Psychotherapy: for a psychodynamic perspective of the intervention
Psychotherapy is considered, unanimously, as a method of intervention carried out with purely psychological means which, although implemented through procedures that differ from each other for the different theoretical orientation to which they refer, are aimed at helping people in solving their problems affective, emotional, behavioral, interpersonal of various kinds and to increase the quality of life
Advertising message The law of 18 February 1989, n. 56, in Italy, decrees that the exercise of psychotherapeutic activity is subject to specific professional training, to be acquired, after obtaining a degree in psychology or medicine and surgery, through at least four-year specialization courses that provide adequate training and training. in psychotherapy (DM 11 December 1998, n.509).
This activity is useful in relation to the “question” with which the patient becomes the bearer and it will be the problem and the objectives that the subject puts in place to direct the latter towards a psychological-clinical or more properly psychotherapeutic intervention (Cionini, 2001 ).
Incidentally, it is useful to distinguish between demand and client. The term client means the interpretation of the situation (the what, the how and the why); the question, however, consists of the generalized meanings that found and make these theories meaningful (Salvatore, 2015).
As far as the development of psychotherapy is concerned, it is interesting to underline that in the last few years different orientations have developed and the diversification of these approaches has favored the possibility of accessing different theoretical frameworks, which make each one useful according to each case and request. specifications that the therapist will have to accommodate.
Also, in addition to the differences between the various schools, psychotherapy has developed differently in the various parts of the world also in relation to the political and cultural traditions existing in the different countries (Cionini, 2013).
To give just a few examples, psychoanalysis originated in Central European culture and only later spread to Anglo-Saxon countries, while, on the contrary, the behaviorist view (and more recently the cognitive-rationalist one) developed in line with the scientific spirit of the Anglo-Saxon culture, and only later did it spread to the rest of Europe (Cionini, 2013).
In this regard, by virtue of the highly heterogeneous presence of psychotherapeutic models, to date it has not been possible to trace the concept of psychotherapy to a single definition (Cionini, 2013). However, aspects common to the different approaches are clearly grasped, without which psychotherapeutic intervention would not be possible. First of all, the concept of therapeutic relationship assumes a fundamental role, that is to say an interpersonal relationship between the therapist and the patient that allows the establishment of an experience emotionally and emotionally meaningful and that involves a beneficial therapeutic alliance for the patient and aimed at achieving change through objectives that are always shared in a highly collaborative space between the two subjects.
This relationship will take place within a treatment space called a setting, which must be reserved and appropriate to the therapeutic needs.
Furthermore, the change process is assisted by the therapist’s action aimed at guaranteeing the patient the knowledge and the acquisition of new points of view and perspectives with which the latter will be able to broaden their range of action with procedures that can direct it towards an increasingly adaptive behavior. The patient must therefore be supported by the therapist, who, with an attitude of containment, emotional support, understanding, acceptance and empathy, will favor the path towards change (Cionini, 2001).
The change in psychotherapy therefore derives from the aforementioned characteristics that are oriented by the procedures and techniques that characterize the therapist’s mode of intervention.
Parallel to the commonalities just exposed, the reference epistemological theories to which each school of psychotherapy refers, in addition to the different ways of thinking about the definition of the objectives, the articulation of the setting, the setting of the therapeutic contract, the modality of clinical evaluation, the more or less central role attributed to the therapeutic relationship and the specific techniques and procedures, on the contrary, represent the different aspects of each approach.
Ultimately, psychotherapy is considered, unanimously, as a method of intervention carried out with purely psychological means which, although implemented through procedures that differ from each other for the different theoretical orientation to which they refer, are aimed at helping people in the solution their affective, emotional, behavioral, interpersonal problems of various kinds and to increase the quality of life; therefore that psychotherapy leads to personal changes that imply a development of the way of seeing, thinking, feeling, acting (Cionini, 2013). These changes will allow those who use them to experiment with new ways in which to live their relationship with the world.
