Last week I wrote about the problem of help in psychoanalytic psychotherapy. I mentioned how the idea of help in this context differs from simply removing the symptoms and the problems, and how help in psychoanalytic psychotherapy involves the process of finding out the meaning underneath the suffering, which will promote understanding, development and transformation. All well and good.
But a question still remained for me, one that comes back every so often both in my work as a psychotherapist and in my experience of myself being on the couch as a patient. Yes, psychotherapists and analysts do go through the process of being a patient for many years, and this is an essential part of becoming a therapist. Maybe I’ll write about that on another occasion. This week the question I wanted to address relates to the how it really feels to be helped.
You see, it’s not easy being a patient in psychotherapy. Although one might expect that being helped and supported in therapy will only bring the relief and sense of wellbeing one wishes for, the emotional experience of help is an intense one, often giving rise to feelings that can be difficult to recognise and work through. I would say that this is not only true for what happens in psychotherapy, but to any experience of asking for and receiving help in any relationship.
And that is the key word for us to tackle the question of how it feels to be helped: relationship. Everything that takes place in psychotherapy happens in the context of a relationship, a therapeutic one, but intense nonetheless. It is in the relationship with the therapist that the patient will, often inadvertently, repeat and re-enact the way they relate to others in life. Feelings and unconscious dynamics will then take place, which the therapist will help the patient recognise and understand. So how the person experiences the psychotherapist attempting and managing to help them should not differ so much from how it feels to be helped in other relationships. And to understand the dynamics of help is to become more able to give and receive help when needed.
But what sort of emotional experience does help bring about? If it’s not straightforward soothing and relief, what else is there to be felt? I’ll list but a few:
1- Vulnerability: to experience help is to face vulnerability. When we are hurting, physically or mentally, we will do all we can to protect our vulnerable spots. In this sense, it can be very difficult to trust others and let them through the defence to look after our wounds. So the person who wants to be helped must face vulnerability, which can be very anxiety provoking.
2- Dependence: to be helped is to experience dependence. Some people avoid dependence like Dracula runs away from the cross. To depend on another person is to submit to their disposition and ability to help. This can be a difficult experience, as it makes us vulnerable to be disappointed and frustrated. We bring within ourselves an innate mistrust, maybe mirroring some of the times when we felt that those we depended on to look after us failed to do so. But to receive help from another person is to have to submit and face such dependence. There is no other way.
3- Envy: the experience of help can bring out feelings of envy. When people need help they may often feel depleted, on the opposite side of self-sufficiency. There is an assumption that the helping other then possesses what they need to be ok, whatever form it takes. This disparity between one who feels empty and the other who has what they need may give rise to unconscious feelings of envy. This is not uncommon in the experience of psychotherapy, as the patient comes with their difficulties and they expect the therapist to have what they need to get better. So often the patient will feel that the psychotherapist is withholding from them what they need to be well again, to feel immediate relief, and this stirs up feelings of anger and envy. So to be helped is to have to come to terms with our own greed and envy, as we submit and depend on the other for help.
4- Frustration: to be helped is to be susceptible to experience frustration and disappointment. When we ask for help we are to an extent surrendering our self-sufficiency and depending on another person’s capacity and willingness to help us. This makes us open to experience frustration and disappointment if the help doesn’t come when we want it, or in the way we want it. This also happens often in psychoanalytic psychotherapy, as I explained on last week’s post. If we want to be helped, be it in psychotherapy or in other contexts of life, we must face the possibility of frustration and disappointment.
You may have noticed that the aspects mentioned above relate to a narcissistic blow that takes place when a person asks and receives help. To be helped is accept and, to a degree, surrender our narcissistic defences, becoming vulnerable, dependent and sometimes envious, willing to face possible frustration and disappointment.
However, the process of help in psychotherapy doesn’t leave the person in such a state. This narcissistic blow is part of the process, and slowly the patient starts realising that help is an interaction, an exchange between two fallible and incomplete human beings. This will then translate to other realms of relationships, where the person will be able to find equilibrium between narcissism and depletion, between self-sufficiency and unhealthy dependence.