NYC Psychotherapist Blog

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Wednesday, May 2, 2018

How Contemporary Psychotherapy Has Changed - Part 1

In the past, in classical Freudian psychoanalysis, as it was practiced in the United States, psychoanalysts in training were taught to be neutral towards their clients and avoid any outward display of their personal feelings about the client (referred to as countertransference).

How Contemporary Psychotherapy Has Changed

At that time, the psychoanalyst sat behind the client with the client lying down on the couch. The idea was that the client wouldn't be distraction by seeing the psychoanalyst, so the client could free associate, and the psychoanalyst could focus on listening to the client rather than looking at the client.

How Contemporary Psychoanalysis and Psychotherapy Have Changed
Of course, as most contemporary psychoanalysts and psychotherapists know these days, Freud may have espoused a neutral stance on paper but, by all accounts, he was warm and personal with his clients in person.  He would often walk with them in his garden or have them over in his home.  But American classical psychoanalysts followed Freud's written word rather than his actual practice.

I believe this is why traditional psychoanalysis came to view the psychoanalyst's reactions (or countertransference) to the client as being something to overcome rather rather than the reactions being useful clinical information about what the therapist was intuiting about the client and their therapeutic relationship.

Fortunately, this has changed significantly and most contemporary analysts and psychotherapists view their reactions to the client as being a useful part of the therapy which can be shared with the client when it is clinically appropriate to do so.

In many ways, this has freed up the psychotherapist to be more emotionally accessible to the client.  It opens up a new avenue for the therapist to use him or herself in a new way.  It also helps to create more of an egalitarian relationship with the client when the psychotherapist is more accessible and shares reactions when they are useful to the client.

In addition, for clients who grew up in an abusive or neglectful environment as children, interacting with a psychotherapist who is free to be more open and emotionally accessible is a welcome change from what traumatized them as children (see my article: The Psychotherapist's Empathic Attainment Can Be Emotionally Reparative For the Client).

But it also makes being a psychotherapist more complicated.  Without the strict practice of the psychotherapist taking a neutral stance with the client, the psychotherapist has to make many more clinical judgment calls about when and how to be more open with clients.  There is always the chance that if the psychotherapist shares his or her reaction to the client that the psychotherapist might make a clinical mistake and share something that the client isn't ready to hear.

Although there is room for error in this more contemporary and open way of working in psychotherapy, I believe it's a refreshing change from the old traditional way.

Under the traditional way, too many clients, who grew up in abusive or neglectful homes were retraumatized by psychotherapists who remained silent most of the time, and these therapists only made occasional comments or interpretations, which could take a long time--weeks, possibly months.

I believe that, generally, clients in psychotherapy need a more empathetic and emotionally accessible psychotherapist who is comfortable sharing his or her reactions to the client when it is clinically appropriate.

I say "generally" because, occasionally, there are clients who still want a traditional stance of neutrality and prefer that the psychotherapist not speak or speak very little.  

Although this is not what most clients usually seek, there are some clients who felt so impinged upon by one or both parents that a psychotherapist who is more interactive would feel like another impingement to them.  In those cases, it's up to the psychotherapist to respect the client's wishes or, if this way of working is so foreign to the psychotherapist, s/he would have to make a referral to another psychotherapist.

The Psychotherapist's Responsibility For Ruptures and Repairs in Psychotherapy
With regard to the possibility of the psychotherapist making mistakes, mistakes can usually be repaired between the psychotherapist and the client (see my article:  Ruptures and Repairs in Psychotherapy).

In fact, it's inevitable that, as a human being first and a psychotherapist second, a therapist will make some mistakes with some clients, especially since psychotherapy is as much an art as it is a science.

Hopefully, these "mistakes" are few and far between and don't involve ethical issues or boundary violations (see my article: Boundary Violations and Sexual Exploitation in Psychotherapy).

Aside from ethical mistakes, which are more serious than the usual mistakes, the mistakes that I'm referring to are clinical mistakes, possibly with the regard to the timing of a comment or a misunderstanding between the client and psychotherapist.

Whatever is involved with the clinical mistake, it's up to the psychotherapist to acknowledge the mistake and make reparations by giving a heartfelt apology to the client and working together with the client to repair their therapeutic relationship.

Most clients are aware that psychotherapists make mistakes at times, and they are able to work through these issues.  If they came from homes where parents never acknowledged mistakes, let alone make attempts at reparations, the process of reparation in psychotherapy can be a healing experience for clients.

In my next article, I'll continue this discussion with regard to the types of reactions or countertransference that contemporary psychotherapists often share with clients (see my article: How Contemporary Psychotherapy Has Changed - Part 2).

Getting Help in Psychotherapy
Attending psychotherapy is a unique experience that provides an opportunity to get to know yourself better, overcome traumatic experiences, and work through current and past problems (see my article: The Benefits of Psychotherapy).

Choosing a psychotherapist often involves meeting with more than one psychotherapist to determine who you feel most comfortable with before you begin the therapeutic process (see my article: How to Choose a Psychotherapist).

If you have been struggling on your own with an unresolved problem, you could benefit from working with a skilled psychotherapist who can help you to work through your problem so you can live a more meaningful an fulfilling life.

About Me
I am a licensed New York City psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work in a contemporary way with individual adults and couples, and I provide a empathetic and supportive environment.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.