20 February 2020

Theoretical Points and Technical Dynamics

In one definition of therapy presented in the first seminar series, I quote the late Merton M. Gill, the wonderful Chicago analyst. A prolific theorist and writer, Gill wrote his last text ‘Psychoanalysis in Transition: A Personal View’ in 1994, the same year he passed away aged in his late seventies. In this extraordinary book, Gill applies great intellectual depth and agility to consider how key psychoanalytic concepts have changed over the history of that endeavour.

An early chapter in the book discusses ‘The Internal and The External’ and all the great debates that fit within that dichotomy.

Again, I indulge myself with a lengthy quote; this time from Gill (1994):

“Such a model is often mistakenly taken to be an essentially environmentalist one, that is, a model that allegedly sees the mind as a blank slate that is written on by experience. From the point of view of classical Freudian theory, such a tabula rasa conception is basically wrong because it omits the individual’s own contribution (the internal factor) to his experience. Such a conception is derided by classical theorists as superficial and naively optimistic because it seems to imply that with a favourable environment there need be no conflict and no psychopathology. It is allegedly a theory that absolves the patient of any responsibility for his troubles and strengthens the tendency to blame others. It would thus undermine any therapeutic program designed to motivate a patient to help himself”. (p. 24)

In my opinion, this wonderful quote captures some of the core issues of psychotherapy, and I restate them below:

1. Is the client born with an inherited or innate personality framework, with strengths and vulnerabilities in an inchoate form from the beginning of their existence?

2. Or does life’s experience (including various traumas) play the definitive role in forming personality and also problematic patterns in the person’s life?

3. And, as with Dr Freud, do we accept that it is in the nature or infrastructure of the psyche to experience and deal with problems and competing demands as ‘conflicts’? Does that structure exist a priori to it ever experiencing serious issues that can be construed into the ‘conflict format’?

4. If we approach the client ‘as an innocent victim who has been filled up with/ distorted by trauma’, do we run the risk (almost guarantee the actuality) of infantilising the client and depriving them of the opportunity to take responsibility for whatever part of their difficulties to which they have contributed (whether by thought processes, unexamined core beliefs, constitution or action), thus limiting their sense of agency and possible potential for active change?

5. Finally, are critical components of therapeutic success the willingness of the client to take responsibility for his or her difficulties and reduce their tendency to blame others, and the capacity of the therapist to assist the client to create a context in which those psychological and emotional shifts can occur?

In many ways, these are philosophical and theoretical questions that can occupy psychotherapy theorists and academics. But the delicious truth is that these refrains and questions are alive and well in every therapy/every therapy session. In fact, discussions in and around these issues, as they are played out in the interpersonal and intrapsychic experiences of the client, form the technical dynamics of the therapy. These considerations are not just available in the abstractions of theory (as necessary and wonderful as theory is), but also in the everyday conversations of therapy.

Paul B. Gibney Ph.D.