object has power to determine our future, the tutor to help or hinder in our academic objectives, the doctor to heal our body, we may also feel anxiety. Will they share their knowledge with us; will the power they have over us he exercised in a way that respects our integrity? Thus we might say that certain professional contacts will tend to evoke transference feelings, particularly those which involve a relationship with someone who has knowledge that we do not, or real power to influence our lives for good or ill.