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CHAPTER EIGHT: Containment: the technical and the tacit in successful psychotherapy

Jane Ryan Karnac Books ePub

Robert M. Young

Idon’t know how psychotherapy works. However, I don’t find that very odd. I have some ideas, but to tell the truth I think of them as a way of comforting myself while I get on with doing psychotherapy, something I do more than thirty hours a week and think about for quite a lot more hours as I teach, write, edit, and talk to colleagues. What I propose to do in this paper is share those ideas and to look behind them to other ideas that I believe to be more helpful in explaining what I do.

First, of course, psychotherapists, at least ones of my persuasion, make interpretations. I was taught only to make transference interpretations, but after I stopped having supervisions, i.e., after a decade of training and postgraduate training, I slowly moved on to making any interpretation I thought might help my patients. Then one day a patient asked me what was the relationship between my interpretations and therapeutic benefit. There was a time I’d interpret the question, but I thought it a reasonable one, and this patient was not prone to use theory as a place to hide. The answer I had been taught was that a truthful or accurate interpretation of a patient’s unconscious motivations, the more primitive the better, and after being worked through, reduces primitive anxieties. This, in turn, makes the patient less trapped in his or her neurotic patterns. The emphasis was on the accuracy of the interpretation.

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CHAPTER NINE: The value of attachment theory in understanding how psychotherapy works

Jane Ryan Karnac Books ePub

James Pollard

The conceptual and procedural problems in assessment of the effectiveness of psychotherapy are daunting. It is not possible here to review the many approaches that have been offered. Each approach raises its own technical issues and reflects a particular value base. The problems are so great that many psychotherapists have retreated from the problem altogether or become content to theorize the impossibility of the task.

In the public sector the profession faces demands for “evidence based practice” and measurements of outcomes on the model of the randomized clinical trial. Many individuals report that they have found psychotherapy to have been helpful to them. This individual experience is so persuasive that psychotherapy flourishes in the private sector. Psychotherapists owe it to those who finance their own psychotherapy, as much as to public sector managers, to remain committed to the task of developing and supporting an account of how and why psychotherapy works. Not least psychotherapists owe it to their patients to offer an account of what they mean by “psychotherapy works”.

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CHAPTER SIX: When thought is not enough

Jane Ryan Karnac Books ePub

Nicola Diamond

Introduction: the relational approach and attachment

In this chapter I will explore a form of relational psychoanalysis, which is particularly influenced by attachment theory and related contemporary developments. The emphasis here is on the centrality of relations with others, in the context of developing a body and a sense of subjectivity. From this perspective, disturbed relations with others in early and ongoing development give rise to emotional problems that can lead to psychosomatic dysfunction and problems with the sense of “self”.

In this theoretical context, the understanding of relationships involves the view that organism and environment are interdependent. The baby’s physiological and neurological functions require facilitating relationships with key attachment figures for their optimal development. The internal world is inseparable from interactions with others. Relationships with others inform the content and form of the world of the developing individual, which is renegotiated and reorganized in later relations in an ongoing way.

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CHAPTER ONE: The fifteen key ingredients of good psychotherapy

Jane Ryan Karnac Books ePub

Brett Kahr

Turn on your television set any night of the week, and you will be able to gorge yourself upon any number of newfangled cookery experts, or so-called celebrity chefs, who attempt to communicate the secrets of their trade to us in a stylish, entertaining fashion. Each evening at eight o’clock, we too, the ordinary viewer at home, can perch on our sitting room sofas, notepads nestling on our knees, as we learn an eminently transmissible sequence of culinary steps. First, we must choose our ingredients; then we rinse, slice and dice, baste and bake, heat or chill, lightly season, garnish with fresh parsley, and … hey presto … we have concocted a veritable replica of a British Broadcasting Corporation feast.

If only those of us who work as professional psychotherapists could communicate the nitty-gritty details of our craft with such grace and dexterity, and still manage to do so in an entertaining twenty-four minute broadcast. If only we could transform our ponderous, arcane, and stodgy textbooks into a foolproof do-it-at-home recipe, then psychotherapy would be available at the flick of a switch, and the mental health problems of Great Britain would be solved. And just imagine if some very visionary commissioning editor from the Channel Four Television Corporation did indeed commission a six-part half-hour slot on how psychotherapy works, how on earth would we translate our hard-won clinical expertise into a snappy format that would engage the attention of millions of viewers?

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CHAPTER TEN: The big picture

Jane Ryan Karnac Books ePub

Carol Holmes

The fact that the discipline of psychotherapy is recognizable by over four hundred competing models attests to its lack of a unified theory and it is this feature more than anything else that underlines the fact that we don’t know how psychotherapy works. What we do know is that these factions in psychotherapy are implicitly or explicitly committed to a particular philosophy of human nature that informs their conception of health and their method for achieving this satisfactory state. Existential psychotherapy for example, is grounded in existential philosophy and the phenomenological method and its practitioners view the recognition of anxiety as an indication and positive sign of the person’s understanding of their uncertain and mortal position in the world. Psychoanalysis, on the other hand, considers the prevalence of anxiety as an indication of unconscious conflict and psychopathol-ogy that requires psychoanalytic intervention. Each school within the profession is therefore underpinned by a philosophy that determines its conceptualizations of both mental health and pathology. Furthermore, unlike the scientific tradition, the schisms that characterize the field of psychotherapy are further compounded and estranged by a general lack of dialogue and cooperation between therapists and researchers from these competing hypothetical approaches. As Feltham points out “It is arguable that the field of twentieth-century psychotherapy has been fundamentally characterised by serious disagreement on views of human nature, aetiology of psychological dysfunction, treatment rationales and goals” (1997, p. 1). Feltham further claims that these divisions interfere with the likelihood of systematically examining these significant inconsistencies and suggests that we have difficulty in questioning our assertions of truth and reality: “It seems to me that we are as least as resistant to examining our therapeutic truth claims as our clients often are to examining their longstanding and unproductive scripts and narratives” (ibid., p. 2). I believe that it is not the lack of certainty that inhibits our ability to better understand how psychotherapy works, but the certainty with which psychotherapists from these clannish schools cling tenaciously to their denominational positions. From my own experience there also seems to be a general lack of courtesy, regard, and modesty on the part of psychotherapists for any position other than their own.

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