How does therapy work and what can I expect?
How does therapy work and what can I expect?
Psychodynamic therapy and counselling works in a non-directive manner. That is, I will not give you advice, tell you what to do, or instruct you in a particular philosophy. Rather, you have the freedom (and responsibility) to fully explore and relate your thoughts, feelings, experiences, and fantasies (wishes, dreams, etc.) to me (and yourself) in an honest way. I will try to follow you as attentively and patiently as I can. Psychodynamic therapy emphasises the client’s capacity to be as honest, open, and authentic with the therapist as possible: to speak whatever comes into your mind, without censorship. This is often a difficult task due to our conflicting feelings (such as shame, embarrassment, social anxiety, or the fear of exposure).
In addition, psychodynamic therapy focusses on emotions and not only thoughts (in contrast to cognitive therapies such as Cognitive-Behavioural Therapy). This focus on feelings aims to connect you with your past experiences that sometimes we find difficult to think about and experience in a meaningful way.
You can expect to experience your emotions (in a safe and containing manner, and of course at your own pace); to think about, and to feel, your past experiences and how they might relate to the present; to consider how to feel about your significant relationships, and how you have felt about them in the past; to reflect on your relationship to me, your therapist, if and when it becomes significant; to relate your feelings, memories, experiences, and thoughts as freely, openly, and honestly as you can, without editing them. We all avoid feelings that are painful because suffering is not pleasant and can feel intolerable. Part of the work of therapy is to connect with difficult experiences to go through them and, in this way, to experience a greater acceptance of yourself and others, and greater freedom. The work of encountering and acknowledging painful feelings or difficult experiences necessitates empathy and compassion towards yourself and towards others.
The goals of psychodynamic therapy, as Jonathan Shedler and others have emphasised, is not only to relieve painful symptoms (such as depression, anxiety, phobias, or relationships difficulties) (Shedler 2010a and 2010b). Although reducing suffering and mental pain is of course at the heart of therapy, there are other goals that are also important. These goals may include: Allowing you the freedom and autonomy to make your own choices and decisions in life; allowing you greater awareness of your past relational patterns, and of your own thoughts, feelings, and wishes that may have been pushed out of consciousness; and enabling a freer, more empathic, and more self-aware relationship to yourself, and to other people.
References and further reading:
Freud, Sigmund. Beyond the Pleasure Principle and Other Writings. London: Penguin, 2003.
Freud, Sigmund. The Penguin Freud Reader. Edited by Adam Phillips. London: Penguin, 2006.
Herman, Judith L. Trauma and Recovery: The Aftermath of Violence—from Domestic Abuse to Political Terror. New York: Basic Books, 2022.
LaCapra, Dominick. Writing History, Writing Trauma (with a new preface). Baltimore: Johns Hopkins University Press, 2014.
Laplanche, J., and Pontalis, J.-B. The Language of Psycho-Analysis. Trans. Donald Nicholson-Smith. New York and London: W. W. Norton and Company, 1973.
Leader, Darian. The New Black: Mourning, Melancholia, and Depression. London: Penguin, 2008.
