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The primary goal of Intensive Short-Term Dynamic Psychotherapy (ISTDP) is to enable change through the mobilization of complex feelings linked to a past attachment bond and trauma that have been displaced and are creating the internal behaviours towards the self and the external behaviours in relationship that have ultimately driven the client to seek counselling (Abbass 2015).
This focus on feeling is for me of particular importance. I view it as leading to the development of a secure attachment to the self, and consequently, in relationship to others. This fits with my own experience of the difficulties that brought me to therapy as a client ultimately being a result of an inability to simply allow myself to feel my own complex feelings. It fits with my own experience of therapy, whereby the identifying and deactivating of my defences and an increase in my awareness of anxiety lead to the unlocking of unconscious complex feelings in me that had resulted from my own attachment trauma and had been negatively active, in many different ways, throughout my adult life. The ISTDP technique may be extremely challenging for both client and therapist alike. It involves the practitioner taking an active stance, and there is potential for their own unconscious activation as well – hence the challenge. Yet, when “resistance is penetrated there is a marked and unmistakable increase in the strength of the therapeutic alliance” (Davanloo, 1990, 2000). Such challenging techniques are, to me and thanks to my experience of them, fully worth the effort. The beauty of this work lies, for me, at the junction of being actively and genuinely caring and compassionate for the client, while tirelessly addressing the resistance to what lies untouched in their heart. The ultimate goal for the psychodynamic practitioner is to assist the client in resolving the core conflicts in their dynamic unconscious (Abbass 2015), and it is my heart’s desire to bring this healing work to marginalized folks, as it was once brought to me. Abbass, A. (2015). Reaching Through Resistance. Seven Leaves Press: Kansas City, MO. Davanloo, H. (1990). Unlocking the Unconscious: Selected Papers of Habib Davanloo, MD. John Wiley & Sons: Chichester, England. Davanloo, H. (2000). Intensive Short-Term Dynamic Psychotherapy: Selected Papers of Habib Davanloo, MD. John Wiley & Sons: Chichester, England. While there may be a number of traumatic experiences awaiting an adult as they move through their life, the psychodynamic approach first suggests that most of the conflicts of the unconscious have their origins in childhood experience, with early childhood in particular - as Freud suggested - understood as the most important period in establishing individual psychology.
Freud’s suggestion paved the way for attachment theory (Bowlby, 1958, 1969), something that provides the basis for much of modern psychodynamics, and my own understandings of the work my clients and I do together. The “Strange Situation” experiments (Ainsworth & Bell, 1970; Ainsworth, 1973) furthered Bowlby’s ideas, enabling the classification of different attachment styles - secure, insecure-avoidant, insecure-resistant (or ambivalent), and insecure-disorganized - providing containers for the different ways the internalizations and understandings that result from early childhood experience persist into adulthood. Personality provides a window for understanding how we relate to the world around us, and the attachment system reflects our first experience of trying to do so. It is characterized by the drive to bond to a primary caregiver (Kernberg, 1980), something that can be thwarted by attachment trauma, producing anxiety-provoking complex emotional states in the developing individual (Abbass, 2015). With representations of self and other formed in this context (Kernberg, 1980), anything less than a warm, unconditionally loving primary caregiver can be understood as having the effect of a hot stove – a child gets burned by sub-optimal care-giving experiences, causing attachment trauma, learns to close up in one way or another, and thus goes on understanding the stove as being hot forever. Adults bring this early formation of expectation for other people’s behaviour to their relationships; it informs how they view themselves and also the manner of any psychopathology (Kernberg, 1980). Healing, in psychodynamic terms, involves some degree of integration of self-other representations, enabling us to recognize our conscious wish for attachment with others and our conscious expectations of how others will respond to this (Abbass, 2015). Such a perspective provides the therapist and client a consciously accessible framework for collaborating on the work of examining any unconscious feelings behind the difficulties they may be experiencing (Abbass, 2015). Abbass, A. (2015). Reaching Through Resistance. Seven Leaves Press: Kansas City, MO. Ainsworth, M. D. S., & Bell, S. M. (1970). Attachment, exploration, and separation: Illustrated by the behavior of one-year-olds in a strange situation. Child Development, 41, 49-67. Ainsworth, M. D. S. (1973). The development of infant-mother attachment. In B. Cardwell & H. Ricciuti (Eds.), Review of child development research (3, 1-94) University of Chicago Press: Chicago. Bowlby, J. (1958). The nature of the child’s tie to his mother. International Journal of Psychoanalysis, 39, 350-371. Bowlby, J. (1969). Attachment. Attachment and loss: Vol. 1. Loss. Basic Books: New York, NY. Kernberg, O. (1980). Internal World and External Reality. Aronson: New York, NY. The emphasis of psychodynamic therapy is on the dynamic forces within the client – on drives they may not be conscious of. The Freudian concept of the unconscious is the foundation of contemporary psychodynamic thought, and what interests me is how unconscious forces are involved in a concept elucidated by thinkers both psychodynamic and otherwise: that of trauma.
