Gary Vaughan
Clinical Psychologist
& Psychotherapist
Treatment Approaches
Offered
To contact me
Call: 0401 791 570
email: info@garyvaughan.com.au
Problems Treated
- Stress
- Panic
- Anxiety
- Depression
- Anger
- Self-esteem
- Relating & Relationship
Difficulties - Trauma
- Childhood Abuse & Trauma
- Grief & Loss
Copyright©2011 Gary Vaughan
Principles of psychodynamic psychotherapy
While this section will undoubtedly comprise ‘too much information’ for some (perhaps most!!), some individuals may be curious and/or interested in knowing more about the theory behind what occurs throughout the psychodynamic psychotherapy process.
In my approach to long-term psychotherapy, I tend to draw from a number of theories, including self psychology; the conversational model; attachment theory; trauma theory; developmental theory; intersubjectivity theory; recent neurophysiological research; and contemporary psychodynamic and analytic theory and practice.
For (somewhat) brevity, I have only included those aspects or principles that I believe are particularly important and relevant to how I work…
The importance of the therapeutic relationship
In psychodynamic psychotherapy, the relationship between the therapist and the client is considered fundamental to the therapy process. Whereby the therapist endeavours to establish and maintain an empathic and accepting stance with the client, to enable the client to feel that his or her emotional experience is understood and valued. The therapist not only listens empathically, but initiates frequent interventions (in the form of meaningful and considered questions; paraphrasing; and tentative interpretations), presented from ‘within’ the client’s point of view. This assists the client to feel respectfully and safely understood, and subsequently enables him or her to talk more openly, and to explore him or herself and his or her experiences more deeply (consciously and unconsciously).
The therapeutic ambience
An atmosphere of respect, safety, and understanding, is required (and therefore established) from the outset, as clients can experience painful feelings surrounding their difficulties (such as sadness, anger, guilt, and fear … perhaps even shame). And therefore, they can understandably be reluctant to talk about these difficulties… let alone to explore and talk about the private inner experience underlying the difficulties.
Exploring and understanding the client’s difficulties
The client’s presenting difficulties and issues are discussed and explored in detail to gain a deeper understanding of what is happening, to understand the significance or personal meaning it has for the client (relevant to his or her past), as well as to articulate and give support for what the client is experiencing and feeling. The therapist helps to identify any patterns in the client’s thinking, feeling, and behaviour that may be contributing to the client’s current difficulties.
It is also important to discuss and explore the individual’s family background and personal history, in order to fully appreciate and understand significant earlier influences on his or her current difficulties.
Having greater understanding and ‘insight’ enables the individual to then be more consciously aware and present, and open to considering alternative ways of thinking and/or behaving.
Ongoing exploration and understanding of the individual’s experience helps him or her to develop a greater sense of self-knowledge, self-awareness, and self-understanding (each of which are important and required components for developing a ‘sense of self’).
Self–competence
Notwithstanding, while there may be times where the therapist’s ‘giving advice’ or ‘being directive’ may be appropriate (in terms of what is in the best interest of the client), generally speaking, the therapist will endeavour to operate from a stance whereby to facilitate and enable the client to solve his or her own difficulties.
The insight or awareness that the therapist enables the client to come to him or herself, is way more powerful to the individual’s growth and development – particularly with respect to ‘competence and self-mastery’. As Basch (1988) points out, “true self-esteem, a genuine sense of one’s self as worthy of nurture and protection, capable of growth and development, stems from the experience of competence…” (p. 24).
Structured and directed versus free association
Some individuals can have difficulty with the seemingly lack of structure or non-directiveness (compared to say, CBT) that characterizes the psychotherapeutic process.
While the therapist will generally be more ‘directive’ in the initial stages to assist exploring and understanding the presenting problem, as well as to assist the client to talk about and explore themselves, this needs to be balanced with facilitating self-initiated thought and process from the client.
If as an infant, an individual’s natural expression and initiative is constantly thwarted by parents who are unable to receive or validate him or her, he or she will find alternative pathways to connect with his or her parents – as we all need the approval and acceptance of our parents. This can result in the development of a compromised or even ‘false self ‘. Where authenticity is lost (Gabbard, 2010, pp. 17). The ‘true self’ is shrouded with shame, and hidden from others… and often from ourselves – at first consciously, and then unconsciously. For such individuals, the therapist seeks to repeatedly recognize and validate his or her ‘true self’.
Making the unconscious conscious
Some individuals may find meeting the initial goal of reducing or alleviating troubling symptoms and/or difficulties to be sufficient. Whereas others may want deeper change and/or additional self-development.
To this end, one of the core assumptions of psychodynamic psychotherapy involves the developmental perspective… that childhood experiences, along with the genetic characteristics of an individual, shape the adult person (Gabbard, 2010, pp. 11). That early experiences and relationships with others are internalized, and subsequently continue to be repeated in the present with others (including the therapist). The therapist serves to make conscious this shaping of experience by organizing principles that operate outside a person’s conscious experience… ‘making the unconscious conscious’ (Stolorow et al., 1987, pp. 12). This is of particular significance when this occurs with the therapist (which is referred to as ‘transference’), and it needs to be talked about (interpreted) in a respectful and understanding way, and ‘worked through’ in the therapy, so that a different (more adaptive and healthy) relational experience and relationship can be experienced and subsequently internalized.
Resistance and responsiveness
Resistance of any exploration into the unconscious is understood by the therapist and responded to empathically as the client’s fear that related emerging emotional states and needs will meet with the same traumatizing response from the analyst that he or she received from his or her parents or original caregivers (Stolorow, Brandchaft, & Atwood, 1987, pp. 14). While the therapist endeavours to respond in a way to meet the needs of the client (optimal responsiveness), when the therapist inevitably inadvertedly does not meet the need (optimal frustration), the resultant hurt and pain is responded to empathically in such a way that this ‘failure’ can be restoring and subsequently repairing (and for this also to be internalized).
The goal of long term psychodynamic psychotherapy
- The goal of deeper and more profound change might include any or all of the following:
- To handle difficulties in a more adaptive and mature manner;
- To attain a higher level of maturity and emotional development;
- To improve the quality and depth of interpersonal relationships; and
- To attain the capacity to continue to develop new insights and further understanding of one’s own thoughts, feelings, and behaviour (beyond the therapy).
Centrally, it is to develop, and to be able to maintain, a sufficient ‘sense of self’ … to ‘know oneself’ … from which to be able to ‘be oneself’.
When is enough therapy?
Providing no external or internal ‘interference’ disrupts the therapy process (and in the case that this does occur, that it is, and can be, worked through in the therapy), I often find that the time of ‘when is enough’ therapy generally comes to the surface naturally (unconsciously) for the client. This obviously needs to be discussed and explored with the therapist, as to whether the client’s goals have been reached.
Termination
The final phase of treatment (often referred to as ‘termination’) can also be therapeutic … through reviewing the process and the client’s progress; in discussing how the client (and the therapist) feels about his or her leaving therapy; and by helping the client to further understand and process feelings around separation, loss, and change. Termination can often involve a mixture of sadness about leaving, but also the celebration of accomplishment and moving forward.
References
Basch, M. F. (1988). Understanding psychotherapy: The science behind the art. New York: Basic Books.
Gabbard, G. O. (2010). Long – term psychodynamic psychotherapy: A basic text (2nd ed.). Arlington, VA: American Psychiatric Publishing Inc.
Stolorow, R., Brandchaft, B., & Atwood, G. (1987). Psychoanalytic treatment: An intersubjective approach. Hillsdale, NJ: The Analytic Press.