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Psychodynamic psychotherapy is a relationship. It is a verbal treatment - one of the talking therapies - it is a verbal treatment which involves a therapist and a patient who try to develop a relationship. In that relationship the understanding is that the patient, will begin to re-experience and re-live all the early, dimly remembered, important relationships in infancy and childhood that shaped that person’s character and way of being in the psychotherapy.
In the process of re-experiencing the early relationships, the patient begins to make meanings of feelings and behaviors that may have impeded that person’s arriving where they want to go. The meanings of the patient’s maladaptive psychological patterns are understood then to have their origins in early traumatic patterns, life experiences, modified and modulated by their own biology and by their social realities. I mean, there is no question if you ever have looked with two children, or had one of two children, they each have a different family somehow. That in part has to do with the environment. I suppose no parent can experience two children in the same way. And it has to do in part with the patient’s biology, their vulnerability, their sensitivity about certain things. And also the sociopolitical realities. If you are a boy, if you are a girl, if you are rich, if you are poor, if you are a person of color, all of that will go into how that person gets their experience.
The impact of these early experiences has been unconsciously repressed out of the patient’s experience, but nonetheless continue to interfere with the patient’s access to current solutions. There are some terms to describe the dilemma and processes that we are talking about. The first is called the alliance. Now people didn’t use to talk about the alliance. When I was in training, we were taught, we would go in and sit down and shut up and the patient would start to do something and then you embarrass him. I was under the idea, I was still living with Freud’s Cartesian fantasy. That you can study something from a distance without influencing them. So if you don’t say hello then you haven’t contaminated the clinical environment. It seems pretty silly by now with what we’ve come to understand. The facts we learned in that kind of thinking. Since then and soon thereafter a lot of people began noticing that a., you lost a lot of patients.
How does the patient’s chief complaint offer a window for understanding the whole personality structure? So a patient who comes in and says, "I’m here because my wife sent me", a lot of patients say that. It is a completely different patient from the patient who says, "You know, somehow everything is in place but I’m just not happy. I just don’t have any zest for life."
Sometimes referred to as the frame. Time, money, all of that. Place, where are we going to meet? I am going to be interested in everything that they should feel, or says or thinks, including their relationship with me. I am going to be very interested in the patient’s dreams and fantasies. I am not going to be interested in giving them advice. I am really not the person to tell them what to do. All of that I think begins to set the games like chess. The goal of this introductory part of the therapy is to build a working alliance that’s going to allow for a deeper curiosity. So a patient who comes in and says, "My wife sent me" only needs, if anything is going to happen, to go a little bit beyond what that may mean. How come? Why now? Has this happened before? Then and only then can we begin to talk about psychotherapy.
They have a very important message. It is that the needs of the patient will be central to our concern in this hour. That opened some interesting questions in our research. Obviously rules of confidentiality or limits of confidentiality is something you want to discuss early in the alliance-building time. Now lets talk about the rule of free-association. The early analysts used to say there is only one rule and that is the rule of free-association. What does this mean? Do we accept that the patient can give voice to confusion and anguish and wrath? The feelings begin to separate themselves from the mass of undifferentiated unease into manageable particles of competently recognizable patterns, what happens in the middle of a temper tantrum is that the child is no worse. The child is overwhelmed with buckets of distressing. Now do we expect that the child will begin to find words with your help? There is some kind of calm afterwards and there is a prayer of the child and you being able to give him what he needs. Until then, the chaos overwhelms and there was no possible hope for successful resolution. That is truly the internal state of the mind in conflict and in distress. And the
Let’s talk about transference next. What is transference? Well, transference is a way of talking about - it’s a preface - a way of talking about unresolved feelings that originated in the early and dimly remembered conflicts with parents and significant others and that necessarily in the attitude and assumptions and yearnings towards the therapist in the hour.