What is Psychotherapy?

Below are three newspaper articles, the first was recently published in The Guardian. The second I found on on the website of the Tavistock and Portman NHS Trust. The Tavistock Clinic is the leading UK centre for the training and provision of psychoanalytic psychotherapy. The clinic has also been at the forefront of the development of Family Therapy. The work of the Tavistock Clinic was portrayed in the recent BBC TV series “Talking Cure” and a book, related to the tv programme, of the same title is available.

The article reproduced from the Tavistock website is titled “What is Psychotherapy?” A little confusingly it goes on to talk about psychoanalysis and psychoanalysts, although what is said applies, also to psychotherapy (and psychotherapists) working from a psychoanalytic training background. There are many different types of psychotherapy today and a large number are either derivatives of psychoanalysis or have developed as a reaction to psychoanalysis. I am registered with the United Kingdom Council for Psychotherapy in two sections, 1) the psychodynamic and psychoanalytic section and 2) the family therapy section. This means that I work in the psychoanalytic tradition paying similar attention to what patients say as a psychoanalyst might – but I am not a psychoanalyst. The article below gives an impression of how I and similarly trained psychotherapists practice. The article rightly attributes our training to the ideas developed by Freud and other psychoanalysts who have, and still are, developing his ideas and methods, but is wrong if it is read as suggesting only psychoanalysts provide psychotherapy.

 

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The king who listened

Alexander Linklater
Saturday December 23, 2006
Guardian
Eysteinn Magnusson was king of Norway from 1103 to 1123, and was renowned for his kindness and loyalty to his friends. According to a Norse saga, one of King Eysteinn's best friends was an Icelandic poet, Ívarr Ingimundarson, who suffered from a melancholy disposition. At one point, Ívarr's depression became so bad that the king took it upon himself to find out what lay behind the poet's dark mood.

Ívarr had found such great fame for his poetry in the Norwegian court that his brother, Thorfinnur, had followed him there, hoping to bask in reflected glory. But Thorfinnur found instead that he resented Ívarr's success and decided to return to Iceland. Before the brothers parted, Ívarr asked Thorfinnur to do him a favour. There was a woman he loved back home, called Oddny, and he wanted to give her a message. "Explain that I think more highly of her than of any other woman," Ívarr said. "And if she can wait for me, I'll come back and marry her."

Thorfinnur set sail, had a good voyage, and went to find Oddny. But instead of passing on Ívarr's message, he proposed to her himself.

When Ívarr returned to Iceland, and discovered the two of them married, the saga explains his reaction with marvellous Norse understatement: "Ívarr felt that his brother had treated him badly." He went back to King Eysteinn in despair.

The king observed that Ívarr was unhappy and had stopped writing. He called the poet aside and said: "What's the trouble?"

Ívarr replied: "I can't talk about what troubles me, my lord."

"Then I'll have to guess," said the king. "Has someone offended you?

"It's not that, my lord," Ívarr said.

"Have I not honoured you sufficiently?"

"You have always been generous, my lord."

"Is there anything in my country you covet?"

Ívarr said that there was not.

"This is hard work," said the king. "Would you like an estate to manage?"

"No, my lord, I'm a poet."

"In that case, is there a woman in your own country for whom you are pining?

The look on Ívarr's face showed the king that he had hit the mark. This would be easy! King Eysteinn offered to give him money and a royal letter recommending marriage, which was as big an attraction as it was possible to imagine for a woman in 12th-century Iceland. But Ívarr said that even this wouldn't work. The king was amazed. If the woman was already married, he could have the husband killed.

"It's tricky, my lord," Ívarr said. "She's married to my brother."

The king did see that this was a problem. So he offered to find the most beautiful women in his Norse dominions and give Ívarr the pick of the crop. But Ívarr was a gloomy poet and replied that other women merely reminded him of Oddny, thus deepening his despondency.

King Eysteinn had almost run out of ideas. It occurred to him to suggest that Ívarr join a Viking raid - killing Englishmen being the best known cure for a bad mood. But then he remembered that this is what the legendary 9th-century hero Ragnar Lodbrok had done after losing his first wife. Ragnar had at first struck lucky on a raid, discovering and marrying Aslaug, the lost daughter of Sigurd (the prototype for Siegfried in Wagner's Ring cycle). It had looked good to begin with - Aslaug being semi-divine and therefore quite a catch - but had ended badly with Ragnar dying in a pit of poisonous snakes in England.

The king smiled. "You are not making this easy, my friend," he said. "I have tried everything I can think of. There is only one thing left, and it is of very little value compared with everything else I have offered. Yet one never knows what is for the best. You can come and see me every day, after the tables have been cleared and I am not engaged in affairs of state, and I shall talk with you. We shall talk about this woman to your heart's content. I shall make time for this, because sometimes a person's sorrow may be assuaged by talking."

