Emotional Health

The Healing Power of Psychotherapy

The key element in therapy is the emotional relationship between the patient and the therapist, sometimes referred to as the “therapeutic alliance.” Remembering or reliving emotional experiences, gaining insight into yourself and your patterns, developing new strategies and finding new ways to adapt and grow are generally the “lyrics,” while the bond between the patient and therapist can be thought of as the “music” of the therapeutic process.

Referring to this bond, the psychoanalyst Wilfred Bion wrote, “when two people meet, an emotional storm is created.” This is not to imply that the relationship is literally stormy and intense, though it can be. But it is always unique —a patient can have quite different therapeutic experiences with different therapists. But for therapy to be effective, the alliance must create enough trust that the patient feels safe enough not only to disclose very personal information, but much more important, to be open to emotional change. This is the real “nugget of gold” in the process: the atmosphere that allows one to let down defenses enough to be open to thoughts, memories and ideas, leading to changes that may be too threatening or daunting otherwise.

The second, more complicated part of the therapeutic relationship is called “transference,” which occurs when a patient behaves or feels toward the therapist with a set of attitudes and feelings originally directed at a person in the past, like a person from childhood. So, for example, you experience your therapist as judgmental, as your father was. This is a phenomenon that occurs in all relationships. But when it happens in therapy, it is especially useful because it allows for the opportunity to study and change the behavior. This is also the reason why therapists are reluctant to answer questions about themselves (although standards about that have changed). The idea is that the less the patient knows about the therapist, the more room there is for the patient to “project” transference feelings onto the therapist.

In any case, this cannot be accomplished with drugs, though they are sometimes a helpful and/or necessary aid to therapy. Anything that relieves suffering sooner, as many psychotropic drugs clearly do, should be offered, in my opinion, though I sometimes have a hard time convincing patients that they are safe. Antidepressants also can be useful in therapy when someone who is battling depression is working through very threatening material in treatment. The medication can provide a “safety net” that allows the patient to feel brave enough to confront the material without the sense that he or she will fall apart.

The “dance” between the therapist and patient that follows to the music of therapy is intricate and intimate. It involves a “new” language and voice, which they develop together to understand the patient’s unique history and reintegrate it. It is a language that can take months or years to learn but no one else knows. While brain research may be able to soon show what areas light up when this happens, can it explain why it happens? As Dr. Friedman days, “we are more than a brain in a jar.” Let’s hope that there are still some researchers with a renaissance man’s sensibility, like Freud’s, in the mix to ask these questions.


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