Thanks to everyone who offered suggestions for future videos. I think I've settled on a series of lectures about the process of psychodynamic psychotherapy and what to expect from the process. I think this overall subject will allow me to incorporate most of the suggestions I received.
A visitor to the site submitted several questions about transference in response to an earlier post, and I thought they were so interesting and useful, they deserved a lengthy reply -- hence today's post. As a prelude, I'd like to say a few things about how I view the transference, which is different from the way Freud thought about it, and different from the way most lay people understand it today.
Although ideas about transference appear in his work as early as the Studies in Hysteria (1895), it is with the case of Dora (1905) that Freud really begins to think about and articulate his vision of the transference: "What are transferences? They are new editions or facsimiles of the impulses and phantasies which are aroused and made conscious during the progress of the analysis; but they have this peculiarity, which is characteristic for their species, that they replace some earlier person by the person of the physician."
In my last post, I discussed how clients need to become emotionally dependent upon their therapists for psycho-dynamic treatment to be effective. How difficult the client finds it to tolerate his or her own needs obviously plays a major role in the development of that dependency. As I've said before, neediness is often one of the first issues we confront when we begin therapy: early experiences of untrustworthy or unreliable caregivers may have taught us that it's unsafe to become too dependent, making us reluctant to "commit" to the psychotherapy relationship. These are ongoing issues that repeatedly come to the surface during treatment, especially around the therapist's vacations, which often stir up abandonment issues or cause the old doubts as to the safety of the psychotherapy relationship to reemerge.
I recently returned to work from a 10-day vacation, and many of my clients had strong reactions to the break, none of them the same and each reflecting the person's particular defenses. During my early years as a therapist, I found that I often lost clients immediately before and after my vacations; nobody decided to quit this time (with the possible exception of the client I described in my last post, discussed in more detail below), but there has been more "instability" in my schedule than usual -- one session time "forgotten" by a client, some re-scheduling, emails expressing confusion about the appointment time, etc. This type of behavior usually (but not always) has a psychological meaning that you might uncover in the next session if you listen carefully.
Continue "Vacation Breaks in Psychotherapy and Defenses Against Need"
The concepts of neediness and emotional dependency have negative connotations in our culture; when it comes to psychotherapy, many people (especially those who've never had any kind of treatment) take a very dim view of clients who come to depend "too much" upon their therapist. You may hear the very cynical opinion expressed that psychotherapists deliberately instill a kind of emotional dependency in their clients in order to exploit them. It seems that a great many people think that emotional dependency in psychotherapy is bad.
In truth, for psychotherapy to be effective, a degree of emotional dependency is inevitable. Clients with extreme amounts of pain and confusion, who have a history of unstable or chaotic relationships, may become highly dependent for long periods of time. If your life isn't working, if you come from a deeply troubled background and never developed the kind of emotional capacity and self-awareness you need to get through life, you have to turn to and depend upon someone else to help you develop it. Effective work can't happen and you can't get what you need if you don't.
Before I began taking on new clients for online counseling in November, it had been quite a while since I'd started therapy with someone new; for the most part, my practice had involved ongoing work with long-term clients who were no longer struggling with depression. A number of people have recently come to me with depression symptoms and I've been struck once again by how important it is to understand the role that anger and rage play in so many depressive conditions.
In an earlier post about different types of depression, I discussed severe cases that result from intensely destructive but unconscious rage; I believe unconscious anger plays a major role in less severe conditions, as well. You've probably heard depression described as "aggression turned inward"; accordingly to this view, depression symptoms are the result of unresolved and unexpressed anger that is turned inward upon the self instead of being directed outside, at other people. This might account for the apparently unjustified feelings of guilt that often accompany depression symptoms: while the depressed person has no real reason to feel guilty -- that is, they haven't actually done anything in the external world about which they might legitimately feel guilty -- their (unconscious) enraged fantasies of wanting to hurt people around them nonetheless inspire feelings of guilt. As therapists, instead of treating the feelings of guilt as irrational and unjustified, we might instead wonder what the person has done (in unconscious fantasy) to justify those feelings.