Ívarr replied: "Thank you for your trouble, my lord. I would like that."

And so, every evening, after the king had done with royal business, he would sit and talk to Ívarr. The plan succeeded. Slowly, Ívarr's happiness came back to him. He started to write poetry again, and became as entertaining as before, living out his life in King Eysteinn's court.

The tale of Ívarr Ingimundarson was composed in 1220, to demonstrate that the sharing of grief is - literally - the sovereign remedy. Despite the Viking taste for tales of war and fate, this may be the first account in European prose literature of successful psychotherapy.

 

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Daily Telegraph article by Priscilla Roth

There are many standard cartoon situations: desert island cartoons, man on a ledge cartoons, furious wives waiting - rolling pin in hand - for their husband cartoons. One of the most common shows two men in a room. There is always an armchair, a couch, usually a carpet and on the wall a framed certificate. These are jokes about psychoanalysts. A man lying upside down on the couch. The analyst: “Can’t you do ANYTHING right?”

People like jokes about how daft psychoanalysts are, and many think they should be placed somewhere between charlatans and down-right con-men. Yet very few people who have not had first hand experience of psychoanalysis, or who have not read about it, have any idea of what a psychoanalyst does. Indeed, many otherwise sophisticated people share the opinion that anyone who goes to a psychoanalyst needs his head examined.

And yet in any of the recent millennium lists of the greatest thinkers of the 20th Century, Sigmund Freud, the Viennese medical doctor who was the discoverer and founding father of psychoanalysis, is always among the top few. And these same, sceptical, no-nonsense citizens entirely accept and are often guided by ideas and attitudes that come directly from Freud, or from later psychoanalytic writing.

For instance, everyone knows what a Freudian slip is, ie the sudden ‘accidental’ betrayal of a person’s true thoughts, unthinkingly blurting out from his or her unconscious. Indeed, the very idea of an unconscious from which such personal truths might spring is a psychoanalytic concept. As are ‘ambivalence’ (as in “I have ambivalent feelings about him), ‘sibling rivalry’, ‘neurosis’, and ‘Oedipus complex’. At the end of the 20th Century, we all speak Freud.

No one disputes the fact that a person’s behaviour could be open to different interpretations, some of which might amaze and disconcert him. We all interpret other people’s behaviour as we struggle to get on comfortably with our families, colleagues and friends, we all make (psychoanalytically derived) shots at interpreting their and our own actions and attitudes. What Freud did was to assume that human behaviour was ultimately understandable, that it followed rational laws, but that those laws could only be seen to be rational if we understand the principles that guide them. Crucially, he added to rational explanations for human behaviour the element of the unconscious; he said that some of the most important things that influence our behaviour and our character are feelings and experiences of which we are not aware.

Freud was certainly not the first to recognize the unconscious in human mental life, but he was the first to study it in such depth and to explore and elaborate a way of making it accessible to conscious thought, one hundred years ago in 1889. The interpretation of dreams, his first and perhaps most revolutionary work, shone a light on the unconscious by showing how it manifests itself in anxieties, physical symptoms and dreams.

This no longer feels like such a revolutionary idea; we are all aware of a reservoir of experiences and memories felt to be located somewhere deep within our minds, which we glimpse when we remember our dreams. We are struck by the feeling that, in the middle of the night, we are a child again, in our parents house, having a temper tantrum, or an actor on a stage, waiting for the curtain to go up and realising we have forgotten to learn our lines.

In the years following the publication of The Interpretation of Dreams, psychoanalysts have been engaged in a broad study of those aspects of the human condition that do not fall directly into the physiological. They study the human mind; how it works and how it falls ill - and they simultaneously treat individuals by applying the knowledge and experience they have gained about the way people feel and think and behave.

The only mystery is why this is ever considered such a crackpot thing to do. Who, after all, has not come across someone who is failing to prosper, and seems doomed to repeat endlessly some self-destructive pattern in life, but who maintains nevertheless that there is nothing wrong with him?

Psychoanalysis is not like physical medicine. It is not pure science, as Freud, in the beginning of his studies, hoped it would be. Psychoanalysts use a combination of scientifically confirmable data, philosophical observations about human nature and painstakingly acquired therapeutic skills to understand their patients. They are not primarily interested in changing specific behaviour, and not at all interested in moulding their patients to some pre-conceived idea of ‘normal.

Rather, practising psychoanalysis can be likened, as the British psychoanalyst Paul Williams put it, to restoring a painting. “Patient and analyst attempt together to lift the grime and wear of the years without damaging the original underneath. Where damage appears, repair is carefully undertaken in accordance with, as far as is possible, the intentions of the creator - the Self of the patient. The process is a science and an art”. Such a process is about discovering, experiencing and assimilating what is authentic and emotionally true in the patient’s self.

