Dr Janette Rankine CPsychol
Counselling Psychologist
More About Psychological Therapy
Psychodynamic therapy has its roots in the psychoanalytical tradition of psychology in which Sigmund Freud was the founding father. There are many schools of thoughts and approaches that go under the umbrella term of psychodynamic theory, including object relations, self- psychology and attachment theory.
One of the integrating core features of the psychodynamic approach is that the psyche is perceived to be constructed in the struggle to deal with psychological pain. The dynamic aspect is the internal turmoil created by these struggles.
A huge part of the therapeutic work undertaken in psychodynamic therapy is to uncover unconscious unhelpful repeating patterns of behaviours that are often set up in early life as a way of avoiding more psychological pain. A good therapist can sense when the client may be ready to uncover inner conflicts and defence mechanisms and to challenge how maladaptive coping mechanisms can presently be contributing to inner turmoil rather than alleviating it. The insight gained from making the unconscious more conscious, can help shine a light in areas of our lives where we repeatedly struggle. This awareness can path the way for seeing ourselves and others in a different light, often providing fertile ground for lasting change in the way we relate to ourselves and to others.
CBT in its purest form, is a structured goal directed, time-limited form of psychological therapy. Various therapeutic tools including; diagrams, psychological assessments and questionnaires are often used to help keep the sessions focused and client progress monitored. The use of "homework" or in-between-session tasks is another important element of CBT. This may involve keeping a thought diary, to help the client and therapist become more aware of the client's negative automatic thoughts. Or, a client who may be experiencing anxiety leaving their home for example, the agreed between-session-task may be for the client to walk out of their door for a minute every day. These tasks should always be decided collaboratively, with therapist and clients as indeed is all aspects of CBT work.
The fundamental formulation of client's distress within the CBT model is perceived in how thoughts (cognitions) and emotions and behaviour are interlinked and can often get enmeshed in a vicious cycle. The work is aimed at breaking this cycle and can be achieved by challenging negative automatic thoughts, and encouraging behavioural change, both of which can have a positive effect on emotions.
The therapeutic relationship or therapeutic alliance is widely recognised these days to be the most important ingredient in effective therapy, regardless of the model of counselling or psychological therapy employed. The ability of the therapist to really connect with their client is of paramount importance. The client needs to be able to trust the therapist sufficiently to feel safe enough to share their pain and aspects of themselves they find difficult to embrace or even to acknowledge. A good therapist opens up the space within the relationship for the client to explore their distress with a felt sense that their therapist can hold it with them.
The three core conditions of creating a good therapeutic alliance were identified by Carl Rogers (One of the founding figures of Humanist Psychology). These are:
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Empathy; where the therapist really tunes into your felt experience.
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Genuineness; where the therapist is truly being themselves.
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Unconditional Positive Regard; where the therapist takes an unwavering, non-judgemental stance.
There is something really healing about knowing that you are truly heard, not judged and do not have to feel responsible for any effect you may have on the listener.