By Kevin Murphy M.Sc.,
For anyone who has difficulty finding trust in relationships, therapy must offer a daunting prospect. What, after all, is being proposed by the conditions of therapy? Well, the first requirement is that very thing, trust.
It is a professional relationship we are speaking about but in the same way that you have to trust your doctor or your dentist, the same kind of principle has to apply with your therapist. Except with one important difference.
The treatment that your doctor or your dentist offers you is not dependant on regular weekly or even twice weekly visits that build gradually into an in-depth knowledge of your inner life. No other professional is expected to go where a psychoanalytic psychotherapist is expected to go.
In short, no other relationship is quite like it. Jacques Lacan, the leading French psychoanalyst once said that the analyst 'pays with his/her being' and this is pretty much what he had in mind.
Therefore, and this might seem an obvious thing, the ease or ability or facility with which a person enters into and sustains a relationship, albeit a strictly professional one, is among the conditions required for a successful treatment.
Put it another way, someone who finds that their life experiences have led them to distrust the motives of others, to distrust the knowledge of psychoanalysis (or any other therapy for that matter), to distrust themselves or anyone else as capable of conducting fruitful, curative relationships, then they will have difficulty making a talking therapy work. Because it is not just a talking therapy; it is a relationship.
You can often find that some people are eager to make it work at first but they simply cannot get over their sense of mistrust. This can manifest itself as boredom, loss of belief in the process, dislike of the therapist, or a myriad of reasons ranging from not having the time to not having the money to not having the interest. But it is not a complete loss. Once a person has come for a few sessions, a process has been set in motion that continues for a very long time afterwards.
Be that as it may, this aversion to forming a relationship because of an inability to trust can also manifest itself in other ways. For those who find relationships difficult or troublesome, there are two aspects that represent a real risk.
The first is that the relationship will impose some form of dependency on the person seeking therapy. This is an interesting one because it leads some people to opt out of going to therapy because they believe, rightly or wrongly, that they will become dependant on it, or more importantly on the person of the therapist.
In a nutshell, they are denying themselves access to the kind of help provided by a trained other on the basis that they believe they might not be able to function without the continuous help of that trained other. It can be a difficult fear to assuage. Yet modern psychoanalytic psychotherapy has one goal; to allow the person stand on their own two feet, so to speak.
The second aspect is that, like all relationships, even the therapeutic professional relationship will come to an end. The end of a relationship (as opposed to the ‘end of analysis’ which is something both Freud and Lacan wrote extensively about) involves a separation. And while for very many people, it can represent a healthy 'leaving' to carry on with their own lives in a more positive and healthy frame of mind, for others it is not so.
They imagine, as they begin therapy, that this is something that will come to an end, that will involve separation (something that has deep roots for all of us) and that this separation will inevitably be painful and distressing.
This is a form of thinking that emanates from an imaginary position in which the person assumes reality will turn out just like it. And, paradoxically, it is the very thinking that the person opting for therapy is seeking to change. Unfortunately, it sometimes doesn't get that far and can just as easily divert them in a completely different direction away from therapy.
Psychoanalytic psychotherapy is founded on a relationship between two people, a professional relationship with very clear boundaries, but a relationship nonetheless. When it succeeds, it does so because it operates using the very tools that each and every one of us has been exposed to since birth. The human relationship is the fundamental soil out of which we all grow. The therapeutic setting is as much to do with recreating the conditions for growth as it is about anything else.