Psychotherapy

The unconscious is not a mysterious thing. For example, you have probably met people who seem to annoy you, and make you angry, but you cannot work out why. It may be that this person reminds you of someone but you do not realise it. The person whom he or she reminds you of is someone with whom you are angry, so you find yourself taking it out on the person at hand. Unless you remember who you really are angry at, it can be hard to get over your feelings of annoyance. In this case, becoming aware of what is unconscious involves remembering and recognising the difference between these two people. Sometimes it can take an awful lot of work to find this out.

When we are not aware of the reason for a strong feeling like this, a therapist might say this is unconscious. By becoming aware of the reasons for our anger with someone, we can treat him or her on a more realistic basis. It is the therapist’s job to help you recognise when the feelings you have towards someone seem to be inappropriate and to learn to understand the real causes.

When you start treatment, you will find that some of the people closest to you, who have encouraged you to get help may change their minds and decide that therapy is not helping you. This is often an indication that you are changing and that these changes are puzzling and trouble some of those close to you. You should know that almost always in treatment some of the people around you will be convinced that you are getting worse – often just at the time when you feel you are really improving. And you yourself might also at times feel worse and discouraged at some stages of therapy. You might feel you are not getting anywhere, your therapist does not know what he or she is doing and there seems to be no point in this, and so on. These uncomfortable feelings are often good indications that you are working on difficult problems. It is very important that you do not give in to these temporary feelings when they come up. You will find yourself making good progress again.

What might also happen, as you talk about more difficult things, is that you may find yourself having trouble keeping your appointments. You won’t be able to get away from work, there will suddenly be necessary overtime just at the time of the appointment, your car will break down, your family will need your help at home for something, and so on. All of these things seem quite unrelated to therapy. The important point is that these problems suddenly seem to crop up at the same time you are getting down to something difficult and important in the therapy. These are the most important times to make sure you come to the therapy meetings. The only way to protect yourself is not to allow yourself to judge how important any given therapy session will be, but instead to decide beforehand that you are going to be there, no matter what comes up.

In other words, if you make an appointment, you will keep the appointment regularly. This does not mean that you cannot postpone a session for good reason, if you discuss it with your therapist beforehand. For example, if you know three or four weeks in advance that you have a business trip, and you know it is something you have to do. It is the sudden emergencies that are almost always unconsciously planned – things that come up unexpectedly.

Another thing – in treatment you will often find yourself feeling uncomfortable. For one thing, your therapist won’t say a great deal, and you will find yourself trying to make decisions about what you say. We do this all the time. If we did not, we would get ourselves into a lot of trouble. If you think your boss is an idiot and you told him or her this, you might lose your job. In general, we have to make a distinction between what we think and what we say. In treatment this is not so. In therapy you say whatever comes to your mind, even if you think it is trivial or unimportant. It does not matter. It is still important to say it. And if you think it is going to bother your therapist, that does not matter either: you should still say it. In contrast to your boss, if you think that your therapist is an idiot, you need to tell him or her about it. You will find this is very hard to do and yet it is one of the most important things to learn in therapy – to talk about whatever comes to your mind. Often what you think is trivial and unimportant is really the key to something very important. For example, you might suddenly become aware that the room is hot, or the therapist’s clothes are awful or something like that which seems both trivial and even perhaps a little rude to bring up. Yet, in treatment, if you think of it, say it. Often such things turn out to be very important. So just like the appointments, we make an absolute rule that you should not think ahead about what you will say and therefore protect yourself from facing important things. Say whatever is on your mind, no matter what.

After some time in therapy you will start to feel like you have achieved your goals and that you feel a lot better. It is best for you to discuss these feelings straight away with your therapist. It is important for you to set aside a number of sessions at the end of therapy to check your feelings before you do finish. This will help to make the ending between you and your therapist a good one. It is best if you do not suddenly leave therapy as just the act of bringing up important material and leaving it unresolved can be quite damaging. Therapy can be a wonderfully enriching experience. Remember to discuss any problems or things you do not understand with your therapist. They are there to help you.

(adapted from: 1995- Brin Grenyer, NDARC & University of Wollongong, Australia; first published by Orne & Wender 1968, American Journal of Psychiatry)

Often you will talk about your needs and wishes both now and in the past. Usually people do not talk about a lot of things because they are too personal, or because they would hurt other people’s feelings, or for some other similar reason. You will find that with your therapist you will be able to talk about anything that comes to your mind. He or she won’t have any preconceived notions about what is right or what is wrong for you or what the best solution would be. Talking is very important because the therapist wants to help you find out what you really want. The problem most people have in making decisions is not that they do not know enough, but that they never have had the opportunity of talking things over with someone who does not try to make their decisions for them. The therapist’s job is to help you make the right decisions.

Often we are confused about ourselves. The therapist is not going to try and tell you what he or she thinks, but may point out to you how things you are saying do not seem to fit together. The job of your therapist is to help you keep in mind all of the important facts and feelings so that you can come to a solution that takes all of the facts into account. This is sometimes hard because these feelings may often conflict with each other.

This is designed to tell you a little about what psychotherapy is and what happens in psychotherapy. Your therapist will be happy to explain anything you do not understand. Just ask. Firstly, it is important to realise that psychotherapy is different from counselling. Many people expect to tell the therapist about his or her problem and that then the therapist will give advice which will solve everything just like that. This is not true; it just does not work like that. Before you came to therapy, you may have gotten advice from all kinds of people: your spouse, your parents, your friends, your family doctor, and so on. Many of these people know you quite well; some of them know you very well, and if it were just a question of getting advice there is no reason to think that your therapist would be much better at it than all of the people who have always told you what to do. Unfortunately, when some people give advice, they usually provide solutions that will work for themselves, but not for the person who has the problem. If all of the advice you have received had helped, the odds are that you would not be in therapy. The therapist wants to work with you in trying to explore and understand your difficulties and concerns.

