by Joyce Prince, CSW
When someone is considering beginning psychotherapy, there is awareness of needing some relief and/or clarity regarding personal concerns. At the same time, the prospective client may wonder what actually will go on in the treatment, the format that assistance will take, etc. Thus, prior to actually arranging for the very first appointment, there may be a variety of questions, hopes, and fears about beginning.
This informational piece will briefly address these questions by looking at the ‘what’, ‘when’, ‘who’, ‘why’ and ‘how’ of psychotherapy; namely, psychoanalytic psychotherapy.
Various precipitants prompt someone to seek psychotherapy. Some precipitants are external in nature, for example, a life situation change, such as a geographic move, or a misfortune such as the loss of a loved one ( a death, divorce, etc.). Sometimes, even a positive event such as a salary increase, or winning an award can be a precipitant. In this instance, even though the event is ‘good news’, it is experienced as somehow unsettling or disruptive and difficult for the person to psychologically metabolize.
At times the precipitant is internal, for example, persistent depression or sense of unfullfillment and malaise. With an internal precipitant, there may not be a specific event that is the trigger. In this instance, someone may have been considering therapy for some time and simply reaches a point where he/she feels ready to begin. Thus, no actual definable event is causative, or the event is minor – ‘the straw that broke the camel’s back’.
Psychoanalytic psychotherapy is premised on the belief that the current adaptation and functioning of an individual is in a large part acquired through interpersonal learning and development. Development includes biological maturation as well as psychological maturation. For just as an individual gradually evolves and grows biologically, the same occurs psychologically. Stages exist both biologically and psychologically.
Thus, the individual’s temperament and biological givens, converge with the interpersonal learning (relationships with other people) to shape how that person relates to himself/herself and others, deals with life’s promises and disappointment, and so forth.
Metaphorically, it is as though psychological blueprints are laid down within the mind. These blueprints stored most often outside one’s awareness nonetheless inform how the individual manages his/her life. Optimally, the blueprints aid in dealing with self and others. Less than optimally, the blueprints are inadvertently experienced as ossified mental straitjackets obviating against a person’s ability to adapt well and comfortably within his/her own life. Subjectively, this results in feeling unhappy and uncomfortable but stuck: stuck without options — stuck without a way to overcome the discomfort and unhappiness; thus, stuck in blueprints that do not allow for creating and building a satisfying life.
The goal in psychoanalytic psychotherapy is to investigate these blueprints by exploring the client’s current concerns. There is the further premise that not all the information contained in the blueprints is accessible to awareness. Some, probably a significant proportion of the information, for protective purposes, has been warehoused in an unconscious mind.
As therapy progresses, there is a gradual unfolding of personal information. The information includes the more readily available conscious memories, thoughts and feelings. The warehoused information also becomes overt. A sense of liberty and relief results as the therapy client becomes unstuck. Greater personal comfort occurs because the client is not guided (perhaps misguided) by ineffectual blueprints. Thus, the client has more options regarding his/her life.
Because these outdated blueprints tend to remain fixed and used automatically, it is necessary to allow sufficient time in therapy to familiarize oneself with them and how they effected the construction of the client’s psychological self. This then, prepares the client to undertake the work of strengthening the blueprints that serve well and remodeling and renovating the ineffectual ones that cause pain.
Therapists are drawn from the disciplines of psychology, psychiatry, social work, nursing, counseling and vocational rehabilitation. To practice psychoanalytic psychotherapy, the mental health provider should have been trained at the post graduate level. It is the specialized training in psychoanalytic procedure gained from the post graduate work that qualifies the therapist to accompany the client in the investigative journey described.