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Q & A About Psychotherapy
Is discussing the past in psychotherapy really necessary? To paraphrase W. Bion, therapy is not about what happened before, or what will happen next, but about what is happening right now. The difficulty is that many people are unaware of how their past continues to be lived out in the present. For instance, one finds oneself afraid to get close to others. This fear is usually based upon experiences from the past. Finding ways to understand the past, including the defenses we erect against becoming more oneself and being free to live now in relationships becomes a task in therapy, so that the past can be buried, and so that new events in one’s life can be lived as fully and spontaneously as possible.
Will a diagnosis of me be made? How important is a diagnosis? A diagnosis is made when your conditions meet criteria for a problem (disorder) that afflicts your life, and is required by the insurance company for billing. Some therapists feel that a diagnosis is necessary to have a treatment plan or approach to therapy. Other than having a general idea of what is going on, the psychoanalytic psychotherapist (such as Dr. Harris) typically views a treatment plan to be largely illusory, since the unfolding realities of the therapy cannot be planned, or have an agenda, and since the exploration of the unconscious requires no pre-conceived ideas, but must necessarily be explored and created (or re-created) in the dynamic of the relationship. This exploration is often so valuable because it gives opportunity to experience the problematic behavior, while at the same time, helping to find new feelings, insights, and ways of experiencing that become a way out of the self-defeating behavior, and towards a more positive and accepting view of oneself and one's life.
But doesn’t my diagnosis tell the therapist where the problems are? The diagnosis, from a psychoanalytic perspective, tells very little, describing general observed behaviors, and often really hides the problem. Although a diagnosis is a clue, it does not inform us about the meaning of the symptoms. A related concept is psychopathology. By breaking up the word into its parts:
psyche = soul, pathos = suffering, logos = meaning.
Thus, the word can be seen as meaning the “meaning of the suffering of the soul.” From here, we can see that the reasons, purposes, and meanings of symptoms become important to the healing process. Just like a fever is a sign of sickness, it is also part of the restorative cure.
Why does psychotherapy need a relationship to be effective? In the words of Irvin Yalom, the very “heart of psychotherapy, is a caring, deeply human meeting between two people,” in which the therapist has a dual role of both observer and participator in the lives of their patients. And the relationship is not defined by a patient and his/her problems, but instead, “we must speak of us and our problems, because our life, our existence…we are, all of us, in this together.”
Is “transference” really necessary? Transference is actually a reality of all relationships. It is what we project from our previous experience onto relationships. In psychoanalytic treatment, when we are the “patient” or “client,” we enter into the therapy relationgship having been accustomed to being treated in a certain way. Transference is meaningful because when those feelings and experiences re-occur in the therapy relationship, there is a chance to have a different response, and the possibility of having a new and different experience of the self. In this manner, while transference feelings can carry some very difficult feelings, transference also seems to always carry the potential of unlocking oursevles as well as pointing to ways of living more completely those unlived parts of ourselves.
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