I am always amused with people’s reaction when they find out that I am a psychoanalytic psychotherapist. One of the most common response is: ‘So, are you reading my mind’? ‘Don’t worry’ – I try to reassure – ‘I’m not Derren Brown’. However, a real confusion takes place when I try to explain to them what a psychotherapist actually does. Maybe they expect something pragmatic, or perhaps it’s my inability to articulate what I do in not-so-philosophical terms, but people often look puzzled, as though they would never be able to understand how psychotherapy works and what the therapist’s role is.
So I decided to put together a description of what a psychoanalytic psychotherapist does. This is not, however, a list of practical duties and responsibilities, as one would normally find in a job description. These can be easily found on Google. Psychotherapists work with the whole spectrum of the human experience, and it would be perhaps very difficult to reduce it to mere pragmatism. So I will approach this from an emotional perspective, attempting to name some of the experiences that happen in the powerful encounter of two people who bravely venture into exploring the complexities of the mind.
Job description of a psychotherapist:
– Tolerating: the psychotherapist needs to be able to tolerate uncertainty, to bear the pain and confusion of not knowing rather than imposing ready-made or omnipotent certainties upon ambiguous situations or emotional challenges. This is what the psychoanalyst W.R. Bion, drawing from the poet John Keats, called ‘Negative Capability’. It takes a lot of experience and strength of mind to be able to withstand the anxieties that the patient will bring, and to stay engaged with conflicting feelings without wishing to resolve them in a magical way. Negative capability serves the purpose of helping the patient feel they can bring out their worst and that the psychotherapist won’t break down or react in a unthoughtful way. It can also help patients tolerate their own uncertainties and frustrations.
– Not knowing: although the patient may think that the psychotherapist ‘knows it all’, the therapist works from an unassuming and not-knowing stance. Nothing is taken from granted, everything is open for understanding and analysis. The patient may wish for an instant answer or a solution to their suffering, but the psychotherapist is there to help bring out the truth from within the person, rather than imposing his own onto the patient. He is there to promote insights that will come from within.
– No memory, no desire: the psychotherapist is there to take in what the patient communicates with no memory and no desire, that is, with no preconceptions or prejudices and with no personal agenda. This promotes a space where the patient is free to say whatever comes to their mind, as the therapist is positioned in an open way, to receive what the patient is trying to communicate. This involves maintaining a thinking position, refraining from reacting to what the patient is bringing in order to help them understand how they are behaving and what kind of response they are inviting.
– Respecting autonomy: the role of the psychotherapist involves championing the patient’s autonomy. A psychoanalytic psychotherapist will rarely give advice or personal opinion, because the patient not only knows best, but he or she will need to develop ownership over their experiences in life. The therapist is there to help the patient make sense of such experiences, to understand implications and motives and to help bearing the feelings with the patient.
– Container: the psychotherapist has to be open to receive the patient’s most troubling projections and feelings. Being able to receive and accept the patient’s feelings is one part of the container function. The second part is to be able to help the patient make sense of their troubling experiences, to ‘digest’ what they are communicating and to give back an understanding that can help the patient to give meaning to their experience.
– Naming: the psychotherapist can help the patient find a name to feelings that had no name, that were experienced as dreadful and bizarre but were too difficult to be put into words. The therapist can help the patient to develop their own language to describe their experiences.
– Avatar: no matter how benevolent and helpful the psychotherapist wishes or tries to be, ultimately he is on the receiving end of what the patient will make him out to be. And, if necessary, the therapist will need to bear to be seen as cruel, distant, dismissive or in whatever ‘just like father/mother/partner/etc’ position they may be put, in order to help the patient to understand and live through the conflicting relationships they carry within themselves.
– Emergence and integration: the psychoanalytic psychotherapist is there to promote the emergence of what is unconscious to the patient, so symptoms and destructive patterns can lose their manifesting functions, giving way to understanding and self-awareness. The psychotherapist is also responsible for helping the patient integrate the healthier and the more destructive parts of him/herself, so the patient can become less defended against these conflicting parts of their mind.
– Reality checking: the psychoanalytic psychotherapist should be in a position to help the patient face a difficult reality they may be trying to avoid, be it within themselves or externally. The psychotherapist should not shy away from the truth, even when it’s too painful, promoting reality checking and then helping the patient bear the resulting feelings. A lot of people come to psychotherapy with an unconscious wish to resolve their problems without having to face reality. Some wish for a magical advice, others for a quick fix. In this sense, therapy can be a reality check in itself, as it can be a painful and lengthy process.
– Actions into thinking: the psychotherapist is there to help patients turn acting-out into think-before-you-act. Psychotherapy provides a space for exploration and thinking, in a sometimes painfully free way. But actions can sometimes be an evacuation for undigested experiences, and the psychotherapist is there to help the patient develop a sort of internal buffer, a thinking space that will allow them to give meaning to the urging impulse to act-out.
This is not an exhaustive list. Nor is it an ideal of a therapist. Psychotherapy is a process, an experience between two persons who work together to understand the most inner feelings, conflicts, difficulties and ways of behaving. And as every human experience, it’s filled with nuances and variations, the kinds that make life interesting and beautiful.
But perhaps after reading this clumsy post you find yourself still confused as to what a psychoanalytic psychotherapist actually does. Well, good! Perhaps it wouldn’t be a bad idea to try psychoanalysis for yourself, to personally go through some of the experiences I tried to describe here.
Allan Gois – Psychoanalytic Psychotherapist in London