What does this mean?

Well, if your therapist sees you getting into some kind of trouble, he or she may warn you about it, but here again the final decision as to what to do will have to be made by you. The great advantage you will have with your therapist is that he or she has no axe to grind. The therapist does not think he or she knows what is best for you, but is going to help you try to find out. The therapist does not think that he or she knows the answers, but rather, he or she just wants to understand, with you, why you do things. The other point is that the ethical rules and standards of their profession bind your therapist. Your therapist will treat everything you say with respect and will ensure complete confidentiality.

Fees normally reflect the qualifications and experience of the practitioner. Occasionally, therapists will negotiate fees since it is understood that therapy usually involves regular sessions over a period of time. Frequent sessions might be advantageous if affordable. But if fees are felt to be expensive it is better to have regular sessions with a greater interval between appointments (such as once per fortnight) than not to have any. The cost of therapy should not create a greater burden than that which brings someone to therapy in the first place. Usually psychotherapy is open – ended such that the time to complete the process is mutually discussed and agreed. Many clients still find it useful to return in the future. (Adapted from The Churchill Clinic, VIC)

Psychotherapists often train privately rather than or in addition to university programmes. This is because psychotherapy is not, strictly, an academic subject. Training involves more than learning a body of knowledge or clinical techniques. Psychotherapists are required to undergo extensive personal therapy themselves in addition to normally a minimum of 3 years of professional training and supervised practice. Currently psychotherapists are not required to be registered in most states. There are, however, professional associations that determine rules and guidelines and provide a code of Ethics of professional conduct to which members are required to adhere. It is perfectly appropriate to ask therapists about their training, qualifications and membership of professional associations.

Psychotherapy is largely a process of self – discovery and personal development occasioned by an atmosphere of open communication. The therapeutic situation should be conducive to self – revelation in a way that is not unduly intrusive or coercive. Psychotherapy aims to encourage emotional maturation, a greater sense of autonomy and effectiveness. Ultimately, such development inspires a feeling of purpose and aliveness, the basis for satisfaction and fulfilment. While psychotherapy is especially important for those in acute distress, deep disturbance or frequent dysfunction, one doesn’t have to be in a specifically pathological mental state to have psychotherapy. It is also appropriate for practically anyone who would like to improve the quality of their way of living, working and being with others.

…Usually non – prescriptive and non – directive.

Psychotherapy is not normally a form of crisis intervention. Yet, for people who are already having psychotherapy when a crisis befalls them, the therapist is in a good position to assist. It makes a difference to know someone when things go wrong. But in extreme situations psychotherapy should not be considered a substitute for hospital care, medical attention or as a type of repair shop for the mind.

Psychotherapy is a form of treatment for disorders within oneself, in relationships and other areas such as work, creativity, sexuality and the ability to achieve one’s goals. At the same time psychotherapy is more than treatment. This is because quick fixes or technical solutions rarely work in sufficient depth to last beyond the present mood. So, while psychotherapy aims to make a positive difference in the short term, therapy also needs to be effective in ways that go beyond the current situation.

Often we notice that the nature of our personal difficulties is repetitive. Similar issues arise time and again in different contexts and relationships. The causes are often complex but may well arise from aspects of our emotional development that have become blocked or arrested. When emotional development is appropriate to our age or stage of life we call it maturity. Psychoanalytic psychotherapy therefore is also deliberately a development process over time for these reasons. Therapy aims to uncover and address whatever has gotten in the way of development. Ideally, the therapeutic process releases areas of development and thereby dismantles the conditions that lead to recurring problems, issues and limitations.

Psychotherapy works at different levels at once. Usually, clients consult therapists with an issue or problem that may be pressing at the time. We proceed by discussing these or any other related issues of importance. Theory, philosophy, the ideas and considerable clinical experience of psychotherapy all go to occasion insight into such issues. The inter – personal relationship is used to produce insight into the meanings and underlying reasons behind difficulties.

Insight into what things really mean to us often leads to uncovering and experiencing feelings which, in turn, integrates or connects us to the issues with awareness. A sense of inner work and movement often follows; a mental/emotional stretch. Therapy usually takes us beyond where we can go by ourselves.

Psychotherapy also works through a special quality of relationship. The private ‘space’ offered in therapy should provide a safe and reliable environment to explore areas that we normally might prefer not to reveal. Therapy is strictly confidential. Over time a professional relationship may develop which makes it possible to face painful issues that may have been buried or denied. While no one likes pain it can be necessary to go into it and through it in order to move ahead. It also takes enormous energy to keep painful issues out of sight and mind. Correspondingly, energies are freed when formerly unspeakable issues have been faced.

Psychotherapy also specifically makes use of the professional relationship itself as a field of reference. What occurs between client and therapist often reflects other areas of our lives where similar issues may have occurred. Psychotherapists are trained to identify and work with those patterns. A potent facility for realisation and change comes from working directly with what happens immediately before and between us. This also differentiates psychotherapy from counselling, psychology and psychiatry – and why professional therapists keep strict boundaries, avoiding social contact outside of the consulting room.