The problem of help in psychoanalytic psychotherapy

As a psychotherapist I am part of what is called a helping profession. This includes doctors, nurses, physiotherapists, social workers, therapists and all those who are committed to help people develop and work through physical, psychological, intellectual and emotional problems, aiming for their wellbeing.

Psychoanalytic psychotherapy however is a peculiar helping profession, as the help someone will receive may be very different from what they wished for in the first place. I’ll explain.

I see a wide range of people in my psychotherapy practice in London, coming from all sorts of cultural, social and ethnical backgrounds. Many seek help in the middle of a crisis, some reaping the consequences of the aftermath. I see people suffering from depression, obsessive-compulsive symptoms, stress, acute anxiety, panic attacks, you name it. So it’s fair enough to assume that what every person wishes for is to get rid of what has been making them suffer. In this sense, help would consist in removing whatever symptom, issue or problem that brought the person to seek my help as a psychotherapist. Fair enough, it’s a reasonable thing to wish for.

However, a psychological or emotional problem, be it a symptom or patterns of behaving and relating to others, is not a foreign entity like a virus or bacteria, nor something that can be surgically removed like a growth or an abscess. Psychoanalytically speaking, everything that happens in the the mind and translates into everyday life is part of a complex construction of ways in which we organise our internal world, as we attempt to deal with some difficult aspects of ourselves and of life. This includes the way we handle our destructive impulses, our innate capacity for hurting ourselves and those we love and how we deal with painful experiences in life, things like frustration, disappointment, guilt and loss.

People often decide to seek the help of a psychotherapist when the way they lived their lives so far becomes unbearable, or when they realise they can no longer sustain a healthy balanced life in regards to how they feel, behave and relate to others. A lot of it has do to with the collapse of this complex mental structure that was put in place to deal with the undesirable and unbearable experiences we all face in life, be them internal or external. Nonetheless, the help that people often wish for when they first come is to actually be taken back to the place they were before the crisis, before they were debilitated by their struggle. As a psychotherapist I then meet (break) this expectation by helping the person realise that the way they were before is actually what led them to collapse in the first place.

Every symptom, conflict and difficulty that people seek help in psychoanalytic psychotherapy is there for a reason, and they all have a function and a meaning. They offer an important opportunity for the person to find out more about themselves, in how they behave, feel and relate to others. In this way the suffering that someone needs help with is not there to be simply gotten rid of or removed through a magical psychological surgery, but to be understood and worked through in the context of the therapeutic relationship. In doing so, the symptom or destructive pattern loses its functions and gives ways for the person to organise their internal world in a less defended and more conscious way.

So the help offered in psychoanalytic psychotherapy really comes through the painful process of discovering the meaning underneath the suffering, which will promote understanding, development and transformation. When what is unconscious surfaces to the conscious mind and is contained in the process of psychotherapy, the person can then become free to live a more integrated life. This unexpected help is long-lasting, as opposed to the short-lived illusion that one can simply get rid of symptoms and bypass the struggles in life without having to deal with them.









Allan Gois – Psychotherapist London BloomsburyPsicólogo Brasileiro em Londres

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  1. Pingback: The problem of help (Part II) - ‘The experience of help’ | The Psychotherapist Blog