Psychotherapeutic Technique: A Brief Overview
Dr Jonathan Haverkampf, M.D.
When patients come to see a therapist, they often have a long list of things that do not work for them in their lives. It is easy to overlook that one of the hardest steps towards health has been taken, stepping into the office of a therapist. Psychotherapeutic Technique is then largely about helping the patient find his or her path and to have the courage to follow it. Empathy, common sense, and a good dose of optimism are helpful in this line of work, as is thinking about what is happening and has happened in the life of the patient, how they relate to themselves and the world, and that in the end everything should make sense to the head and to the heart.
The reasoning mind plays a greater role in psychotherapy than it is given credit for. Many mental health conditions arise because of what we think we have to achieve, because we think there are no alternative options or because we think we have failed. If one’s thoughts can make one feel worse, it also makes sense to look to one’s thoughts to make oneself feel better. However, the goal is not to engage in endless loops of thinking about unanswerable questions but to engage with one’s thoughts by asking whether they make sense or not.
In the best-case scenario, a patient engages in a process of ‘making sense’ with the help of the therapist. This does not just mean using logic, but seeing one’s thoughts within the context of one’s values and aspirations on one side, and one’s experiences and interactions with other people on the other side. In the end, the objectives and goals of one’s thoughts have to make sense within the context of one’s values. This ultimately leads to stable and persistent happiness and mental well-being.
Let us look at an example, which applies to many people. If one of my values is to provide a safe environment for my family, thinking about how to make more money can lead to greater happiness (and less stress), if I am aware that I am thinking about earning money to be able to buy a house that can offer my family a greater sense of security. If I see money as an end in itself, on the other hand, it can lead to an obsession, which may become endless, because I lose sight of when I have reached my goal.
In other words, life becomes easier once we see our actions and interactions with other people as something that ultimately makes sense for us. One does not need to have a specific outcome in mind. A feeling of significance to oneself is already a good starting point. Many people lack even this general feeling in most of their daily lives, which can lead to emotional disengagement, burnout, depression anxiety, panic attacks, heightened OCD, and so forth. Therapy has to bring ‘sense’ and meaning into the equation again.
Much of what can happen in therapy depends on the expectations of the patient. It determines how much he or she will participate in therapy and contribute to the process in general. This makes it worthwhile to point out early to the basic working in principle in therapy, that the therapist can help patients help themselves, but should under normal circumstances not tell them what to do.
The Search for Meaning
Therapy is about meaning, helping a patient find relevance in things, which also asks patients to look at their fundamental values and basic interests. Following one’s values and basic interests leads to happiness and not knowing them to such conditions as anxiety and burnout. Many people in today’s busy and increasingly complex world lose their ability to see relevance in the world and in what they do. Helping people to reconnect the world as they perceive it with what they value is an important aspect of therapy. It requires the ability to communicate with oneself and between the inside and outside worlds.
The Therapeutic Relationship
Therapy is an exchange of information, which ultimately should help the patient to lead a happier and more fulfilling life, as well as be free from any symptoms that interfere with these goals. The motivation for it should come for a need for the feedback and information that is provided in therapy. The therapeutic relationship is the bundle of channels along which the therapeutic communication takes place.
The therapist should be able to see how patients deal with information and interact with themselves and the world around them. Better communication with oneself and others can lead to the patient feeling safer, developing greater abilities of introspection and reflection and facilitating a healthier communication with oneself and the environment. All this requires that the therapist has an understanding of the dynamics of interactions in general and of the interactions of the patient in specific, the mutual flow of information and the values, aspirations and interests everyone holds.
Empathy and Interest
Therapeutic work requires empathy and an honest and true interest in the patient and his or her inner worlds. The therapist should also have an interest for the own inner worlds and how they are are influenced by the communication of the patient. In psychoanalysis, the concepts of transference and counter-transference are used here.
Mostly therapy is about leading the patient with questions and comments to find new perspectives, open up to new information and process information in new ways. The epiphanies should take place in the patient, while the therapist can create the setting in which they take place. The motivation, ownership and integration into the own person that takes place in them is important for the success of therapy.
Values, Interests and Aspirations
The psychodynamic process helps to shift through derivative values and non-derivative values to get to the fundamental values which everyone holds. Here are the things which are really important to the individual, whose pursuit makes happy and life worth living for. To compromise these values causes great suffering and a loss of direction.
