As lockdown continues, and we face another few months of life without access to our traditional gym settings, I have been inundated with questions regarding training strategies that can be implemented at home.
I am writing here today about what conditions or illnesses do psychodynamic psychotherapists treat. It is a question I’m often asked in my private practice when people phone up to enquire; and it’s not an easy answer. People often see psychotherapy as a treatment option much like medication or psychical treatment options. This is not the case and can then lead to the opening of a whole different sort of world for people, that can seem for some foreign, exotic and inviting; while for others alien, scary and unsettling and all those feelings in between.
It may be better for us to take this at a slightly different angle then. What sort of world are we more used to prior to travelling to psychotherapy-ville? The medical world of health seems to categorise, as do we as humans in general; and try to place things in neat little boxes that have a working flowchart of ‘what to do if....’
Symptoms are classified and placed into boxes we call ‘diagnosis’. If you feel ‘this’ or ‘this’, have ‘this symptom’ or ‘that’; then this is the box you fit in. It has a treatment plan, or at least treatment options, medication and a path that is more or less clear. The doctor will go through a series of tests and procedures that will be performed on you with little or no involvement on your part apart from turning up at the right time and right place. Things will be done to you, with your approval of course, on the most part, and you will have some reassurance that by being placed in these categories that something is ‘known’ about your condition and that there are things or procedures that will be done to control or try to work out what is happening to decide on a treatment plan.
I’m not going to say that psychotherapy is a completely different planet we need to visit; but there are definite and subtle differences that definitely make people feel that it is unusual, and not in the general world that they’re used to living in.
For a start, the mind is a complicated thing and a little harder to box up and determine the path any treatment can take. The path someone has taken in their life is always individual to them. The set of experiences unique and with that, the way in which they have digested these experiences is unique. It makes the mind both an interesting and often confusing place to be. When Psychotherapy began and people tried to start to make sense of how we feel and think, it needed to be thought about in a different way to ‘normal illnesses’. People, and particularly a man named Freud, started to map out what the mind looked like. This is no easy task and continues to be done today.
Like an update of the sat-nav that is needed now and again as routes change or are added to; it is a developing science like any other, I guess.
Well, the mind was mapped out into three main areas initially:
This was a way that Psychotherapy could start to think about communication, and start to see the real mechanics of what went on underneath the bonnet of the mind. As this progressed, other contributions included a lady named Melanie Kline, added to the mapping and started to see that the development of the mind began in a very split off and black and white way before eventually integrating to a more complex and reality-oriented way; no matter how painful or uncomfortable this might be.
So, let’s recap, because I’m aware it’s a lot of summarising of something that can be really confusing. This new planet is indeed full of rocks and hills that aren’t always what we are used to seeing and can often behave in very different ways than we imagine. Also, I hear you say, in a very Monty Python voice ‘get on with it’ and we don’t want to lose the original question.
The journey from being in a state of confusion at the world around you, and having to quickly classify into good or bad, right or wrong to survive, can create problems. There are created rips or tears in the way we think and understand how we feel. This is entirely normal and a way that the mind develops and grows. It does however fall down at times.
What if the environment is not enough to be able to support the sometimes fall from the path of reality? What if the person does not have the support, or even just feeling like they don’t have the support, to pick themselves up and make sense of what is happening or how they feel? This then creates a potential issue. The mind, being an extraordinary thing decides that it will create a way to survive. This survival tactic is both exceptional but also problematic. Yes, it helps us deal with life’s struggle; each time we hit a wall the mind tries to bend reality or how we think or feel and adapts, to keep moving. What we are then left with, at times, is a system built on survival and chance. The incidents and occurrences in each of our lives and experiences shape and mould an individual mechanism that runs most of the time, in a reasonably good manner with occasional stalls or hiccups. If these rips or tears have been repaired however, in a less than adequate way, then we are left with scars that hamper our lives.
You ask what illnesses Psychotherapy treats? It’s hard to answer that question as it depends so much on the exploration of each of the individual worlds in which our minds have developed. What may be easier is to establish the ingredients that can make Psychotherapy a useful and helpful experience. One that allows you to see these tears and scars and be able to make some sense of them; and be able to try and find a way of recognising when the engine isn’t running quite as it should.
You will face a journey to another planet that you feel unfamiliar with. It may seem at times that the therapist is a part of this strange planet, or that they are next to you on the journey; but it will become more or less a journey that allows you the space to explore what is there and with someone that is able to support you when things feel tough. It is sometimes true that some of these scars and tears are so big, that it can take more time to explore and survive the experience. It takes patience and the ability to engage with the experience fully. Maybe not at first, but your therapist will; even if it may feel uncomfortable, help you to see this, and invest in yourself and your journey.
There are times that the tears and ways of dealing with these are so fragile, the earth may split beneath you and may feel like you will fall. At these times psychotherapy may not be at the right treatment or maybe not the right therapy for the specific problems. Alcohol and drugs can make the journey a lot harder as although they are used to manage these tears and scars, they also cloud and dissolve the actual reality of the new world waiting to be explored. If the mind is too confused or not ready for exploration it can make the journey more difficult and sometimes impossible. Sometimes the road is blocked with biological impairments, meaning that there is no clear way across to explore further; or the lens we see through is clouded and warped in some way.
I am a great believer though that with the right psychotherapy at the right time, with the right therapist, people can explore these new worlds and find a new way of being. You can learn to make sense of what previously just caused confusion and pain; to feel that the world is more balanced and they can see more clearly what lies ahead and inside. Maybe not the perfect world; but our own world in which we can feel more comfortable in.
Imagine playing a complex board game where everyone is playing by their own rules, except you don’t know what the rules are or how to invent your own. That’s what life can feel like when we haven’t learnt the skill of healthy personal boundaries.
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