Developing Psychodynamic Counselling
Publication Year: 2008
`This book deals with many aspects of psychodynamic counselling from the minutiae of the extrinsic context, such as decor, through the "therapeutic stance of attentive reserve" on to an elaboration of the elements of a therapeutic relationship... the book is liberally garnished with case studies... informative and thought-provoking... a useful resource to those teaching psychodynamic principles... If you are new to psychodynamic work, this book could be a safe and helpful guide... The ideas and techniques offered by the author may also prove intriguing and even inspiring to those (like me) from a different therapeutic orientation' - The International Journal of Social Psychiatry Psychodynamic counselling has d
- Front Matter
- Back Matter
- Subject Index
Part I: Developing Work with the Internal and External Setting
- Chapter 1: Establish and Maintain the Therapeutic Setting
- Chapter 2: Cultivate and Develop Your Therapeutic Stance
- Chapter 3: Negotiate and Articulate Clearly the Therapeutic Contract
- Chapter 4: Identify and Assess Your Client's Inner World Position
- Chapter 5: Assess Your Client's Availability for a Therapeutic Alliance
- Chapter 6: Abandon Memory and Desire in Relation to Your Client
Part II: Developing Work with Issues Around the Boundaries
- Chapter 7: Observe and Respond to Your Client's Activities Around the Boundaries
- Chapter 8: Pay Particular Attention to Beginnings and Endings
- Chapter 9: Allow for the Importance and Impact of Gaps, Breaks and Interruptions to the Counselling
- Chapter 10: Receive and Respond Appropriately to Your Client's Signals about Money, Time and Space
- Chapter 11: Recognize the Limits of Your Competence and Refer on Where Appropriate
- Chapter 12: Resist the Invitations of the Client to Collusion
Part III: Developments in Understanding and Working with the Transference
- Chapter 13: Allow Yourself to Become Available for Use in Your Client's Inner World
- Chapter 14: Identify and Work with the Client's Focus of Transference
- Chapter 15: Identify and Address Resistance to the Counselling
- Chapter 16: Accept and Contain the Development of Negativity in the Transference
- Chapter 17: Monitor and Assess Your Client's Responses to Your Interventions and Interpretations
- Chapter 18: Monitor and Attend to the Presence of Sexuality in the Relationship between You and the Client
Part IV: Developments in Understanding and Working with Counter-Transference
- Chapter 19: Observe and Digest Your Own Responses to Client Material
- Chapter 20: Balance Your Feeling and Thinking Activities in Your Practice of Counselling
- Chapter 21: Use Supervision, Peer Groups and Personal Therapy to Work with Your Counter-Transference
- Chapter 22: Allow for the Interference of Your Own Unresolved Conflicts in the Process of the Counselling
- Chapter 23: Attend to the Impact of Your Client's Discourse as Well as to the Content
- Chapter 24: Be Prepared to Get it Wrong and to Build on That
Part V: Developments in Working with the Whole Counselling Relationship
- Chapter 25: Respect and Interpret Your Client's Defences
- Chapter 26: Wait and Wait again before Responding to Your Client
- Chapter 27: Inform Your Counselling with Regular Theoretical Input
- Chapter 28: Develop Your Capacity for Thinking and Responding at Different Levels
- Chapter 29: Permit Yourself Not to Know What is Going on
- Chapter 30: Give Time and Space to Work towards an Ending
About the Series
[Page ii]Developing Counselling, edited by Windy Dryden, is an innovative series of books which provides counsellors and counselling trainees with practical hints and guidelines on the problems they face in the counselling process. The books assume that readers have a working knowledge of the approach in question, and, in a clear and accessible fashion show how the counsellor can more effectively translate that knowledge into everyday practice.
Books in the series include:
Developing the Practice of Counselling
Windy Dryden and Colin Feltham
Developing Counsellor Supervision
Colin Feltham and Windy Dryden
Developing Counsellor Training
Windy Dryden and Colin Feltham
Developing Person-Centred Counselling
Developing Rational Emotive Behavioural Counselling
Windy Dryden and Joseph Yankura
Developing Cognitive-Behavioural Counselling
Michael J. Scott, Stephen G. Stradling and Windy Dryden
ISBN-10: 0-8039-8979-2 (hbk) ISBN-13: 978-0-8039-8979-5 (hbk)
ISBN-10: 0-8039-8980-6 (pbk) ISBN-13: 978-0-8039-8980-1 (pbk)
© Brendan McLoughlin 1995
First published 1995
Reprinted 1999, 2001, 2002, 2004, 2005, 2006 (twice), 2008
Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act, 1988, this publication may be reproduced, stored or transmitted in any form, or by any means, only with the prior permission in writing of the publishers, or in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency. Inquiries concerning reproduction outside those terms should be sent to the publishers.