Advertising message Talking about psychodynamically oriented psychotherapies means referring to those techniques deriving from psychoanalysis, born by Sigmund Freud (1856-1939) at the dawn of the twentieth century. Within this paradigm there are several contributions such as that of CG Jung’s “Analytical Psychology” (1875-1961), Alfred Adler’s “Individual Psychology” (1870-1937), “Ego Psychologists”, ” English School “with Melanie Klein (1882-1960),” Interpersonal and Relational Psychoanalysis “, Kohut’s” Psychology of the Self “(1913-1981), Bowlby’s” Theory of Attachment “(1907-1990) and continuation of her work edited by Mary Ainsworth (1913-1999), Jacques Lacan (1901-1981) and the “French School” (Cionini, 2013). However, the psychoanalytic movement does not exhaust its reach to the aforementioned schools; the latter, in fact, represent only some of the theoretical developments and scenarios that have hosted a vast variety of other authors.
The psychodynamic approach is therefore based on the foundations of psychoanalysis but differs from the latter in the number of sessions and the non-use of the bed. In psychoanalytic therapy, in fact, the patient is relaxed and the number of sessions is greater than that of psychodynamic therapy, where the patient will also be seated.
Also, within psychodynamic psychotherapy there are a type of long-term psychodynamic psychotherapy (more than twenty-four sessions or lasting more than six months) and a short-term psychodynamic psychotherapy (less than twenty-four sessions or six months) (Gabbard, 2010).
The psychodynamic therapies, although based on different theoretical models, present common aspects that go beyond the specific frames of reference and that concern the concepts of therapeutic alliance, transference, countertransference, resistance and elaboration and the final modalities of therapy (Gabbard, 2010).
It is interesting to note that a fundamental aspect of the particularity of this approach is represented by the curiosity that the patient shows about the knowledge towards himself.
The patient who can benefit from such an intervention is a subject interested in knowing and understanding those previous and unconscious models that have traced, in his subjective life experience, a more or less consolidated path that makes him today trapped in dysfunctional patterns that cause him suffering. It is therefore the desire to understand oneself, the willingness to realize a certain awareness of the functioning of one’s self and a significant motivation, to indicate to the patient his or her adequacy for such treatment (Gabbard, 2010).
In this sense, it becomes important during the intervention that the therapist knows how to grasp the patient’s ability to mentalize, or the latter’s ability to perceive their own and others’ mental states as explanations of behavior and, therefore, to understand that one’s behavior is guided by points of view and beliefs not always shared by the other.
All this requires and implies an understanding of one’s internal states (Gabbard, 2010).
Likewise, the psychodynamic intervention oscillates between a more purely expressive attitude to a more supportive one, which the therapist must flexibly adopt according to the patient’s needs (Gabbard, 2010).
The psychodynamic psychotherapist also observes the ways in which the patient is used to relate to the world and to the other, and in this case to the therapist, manifesting them in the relationship with the latter.
In addition to observing the aforementioned characteristics, the therapist must be able to grasp if the patient is able to manage impulses and tolerate frustrations by showing himself resilient in the face of adversity; in this case we will find ourselves in front of a strong ego characterized by good resources. On the contrary, a subject who controls impulses with difficulty and shows problems related to the examination of reality or to the tolerance of certain affective states, shows a weak ego (Gabbard, 2010).
Fundamental to solving the person’s mental distress is also knowing how to understand the unconscious conflict that animates and moves the patient’s manifest suffering, that is, the defense that opposes a desire or an impulse, creating discomfort and pain (Gabbard, 2010).
All the elements presented so far are captured and elaborated with a view to constant collaboration between the therapist and the patient, who, from the first moments of their relationship, will communicate with each other and will always openly establish the objectives to be achieved and moments of exploration of some issues.
In this sense, even the final part of the therapy can take different forms and occur in different ways according to the specific case and must be a highly participatory and shared moment between patient and therapist.
Ultimately, psychodynamic psychotherapy aims to understand another person in an empathic and non-judgmental way, within a significant relationship established with the latter. In this way it is possible to foster a process of understanding oneself and one’s own ways of relating to the world, facilitating the process of openness and trust with and in the other by oneself.
The therapist who is sensibly interested in welcoming and understanding the other’s story, can support the person and help him to free his existence from the blanket of fog that has obscured, for perhaps most of his time, those resources that often are not they know but that they own and that, therefore, must be identified and recognized.
In this way, after being accompanied and emotionally supported, each person can finally learn to hover towards an autonomous and more aware flight of his or her existence, free to let new worlds, new spaces, for wider tales of himself enter inside.