Modern day neuroscience and contemporary models of the brain often negate consideration of unconscious drives due to the inability to empirically prove their existence, and many pathologies are increasingly being ascribed to physical causes, but this does not, to my mind at least, satisfactorily account for the issue of trauma and the human response to it. My belief is that all beings experience trauma, even if the worst that one has experienced is the painful separation of birth itself. Traumatic experience is “a pervasive fact of modern life” that can live on in individual bodies long after the event, and even cross “generations in families, communities and countries” – but does not “have to be a life sentence” (Levine, 1997). The role of the unconscious in the response to trauma is something that psychodynamic work seeks to address. A typical psychodynamic aim is the removal of obstacles to the processing of emotions that remain locked in the body as a result of traumatic events. “Emotion, which is suffering, ceases to be suffering as soon as we form a clear and precise picture of it” (Spinoza, as cited in Frankl, 1984). One relevant aspect of this in my own lived experience was that of the painful feelings that arose internally as a result of external, systemic causes. Psychodynamic approaches tend to focus on individual relational experiences and the internal reactions to these, but in my practice I also ensure systemic causes are, at the very least, named as causes - as having a role in individual relational experiences. Structural oppression is the socially mandated experience of being one-down, and the psychological impact of this has been explored through the psychodynamic lens in terms of the adaptations required of us when we experience ourselves as less-than, and the costs of these adaptations (Turner, 2020). This understanding – of the way external systems of oppression can give rise to, or further compound, oppressive internal, unconscious systems – is an important part of my own psychodynamic practice. Frankl, V. E. (1984). Man's Search for Meaning: An Introduction to Logotherapy. Simon & Schuster: New York, NY. Levine, P. A., & Frederick, A. (1997). Waking the tiger: Healing trauma: the innate capacity to transform overwhelming experiences. North Atlantic Books: California, CA. Turner, D. (2020). Fight the power: A heuristic exploration of systemic racism through dreams. Counselling and Psychotherapy Research, 00, 1–6. doi: 10.1002/capr.12329 The contemporary psychodynamic approach to counselling developed from the psychoanalytic tradition begun by Freud and his contemporaries. One of its core tenets is the awareness that the unconscious has a major role to play in internal conflict and pathology, and that resolution of these can be achieved via work performed within the container of a therapeutic relationship.
The way that psychodynamic therapy orients away from Freud’s conception of the psychotherapist as detached observer and the client as object of observation, and toward the concept of the therapeutic relationship instead, particularly appeals to me. Psychodynamic approaches acknowledge that healing, as bell hooks (2004) writes, “does not take place in isolation”. The psychodynamic practitioner understands that therapist and client “are the two major variables in the approach, rather than treatment and disorder” (Sundararajan, 2002), and that “detached following of rules describes the novice rather than the expert, who is affectively involved with the task” (Sundararajan, 2002). The mechanism of change is found in two equally meaningful presences in the room (Laws et al., 2017), the dynamic of transference and counter-transference between them, and a commitment from both to address the anxiety, defences and resistance that may arise during their work together. Studies of practitioner characteristics that can harm the therapeutic alliance highlight inaccurate interpretations (especially those responding to client resistance), inflexible adherence to interventions, and a lack of attention to the repair of ruptures in the relationship (Moyers, Miller, & Hendrickson, 2005). As such, a skilled psychodynamic practitioner seems to me to be one who is always seeking to balance their learning and knowledge of technique with the experience of the relationship in the moment. It is for this reason that in my thinking around psychodynamic counselling, I feel it necessary to also include a passing nod to theorists beyond this particular orientation, such as those of the feminist and client-centred approaches. hooks, b. (2004). The will to change: men, masculinity, and love. Atria Books: Harvard, New York, NY Laws, H. B., Constantino, M. J., Sayer, A. G., Klein, D. N., Kocsis, J. H. Manber, R., ... & Arnow, B. A. (2017). Convergence in patient–therapist therapeutic alliance ratings and its relation to outcome in chronic depression treatment. Psychotherapy Research, 27 (4), 410–424. doi: 10.1080/10503307.2015.1114687 Moyers, T. B., Miller, W. R., & Hendrickson, S. M. (2005). How does motivational interviewing work? Therapist interpersonal skill predicts client involvement within motivational interviewing sessions. Journal of Consulting and Clinical Psychology, 73 (4), 590-598. doi:10.1037/0022-006X.73.4.590 Sundararajan, L. (2002). Humanistic psychotherapy and the scientist-practitioner debate: An “embodied” perspective. The Journal of Humanistic Psychology, 42 (2), 34-47. doi: 10.1177/0022167802422004 “In the modern era, the emergence of the separate rational ego, believing itself to be wholly autonomous, has in some cases led to pathological states of […] alienation” (Le Grice, 2016). In contrast to this, Vine Deloria Jr describes ‘participation mystique’ - the “idea that a strong […] psychic bond exists between […] peoples and various objects in nature” – something perhaps at best “a highly spiritual communication” but at worst, allegedly, an inability in people “to distinguish themselves from their natural environment” (Coppin & Nelson, 2017). It is interesting that western minds – ones borne of societies in which schizophrenia, for example, is most prevalent – consider such a thing as too much connection to the world around them even possible. Could it be, instead, that this arises because of the lack of a satisfactory cognitive framework for that connection? “The original experience of mystery was […] beyond understanding or articulation…” (Hollis, 1995); perhaps now the mind, positioned as the seat of consciousness, sees danger in such connection, and relegates it to a characteristic of the pejorative “primitive peoples” (Coppin & Nelson, 2017). As Camus (1965) said: “Beginning to think is beginning to be undermined […] The worm is in man’s heart. That is where it must be sought. One must follow and understand this fatal game that leads from lucidity in the face of experience to flight from light.”
My position, straddling cultures as I do, is that connection is in - and is nothing more complicated than feeling - the experience which Jung describes as giving “a colorful and fantastic aspect to the […] world” but which people now have perhaps “lost [..] to such a degree that we do not recognize it when we meet it again, and are baffled at its incomprehensibility” (Coppin & Nelson, 2017). Perhaps it has become incomprehensible because of our privileging of the aspects of it we have deemed desirable, and the efforts we each make to avoid the aspects of it we deem undesirable? This may be the essence of the conflict, for “thinking is derivative, a secondary process. We experience phenomenologically, as a felt movement of body and soul” (Hollis, 1995. From “…the ego’s narrow view of the world, the task is security, dominance and the cessation of conflict; from the perspective of depth psychology, however, the proper role of ego is to stand in a dialogic relationship with the Self and the world” (Hollis, 1996) – “to engage in a genuine dialogue with the unconscious” (Le Grice, 2016). For me, this dialogue already exists, in feeling. The ego, the mind, needs to be re-integrated into the activity of feeling – it needs to be used to attend to feeling, and to the nature and course of any systemic evasion of feeling. Most “of life is a flight from the anxiety of being radically present to ourselves and naked before the universe” (Hollis, 1996), and this avoidance of “the dismal states of the soul becomes itself a form of suffering, for one can never relax, never let go of the frantic desire to be happy and untroubled, can never rest easy” (Hollis, 1996). As Camus (1965) wrote, the war “cannot be negated. One must live it or die of it.” Camus, A. (1965). The Myth of Sisyphus, and Other Essays. H. Hamilton, London. Coppin, J. & Nelson, E. (2017). The Art of Inquiry: A Depth-Psychological Perspective. Spring Publications; Thompson, CT. Hollis, J. (1995). Tracking the Gods: the Place of Myth in Modern Life. Inner City Books, Toronto, ON. Hollis, J. (1996). Swamplands of the Soul: New Life in Dismal Places. Inner City Books, Toronto, ON. Le Grice, K. (2016). Archetypal Reflections: Insights and Ideas from Jungian Psychology. Muswell Hill Press; London/NY. |
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