From Counseling to Pschoanalytic Psychotherapy: A Lifetime of Caring for Others (Part IV)

Upon grauation from the pastoral psychotherapy training institute with a Certificate of Training in Pastoral Psychotherapy, I went to work as a Certified Pastoral Counselor by the American Association of Pastoral Counselors( AAPC.) I was also a Licensed Professional Counselor (LPC) Resident (1994-95.) My religious views continued to change and I was feeling more comfortable with Unitarian and Chritian Humanism views......... I soon discovered one of the classic texts in how to conduct psychoanalytic psychotherapy. This text was entitled, Psychotherapy: A Dynamic Approach by Paul DeWald, psychoanalyst and psychiatrist. DeWald's book discusses both the theory of therapy and the technique itself.......... His book is one of the few classic texts that gives equal amounts of time to both insight and supportive psychotherapy. At this time in my life I concentrated on the insight portions. Insight therapy, like supportive therapy, requires a caring, supportive, empathic relationship with the patient. This deep and abiding relationship is called the Therapeutic Alliance. But insight therapists, unlike Carl Rogers and others, believe that though the relationship with the patient is necessary, it is not sufficient. In other words, something in addition to care, love, and support has to happen in the therapy. And this addition is insight. What is insight? Insight means you experience and learn about what is going on in the unconscious part of your mind. This does not usually happen in supportive therapy. But the techniques used in insight therapy are all about opening up the unconscious. This requires frequent sessions over a number of years, with someone trained in these techniques.............This is the training I began to receive in pastoral psychoanalytic psychotherapy training as well as in five additional years in supervision in psychoanalytic psychotherapy. My two supervisors as well as my former analyst were all members of the Virginia Psychoanalytic Society (VPS.) I learned in supervision and reading that the main technique used in insight therapy is called the Therapeutic Triangle. The points of the triangle are the patient's present relationships outside the therapy, the relationship with the therapist, and the relationships of the past--especially childhood. The therapist attends to all three sides of this triangle. The therapist continually helps the patient see that they are today repeating the same dysfunctional patterns and relationships of their past in their relationships outside of therapy, and in their relationship with the therapist.( These repeated patterns are the result of unconcious, repressed, childhood predictions that are unworkable solutions to childhood conflicts.) Over time the patient is enabled to see those patterns, to reexperience them, to come to understand when they began in childhood, and to change them--replacing them with healthier, more mature, and more adult patterns of living and relating......... So the key elements in the insight oriented psychotherapy process are establishing a deep therapeutic relationship, helping the patient gain insight into their habitual patterns of relating to others, to understand these patterns, and finally to alter them. When this goal has been reached the patient is ready to end their treatment. This is called termination............ For the first 15 years or so of my practice this was the type of therapy I learned to do and actually did. I saw a number of patients 1-2 times weekly over a number of years. Many of these patients got better, and we terminated the treatment by mutual agreement. I enjoyed that type of work. Some of the key books that helped me over the years learn this type of insight therapy were as follows: 1. A Primer for Psychotherapists (1945) by Kenneth Colby 2. Psychotherapy: A Dynamic Approach (1964) by Paul DeWald 3. Principles of Psychoanalytic Psychotherapy (1984) by Lester Luborsky 4. Psychodynamic Psychiatry In Clinical Practice (1994) by Glen Gabbard 5. A Primer for Beginning Psychogtherapy (2001) by William Goldstein 6. Psychoanalytic Psychotherapy (2004) by Nancy McWilliams 7. Long Term Psychodynamic Therapy (2004) by Glen Gabbard 8. Get the Diagnosis Right (2011) by Jerome Blackman 9. Psychodynamic Psychotherapy (2013) by Richard Summers 10.Psychodynamic Psychotherapy (2011 )by Debora Cabaniss I have shifted over the years from doing primarily insight therapy to doing more insight to supportive therapy according to the needs, ability, and interest of my patients. I may write about this shift in a future post.