Have you ever considered entering psychotherapy? How do you decide on a psychologist and what can you expect? There are many schools of therapy and it is important to make an informed decision about the type of therapy you want. Not all psychologists work in the same way or with the same knowledge and theory. There are often vast differences in the way therapists work. Some of the well-known therapies include cognitive therapy, gestalt therapy, transactional analysis, narrative therapy, psychoanalysis and psychoanalytic psychotherapy (just to mention a few). When you contact a psychologist you are free to ask what theory they use and what the principles of this theory entail.
In this article I will focus on psychoanalytic psychotherapy and what you can expect when you enter this type of therapy. Psychoanalytic psychotherapy is a serious commitment for both the therapist and the patient. The patient is normally seen at least once a week. It is important to see the patient at the same time every week. This creates a sense of safety and containment. Therapy happens within a very specific framework – this includes the regular weekly appointments, a very specific cancellation policy (eg a twenty four hour cancellation policy), the therapy happens in the same therapy room without the interference of telephone calls or other people, the sessions are always 50 minutes long. The fee is decided on and the patient has to pay this fee at the end of every month. This structure provides a safe environment in which to commence therapy.
The therapist is not there to judge the patient, but to help the patient understand his/her functioning, symptoms and relationships. Judgment is in opposition to insight and therapy is about insight. The therapist creates an atmosphere in which it is safe to talk about all – even the things we have never told ourselves. The therapist will help you understand why you think, feel and do as you do. The patient and therapist together face the truth about the patient. The therapist should have a thorough knowledge of human psychological development, the meaning of symptoms and the consequences of certain traumas and experiences. During psychoanalytic psychotherapy the therapist always allows the patient to start a session. At times this is difficult, but the purpose of this is to allow the patient to start with what is on his/her mind. This ensures that the process of therapy stays linked to what is truly going on in the emotional world of the patient. If the therapist starts the sessions she/her can (even well meaning) miss the patient. The process should stay with what the patient is really experiencing and what their true struggles are. It does not matter with what the patient starts the session, because before long the patient will reveal his/her internal struggles. The therapist is not a teacher giving lessons, but a person who enters the patient’s internal world with them. The therapist helps the patient understand what is going on in his/her internal world.
The psychoanalytic psychotherapist will focus on three areas: the patient’s childhood (the events, traumas and relationships), the patient’s present life (symptoms, patterns and relationships) and the patient’s relationship with the psychotherapist. These three areas are linked and all contribute toward insight in the patient. Because the relationship between the therapist and the patient is analyzed this relationship is different from other relationships. This relationship is not lived – meaning that the therapist always stays in the role of therapist, does not accept gifts and does not get involved in the patient’s life outside the therapy room. The therapist should act ethically, not have any physical contact with the patient and should not meet the patient outside the therapy setting. All of this helps to create a very safe environment in which the process can unfold and the patient’s internal world can be entered.
How people act, what they are sensitive (or oversensitive) to, what they expect or struggle with in relationships or in other areas of their lives, what they fear, the patterns they repeat (consciously or unconsciously), the relationships they choose are all meaningful and has an origin, meaning and cause. A therapist can help the patient gain insight in these and can at times help the patient face pain that can seem to unbearable to face alone. Therapists must be cautious not to assume to quickly that they have the answers. It takes time for the internal world of the patient to unfold, but it always does. The therapist does not only focus on what the patient says, but is sensitive for what is avoided, how things are said and what type of relationship unfolds in the therapy room.