Tuesday, January 27, 2009

Learning From Things That Go Unsaid - 1

By Kevin Murphy, M.Sc.,
Psychoanalytic Psychotherapist
Dublin, Ireland.

Most people have the idea that going to therapy is a bit like going to night class, except with a bit more conversation thrown in. They’ll sit in a room with a trained person who will listen, ask questions and then give them ideas, suggestions, tips, advice and maybe even exercises to carry out between sessions. All designed to cure whatever it is that is wrong. In short, they will learn according to whatever level of knowledge the therapist imparts to them.
This picture is of a one way street, with all the action going one way. The therapist is the producer of knowledge and insight, the client is the consumer of same. It pretty much matches the world outside the therapy room where, by and large, we are all consumers of whatever it is that ‘smarter’ people decide to produce for us.
In the broadest sense, the goal of psychoanalytic psychotherapy is to shift clients away from this mindset and position them over time as the producers of their own knowledge – that’s why we don’t give tips, advice or quick solutions that satisfy a short term need. Instead we help the client back into the driving seat of their own lives. And when it works it has profound and long lasting effects.
But the process of getting there happens on two levels – through what is actively said by the client and through what is not said in the professional relationship between the client and the therapist. I’m not talking about body language here or telepathy or mind reading. I’m talking about an unspoken discourse that the client engages in, often without understanding it or realising. As a result, some useful knowledge is available to the client that often goes unnoticed.
Why does it go unnoticed? Because, unfortunately, what you usually find is that before they come for therapy people’s belief in their own selves has taken such a battering that they cannot recognise it or if they do they tend not to give it any weight.
So what is this unspoken knowledge? Well, for example, in the first instance the act of seeking out a therapist and going to the first session is a direct communication in itself that tells us a number of things. The person has reached a point of saying ‘enough is enough’, they have at some level made a decision to change their lives, end a pattern of living that is un-pleasurable and, importantly, to put their trust in another person to help them in that process.
We can also assume – and this is something that is often overlooked – a degree of courage in the face of uncertainty. The client will have had to make the call or email and follow up on the agreement to arrive at their appointed time on the appointed day. For some this is easier than others. Often people go through a great deal of internal debate before they reach the therapy room. And if they do make it, then they have overcome a great deal of resistance.
So now we have the elements of perseverance, courage, decision-making, ability to keep an agreement, sufficient trust in another person to provide help and a real, motivating desire to get answers. But if you asked someone on their first day to name any qualities they have displayed in simply turning up they’d be hard-pressed to name two of them.
That’s not to say that once the therapy has begun the battle is over. Yes some people can treat it as a liberating way of looking at their life to date and their own place within it in order to build up a clearer picture of who they are and why things have turned out the way they have.
For other’s, though, the here-and-now pain is so great they cannot focus on the business of talking and instead produce a continuous string of demands to be made feel better. Once again, they take up the position of consumer of cure rather than producer of cure. Wanting to feel better is not a problem. But they are blinded by the specific nature of their internal pain to the fact that they have actually begun the process of doing something about it: the treatment is (the path to)the cure.
It’s like the unfit person who goes to the gym and repeatedly tells the instructor that they want to be physically fit but they refuse to use any of the gym equipment. And when the instructor encourages them to do so and work their muscles, they tell her they don’t want to because they don’t like it and they ask why can’t she make them fit without them having to do that?
In reality you wouldn't really find someone going to a gym with that mind-set. But you often find people coming to therapy with it. That's because the relationship between the client and the therapist, particularly the pscyhoanalytic psychotherapist, is qualitatively and quantitatively different to practically all the other relationships in the clients life. And it is in this relationship that the bulk of the unspoken knowledge is to be found.
I’ll continue with this theme next week because it is useful for people to understand that the way they conduct themselves in therapy, and in the professional relationship with the therapist, can tell them as much about their own selves as the things they actually talk about.

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