In the practice of psychotherapy, practitioners must ensure that they are able to work at a level that matches the depth of interactions in a patient’s past and present life.
All human contacts change us in depth, from conception onwards. Our personalities, memories, habits and traits are a direct function of the personal history we have with anyone we ever came into contact with, no matter how briefly or remotely. Our parents, siblings and friends matter most of course, but it is still possible to be profoundly changed by an encounter that lasts a fraction of a second – be that high-fiving a star performer from the first row of their show or being the victim of a pickpocket.
This is why the crucible of the therapeutic relationship can only effect change in depth, and this is why the psychotherapist will make every effort to provide the best possible conditions so that this change is beneficial to the patient. In few words:
1- The stance of the psychotherapist
Psychotherapy is yet another relationship with a stranger, albeit a stranger who will receive payments to suspend the gratification of their own needs for the length of a session and make their minds completely available to the person coming to them for help. The psychotherapist is there purely to attend to their patient and nothing else.
2- The importance of the unconscious
In his foreword to Ginot’s Neurobiology of the Unconscious, renowned psychiatrist Allan Schore reminds its that “Far from serving a defensive function, unconscious processes are ever present and widespread and in essence are the neuropsychological force behind most of our mental and behavioural operations”(1). This means that our unconscious is not just a mental storage space away from our awareness, where unwanted memories are gathering dust. It is involved in all that we do – it is really is in the driving seat.
This is why, during sessions, it does not matter if the material that is presented by a patient is well thought-through and elaborate, or, on the contrary, coarse and chaotic. All material, verbal or otherwise, speaks of the patient’s conscious and unconscious experience in the session and therefore is susceptible of being brought into further light by the therapist.
3- Why repetition matters
First, much as every contact changes us deeply, it is the relational experiences that we have within our closest circles that founds most of our psyche. By repeating sessions regularly and for as long as we can, we are more likely, by unconscious association, to bring up material that is closest to our relational foundations, and therefore most active in our minds.
Second, repetition is the foundation of all learning, at all ages. Psychotherapy certainly allows to develop deep and lasting insight into ourselves, but beyond intellect and comprehension it focuses on a form of learning that is mostly unconscious and emotional – where the hurt lives and works on us.
4- How repair ‘works’
In relation to the last point, it is highly desirable but not enough to ‘know yourself’ in the common sense of the word. This form of knowledge is precious but, people will often find that they get better in ways that they don’t quite understand. Psychological repair is founded on the repetition of affectively reparative experiences, that is, experiences that help integrate the person’s emotional world with the rest of their psyche. These principles are held in mind by the therapist, who will be attuned to the patient’s emotional as well as intellectual needs.
(1) Ginot, E., “The neurobiology of the unconscious”, 1995, W.W. Norton & Co., p. XIII