Sunday, 27 March 2016


What is psychoanalytic psychotherapy? I sometimes like to ask this question afresh, trying to forget everything I already know or believe, and trying to avoid the terms often used to answer it.

As we grow up we develop a sense-of-self-in-relation-to-others, and a sense-of-others-in-relation-to-self. Hopefully we have a sense of self as often-enough valued by and desirable to others. And a sense of others as often-enough trustworthy and kind.

These moral-emotional senses of self and other are essential for us to fully function as human beings and essential for us to be able to relate with any comfort to others. My talk of 'senses' is, however, a little lazy. I'm not really talking about something consciously recognised, but more about an ability to be truly settled and open and relaxed with others.

Someone who believes that their ownmost music will be appreciated can relax enough to give of it spontaneously. Someone who is anxious about this will become preoccupied with how they are seen, will become involved in putting on a performance rather than simply performing, or will develop annoying narcissistic defences to manage their narcissistic wounds. (Damn, didn't take long for the psychobabble to start up...)

These 'senses' I'm talking about largely manifest as repeating mood states, and take their shape in those moods that are sedimented into our characters, rather than present primarily in the contents of our thoughts. The moods may in fact be so pervasive that they go unrecognised as such.

One of the tricks of therapy is just to try to attend to such general facts about particular people as often escape our notice since we tend to think (if we think at all) 'oh that's just them'. Inflections of mood and character then show up as meaningful - and, importantly, as potentially optional. By resisting being pulled into the 'oh that's just them' and taking a stand against a patient's habitual moods and expectations, we take a stand for them too, offering them the hope of freedom from expectations-of-others-in-relation-to-self which greatly constrain their self-becoming.

Sometimes someone grows up with parents who are significantly mentally ill or otherwise unavailable, unreliable and unloving. What will now be adaptive for the child will not be a resting attitude of openness and trust in the other, and will not be a sense-of-self as valued by the other. They will instead do better to develop a wary fight-flight-freeze attitude to social life.

A patient of mine talked thoughtfully and movingly of Katniss from The Hunger Games with whom she partly identified. For Katniss and my patient it would not have been adaptive to have grown up with a settled trust in others. And internalising a sense-of-self-as-experienced-as-good-and-valued-by-others would not have been possible or desirable (given how unforthcoming and conditional that love was).

Psychoanalytic psychotherapy provides an opportunity for the recalibration of such fundamental expectations of others-in-relation-to-self. It does this not primarily through intellectual discussion and disputation, the recovery of memories, the provision of tips and tools, etc. Instead it does it through a new formative relationship.

A formative relationship is one which doesn't simply take its shape from previous relationships. It is one in which those standing expectations which constitute character can be refashioned in a more comfortable shape. One develops a new sense of one's perspective as valid, of oneself as loveable, of one's failings as forgivable, in and through an ongoing relationship with the psychotherapist.

One of the ways in which a psychotherapist differs from a friend is that the psychotherapist refuses to equate, or insists on drawing a distinction between, a person's subtle or not-so-subtle reactive habits of distrust and their potential self. They do not say 'well that's just them'. They see reactive habits of distrust as what must be worked on and through. These habits may even be such as to be alienating to certain people, making it hard for a patient to find friends. Psychotherapy makes for the possibility of friendship in the same kind of way that surrogacy makes for the possibility of sexual intimacy. In fact psychotherapy makes it possible to truly choose one's friends.

One of the boons of enjoying a new formative relationship is that it enables enough strength to develop in one's sense-of-self-as-good-enough that one can now fairly and confidently stand up to bullies without collapsing into doubt about the possible validity of their message about oneself. One grows in realistic self-possession.

Psychotherapy, then, involves recalibration of the scales which constitute one's sense of self-in-relation-to-others. But it involves not only resetting the scales, but the development of steadiness and confidence in the readings the newly calibrated scales give. Now the shit that belongs to the other can be allowed to remain with them, and the shit that belongs to oneself can be owned without fear of excommunication.