The information to be gained from inside one’s body can be tremendous if one is willing to listen to it. We produce a lot of information in our body, which, though it requires the environment to interact with, is in many ways a very complicated self-contained system. The parallel information processing power of the nervous system and the networks of cells of the rest of the body, connected by chemical and electric pathways, is very large. Even information coming in from the outside world has to pass through cellular networks to reach higher brain centers.
Self-connectedness means being aware that the information reaching the brain is made up of information that is largely influenced by the information processed in our bodies. It requires becoming aware of the shear infinity of information sources our brain is processing, and not just the sentence one may see on a computer screen at work. This awareness is important to deal with anxiety, OCD, burnout, depression, psychosis and a host of other conditions. It does not mean one has to process all this information consciously, just that the processes are stable, while the sources and the information may change. Our values as a result of these processes change little, while our experiences on the summer vacation may be vastly different from year to year.
To many patients, time has become convoluted. They do not know what to do with their past, are afraid to think about their feature, and are caught between past and present which deprives them of the present. Making sense of the relationship between the present, the past and the future establishes the bridges that can anchor them in the present moment. Awareness, feelings, feedback and communication are important factors in this process.
Thinking about values and interests helps to rebuild a future, but this might confront the patient with ‘bad decisions’ in the past. The best way to deal with this is through acceptance and integration. This means the past has to be accepted and to a certain extent embraced, which is an important process in therapy.
The most important communication tool one has in psychotherapy is to ask questions. In Socratic questioning the question can lead to insights for both, the patient and the therapist. However, to ask questions that bring greater insight requires having a sense of the type of answers that will be useful to allowing the patient greater awareness, insight and connectedness. The type of answers may often not be apparent early in therapy. However, they should be related to greater happiness, and thus a knowledge of the patient’s values, interests and aspirations.
One needs to have faith that the interaction between therapist and patient will reveal the information that provides the course in treatment. And this will always happen if there is meaningful communication, which means that something new is communicated every time information travels between the two partners in the interaction. Information can be little gestures or a twitch on the forehand which signal emotions or thought processes, words that can be understood by the other person and in general every signal that can be sent and received by therapist and patient. This requirement is easy to satisfy, if there is a minimal openness to engage in a therapeutic process.
Types of Intervention
An intervention should create greater awareness, insight and connectedness in the patient. A few examples follow.
“I want to be in control in social situations.”
“What does it mean to be in control in social situations?”
“I would feel free, I would not think anymore so much, I would not analyze so much what other people think.”
The next step is to put together the information from the client that reaches the therapist.
“So, you are telling me that you …”
The Logic Test
The logical test is a result from assembling the information. Here contradictions can become clear, or spots that have not been thought about at all. These do not make up the world we imagine, but are the things that have to be overcome to get closer to one’s wished states.
Imagining is that step in which people project their wishes, needs and aspirations into their inner world using building blocks they know from the real world. It is here where we build the world we compare the real world with. This comparison motivates us to change our world, but it can also raise emotions, such as fear or happiness. As emotions have influence over the worlds we imagine, so the worlds we imagine have influence over our emotions.
Our vision of the future plays an especially important role, because it can provide motivation and a sense of direction, as long as it is congruent with the person’s underlying values, aspirations and interests.
“Can you imagine what it would be like not to feel socially anxious anymore?”
Bridging real and imagined world
This requires looking at the changes that may have to be made in the present world to get closer to the imagined world. These thoughts should then lead to behavior changes that get the patient closer to where he/she wants to be.
Creating new communication pattern
Change also means we have to communicate with the world in new ways. This grows out of the rediscovered values and interests, the feedback and dynamics in the work with the therapist and the life of the patient outside the therapy. Over time, the new communication patterns should solidify as the patient is reinforced by better interactions with the environment.
Psychotherapy is both, creative and supportive work. It requires a keen eye for the process and the dynamics unfolding within a session. Working with the patient on communication patterns, interaction dynamics, uncovering values and basic interests often goes a long way towards a successful therapy.
Dr Jonathan Haverkampf, M.D. MLA (Harvard) LL.M. trained in medicine, psychiatry and psychotherapy and works in private practice for psychotherapy, counselling and psychiatric medication in Dublin, Ireland. The author can be reached by email at jo****************@gm***.com or on the websites www.jonathanhaverkampf.com and www.jonathanhaverkampf.ie.
This article is solely a basis for academic discussion and no medical advice can be given in this article, nor should anything herein be construed as advice. Always consult a professional if you believe you might suffer from a physical or mental health condition. Trademarks belong to their respective owners. No checks have been made.
© 2012-2017 Christian Jonathan Haverkampf. All Rights Reserved.