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About Psychotherapy

 

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Page Contents: Why you need instructions and directions for psychotherapy.                    

 

I am the type of person that needs directions for everything. Isn’t there some way of getting instructions on how to be an open and honest patient without causing a total meltdown of emotions?

 
Well, now there is a way, because I will provide some instructions here.

In terms of your need for directions, let’s admit that psychotherapy can often have an exhilarating intellectual satisfaction to it. In fact, much of the material on this website has an intellectual flavor. Nevertheless, there is a big difference between describing psychotherapy and practicing psychotherapy, because good psychotherapy is primarily an emotional, and often intuitive, process. Without the emotional basis to the work, the intellectual discoveries have no real, practical value.

Imagine having to undergo a painful medical procedure. You can research it until you know everything that is going to happen, and you can say, “OK. I’m ready. I know what to expect.” Well, knowing is one thing, but when you encounter the real procedure it will be a different matter altogether.

And as I say on other pages, during the psychotherapeutic process you will experience many emotions that are similar to the intense and confusing emotions you felt as a child. Disappointment. Anger. Confusion. Feeling misunderstood. Feeling devalued. Feeling abandoned. Many different events—some of them just chance occurrences during psychotherapy, and some of them deliberate therapeutic interventions by the psychotherapist—will trigger these emotions. Just remember that when you feel an emotion in psychotherapy, the therapeutic task will be to name it as an emotion and understand it as an emotion—not get caught in it as if it were your helpless destiny. For if you get caught in it, you will feel like a victim and will blame the psychotherapist for your pain. The entire therapeutic process will feel like judgment and criticism. And then, in deep bitterness, you will want to “get away” from the psychotherapy just as you wanted to get away from the original emotions as a child.

Maybe something happens in the psychotherapy and you feel abandoned. So instead of impulsively acting on that feeling by doing something to control things and protect yourself (e.g., punish yourself, or terminate the psychotherapy), just sit with the feeling for a while. Understand that the psychotherapist (at least, a competent psychotherapist) isn’t there to hurt you but is there to help you learn. So just say to yourself, “OK Self. We feel abandoned. But it’s not really abandonment, it just feels like abandonment. So how have we ever felt like this before? When did it happen? Under what circumstances? What did we do? What are the similarities across different events? What can we learn about our past behavior from this feeling that is happening now? What can we see now by examining the feeling with curiosity that we couldn’t see then when we just blindly reacted to the feeling?”

There can also be times during psychotherapy—for example, when you are working on recognizing suppressed anger at your parents—that you will feel oversensitive and ill-humored outside the therapy setting. You can come close to losing your temper with everyone. You will feel “flashes” of anger. Your thoughts will seem irrational. So what do you do?

Well, just go ahead and be irritable. You won’t be able to stop it anyway even if you try.

But, while you’re in this mood, don’t make any rash decisions, such as deciding to quit your job.

After you cool down, make appropriate apologies to everyone you have offended.

And then tell your psychologist about everything in your next session so that you can discover the real source of the anger behind your irritable mood. Most likely it was anger being displaced from some childhood experience.

Now, as your question shows, in addition to your conflicted fear of your emotions, you also have a healthy respect for your emotions. After all, if everything came pouring out of you at once it would be a psychological disaster. But thankfully the unconscious, when treated with respect, has a way to protect you. Dreams, for example, tell you only what you need to know, as you need to know it, and as you are capable of knowing it. Even the experiences you have in psychotherapy are given out in healthy “doses” by the unconscious. All that matters is that you and your psychologist have a healthy respect for the dosing process.

  

As an example, let’s assume that for some reason you decide to go on a sudden short trip. You call to cancel your psychotherapy appointment the next day. When you show up at your next appointment the following week, your psychologist tells you that when you canceled your session, you gave only 23 hours of advance notice, rather than the required 24 hours notice, and so you must pay for a late cancellation. You don’t say anything, but when you get home you send an angry e-mail to your psychologist saying that most people understand “24 hours notice” to mean “about 24 hours,” and that you can no longer trust therapy and so you have no choice but to terminate therapy.

OK. Now let’s follow out a different outcome. Imagine that when you get home you’re feeling miserable and shaky. You’re hurt, but you don’t quite understand it all. You feel distracted the rest of the week and have minor conflicts with everyone. But, because you are committed to your psychotherapy, you show up for your next session. And you begin the session by complaining about how poorly you have been treated by your husband (or wife, or boss, or whomever). And you mention an example about a dispute over money. Suddenly, your psychologist interrupts you and reminds you about the late-cancellation fee and asks what sort of reactions you had to it. You hesitate. But then you start talking. You describe how you went home last week and got drunk. You talk about how you thought of stopping therapy. Your psychologist asks for more associations, and before long you’re describing how your father used to make rash, arbitrary decisions and how you always felt angry but never said anything. So you would secretly do something self-destructive, like purposely fail an exam in school. Your psychologist keeps probing. What did you hope to accomplish by failing an exam? Well, as you ponder it, you realize you wanted to hurt your father with your failure....And on it goes, for the rest of the session. If your psychologist is really good, you will also encounter the very self-destructive impulses that led you to make that provocative 23-hour cancellation in the first place.

  

So what do you learn from this? Well, you learn about feelings of hurt, anger, helplessness, and revenge. You learn how your current behavior is connected to your past behavior. You learn how in the past you failed to recognize your own emotions. You learn how to speak honestly about your inner experiences to another person. And you learn how irresponsible behavior flows directly from the failure to recognize your own emotions.

Your ability to learn that you can encounter your emotions without causing a “total meltdown of emotions,” though, depends on your willing choice to make an honest commitment to the psychotherapy process, however painful or frightening it might seem to let go of your need to be in control of everything in your life. Then, as you let off the heat bit by bit through emotional honesty, the heat will never build to the melting point.

 


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Raymond Lloyd Richmond, Ph.D.
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A Guide to Psychology and its Practice

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