Tag Archives: Psychotherapy

The Talking Cure

I am often asked to explain what psychotherapy is. Or more particularly : what does one talk about in therapy?

The simple answer is that the client talks about whatever comes into his mind during the session. It is nature of the talk, or discussion,  in therapy that distinguishes it fundamentally from everyday discourse.

Sometimes the emotional distress that is being experienced is woven deeply into the person’s life. In many cases it is only through therapy that this distress can be accessed and explored.

Psychoanalytic Psychotherapy focuses on a number of areas to help the client access the areas in his life that are causing difficulties.  I have outlined these areas below.

Focus on Feelings

The therapist helps the client describe and put into words feelings that may be troubling, threatening or feelings that he may not have been aware of. Psychoanalytic Psychotherapy resonates at a deep level and gives an experience that is different from an intellectual understanding. Many intelligent people can explain the reasons for their difficulties yet their understanding does not help them overcome these difficulties.

Exploring distressing thoughts and feelings

The client may avoid certain aspects of experience that are troubling or painful. The therapist may draw the client’s awareness to the way he describes a troubling event. In many cases the client may do this without talking of how the event affected him.

The therapist may also explore why a client comes late or misses sessions.  Sometimes therapy can bring up subjects that the client wishes to avoid.  The client may not be aware that he is doing this and acts out by coming late or missing sessions.

Recurring Themes

The therapist helps the client to identify recurring themes in a person’s thoughts, feelings, self-concepts or life experiences. In some cases the client may be acutely aware of these but may feel drawn into situations and feel unable to do anything about them. E.g. a man is consistently drawn romantically to women who are unavailable.

Discussion of Past Experience

Past experience of major figures in our lives affects our relationships. The therapist highlights how the past lives on in the present. The goal is to help the client live more fully in the present.

Focus on interpersonal relationship

Psychotherapy places a heavy emphasis on the client’s relatonship and interpersonal experience. Aspects of our personality are forged in the context of interpersonal relationships.

Focus on the therapy relationship

This relationship can become deeply meaningful. If there are repetitive themes in the person’s way of interacting then these will emerge in the therapy sessions. For example, a person prone to distrust others will also distrust the therapist. This can be brought alive and examined in the safe confines of the relationship. The goal is greater flexibility in relationships and enhanced capacity to meet emotional needs.

Exploration of Fantasy Life

From the beginning of therapy the client is invited to say whatever comes to mind regardless of how silly, embarrassing, Irrelevant or random it may seem. Daydreams, desires and fantasies are also explored. In many cases these may not have been put into words. This area is a rich source of information about how a person sees himself and others and how he makes sense of experience.

What are the benefits?

Psychoanalytic Psychotherapy is not just about symptom remission. It is about developing one’s own psychological capacities. These may include:

  • more fulfilling relationships
  • better use of one’s talents and abilities
  • better relationships with others
  • a realistically based sense of self esteem.

Self development, self reflection and self-discovery continue between sessions and long after the therapy has ended. In short, the client can acquire a higher degree of self-knowledge.




Illness and Our Attitudes


As long as we are healthy, illness is something that we generally do not want to think about. It is something to be denied, hated or even hidden. In the worst case scenario, it reminds us of our own mortality. Death!

Yet illness can be a visitation of our unconscious on us, forcing us to slow down to take stock or indeed to wake up to the reality of our lives, the reality of our own unhappiness. Unhappiness with a job, relationship or a family difficulty for example can literally make us ill. We may not be fully aware of what it is that is bothering us but our illness may offer us the time and space to take stock and may encourage us to go to therapy. It may help to examine our lives and discuss why we have landed ourselves in the situation we are in.  It may also help us to cope with with the feelings that are stirred up by illness, both in ourselves and in others.

Intolerance of Illness

For many, illness may not be viewed as an opportunity to recharge batteries, it is intolerable in ourselves and to a much lesser extent, in others. Why? Because it indicates weakness, incapacity and inability.  It is something that should remain hidden. We do not wish to discuss our illnesses when we are suffering with diarrhoea or vomiting. We may be carriers of an infection or disease. In the past, those who were carriers of illness were often ostracised e.g. those suffering from leprosy or, more recently, AIDS.

Society has an implicit view that illness is a drain on our resources. In Ireland for many years any discussion about the provision of health services has gone hand in hand with a discussion about money. How much money is sick leave costing the economy? we ask. Implicit in this discussion is the belief that many who absent themselves from the workplace are malingering – feigning illness in order to avoid work.  Again, this is a label we usually try to avoid.

Explanations of Illness

There is a drive in us to seek rational explanations of illness. Why do we get ill? Why do some of us become seriously or terminally ill? We attribute so much to diet, lifestyle, exercise, intake of alcohol or other substances. Moderation in these areas is of course healthy and commendable.

Perhaps we feel that if we can explain why illness happens then we can predict its occurrence and control it. If we can do this we are powerful, we are in control of our destiny. We are Gods!

The fact is that in many cases we cannot predict it leaving us feeling powerless, useless and frightened when it occurs. Illness frightens us!

Our Individual Experiences

Psychoanalytic Psychotherapy does not offer textbook solutions to problems. It is not a one size fits all exercise. Instead it focuses on the individual’s experience and how he makes sense of his own experience. The experience of being ill may have quite specific meanings for the client.

A client of mine spoke of the violent physical abuse he suffered at the hands of his father when he was a child. He described his memory of being sick when he was 7:

My mother was really kind and affectionate towards me. She let me lie on the couch and would bring me in drinks. I could lie there and watch the TV. That was ok until my father came home and told me that I was n’t allowed to lie on the couch. He told me that if I was sick I had to remain in bed.

His father was resentful of the attention his mother lavished on him while he was sick. This could raise his father’s anger so as a consequence it was better for the boy to deny that he was ill. In later life he never acknowledged being ill or perhaps, more accurately, he never missed work due to illness.

Through counselling or therapy the way that we interpret what illness means to us can be made clear and can be a useful part of our self reflection, growth and development.