A Guide to Psychology and its Practice

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Page Contents: How much should I tell my psychotherapist?.                    


How much information does a psychologist need to know in order to help a patient? What is important and what isn’t?

When Sigmund Freud started practicing psychoanalysis, he essentially told his patients to lie on the couch, start talking, and say whatever came to mind without censoring anything. This was called free association, and it made the question of what to say during the treatment totally unambiguous: everything.

Now, if you happen to be in psychoanalysis today, the same rule about free association still applies. In contrast, if you happen to be in cognitive-behavioral therapy, you don’t have to worry about what to say because the psychotherapist will tell you exactly what you have to do and how to think. But if you are in psychodynamic psychotherapy, then you face the dilemma of what to talk about in each session. And for many new clients, this is a real dilemma, because they have to confront not just the question of what to say but also the possibility of what to leave out. Thankfully, a good psychologist can see through all of this. And so it can be said that even in spite of yourself the truth will come out. It is important, therefore, to be committed to allowing it to happen, despite your fear of the consequences.

Consider the following example which illustrates how a casual—and seemingly meaningless—comment can be the opening into a major psychological conflict:

“I’m really rushin’ today,” said one of my clients, standing up eagerly as I greeted him in the waiting room. Then, as we walked down the hall to my office, he looked back over his shoulder to me and added, with a sort of self-satisfied smile, “I only had three minutes for lunch.”

In the office, I sat down, musing. A smile came over me, and I said, “This might seem like it’s off-the-wall, but tell me—who do you know who’s Russian?” [1]

His face twitched in surprise. With a shrug, he said he couldn’t think of anyone. But I knew the gears were turning. Then, after a long pause, during which I waited in silence, he said, “Well, there’s my uncle; he was Russian.”

I asked him to tell me a bit about his uncle, and it turned out that the uncle had willingly made a very profound, spiritual choice about his life many years ago.

Now, at the time, my client was struggling with many decisions about his own life and vocation, and he was almost at the point of realizing that he wasn’t a victim in life and that he had the responsibility—and the freedom—to choose his destiny. Although he would have preferred to live in all the denial of the mindless rushing around, it slowly started dawning on him that he had to start making some serious and responsible choices about his future. And, believe it or not, that unconscious realization found its symbolism in the Russian uncle who made a free and willing choice of his own many years ago. Our discussion of his uncle, based on that flip comment at the beginning of the session, led to a deep examination of his current emotional struggles.

This illustration, then, leads us to one key point about psychotherapy: something that you think is meaningless can hold a profound image of your life’s meaning at that moment, and something you think is important can be just a distraction.

So how do you, the client floundering in the midst of all this confusion, know what is important? Well, you can’t.

Then how do you bear the anxiety of sorting it out? Well, just remember that psychotherapy is not like the adversarial legal system where anything you say can and will be used against you. Good, competent psychotherapy has only one purpose: to help you get close to the unconscious experiences that you have been running from all your life. If you accept this premise, then you can relax a bit, for anything you say in psychotherapy can and will be used to help you. It requires only that you be willing to be honest with your psychologist—and yourself. The being honest will come with training and experience through the psychotherapy itself.


1. Russian and rushin’ (rushing) sound the same in English. Word plays such as this can often reveal significant points of unconscious connection.

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



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