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[Page v]for Fionnuala and Adam[Page vi]
In writing this book my purpose has been to address the counsellor who is about to begin to work with clients. I have assumed that she will at least have completed an introductory year and will therefore have some knowledge and understanding of the theory of psychodynamic counselling. Thus what I have to say is not an introduction to the field but rather a discussion about practice. This is not intended as a definitive textbook nor as an exposition of original ideas. Within the limitations imposed by the format, it is an attempt by one practitioner to speak to new colleagues about the transformation of theoretical knowledge into an aesthetic of practice. My hope is that it may encourage the reader to develop her own way of thinking about her work as a psychodynamic counsellor, about the way in which she can begin to hold it all together as a specialized form of relating. As will become clear in the main body of the text, my expectation is that the reader who becomes a counsellor will commit herself to an ongoing dialogue with psychodynamic literature and culture. What I offer here is intended to facilitate that dialogue.
A word is in order about the way in which the book has been written. The format of the book is derived from the series to which it belongs. The need to adhere to that format means that it has not been possible to deal with the various points at great depth. Therefore this is not the book in which to discover all there is to know about transference for example. The reader needs to be prepared to go on reading many other textbooks to develop an in-depth knowledge of a particular topic. What I hope the reader may get from this book is a broad overview of how the counsellor seeks to translate what she is learning into something she can use in a living therapeutic relationship.
Throughout the book I have referred to the counsellor as she and the client as he except in some of the case examples where I have indicated otherwise. I am indebted to those people who have allowed me to use their material to illustrate the points.
As I have already said, I am not claiming to be original in this book and I would like to acknowledge my debt to the many influences on my thinking, through my training, therapy and reading, which have contributed to my own development in the psychodynamic tradition. I am particularly indebted to the many [Page x]people over the years in whose counselling, therapy, supervision and training I have had the privilege to be involved.
Finally, I would like to thank my wife and son who have supported me in my task and given me tune and space to do it, even when they would have preferred me to be with them.
The field of psychodynamic counselling has developed from the psychoanalytic tradition inaugurated by Freud. At its core is a belief in the role of the unconscious in the development of conflict and disturbance. Through the careful unfolding of the therapeutic relationship, within a defined setting, it is understood that resolution of conflict and disturbance may be achieved.
This is chiefly made possible via the agency of the transference counter-transference dynamic, the operation of which focuses the relevant issues between and within the two members of the counselling relationship. Through their commitment to the working through of this relationship, via discourse, attention and interpretation, the counselling couple find their way to a resolution of the client's distress. It is understood that during this relationship the client and counsellor will face anxiety, defence and resistance and that much of the relationship will attend to the painstaking mediation of these difficulties.
Psychodynamic counselling involves the counsellor not as a detached expert but as a primary element in the counselling process and she must therefore be able to rely on her setting to accomplish her task. In this book it is my intention to explore the ways in which the counsellor may develop her own practice of psychodynamic counselling by integrating psychodynamic theory and context. Those readers not yet familiar with the field I would refer to Michael Jacobs's Psychodynamic Counselling in Action (1988), also published by Sage. I will begin by discussing some ideas about the psychodynamic context and encounter.
What do I believe myself to be doing when I agree to start a psychodynamic counselling relationship with a client? In the first place I believe I am creating a container in which meaning can be explored and rehearsed. It does seem to me to be a matter of trying out different versions until something seems to fit. To put it another way, until something becomes digestible. Behind this basic idea I see that I am assuming some kind of fundamental exchange between my client and myself.
