11 Chapters
Medium 9781855753068

CHAPTER THREE: The questions we have to ask (ourselves) before we answer the question: “How does psychotherapy work?”

Karnac Books ePub

Joseph Schwartz

Iwas an experimental physicist before I became a psychotherapist. The experimental part of my previous career has been very helpful in dealing with theoretical issues in psychoanalysis. Traditionally experimentalists have always been very very critical of theory. The important thing for an experimentalist is that the theory be right, not that it be intriguing, or interesting, or even beautiful. The experimental question is not “Well, could it be that?” The experimental question is “Is it that?”

Although there always needs to be space for exploration of theoretical issues, my appraisal of the field of psychoanalysis over the past twenty years is that psychoanalysis is at a particular point in its historical development where too many people are playing around with psychoanalytic ideas and not enough colleagues are asking, “Is it that?”

There are very many different ideas being put forward to answer the question “How does therapy work”, or indeed, “Does therapy work?” But what the field has lacked is a disciplined engagement between practitioners with a view to sorting things out. It is not good enough for us to sit in our separate corners, slag each other off, and turn up our noses at how our colleagues have understood the experience of the consulting room. There is a certain discipline in natural science, not very well understood within psychoanalysis, that our field sorely needs. My psychoanalytic colleagues seem to carry around a lot of the ambient mythology about the so-called precision, and the so-called objectivity of natural science that appears not to apply to the subjectivities involved in psychoanalysis. The result has been that our community has lost track of the salient point of any exploration of human experience: it takes discipline to get results.

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CHAPTER ONE: The fifteen key ingredients of good psychotherapy

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

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

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 FOUR: The psychotherapy relationship

Karnac Books ePub

Susie Orbach

There are so many ways of describing how psychotherapy works and the purpose of this book is, of course, to try to address particular facets of it. I shall restrict myself to a discussion of how entrenched ways of being that cause distress can change through the therapy relationship.

The aims, conventions, and experience of therapy makes for an encounter that creates the conditions for reflection, feeling, analysis, and experimentation to occur. Reflection, feeling, analysis, and experimentation lead to a reinscribing of experience in which the individual’s present feels made by, but not bound by history and in which her or his past is animated by new thoughts and understandings. Transformation of the individual’s subjective sense of self is the outcome of a successful therapy: the individual experiences her or himself as an actor in their own life who has the flexibility to respond in novel ways to the emotional demands upon her or himself.

Psychotherapy is a very personal human endeavour. What I mean by this is that unlike psychological treatments, which are essentially procedural such as CBT or phobia desensitization, psychotherapy involves the therapist and patient in a relationship with one another. The therapy relationship itself is akin to a human laboratory for the exploration of change and risk. Although there for the benefit of the patient, the therapy relationship also affects the therapist in often profound ways. It can make the most enormous demand on the therapist as well as delivering considerable emotional and intellectual satisfaction (Orbach, 1999).

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