The problem of help (Part II) – ‘The experience of help’

Experience HelpLast 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 in London 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.




Allan Gois – Bloomsbury PsychotherapistPsicologo Londres – Psicologo Espanol Londres


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