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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 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 |
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