I am very grateful to Dysthymia Bree for writing this excellent review of an excellent book, which I can heartily recommend to anyone interested in the process and nature of psychotherapy. I read it a couple of months ago, and it was one of the few books which I wanted to pick up straight away and re-read, the moment I had finished it.
It was an interesting, informative and thought-provoking read, and for me, it played a crucial role in helping me to overcome some big obstacles I had been struggling with in my own therapy. Before starting with my current therapist, I had spent five months working with a psychodynamic psychotherapist to whom I formed a very deep and idealised attachment, despite the fact that I knew from the beginning, that our work was time-limited. For me, she came to define ‘the perfect therapist’, and the way in which she conducted therapy became the model I looked for in my subsequent experience. In consequence, my commitment to, and my relationship with my current therapist suffered, due to constant comparisons and very particular expectations on my part. I did not feel cared for or understood, and that fact led me to seriously consider leaving therapy (or at least therapy with her) on a number of occasions.
Reading ‘Psychodynamic Counselling in a nutshell’ had a profound impact on me, in that it really brought home to me, two key points about therapy.
Firstly, when my therapist withholds reassurance, she is not doing it because she is evil, difficult, controlling, or because she does not understand or care for me. She is not rejecting me or abandoning me, however much I may not understand the reasons for her withholding. Withholding reassurance can be immensely difficult for therapists, who may long to provide what they know is being sought from them, and who know that the implications of not providing it, may be that the client (temporarily) hates them or withdraws from them. Sometimes, providing reassurance may be the easy path, but not the one which has the longest-term therapeutic benefits. In those situations, far from acting uncaringly, the therapist is acting more like a loving parent, ‘holding’ the client in their distress while at the same time acting for their long-term benefit in order to try and teach them how to trust and to reassure themselves. Realising that not always rushing in with reassurance may sometimes be as difficult for my therapist, as it is for me when I don’t receive that reassurance, helped me to have a much more ‘human’ view of her, when I might otherwise be tempted to view her as callous and uncaring.
Secondly, the nature of short-term therapy is very different to the nature of long-term psychotherapy, and therapists use different strategies in each case. Some of the things I remembered and valued most about my ex-therapist, were the statements that she made which ‘bound us’ and ‘bonded us’ together (for example, talking about how we both recognised that we worked well together), and the things she said that made me feel cared for (for example, worrying about whether she had hurt me with something she had said, or offering me a ‘metaphorical hug’). I remembered the statements, and criticised my current therapist for the absence of similar statements, but what I never considered was WHEN those statements were made and WHY.
How quickly and successfully a therapeutic alliance can be made, is key to the success of short-term psychotherapy. My current therapist had the freedom to allow an alliance to develop gradually (which was particularly difficult given my attachment to my ex-therapist), whereas previously, a relationship had to be forged quickly, and my ex-therapist had to lead that process. As for the statements I treasured because they made me feel cared for – they may have occurred ‘only’ fourteen sessions in, but my fourteenth session was also my penultimate session. So although those statements felt as though they happened ‘early’ or ‘quickly’, it’s not the time elapsed that is significant, but the fact that they happened at the very end of our therapy together. The time-scales in long-term work are very different, and things unfold and develop at a very different pace and in a very different way. Direct comparisons between the two can be very unhelpful, and they certainly held me back for a long time, in terms of trusting and committing to my current therapist.
I am grateful that I came across this book recommendation when I did, as it contributed to changing the course of my therapy, and the view of my therapist. I hope that it may be similarly helpful for you!
Readers often ask me about psychodynamic psychotherapy; the whole concept of a therapist who works hard to be unobtrusive can seem strange – as my mother once exclaimed, “So he just sits there and listens?!”
What a psychodynamic therapist actually does is far more than listen, and Psychodynamic Counselling in a Nutshell offers a readable yet rigorous introduction to the field for patients and even professionals reading about psychodynamic therapy for the first time.
Susan Howard walks the reader through both the theory and practice of this style of counselling, and also addresses ethical issues, its history, and potential pitfalls for the both practitioner and patient. The pitch and tone of the book are accessible without being condescending.
While there are other books about psychodynamic psychotherapy I’m fond of – The Science of the Art of Psychotherapy (Norton Series on Interpersonal Neurobiology), for example, provides a more rigorous…
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