Friday, 9 September 2016

what is (curative in) psychotherapy?

The title is a question I often ask myself. As I ask it I think, naturally, of the therapy I myself practice. But yet generalise beyond that to what is curative in the therapy I myself have received, and to what I understand would and wouldn't be helpful for the patients I meet with simpliciter.

I want here to offer an answer which does some kind of justice to the value of psychoanalytic understanding, yet which places something more humanistic at centre-stage.

Thus it occurs to me that what is only actually helpful to any of us is ordinary care and concern and recognition and love and security and safety and a modest tenderness and being taken seriously and jovially and shown everyday solicitude and and honesty and informal respect and being called on one's bullshit in such a way as makes clear that redemption is not too remote a prospect.

And it's impossible to offer these by way of a strategy or technique or intervention. When people talk about, say, 'using humour' in their work my stomach turns. Not because there's anything wrong with humour - which can be a wonderful thing (unless deployed in the service of avoidance of pain or awkwardness that needs to be faced). But because there's something wrong with 'using' it - or 'using' any strategy for that matter. Someone who is 'using' humour is strategising, devising, planning, implementing. They are not offering themselves to the patient to meet with. They are offering an intervention. They are still at a remove.

So, offering oneself - sincerely, lightly, honestly, carefully, whimsically, truthfully, straightforwardly, undefendedly - this is what matters. This is what is meant by 'making one's mind available to the patient'. It's not a matter of thinking about them psychologically, although let's not rule that out. After all, if you're a psychologist then it's likely that you will sometimes be thinking along such lines. But it's the offering of the you who is doing the thinking in that thinking, or of the you who is feeling or remembering or dismayed or proud or delighted or interested, that matters. Thoughtfulness is the key: not cogitation or theorising, but sincerity and truthfulness, where cognition is primarily put in the service of clearing away the crap in one's own head rather than reasoning one's way to an answer. Offering oneself in a direct and uncontrived and genuine manner. This is what matters in a friend, and what matters in a therapist.

A therapist, though, is not a friend. So what is it that makes for the difference, leaving aside the obvious lack of mutuality?

A therapist has another job too: Of being wise to the defences the patient is erecting, being wise to her unmet needs and her unconscious feelings, wise to the way his patient's character has potential which is yet bent out of shape by her defences. Of being skilled in negotiating these defences - dancing around them, challenging them straight on. Noticing what feelings can't yet be tolerated and, when they are projected, tolerating them without retaliation and thinking carefully about them before challenging them at the right time. Gently yet firmly handling the superego. Articulating the unrecognised doubts that get in the way of trust and emotional contact in the room. Avoiding the temptation to falsify through 'normalising' or to offer 'interpretations' or any such knowing cognitive understandings of the patient's inner predicaments. Listening with interest to daytime and nighttime dreams as embody the distinctive idiom of the patient's ownmost unconscious life. Noticing his countertransference and sifting through that, apportioning it in an ongoingly revised way to himself or to her transference. Getting rather lost and finding himself again in the muddle of the therapeutic relationship. Getting rather lost and finding himself again in the muddle of psychotherapeutic thought. Waiting it out, sitting on his hands, when there's just crazily little hope around without resorting to a kind of fixology that smacks of denial of disturbance and desperation.

Sometimes it takes a whole lot of clearing work to just let one very little bit of ordinary love sneak through the undergrowth and work its humane magic. The gardening analogy is trite yet apt. The craft of it - the weeding, the painful but necessary pruning - requires special skills, yet it's the soil, the water, the sunlight of the raw uncontrivable humane encounter, which make the plants grow and thrive.