There is nothing prurient about this and nothing destructive. It is not messing with people’s minds; it is about easing suffering and clarifying mental confusion. Contrary to another popular myth, it is not “all about sex”, although sexuality - fantasies, difficulties, experiences - are often part of a much more far reaching exploration of the patient’s whole emotional life.

Sometimes people are nervous about going to see a psychoanalyst because they feel they will betray aspects of themselves that feel deeply private. They think that analysts, like witch doctors perhaps, will look into their souls, or make impertinent trespassing sorties into their private thoughts or desires.  And yes, it is sometimes frightening to get to know yourself, to confront your demons. But the analytic relationship allows this to take place in an atmosphere of developing trust, an atmosphere in which difficult, painful experiences can be safely explored and understood.

It is in such situations of closeness and dependency that people have a chance to grow. For many people the home of their childhood provides such a setting, but for many others (and for many different reasons) it does not, or not sufficiently. It is then that people need further help in order for their lives to become more rewarding.

One familiar argument against going to talk to a psychoanalyst is that it would be “self indulgent”. But in fact it could be argued that nothing is more self indulgent than allowing one’s uncontrollable patterns of behaviour to make life difficult for family and friends. The perennially dissatisfied wife, the workaholic husband, the boyfriend who is an incipient alcoholic, all place intolerable pressures and burdens on people who care about them. In such circumstances, to take responsibility for one’s own life, for one’s own problems, however difficult and even painful it might be, is a grown-up unselfish thing to do.

 

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Susie Orbach

Last year The World and Health Organisation published a report declaring that depression had reached epidemic proportions - 1 in 4 people are estimated to suffer from depression.  In response to a new report revealing that students are experiencing a dramatic increase in mental health problems the following article by Susie Orbach appeared in The Guardian on 9th January 2001. 

 

 

And now for the good news…..

(well, better)

 

 

The silver lining in the alarming study that shows that one in four of us suffers with depression is that the past 15 years or so have created a climate and the beginnings of a vocabulary in which mental anguish can be recognised and talked about.

 

The advert of Oprah-type television, the new anti-depressant medications such as Prozac, the recognition that emotional life is linked to the wider world, the psychotherapist as commentator, the counsellors at the scene of national disasters such as Paddington – all these have helped to make the private agonies, the lonely, often unfathomable despairs, the dark, empty, sometimes frightening mental spaces that individuals find themselves inhabiting less stigmatised and more part of what we know to be our world.

 

Depression has become a catch-all phrase that people use to explain lives that are not working for them, that they don’t understand, that they feel lost in or lack meaning.  These states and the allied experiences of not being able to hold on to pleasure, of feeling empty, unaccountably weepy, adrift or strangled by “what’s the point” type feelings, collect together a set of symptoms that, once named, can have a place and a legitimacy.  It is not simply that there is an explosion of depression, but that the word itself has come to symbolise psychological dis-ease, a shorthand way of conveying that things are very far from being all right. 

 

The willingness of those in the public eye – Roy Keane, Rory Bremner, Jerry Hall – to talk about their mental pain and depression reflects the culture’s growing acceptance of the idea that our emotional lives are important.  They don’t just belong at the movies, in great literature or watching football.  Emotions, once thought of as an interruption to the rational, are the triggers to thought.  They constitute who we are and emotional processes are what make it possible for us to make clear-headed decisions, have opinions, and organise our mental processes.

 

Alongside the idea that emotions are fundamental goes the notion that all individuals are vulnerable to bleak states of mind and to emotional terrors.  Where once we reserved such notions for the mad or the depressive, as though either were a state one could not escape from, we are now accustoming ourselves to a broader idea of depression both as a category that can afflict one at a particular time – post-natally, for example – and as a way of signalling mental distress.

 

Depression, then, is often a stopgap word for a vocabulary that is still scarce for talking about troubling states of mind.  If we develop more facility with describing the perplexing and anguishing states we can experience we can hope that this vocabulary will expand and more accurately and elegantly describe the mental states that so confuse and hurt us at different times.

 

What is continually shocking is that we might have thought otherwise.  That we might not have taken seriously the scale of mental misery around us.  What on earth is all the non-interruptible drug and drink usage about if not soothing for anguish?  What are so many girls and women doing hanging their heads over toilet bowls or starving or stuffing themselves for if they aren’t in considerable psychological difficulty?  What is workaholism about if not a salve to otherwise feelings of uselessness?

 

Although there is no way one wants to welcome these alarming statistics of the emotional pain around, perhaps the sheer number means that all of us know several people who are surviving with great psychic pain.  And this can give us pause: a chance to think about how we might better relate to the emotional devastations that so many people’s experiences.

 

© Susie Orbach 2001

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