So how do I think about this container? Clearly it is the consulting room, in the sense of a defined space set apart for the purpose of counselling, including its physical contents, its colours, shapes, textures and smells. I see the room as having particular [Page xii]accents and views, in short a kind of personality, which is in part a reflection of myself and in part a perception of my clients. In any event it is an emotionally laden space which contrives to provide regularity, reliability and security. Perhaps I can say further that I see the consulting room as contributing to the idea of a therapeutic container, matrix, context or space, which is in itself an externalization of such a space within the counsellor. Such an externalization is evidently necessary but I feel it is important to remember that during a counselling relationship, the room is potentially in several different places. It has its own locus in a geographical and temporal sense, but its psychological locus may be the client's inner world or mine, or some representation of my body in its psychological or somatic sense, or potentially some such representation of the client's body or mind. Such considerations may also apply to the waiting room or any other room, e.g. the lavatory, used by the client, as well as the building and street in which they are all located.
The therapeutic container is also a consequence of my behaviour as a psychodynamic counsellor. By adopting a certain way of being and by modelling certain behaviour, I constellate the sense of a contained and containing space. Specifically, I set the boundaries of the relationship in time and space. I say where it will happen and when. I set the duration, the frequency of the sessions and the intervals between them. By the provision and disposition of the consulting room furniture, I orchestrate the space. In doing this I make myself available for use by the client. I invite the use of metaphor rather than literal forms of communication, thus setting frustrations to the acting out of behaviour.
The container is also maintained by the setting of a fee and by the arrangements over such issues as cancellations, missed sessions, holidays and illnesses. Clarity over such issues as place, time, frequency, interval and money, becomes the containing mechanism which allows psychodynamic counselling to begin and to go on. Placing a value on the counselling hour anchors it in reality and signals the need to safeguard the adult realities of both the client and the counsellor. It marks the contractual nature of the agreement, underlining the commitment both parties make to each other and to the pursuit of the counselling. The fee acts as a moderating influence on the omnipotent tendencies of both counsellor and client, and underpins the containing function of psychodynamic counselling by making explicit the professional nature of the contract. A proper level of payment is a safeguard against exploitation in either direction and enables the counsellor [Page xiii]to tolerate the extremes of object usage to which the client may subject her.
A further important element in the provision of a psycho-dynamically therapeutic container is, I believe, the theoretical stance and orientation of the counsellor. A practitioner does not just offer a containing space but rather a space which aims at understanding and resolution. To do this the space or container must itself be informed by thinking which, at least in a general sense, seeks to explain experience. Therefore the therapeutic space extends beyond the physical boundaries of the consulting room to occupy a place within the counsellor which is concerned with meaning. The particular elaboration of meaning is the task of every counselling relationship and involves a particular kind of receptivity in the counsellor which allows her to interpret what she receives in ways which together add up to a psychoanalytic worldview. However, the intellectual understanding of what a client says or does in therapeutic space is only one component in the counselling interaction. Equally important is the personal capacity of the counsellor to make herself available for use by the client as one element in a complex form of communication. This requires in the counsellor an openness to emotional and psychological resonances within herself. It is such openness and availability combined with a theoretical matrix, within the setting of a consulting room and a professionally arranged contract, that begins to give the idea of a container in psychodynamic counselling its rich and complex meaning (McLoughlin, 1990).
Psychodynamic understanding and theory is based on the work of psychoanalysis and its various developments. It thus becomes possible to speak of a Freudian, Jungian, Kleinian container and so on. These different theoretical orientations are like differing accents and idioms within the same psychoanalytic tongue. As in language generally such differences should never be underestimated in terms of their impact on the individual's acquisition of linguistic skills. An ability to speak English is no guarantee of a capacity for understanding across the spectrum of regional variations and dialects. Additionally, within a given idiom there is the defining impact of the verbal range and of the voice which gives particularity. Beyond such particularities, which may be thought of as the markers of the individual speaker of a given language, there is surely that additional difference which is the tone of a given relationship.
Thus it seems to me that some aspects of the containing function of the psychodynamic counselling relationship are provided by the generally recognized elements of technique and [Page xiv]orientation, which by now we can think of as a culture. Other elements, which to me seem equally important, centre rather more on the person of the practitioner, in physical, psychological and emotional terms. Yet further aspects of the containing function emerge and grow with each counselling relationship, and as such identify a given therapeutic couple; these are aspects which I have already referred to above as tone.
So it seems to me we may think of a psychoanalytic language, which contains a number of dialects and regional variations. We can think of different speakers of psychoanalysis whose accents may be influenced by regional variations, for example the training body, personal therapist or supervisor, on the one hand, and by voice and verbal range on the other, and who in any given psychodynamic relationship find a tone and idiom which belongs to that relationship alone, even if echoes and resonances of other relationships may be heard.
