A special kind of relationship

Psychotherapy is at the forefront of therapies, but it is often misunderstood as elitist, the choice of the privileged or professionals...

The general view of how we perceive psychotherapy seems to have changed little since Freud's day. Many of us are still not quite sure what therapists do - all we know is that it can take a long time to do it. Think Woody Allen. We tend to imagine the psychotherapist as God-like and powerful, set apart from the tribulations of the real world. He/she may even be seen as mildly eccentric, an almost extinct species, occasionally to be spotted in the rarefied oasis of Hampstead, hanging out at the Freud Museum.

Alternatively, we assume psychotherapists are a source of all wisdom, calm and cultured, yet slightly distant, and mythically silent. It is well documented that the psychotherapist will disclose nothing of himself, but will smile enigmatically when asked a question, and annoyingly reply, 'and what do you think?' At the end of the therapeutic hour, (50 minutes!) the therapist, according to some, will simply nod when you leave, without any of the usual formalities. 'What was that all about?' you will wonder, as in a daze, you search for your car.

These days, it seems very strange, when everyone on social media knows what you had for dinner last night - and with whom, to have this one-dimensional conversation. The only other place this occurs is in the dentist's chair. We can't bear not to know what our therapist thinks or feels. It makes us uneasy, as if we were talking to ourselves. 

Well I'm not here to defend Freud, thank you very much. There are always going to be different reactions to psychotherapy. We might consider telling our therapist in no uncertain terms what nonsense it all is. And how people need to 'get over it.' (Nothing will happen. We don't do anger.)

If only life were that simple. Sadly, it seems, those who appear most scathing about psychotherapy, are often the most fragile, struggling with intractable problems. And often in denial.

At different periods of my life I have shared all of these doubts. I remember feeling a wave of hysteria, giggling uncontrollably during an encounter with my first psychotherapist, as she faced me with a passive look of enquiry, head tilted to one side, as I averted my eyes and self-consciously studied the patterned carpet. All that seems a long time ago.

No-one was more resistant than me. Until, that is, I too needed help. It is a strange, but understandable phenomenon that we rarely acknowledge our own problems or failings, yet see those of others quite clearly, and are convinced we know how they should deal with them. But it is not so easy with our own. Our problems are beyond us. We are often too emotionally depleted or involved to call on our own resources.

Despite the little local difficulties stated above, the reason people choose psychotherapy, is their absolute confidence in the therapist's depth of understanding, their ability to recognise the underlying problems, their knowledge of child development, parenting, relationships and mental health issues, as well as their professional ethos of confidentiality and non-judgemental attitude. All of which engender trust.

But there is another factor above and beyond this. Psychodynamic psychotherapy embodies a particular way of relating. It is what the eminent psychoanalyst, Fairbairn, (1958) described as a 'personal relationship that is therapeutic.' Symington too, talked of 'a special capacity to reach and communicate with a part of [us] that is hidden from view.' (2007) Our inner world.

'The therapeutic stance,' involves an intimacy and neutrality, which can lead to heightened success in all matters emotional. Whilst the much derided 'silence,' is the listening, observing, and considered interpretation of the 'total relationship.' (Joseph,1975) A relationship which reflects what is happening with other relationships in the world outside.

The emphasis nowadays is on the new and brief therapies. For some, with single issue problems, it can work. But for many people there is a comprehensive mix of problems of varying complexity, perhaps going back many years, which takes time and skill to unravel. It is the reliable, understanding human relationship, coupled with the intense training of the practitioner, which sets psychotherapy apart from all other therapies. It is a very special kind of relationship. That is what makes the difference.