Academic journal article American Journal of Psychotherapy

Psychotherapy: Some Guiding Principles

Academic journal article American Journal of Psychotherapy

Psychotherapy: Some Guiding Principles

Article excerpt


It is said that the older you get, the wiser you get because you begin to realize that there are more questions out there than there are answers. Nevertheless, based on a long career in psychotherapy, I will risk listing some treatment principles that I believe in.


Everyone seems to agree that it is important to have your own personal treatment experience. Your therapy will maximize your ability to understand yourself and to be yourself, and will minimize the tendency to act out or gratify your own needs in the treatment relationship. It will also deepen your respect for your clients' courage, and authenticate your relatedness and empathy with their struggle. Your self-awareness will be a basis for understanding your clients; and your own therapeutic experience-which generates self-confidence-will provide a basis for communicating subliminally that therapy works.


For many years it has been fashionable to attack psychoanalysis, both as a theory and as a method of treatment. Freud, himself, has been variously criticized as authoritarian, sexist, intellectual, patriarchal. Psychoanalysis has been condemned as regressive and unreal, encouraging clients to live in a vacuum-a closed system of their own intrapsychic world. Fortunately, Gilligan1 and others have succeeded in modifying and improving psychoanalytic theory without scuttling it, and without negating Freud. Gilligan's writing reflects her respect for Freud whom she credits with "seeing so much and so well" (p.9).

Freud's discovery of unconscious mental life and of infantile sexuality has revolutionized the understanding of the human condition. Feelings of need and fear and love and hate are now understood multidimensionallyeach feeling complicated by particular histories and secrets of its own. Freud postulated an internal logic to these unconscious secrets that is both "knowable" and normal. A new language evolved that has become part of our educational heritage and knowledge base-terms such as transference, unconscious, acting out, ego defenses, dreamwork, object relations, repetition compulsion, oedipal conflict, guilt, and resistance, to name but a few.

There are many who prefer not to use this language any longer. These creative pioneers have developed different languages with different treatment techniques that work very well. I would venture to say, however, that they all know their Freud, and that their new approach will be based in some measure on a firm understanding of psychoanalytic theory. My concern is that newcomers might reject Freud out of hand before they have done their homework and have understood his importance. To them I would say: Don't throw out the baby (or the father) with the bath water.

Here are two cases that illustrate how psychodynamic psychotherapy helped two individuals who had not resolved their problems in other therapies. Both were well-educated, motivated individuals who were socially popular and occupationally successful-but intimacy and commitment eluded them.


Ann, age 31, came into treatment with her live-in boyfriend of two years hoping he would agree to marriage. They had shared much warmth and affection, but it became clear that he was not interested in marriage. She left him after our second session and therapy began in earnest. What emerged was a long history of disappointing love affairs, including another failed live-in arrangement. Ann was extremely impatient with her choice of "unavailable" men, and with her rejection of mature men who had pursued her. She despaired of ever having the marriage and family she wanted. She denigrated her own passivity and sense of helplessness and failure.

Historically, Ann was the oldest of three children of an overwhelmed, joyless mother. Father, a successful businessman, was alcoholic, domineering, and critical of the children, especially Ann. …

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