Yesterday I started to write an article explaining how my three years of professional training informed my practice; i.e. how I work today. Today’s article is the second of three explaining different styles of my training.
A Counselling Centre provided my second year placement, which offered a psychodynamic approach to therapy. ‘Psychoanalytic tradition emphasises the unconscious, drive theory, transference and the repetition compulsion, ego psychology, objects relations and more recently, self theory’ (Woolfe & Dryden, 1996, p.262).
This was a very different experience for me after coming from a NHS secondary care placement. Everyone in the service worked within psychodynamic theory, so there were no radically competing models to consider. Clients generally self referred reducing the interaction with GP’s or psychiatrists. There did however, as within many systems, exist constraints to practice as my supervisor worked within a Kleinian model.
Klein saw children even very young ones as being much like adults: propelled by powerful drives, able to express in their own way the power of their drives and able to respond to the therapistís interpretations. Crucially, she focused on the child’s phantasy life paying attention to the role of innate destructiveness and on how anxiety was managed from the very beginning of life (Lemma, 2003, p.30).
Read more about Klein’s theory
I initially found it difficult to work within this model as I felt it did not resonate with me personally. I struggled in supervision trying to conceptualise client difficulties in ways that seemed foreign to me. I am drawn to psychodynamic theories that emphasise the relational nature of human beings, such as attachment theoryí (Bowlby, 1988). It makes sense to me that our physical and psychological security depends utterly on our connections with other people (Holmes, 2001. p.30). Trying to negotiate an inner world of phantasy that includes, love and hate, destructiveness and envy, was as a threat to my psychological identity. Referring back to the opening section of my psychological identity, I drew the readerís attention to the proposition that some theories were already assimilated and accommodated into my professional identity. This can be explained by referring to Breakwell’s (1986) Identity Process Theory. When I was presented with new theories that I received in a positive light, i.e. they made sense to me, had a degree of fit with who I was, I was able to use, for example, what Breakwell (1986) termed as a principle of continuity to guide the process of assimilating and accommodating the new theory into my identity. For example, attachment theory could easily be assimilated and accommodated as it provided me with a sense of continuity over time; I already appreciated the underlying assumptions of the theory. However, when presented with Kleinian concepts such as part objects and greed and envy, they did not provide me with a sense of continuity over time, nor could I use another principle of evaluation to aid the process. The theory did not fit with my previous continuity and I could not evaluate it positively, as such it represented a threat to my existing identity structure as a psychologist (Breakwell, 1986). This is not to say that I did not appreciate the theory, but rather it was a ëtheoretical exercise that I could not embody (Spinelli & Marshall, 2001).
However, I did appreciate the contribution of Klein’s (Hinshelwood, 1994) concept of splitting and projection as can be seen in my work with the following client. Mr D was very clear that he loved his mother and he hated and blamed his father for his current difficulties, of being very lonely and craving a relationship with a woman, as his father was not around to offer a father figure to guide him through life. I hypothesised that he began to idealise his mother and denigrate his father in order not to experience the loss of his father, with whom he had little contact and also to protect him from hateful feelings he may have experienced towards the parent he was left with who did in effect not treat him well. I found myself during the process of therapy feeling very uncomfortable, as Mr D began to call me his saviour that I could fix his problems. I found it more uncomfortable when he would comment on my appearance and describe his ideal woman, as someone who fitted my description. I took these uncomfortable feelings to supervision where I began to understand that in the transference/countertransference relationship (Clarkson, 2002) I was being idealised, I was the perfect therapist and the perfect girlfriend. I worked with my own countertransference in relation to this. In particular, my irritation at being brought into the room in a way that was not congruent to my ideas of being a psychologist. I became aware of the clothes I wore to session and the style of my hair. Due to work commitments Mr D had to take a four-week break from therapy. In supervision, we hypothesised that Mr D may feel abandoned by me (in order to respect anonymity I will not go into the reasons for this in this paper) and rather than cope with this loss, he may denigrate me as a therapist as he had done with his father, when he returned to therapy. After the break in therapy, Mr D stated that he had resolved his problems and did not wish to continue therapy with me. During the break, the unmanageable feelings were being projected onto me. It was easier to attack and denigrate the therapy than experience the loss.
Even though I gained an understanding of Kleinian theory, at the end of my second year a more comfortable place for me was that individuals are driven by their attachment needs, their need to form relationships with other people. As opposed to being propelled by innate destructive drives.
Kleinian theory also clashed with me, as I perceive there to be a lack of the appreciation of social interaction, which recent research has been exploring;
the quality of the relationship between parent and child influences both the biochemistry and the structure of the brain. The most frequent behaviours of the parental figures, both mother and father, will be etched in the babys neural pathways as guides to relating. These repeated experiences turn into learning, and in terms of the pathways involved in emotion, this consists primarily of learning what to expect from others in close relationships. Are other people responsive to feelings and needs, or do they need to be hidden? Will they help to regulate them and make me feel better or will they hurt me or disappoint me? Our basic psychological organisation is learnt from our generalised experiences in the earliest months and years (Gerhardt, 2004, p. 211).
This is based on the work of LeDoux (1996) the main tenet of which is that during a traumatic experience, conscious memories are stored by the hippocampul system and unconscious memories are stored by an amygdala-based system. Both these systems operate in parallel and I believe the important point for psychologists is that when triggered (for example by a schema) the unconscious body responses are activated via the amygdala system without having the benefit of being cognitively appraised by the hippocampul system. Or put more simply, because the amygdala system is faster, the individual experiences the uncomfortable feelings relating to the original event, without necessarily understanding why. This also has, I believe important implications for cognitive behavioural models, which will be explored in tomorrows article.
References
This article is number two of a three part series and all references can be found on the first article.