how i think therapy works
Choosing a therapist is a big deal. Some people make this choice on instinct, and others want to know a lot of information about what they’re signing up for. For the latter, I’ve shared here my particular understanding of the important aspects of therapy, and what I hope to offer each patient who comes to see me. I hope this will provide you with what you need to make the right decision about whether this kind of support might be a good fit for you.
acknowledgment of the unconscious mind
Psychoanalytic therapy has its foundation in the idea that we are often impacted by patterns and forces within ourselves that we are not consciously aware of. Even people who are particularly clever or self aware are still imprinted with beliefs and ways of manoeuvring through the world that are so deeply and implicitly embedded that they remain entirely unconscious to the person. These aspects of each individual’s ways of being find their source in different places - intergenerational trauma, the collective of humanity itself, what is expected of us men or as women, our experiences within our physical bodies, and, in the stories of our early lives and important relationships. Psychoanalytic therapy aims to facilitate the illumination of these unconscious aspects of the patient. For this reason, it is often of particular interest to people who are naturally deep thinkers and problem-solvers themselves, but have tried a few other solutions to what is troubling them without much luck.
We live now in a cultural paradigm that is severely polarised in favour of reason and cognition as means of determining what is true, and what is the right path forward. Even in the psychotherapeutic space, cognitive therapy is widely considered the ‘gold standard’ or most ‘evidence based’ treatment for a variety of problems. Cognitive therapy is based on a theory which broadly suggests that replacing maladaptive thinking patterns with more positive oriented thinking can resolve symptoms. Although this idea aligns with the current cultural climate, it does not acknowledge the role of the unconscious in our experiences. This paradigm can also also neglect the value of the intuitive mind, our emotions, our felt-sense of what is happening in our bodies, and the roles these aspects play in our lives in their own right, as separate from our thoughts.
Psychoanalytic therapy works on the basis that, for a person to heal, they need to be supported to discover an alternate way of being that is not only rationally thought through, but fully realised and wired into their physical body, so that it exists in an organic, spontaneous way. In the mind of the psychoanalytic therapist, a person who is left to police their thinking patterns forever is not healed.
integrating logic and intuition
This is not to say that our rational, logical minds should be ignored or dismissed. Rather, through the process of therapy, the mind is returned to its rightful place within the patient. In largely forgotten history, the rational mind was considered the important, faithful servant of one’s intuition. Revered teachers, leaders and healers were those considered to be the most attuned and receptive to their intuitive wisdom. I think of good therapy as a process that supports the patient to become reacquainted with this aspect of themselves. This 'thing’ can be called by different names - the heart, soul, instinct, intuition or the real self.
One might think about healing as the process of the intuitive and the rational within a person coming back into correct balance. When, through the process of therapy, the patient’s true, intuitive self starts to become clearer and more intimately known, their rational mind has an important and rightful place in bringing the desires and ideas that are revealed into expression and manifestation in the patient’s life.
The process of retrieving this ‘real self’ can involve uncovering the source of unconscious patterns by exploring the patient’s history, their relationships, and the repetitions they notice in their life; what psychoanalysis is typically known for. It also requires the patient and therapist to engage in what has become an uncommon and unusual process: deep listening together for how the patient’s real self is trying to reveal itself in the present. In my experience, this often takes great courage in the patient - they must say the things they’ve long felt should not be said, be silent in spaces where they have been long told they must be articulate, speak to what comes into their mind even when it doesn’t make any sense to them yet, and reveal their true feelings - of love, hatred, rage and terror - sometimes after a lifetime of caution and editing. One reason I invite new patients to attend a few sessions with me before deciding to commit to the therapy in the long term, is that it is very important for the patient to feel that the therapist is the right ‘someone’ to accompany them through this process.
CURIOSITY + RESPECT FOR SYMPTOMS
Psychoanalytic psychotherapy offers a space where all the parts of the patient are welcomed, particularly aspects of them which may previously have been denied, denounced, policed or ignored. For example, where other paradigms might use terms like ‘overthinking’ or ‘unhelpful thinking’, a psychoanalytic approach makes room to think with the patient about why a particular aspect of themselves feels such an urgency or preoccupation around certain experiences or ideas. If a patient presents with depression, rather than focussing on immediate relief, the therapy focuses on uncovering what may be going on within and around the patient to evoke their depression in the first place. Symptoms are considered then, not as a function of some innate wrongness or disorder, but as signposts to aspects of a person which have fallen out of alignment. Rather than being berated, annihilated or even reasoned with, they must be listened to for the innate wisdom they hold about how to restore the person to their most authentic, well self.
Psychoanalytic therapy is an intervention I deeply believe in, and it has a strong evidence base for a variety of problems. What is interesting about psychoanalytic therapy outcomes in research, is that patients appear not only to benefit from treatment, but to maintain their recovery and continue to improve after treatment has finished, both in long and short term (i.e. less than 40 hours) therapy. If you would like to read more about this in more academic language, you can do so here.
In real life, psychoanalytic therapy is rarely a simple or linear process, but I believe this is virtue of the fact that it honours the real intricacy, injury, complexity and potential of the patient. The outcome looks different for every person, but may include, not just the relief of symptoms, but more spontaneity, energy, intuition, creativity, productivity and a sense of freedom and choice that they had not previously been able access.