Beyond Sigmund Freud, ink-blots and crushes on your own mum.
Therapy in 2022 has become increasingly accepted and de-stigmatised, perhaps an unintended positive consequence of the COVID pandemic that began in 2020. COVID has been a kind of pressure cooker for pre-existing difficulties, and has been a catalyst from which new challenges have emerged. On the whole in Australia, there has been a response of the tone that rather than to shun and make unconscious these issues, a light has been shone upon mental health and it's existence.
With the recently increased social acceptance to begin therapy, a new question is being raised: who should I go to? What kind of therapy is right for me? A very well known branch of therapy in our Westernised world is CBT, and it's newer '3rd wave' counter parts such as mindfulness and Acceptance Commitment Therapy. However, before these newer modern techniques, there was the originator, the most classic and traditional of therapies: Psychoanalysis.
Psychoanalysis.
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Many key contributors have worked tirelessly to re-define, explore, expand, mould and evolve psychoanalysis, and from it there have sprung many modern taxonomies from that original seed. What is psychoanalysis? Sigmund Freud, with the best tools and knowledge he had at his dispense at the time, understood that it is a universal and human experience to have drives within us, deep down, often conflicting, and that these warp and change throughout stages of our lives and events, beginning in our childhood, involving the relationships to the important figures in our lives. He also understood that we can find ourselves in patterns of being, with roots in our past, that these patterns elicit emotions, painful ones that we defend against with varying degrees of awareness and success. He had a lot of ideas that were a product of his time, and today are hard to translate into the modern understanding, but nonetheless he lit the fire that continues to glow to this day.
Psychodynamic Psychotherapy.
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So with all the information out there, what can you expect from the evolutionary product of psychoanalysis, referred to as 'Psychodynamic Psychotherapy'?
There are a number of principles that underlie it, but in essence, it postulates that the increase in self-understanding and the therapeutic relationship are the main vehicles of change. There is very little emphasis on the advising and prescription of strategies, homework and teaching such that is common in therapies such as CBT, ACT and DBT. The process itself is ventured into by the therapist with curiosity, openness and exploration.
"Not much practical strategy based work", you ask. Psychodynamic therapy asks us, how can we possibly make meaningful and authentic changes in our lives if we don't understand what it is that we're doing, feeling, wanting, needing, repeating and thinking? I can tell you to take controlled breaths and face what scares you the most, but without proper understanding of the underlying need for this kind of strategy, we are jumping to a premature short-term solutions that can stifle the possibility of getting to know what's really going on and needed, and potentially bar ourselves to not only a deeper self-understanding, but long-term change that continues post therapy (Abbass, Hancock, Henderson, & Kisely, 2006).
I do note an important caveat. Not everyone is ready for psychodynamic therapy and that is okay. It is journey of patience, at times discomfort, and discovery of hard truths. I acknowledge that sometimes, it's alright if you're trying your best to protect yourself and need some strategies to make it through each day. However, if you're seeking out a long term change and deeper self-awareness, then psychodynamic therapy is for you. Some key ingredients to psychodynamic therapy are (Shedler, 2010):
Affects, feelings, needs and wishes.
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Sage and beautifully simple advice that I received from my first psychodynamic supervisor was to "follow the affect". What he meant by this is a core principle of psychodynamic therapy, which is to be in tune to the flow of emotions and affect of the client and within the therapeutic relationship, and provide therefore an inquisitive and curious attitude/space to the emotional flow of the client. Why? It is thought that the understanding of feelings, and just as importantly, conflicting feelings, is a window into self-understanding, above and beyond that of pure intellectualisation. Making sense of our emotions in each interaction is clue into our wishes, desires, repressions and values. To understand this is to make sense of what can be chaotic, painful and seemingly nonsensical, and allows us an observer's stance to make new choices. Many of us can rationalise and intellectualise around our thoughts and situations, but until we can make contact with our affect, our self-understanding will be constricted.
Defences and Resistance.
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It makes sense that we do not want to make contact with what makes us uncomfortable. CBT looks at 'avoidance' in a broad and structural sense, such as avoidance of going out into shopping malls, and how to increase doing this more. Psychodynamic therapy seeks to acknowledge many types of avoidance/defences/resistance, such as those that are conscious, subconscious, out there in the world, in the therapy room, interpersonally and intra-psychically. Some examples are changing the topic, looking away, speaking at an intellectual level, and even being late to appointments or forgetting them all together. In my professional stance, I see defences as something to be acknowledged, and respected, to point out their function and dysfunction, but not pressure my clients to destroy such defences or make them feel 'analysed', but allow a subtle change in how people respond to them. It is best for hermit crabs to find and discard their out-grown shells in their own time, rather than to rip and pull them out of these shells prematurely, left vulnerable and exposed. Defences have something to teach us about ourselves. To rip these away and provide a short-term 'fix' is to also deprive someone of important self-understanding that will lead to long-term benefits.
Patterns: Present and Past.
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Musical number Hot Chip got it right when they identified our proclivity to find ourselves in repetition and patterns, particularly those that tend to no longer serve us well. Psychodynamic therapy too seeks to understand our patterns of feelings, thoughts, behaviours, situations, introjects, and relationships in particular. Psychodynamic therapy seeks to truly understand why these patterns occur, and such self-understanding leads to new choices.
An important part to self-understanding and also psychotherapy is to understand where our patterns began, often in our youngest years. Different schools utilise different theories, my tendency is to mostly draw upon attachment theory, object relations and a self-psychology lens. Exploration of the past can help us break the bonds of our repeating patterns of thought, self-concept, behaviours and relationships.
Relationships.
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Human beings are innately not just social, but our own mind is co-created through the minds of others. We are very relational beings, and our sense of self, the world and others is fundamentally linked to how we interact interpersonally. Relationships are therefore much focus in this therapy style. Ultimately, attachment is not just our feelings towards our mum when we were just a baby, but is truly an 'internal working model' that we carry with us through life.
Not only are the relationships in your life an important focus of therapy, but the relationship with the therapist is also important. Another formative mentor of mine and psychotherapist often said "all is grist for the mill", meaning, if there is a certain feeling tone, an unspoken 'vibe' in the room, or a pattern of interacting with the therapist, this is also up for discussion. What happens out in your world will often repeat itself in the therapy room, which is fantastic because we've finally caught the illusive pattern live and in action, and can make sense of it in a safe environment.
Symbols and fantasy.
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What has been seen as most famously derived from psychanalysis is the value placed on "symbolic material" and fantasy. We're talking classic free association, Jungian dream analysis, or merely the absence of a rigorous agenda to a therapy. I like to begin therapy by asking the client where they would like to begin the session, and encourage 'rambling' as it elicits what is purely flowing from their mind and what is important for them to speak of, and this tells me a lot. Everything happens for a reason, and these materials are all windows through which we can see ourselves.
In all, I hope this has offered a little clarity to what is Psychodynamic Therapy and my preferred approach as a therapist. At the end of the day, I respect your own goals and needs, and the way that we go about therapy is up for discussion.
If you're interested in psychodynamic work, please feel welcome to book an appointment with me.
- Chelsea
References:
Abbass, A. A., Hancock, J. T., Henderson, J., & Kisely, S. (2006). Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database of Systematic Reviews, Issue 4, Article No. CD004687. doi:10.1002/14651858.CD004687.pub3
Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American psychologist, 65(2), 98.
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