The factors influencing the acquisition of particular linguistic markers are going to be professional and personal. The professional elements comprise the training institute and experience within which a counsellor first learns to speak psychoanalysis. The personal will comprise of all the individual variations which make up a particular person's experience of life. Between the professional and the personal lies the practitioner's own experience of being a client, which brings together what I have called above elements of dialect and tone. Through becoming a client herself the practitioner is enabled to develop her own authentic voice.
The client, of course, brings his own language and story into the therapeutic space and the counsellor will learn from him how he perceives and experiences before she will be ready to speak to him about himself. By meeting him within the psychodynamic container the counsellor will engage the client in a relationship which will develop in him new capacities for thought and understanding.
Thus we have space and we have language. I now want to go on in the rest of this book to look at how the psychodynamic counsellor makes use of the therapeutic container in her relationship with the client.
The points I have made in the foregoing sections which comprise the body of this book have been offered in an attempt to illustrate some of the important elements in the development of the practice of psychodynamic counselling. They have taken as their underlying premise the concept of a container within which space, both internal and external, may be considered as a context in which the discourse of the client may find meaning. From the time that Freud first heeded his patient's insistence that he should let her talk to him (Gay, 1988) the psychoanalytic tradition has learned the importance of providing a context within which the client may unfold his own narrative in relation to the counsellor. In this book I have tried to describe some of the ways in which the psychodynamic counsellor may develop her ability to do this.
In the Introduction I looked at the way we may consider psychodynamic counselling from the viewpoint of a language that may be learned and spoken. Throughout history human beings have found it necessary to tell their own story both collectively and as individuals. Telling a story in a certain context allows it to find a particular meaning and gives the individual the sense that their own experience can be understood. Whether the story has been told around the campfire, or the hearth, whether openly or in the privacy of a confessional, it has always been in the expectation that it will be heard by someone who will bring to it considered attention and understanding. In some cultures the professional listener knows that meaning will stem not simply from the telling of the story but also out of the listener's own subjective response, carrying as she does the tradition of understanding that gives a culture its own particular character.
So it is in psychodynamic counselling. Through training and personal therapy, through supervision and reading the literature, the counsellor immerses herself in a culture which brings a particular viewpoint to the understanding of human experience. She develops within herself a space for reflection which is informed by the story and thinking of psychodynamics. In developing this space she makes possible her management of external space in ways which facilitate the exploration of meaning in the unconscious. By defining and constructing a space at [Page 111]internal and external levels she acquires her potential for usefulness in relation to her client. She acquires a semantic framework within which she may understand her client's communications and out of which she may address him in meaningful terms. In speaking of psychodynamic counselling in terms of the acquisition of a language and a culture, I am wanting to suggest that the counsellor will find herself developing a fluency in and a familiarity with the language of psychodynamics which will eventually inform and serve her meeting with the client. The practice of psychodynamic counselling will further develop her capacity for a certain kind of availability, a certain kind of attention, a certain kind of being there, which will allow her to interact with the client at the level of his deepest need.
In Part I, Developing Work with the Internal and External Setting, I discussed ways in which the psychodynamic counsellor is quite active in fostering the provision of a therapeutic setting. To borrow from Winnicott (1963), she creates a facilitating environment, safeguarding the constancy both of the room in which she counsels and of the space within herself devoted to counselling. I invited the counsellor to think about the relationship she has with her setting and the way in which she may need to tend it and so maintain its integrity. In some respects the counsellor is required to be very practical about the disposition and management of the setting. This is no bad thing as attention to ordinary details is often a valuable anchor in a context where orientation to the nature of things may be both subjectively and unconsciously determined. In other respects the psychodynamic counsellor needs to be able to rely on the given of her setting as she allows herself to float freely, as it were, being directed not by aim or intention, but by her availability to connect with her client's unconscious. It may be seen that sensitive attention to the setting involves the counsellor in the discipline of her practice and that following that discipline will facilitate her development.
