Psychodynamic Counselling

Qualities needed by a therapist & Therapeutic effect

Lecture 7
Dr. Reem Ibrahim Ahmed
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Introduction
it was not generally recognized that the temporary separation of young children from their mothers had any particular damaging effect. Everyone could observe that after an initial stage of distress children became quiet and well behaved, and it was natural to suppose that they had got over the separation and settled down.
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 Thus the therapist had to possess a very good theoretical knowledge that children do not get over separation so easily; that quietness, and particularly exaggerated quietness, does not necessarily mean that all is well, and might well hide feelings of the utmost intensity;
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 that the consequences of allowing the situation to develop unchecked would certainly be distressing and might well be serious; and that the way to deal with it was to bring out the hidden feelings there and then.

 He had also to possess an attitude to human reactions and emotions like the attitude of a physician to human physiology that these internal processes are a subject fit for study, that an understanding of them is possible, and that rational interventions based on this understanding can have predicted effects.
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 What he should not have, of course, is the plain physician's attitude to human emotions: for feelings need to be dealt with by feelings, and not by reversing their physiological effects The correct treatment for psychological problems is hardly the immediate prescription of anti-depressants
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 The therapist must have deep insight that should be enhanced by many years of personal analysis and be aware of the consequences for himself of being in the same situation as the patient. He will thus be able to use his knowledge of his own feelings in a process of identification with the patient;
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 to know not only theoretically but intuitively what was needed; and, having faced his own feelings in the same situation, not to be afraid to face those of someone else.

 The therapist's feelings can be shown, but must only be shown objectively, under complete control, entirely in the service of the patient. It is so easy, in this kind of situation, to project one's own personal feelings into what one says to the patient, which very quickly goes over into seeking sympathy rather than giving it.
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 Patients are not interested in one's personal tragedies; certainly not when they are in the midst of their own. Everyone who undertakes psychotherapy needs to have these qualities. Not everyone has even the potential to possess them, though they can be taught; and the best way of learning them, of course, is by undergoing psychotherapy oneself.
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The question of advice

Now advice is something that it is absolutely correct to give in its proper place, particularly when one has expert knowledge not possessed by the other person. This is so, for instance, when a psychiatrist is asked to recommend a suitable form of treatment; and even more so when a solicitor is asked to recommend a course of action involving complexities of the law.
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But in emotional situations advice is beset by difficulties, and there are several reasons why giving it may be a mistake. no one can know everything and foresee all the consequences of a given line of action. it is far better for a patient to take responsibility for his own decisions. But the two most important reasons are simply that the advice is likely to be ineffective, and that clarification of the feelings may make advice unnecessary.
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class work
why does the pt need to ask advice, and from a therapist at that? This suggests that there is more to his request than meets the eye. If so, what is it likely to be?
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 the first answer to this question is that there is some reason why the patient cannot do what he knows to be sensible; If the therapist simply tells him to go ahead, the likely consequence is that the patient will superficially agree that this is what he should do, He will go away, come up against his inability to do it, and then be left in exactly the same situation as before.
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 This now raises another contradiction. If the above formulation is correct, then why has the patient not simply said, yes I know this is the sensible thing to do, but I cannot do it? Instead he has come asking for advice. The answer is almost certainly that he has not quite faced the reason why he cannot do it, and his request for advice from an expert in emotional problems - though he does not know it - is really a request to have his feelings clarified for him.
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The question of therapeutic effects

The situation described here represents one almost universally encountered in psychotherapy, namely that (1)the patient is brought to seek help by a current conflict, but that in addition (2)this is within the background of longstanding emotional difficulties, and (3)both clearly have origins in the distant past.
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The fundamental question is now whether it is sufficient therapeutically to bring out the current conflict, or whether it is necessary also to make the links with the past.

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therapeutic effect emotional growth independent of therapy ('spontaneous remission ').

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