Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for April 23rd, 2015

Psychotherapy: Technique vs. Relationship?

Posted by Dr. Vollmer on April 23, 2015

The longstanding debate in the psychotherapy world centers around the issue that we, the providers, do not understand how we heal. At first pass, it might seem that this field is so uncertain, why would a person devote his/her life to work in which outcomes are vague, and mechanisms of therapeutic action are subject to deep speculation? As with all issues involving uncertainty, the management of “not knowing” involves “pretend knowing” meaning certainty when there is none, and/or embracing the opaqueness of what we do. These two camps, those who feel certain, without science to back them up, and those who coexist with the uncertainty, are antagonistic to one another. I tilt towards embracing complexity and “not knowing” and I begin to tremble at the sound of pseudoscience presenting as science. Having said that, it has felt intuitive to me that people get better through relationships, be that marriages, friendships and/or psychotherapy. Feeling understood and cared about provides the soil in which growth can take place. Yet, one can challenge me and ask that if the most important aspect of psychotherapy is the relationship, than why do I teach “technique” in that most relationships evolve over time without structure or rules. Technique, by my way of thinking, is a litany of structure and rules which is woven together with a therapeutic relationship, resulting in a thoughtfulness about applying or not applying the rules. In other words, there needs to be guidelines in psychotherapy which stimulate the therapist to decide if and when to deviate from those suggestions. Issues such as self-disclosure, doing a home visit, working from home, are all issues which question orthodox views of psychotherapy, and yet with thoughtfulness these rules can be broken with great therapeutic success. The rules promote thinking about thinking and in so doing, therapists need to be taught about how to think about the patient and him/herself at the same time. Two minds engage together, a relationship forms, but the patient is focused on his/her mind, while the therapist is focused on both minds. The asymmetry follows from this thinking pattern, and with this asymmetry the patient learns to trust his/her therapist as someone who is mindful to take care of himself (the therapist) and the patient. This trust that the therapist will neither be a martyr or self-centered allows the patient to explore his/her mind. The relationship, the feeling of mutual caring, with these assigned roles, gives way to introspection and mastery over unconscious motivations. The work is hard because generally speaking, the relationship is necessary but not sufficient for growth. For growth, learning technique is essential. And still, at the end of the day, there is a lot we do not know.

Posted in Psychotherapy, Teaching, Teaching Psychoanalysis | 6 Comments »

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