In Part II, Developing Work with Issues around the Boundaries, I began to explore the idea that the therapeutic container might need to have its limits. In the first instance, I think of limits acting as markers against which it is possible to gauge what may be happening. Because counselling is a limited activity it is possible for the counsellor to interpret the client's behaviour with reference to the boundaries. Just as borders usually define a country and in a sense enclose a culture, so the boundaries safeguard the integrity of the psychodynamic context. The boundaries, therefore, provide the objective parameters of what must essentially be a subjective activity, since it can be neither more nor less than a [Page 112]special kind of human relationship. Paradoxically, boundaries both facilitate and discourage. They facilitate the meeting of the counselling couple in a context which is recognizably psycho-dynamic, allowing both to know what is expected of them. They discourage anything, deriving from client or counsellor, which would take them outside psychodynamic territory and into an altogether different story. By tending the boundaries, the counsellor builds on her attention to the setting and underlines her invitation to the client to follow his discipline of telling his story in metaphor and symbol. By working with issues around the boundaries the psychodynamic counsellor develops her ability and skill in the practice of her craft.
In Part III, Developments in Understanding and Working with the Transference, I turned my attention to a key area in the practice of psychodynamic counselling. In a sense, transference is what makes psychodynamic counselling as such possible. Under the auspices of the repetition compulsion, the client re-experiences significant aspects of earlier relationships in relation to the counsellor. This much is easy. What engages the counsellor in much greater difficulty is developing her capacity to work with the transference. Without a sense of being comfortably located in her own therapeutic setting, the counsellor will find it difficult to work with transference. From within that setting she will find the support to receive and gather in the transference and develop her ability to mediate it. By entering a therapeutic relationship with her client, the counsellor invites transference and offers herself as its object. By remaining within her therapeutic setting, she develops the ability to respond to the client not just with feelings, but also with a capacity for thinking. Through the mediation of her counter-transference, as discussed in Part IV, Developments in Understanding and Working with Counter-transference, she acts as a bridge to the client's unconscious and thus enables and facilitates his dialogue with himself.
The concept of the therapeutic relationship in psychodynamic counselling as expressed in the dynamic of transference and counter-transference clearly envisages a richly complex and interactive partnership at both conscious and unconscious levels. I have wanted to suggest that the counsellor is responsible for fostering and maintaining this interaction and that she may develop her ability to do this by a kind of action which must not disturb her stillness. Alongside the reserve of her therapeutic stance there is the activity of her therapeutic enquiry; she feels with her client but thinks where he cannot. She may do this because her engagement in the transference counter-transference [Page 113]relationship is supported by her involvement in the psycho-dynamic culture. Thus the counsellor inhabits a space which defines and informs her activity. She develops her ability to work in that space by subjecting herself to the same kind of therapeutic attention that she offers her client. During the session she achieves this through careful attention to her own responses and beyond it she draws on the support of theory, peer group and supervision.
In the fifth and final part, Developments in Working with the Whole Counselling Relationship, I turned my attention to thinking about the client and the counsellor as separate and, ultimately, as separating individuals. In all the intensity of the transference counter-transference relationship, it is sometimes difficult for the counsellor to hold on to the integrity of the client's separateness, while her own may also become compromised. In developing her practice, the counsellor needs to incorporate within her setting a sense of perspective which respects the space between her and her client. On rare occasions I have had the opportunity of seeing someone I have worked with in a therapeutic setting perform in their own context, an actor, a musician or politician. It has been very important to me to witness the reality of the client's life outside my consulting room, independent of my setting and speaking with a different voice. Such opportunities allow the counsellor to hold the balance between what is internal and external in her relationship with the client and encourage her to focus on her task as a counsellor.
I hope it may have become clear to the reader that in writing this book I have not set out to dictate how she will develop as a psychodynamic counsellor. I have rather wanted to talk about the way in which I find myself thinking about how I practise psychodynamically at this point in my development. Some of what I have written has, as it were, taken me by surprise, as it has expressed itself in one point or another. The task of writing has required me to emerge from my therapeutic reverie to articulate something that by now I do without noticing, rather as I breathe. If I have used metaphors or analogies to try to express something, I have done so arbitrarily. I have not attempted to describe things as they are but as they might feel and as if they might be so. As you train and as you practise so you will develop and so you will grow your own habit of mind which will form your ways of saying what it is you do.
The title of this book begins with the word developing, which carries with it the suggestion of something unfinished. Psycho-dynamic counselling is not a body of theory but a specific kind of [Page 114]activity which takes place between two people. It is therefore, of its nature, always developing as each counselling couple discover anew the form, content and meaning of their particular interaction. I hope the counsellor who has read what I have had to say will be encouraged to trust in the process of psychodynamic counselling and will feel that her development as a counsellor will evolve with her attention to herself as the inaugurator and guardian of therapeutic space.
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