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copyright M. "Poseidon" Evripidou
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Fall 2002
To be announced
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Psychotherapy is a purposive endeavor. It can be spontaneous to various degrees, but it should not be aimless. Intention and plan separates psychotherapy from mere helpful conversations. Psychotherapy has been called the “talking cure” because it famously relies on language arts as a means of moving ideas around. As an application of language arts, the discipline is inexact. The fact that talk therapy cannot be a “hard science” only emphasized the importance of proper context and boundaries, including theoretical considerations and ethical standards.
There are as many talk therapies as there are individual therapists multiplied by the number of theoretical orientations. Probably the safest common denominator that may be generalized across methodologies is that psychotherapy attempts to effect change in the patient. From this point, the models diverge wildly. What sort of change are we looking for? Behavior change? A change in the internal emotional climate? More satisfying relationships? And different methodologies will also disagree about how to encourage that change to happen. Does the therapist teach new information, or demonstrate certain behaviors as a model, or encourage deeper expression than the patient is used to? In terms of the atmosphere or tone of the therapeutic relationship, does the therapist boldly confront the patient, or quietly bide his time, or guide the patient into increased understanding through Aristotelian questioning? The answer to all these questions is determined by two factors: the intentions (plan of action) of the therapist and the personality of the patient.
There are two directions of psychological “growth” or development: inward and outward. Inward growth involves development of and linkage among the internal working models, objects, symbols, and other representations, along with the emotions associated with them. This type of growth is the goal of depth psychotherapy and psychoanalysis, along with other more “exploratory” and revelatory (or insight-oriented) disciplines. But inward growth by no means only occurs in the crucible of a therapeutic alliance…fortunately. Artistic expression, intimate and emotionally honest relationships, simple acts of personal courage, and even, I think, a good book can accomplish many of the same things. Internal growth involves the strengthening and flexing of internal resources, the effective and natural “alignment” of psychic content, conscious and unconscious.
External growth, by contrast, involves developing strategies of interfacing effectively with the environment…the outer cosmos of people, events, and things. External growth involves elaboration and development of extra-psychic content, including relationships, work performance, social status, and various behaviors ranging from drinking habits to parenting to public speaking. External growth is more usually the goal of counseling, behavior modification, skills building, and supportive insight-oriented psychotherapy. Once again, there are a host of factors which either assist or obstruct external growth, ranging from the environmental to the psychological.
I think most psychotherapists would agree that the practice of psychotherapy is more art than science, but it contains elements of both. Responsible and effective psychotherapy requires an artful flexibility and empathic receptiveness to the needs and circumstances of the patient, all grounded in an empirical understanding of some type of model. I have read some writers in the field who suggest that psychotherapy models are for graduate students; they are exercises for beginners who don’t yet have a feel for what they’re up to, and later on you kind of “just do it.” I certainly agree that this is often what happens, but I personally don’t like or trust this kind of thinking, and I think beginners and seasoned veterans alike should keep in mind a treatment model to guide therapy. It is suspiciously easy to give up the “science” aspects of psychotherapy as one sinks deeper into the “art” of it.
How do theoretical models guide therapy? The models tell us what to look for, and help us make sense what we perceive, and put it into some kind of useful context. Behavioral models have taught us to carefully analyze and parse behavior into measurable and modifiable units of intervention. Systems models remind us to consider the individual in an environmental context, and even perhaps as an agent of external forces. Object relational models describe internal working models of self and other that presage intrapsychic boundaries and interpersonal functioning. Given a 14-year old Mexican American girl exhibiting behavior problems in school, these models lead us to:
-- Describe the behavior problems that may be targeted for modification or elimination (and help us decide when this has happened or not)
-- Understand her behavior as the expression of multi-generational familial and cultural standards, perhaps in the form of limitations on self-expression or amplification of certain emotional ways of relating
-- Assess the ego strength of this particular teenager, her ability to tolerate strong negative emotions, the cohesion of her sense of self, and her degree of individuation from her family of origin.
Each of these examples represent valid and useful means of inquiry in the course of psychotherapy; however, what happens “in real life” is that one of these avenues is explored at the expense of other areas, as a result of ideological devotion to a particular model on the part of the therapist, or (perhaps more commonly) simply because that’s the way the therapist has always done it. We ask for flexibility and change in our clients; can we expect any less of ourselves as therapists?
To this schema, of course, analytical (Jungian) psychology would add a more fundamental aspect, including treatment of the raw, elemental mythic stuff of humanity which wells up in each person by dint of his or her membership in the human race. As noted before, Jungian oriented therapists stand nearly alone in paying attention to this layer of human experience. I use the phrases “mythic space” or “meaning systems” roughly synonymously to denote this aspect of clinical presentation, borrowing a word (“mythic”) which describes a story which is more than a story…it is a container and vessel for numinous and archetypal content, the means by which the elemental creative energy of the psyche enters the individual personality, welling up from below.
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