Thursday, July 5, 2012

Free Association and Psychiatrist "listening".

Patients have a sense that just talking to a counsellor is 'good'. True, a problem shared is usually halved.  By linking up two computers there's greater potential for problem solving.
But lots of patients think that 'complaining', 'belly aching', "diatribing', 'singing the blues' etc is intrinsically beneficial.  The problem with these patients is that they claim to seek 'professional help. They often say they want 'psychotherapy'.  More often than not they have worn out their own resources. No one they know wants to listen to them go on and on about some 'sore' they are holding onto.  The therapist becomes the 'new' terrain.
These patients commonly are seeking agreement. They have made up and closed minds and want others to agree with them, usually that they are 'hard done by', 'persecuted', 'belittled', and someone else is to 'blame'.
In conventional supportive psychotherapy and counselling such a person is helped gently by the counsellor to view their often extensive list of problems therapeutically. In the process of cognitive behaviour therapy the patient is taught some tools for dealing with their emotions and for problem solving.  Bibliotherapy involves being advised to read a book and clearly only 'works' if the person follows through and reads the books.  Those who benefit most from 'bibliotherapy' tend to be the best students and have greater 'learning' skills.   Journalling is a common recommendation these days. It's extremely useful if a patient has a record of what they are concerned about and can discuss specifically 'events' and concerns with some reference to writing around the specific events. Often therapy is limitted by memory and journalling can improve on this obviously.  These days its common to have therapists recommend meditation. I wrote papers on meditation back in the 80's so it's not new but definitely more popular.  I was seen as a maverick in the old days and these days I feel boringly main stream.  
None of this is 'free association' though. When I did psychanalytic psychotherapy the principal form of therapy used by the early analysts like Freud and  Jung patients had to be 'taught' to 'free associate.'   It was indeed a technique Freud developped having begun his work with hypnosis.
I encourage people to look at how this relexive process is different in kind and content from what people tend to think is counselling.

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