Sunday, January 1, 2012

Eclectic Psychotherapy - 3) Insight Psychotherapy

I am best described as an "Eclectic Psychotherapist".  I was originally trained in psychoanalytic psychotherapy.  Note my dog, Gilbert,  on the couch!IMG 0182
In psychoanalytic psychotherapy, the therapist is verbally passive to a large degree. The patient is taught "free association".  Free association is a very different process from the directed communication that most people encounter in counselling which is very much  a 'rational' and 'conscious' often 'educational' process.  Free association by contrast is learning to speak about whatever comes to mind continuously without censoring.  The therapist listens to this 'unconscious' processing of whatever is on the mind of the patient.  The patient may recall dreams, events from the the past and anything that may be associated with the primary material being presented.  Eventually as 'patterns of assoctiations' become apparent the therapist shares these 'insights' with the patient and asks for feed back..  Commonly the therapist asks the patient what they think a dream, free association, or focus of thought means.  Therapy is often a quest for meaning and if Jungian an attempt to tie the meanings to the greater world of archetypes. Another more generic term for 'psychoanalytic psychotherapy is 'insight' psychotherapy.  The patient with the help of therapist is gaining 'insight' into otherwise unconscious process and beginning to make sense of otherwise obscure behaviour and thought process.
In psychoanalytic therapy Freud considered the internal processes of the mind to be a kind of family dialogue with the id, the out of control unconscious, the ego, the conscious and the superego the controlling unconscious.  Eric Berne in Transactional Analysis made sense of these divisions by describing Freud's Id as "the child", the Superego as the Parent, and the Ego as the adult.  Later variations on this included the good child and bad chlld, good parent and bad parent. The ego or adult was the individual who managed the demands of the id and superego.  Kernberg was by far my favourite theorist and practitioner of modern psychoanayltic psychoatherapy though it took Masterson to better communicate the developments of the field.  Kohut developed Self psychology which looked beneath the ego to perhaps what might be called the true potential.
The defences were unconscious processes, later called 'coping strategies' in the conscious realm for dealing with unacceptable material. Hence 'denial' might be noted by the therapist who found that the patient couldn't talk about sex and couldn't remember a year in their life when they were in a particular foster home.  Projection might be interpreted when a patient described a 'bad' sibling and how they were so hurtful when in fact in time the patient might gain insight into how they were infact 'projecting' their envy at the next born child.  Acting out was a defence like somatization which served the pateint by keeping them in the dark about some truth that motivated them.  Hence a person might have sex with people indiscriminately when in fact they feared rejection so jumped the gun, acting out some childhood trauma.  Commonly in psychoanalytic psychotherapy the 'patterns' of behaviour noted today derived from dramas that began in the childhood of the patient, in their family. Bradshaw was very good at explaining these early childhood dramas Transference referred to the patients tendency to transfer emotions and roles from past onto the present especially on the therapist.  The therapist in insight psychoanalytic pscyhotherapy 'interpreted' the relationship of therapy in the here and now.
Depth therapy was specifically looking into the darker recesses, the sex and aggression, which Freud said dominated the development.  Interpreting patients 'sexual feelings' towards therapists, or 'lack of sexual feelings' towards therapists (defended against) and feelings of 'hostility" or 'fear' of therapist and working these through without 'acting out' lead to a person being grounded and confident in relationships with clear sense of their own behaviour, their 'boundaries' to use a poor modern term for the membranousness of human relationships, but really having 'insight' into their own motivation and seeing when other's falsely accused them of other motivations or denied their own underlying motivations.  Often there are 'motives in motives' and the the patients of psychoanalytic psychotherapy become very conscious of the behaviour of themselves and those around them.
Indeed administrators and leaders of society commonly sought psychoanalytic psychotherapy so that they would not just mess up society and their workplace with the unresolved issues of their childhood.
Today psychoanalysis despite it's hugely demonstrated benefits is rarely covered by health care because cheaper and often more effective less labor intensive therapies have been developped to address specific psychiatric problems.  Psychoanalytic psychotherapy, as evidenced in Cameron's book on cost effectiveness of therapies for the Ontario Government , is still widely used and hugely beneficial. It's limitations is in the rigors of training which fewer people are willing to undergo. A cornerstone of true psychoanalytic psychotherapy training is for the therapist to themselves be in therapy. This is often too humbling for the modern practitioners who claim 'bigger and better' brains and see their role as 'fixing' patients.
The fact is, experienced therapists rarely today are 'purists' and hence the designation "eclectic'.  One may begin with one therapy but in time and with more advanced training add to the original basis.  Psychoanalytic psycotherapy and psychoanalysis are still considered the best trainings for therapists because, frankly, too many counsellors use therapy to work out their own issues and to propagate their own agendas.  Insight helps patients and therapists alike.
I will go on to discuss the therapies I learned in the order which I learned them giving some insight into the terms used so that people might be better 'consumers' and make more sense of their own experience, their therapy and possibly guide them better in the direction of what they need rather than simply accepting what is offered.

1 comment:

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