What would Freud say
if he overheard me offering medical advice to a client for a toenail infection?
He might be horrified because he’d want to probe for the deeper meaning of the
topic. Imagining this
conversation with the great psychoanalyst inspired me to
address some changes in the practice of psychotherapy and psychoanalysis since
Freud’s time.
Of course like Freud,
the psychotherapist aspires to the motto that “Nothing human is alien to me.” Ideally, we’re not shocked
by any confession, and we’re sworn to honor a client’s privacy, except in
situations of potential suicide or homicide.
Freud believed that
the mind is a blank slate or tabula rasa in Latin. The question then becomes to
what extent does heredity, opposed to the environment, impact the tabula rasa
of the developing brain. A simple answer today is that our perceptions of the
mind change in accordance with discoveries in neuroscience.
For example,
disorders like autism and attention deficit disorder, recognized and treated
early in a person’s life, portend a more favorable prognosis. This observation
connects and supports the hereditary nature of both conditions, and the
environmental factors (involved in timing) of treatment. In other words, early
intervention has a greater impact on the developing brain, and implies that
windows of opportunity close rapidly.
Today psychotherapy
is not restricted to an exploration of the unconscious, nor to the wealthy,
elite, artistic, or intellectual.
The variety of psychotherapeutic techniques has broadened, and the
psychotherapist hopes to meet the client’s challenges rather than adhering to a
theory.
Freud’s outlook was
decidedly more deterministic than today’s open-ended approach. Diagnosis
doesn’t necessarily determine prognosis. We know we don’t have all the answers
and expect the unexpected regarding possibilities and potential. Like the stock
market, the outcome of psychotherapy is unpredictable: Past performance doesn’t
predict or guarantee future results.
For example, a
patient of mine, whom I refer to as Mr. Z., began psychotherapy following an
affair. He questioned whether he should leave his wife. As therapy progressed,
he was surprised to realize that he, himself, was the problem, not his spouse.
He could barely tolerate his own company. He simply didn’t like himself. His
outlook changed: Instead of focusing on what his life lacked, he began to appreciate
his partner and home life.
For Freud, an
objective of treatment was to convert neurotic suffering to the universal suffering
of humankind. Today, the psychotherapist is more likely to focus on the positive
aspects of life, like transformation and appreciation.
We live longer and
recognize the capacity and human potential to change: We have the chance to
engage in multiple careers, relationships, hobbies, interests, and travel. The
psychotherapist supports change and maintains an open mind regarding the
ability of a client to transform his life. Our objective is to help the client become aware of how,
when, and why he may get in the way of his goals (for example, fears of change,
success, failure).
Regardless of a
therapist’s orientation ––interactive, relational, psychodynamic,
behavioral, cognitive––the “good-enough” psychotherapist conveys a belief in
his client, and supports his efforts to improve his life and become the best,
authentic person possible. (The term “good-enough” originates from the
psychoanalyst, D.W. Winnicott, who applied the term to mothering).
Conclusion: The
“good-enough” psychotherapist adapts theories to relate and collaborate with
clients to support their growth and help examine obstacles that interfere with
their constructive goals.
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