An Important Difference in intervention practice.
This post grew out of one on my other site, which was inspired by a prompt: How something appears is always a matter of perspective.
Looking from a different perspective is not always easy to do, even when one intends to try to do that. a perspective, a world view held, is predominantly unconscious. The good news is that unconscious patterns can change, can be changed, to some extent. Whether the major trends in its patterning have been laid down by ‘nature’ or ‘nurture’ we now know that there is more plasticity in the mind than was previously thought.
Change can happen. The questions now become: What kind of change? How can the change be brought about? Is the change we get one which is wanted? Who wants this change? I am thinking about children and ADD or ADHD diagnoses and treatments here. However, this post is not going to go far into the debates about treatment and theory of mental wellness, illness, medications, diagnoses, psychiatry, talking cures etc etc. Any or all of these, maybe especially medications, can cause shifts in neural circuits. Afterwards, will these circuits return to more or less where they were, or will the change be permanent. More important, will the change be good? At the moment, what happens is frequently trial and error, with some hope and fear and attempts to monitor what is happening. Hope and fear, like all feelings, are active in the unconscious and may create change or its opposite, solidify a pattern. Treatment and monitoring, like all interventions, take time and expense. When are they worth it?
With so many variables, I hope all those involved are thinking about “do no harm” and about the ethics of what really amounts to EXPERIMENT.
This post addresses this aspect of ethics, by outlining a little mentioned difference between Medication, psychiatric intervention, even ordinary cognitive education processes etc. and therapy, counselling or emotional education which is psychoanalytically based. (In this I include all the many psychodynamic perspectives which have developed from psychoanalytic thought and insight, not just therapies, and not just psychoanalysis itself. I can’t comment on whether the difference exists in other forms of ‘talking cure’ as I do not know enough about their practice, but I think it does not, as non-psychodynamic practitioners are differently trained. They understand ‘psychodynamic ideas’ as aspects of a theory, not as lived practice.)
Question: Where does the intervention for change take place?
One of the greatest fears commented on by those wondering about trying ‘psychoanalysis’, or any of its little sisters, psychodynamic counselling, psychodynamic consultancy to work roles or to organisations, a psychodynamic education class etc. is the thought that someone is going to get inside my head and guddle about in my mind, mess with my psyche, my self. It is terrifying. Is it paranoid or real? They (the analyst types) will interpret, I will be helpless, I will be faced with an authority telling about my own unconscious world.
Real fear: I don’t want anyone in here inside my deepest self.
PARADOX: Psychoanalysis is possibly the ONLY place where this is precisely and exactly what does NOT happen. It does happen as a result of medication, as listening to anyone who has had that experience can tell you. It even seems to be the intention of medication – make a change inside the psyche and then see if the person is OK with it, better or worse than before, certainly different.
[I am now just going to use the word ‘psychodynamic’ for all of the psychoanalytically based notions, and the shortened word ‘psyd-practitioner’ for the analyst/counsellor consultant etc. I will use the word ‘person’ for the person who is seeking change, so many of the other terms (patient, client, analysand, etc.) having unhelpful connotations. I will use ‘practitioner’ for other sorts of professionals, non-psychodynamic, who intervene to help change, and the same word, ‘person’ for those they work with.]
In present-day psychodynamic encounters [more than 100 years since Freud’s first adventures and discoveries]
the person seeking change ‘borrows’ the mind of the psyd-practitioner
[one of Freud’s insights, the recognition of unconscious transference/counter-transference but greatly developed in practice and theory since then.]
The psyd-practitioner allows the other person in. In a full psychoanalysis, this is even encouraged, as the often derided practice of presenting a ‘blank screen’ does encourage the person to unconsciously try to enter. This is technically called something like ‘developing the transference’. Developing transference is not always appropriate when the psyd-practitioner has other roles, but some transference will always take place anyway. This is seldom acknowledged outside of psychodynamic practice, but it is what people do, all of us do, all of the time. We go in and out of each others’ minds, or at least bits of us do, mental emotional activity is exchanged. How else would you have a relationship? This everyday, every moment, interaction with mother father sister brother child teacher doctor priest friend stranger … is happening as we live and act and are acted upon. Their trace is monitored by our unconscious, which is so very much more organized than a big bucket full of stuff. Defences was the name given to some of the processes or mental structures developed to monitor and manage these comings and goings, and maybe, seen from the perspective of “whose mind is going into whose”, it is the right word to use.
To put it the other way round, the person seeking change goes into the psyd-practitioners mind and ‘guddling’ or ‘messing’ or ‘staying inside’ happens in there, not in the person’s mind. From the strength and length of the psyd-practitioner’s training, s/he works consciously to be aware of what is going on inside herself (counter-transference) works to let her own defences be lowered (putting own feelings on hold) and thus generates an understanding from a different place, even a new understanding. This is offered: only sometimes through interpretation; sometimes through empathy or the silence which speaks volumes as unconscious communication takes a more central role. The person actually has a different experience, which happens within the mind of the psyd-practitioner, and can choose to take it or leave it.
Others besides psyd-practitioners, let their minds be borrowed so another can develop, but it is seldom a conscious process. One prevalent example is reciprocal mothering (caring). How does a mother sense the unique need of this baby at this moment? She knows the need because she feels it in the depth of her own mind (which also contains the support, advice and help she has available to her).
In many of our roles, we know that someone has ‘got in’. We dream, re-arranging or recovering the patterns of our experience. In some contexts (nurses, teachers, other carers, managers, emergency responders, etc etc) people cannot shake off the stress or the despair, highly professional people become drained or burnt out. (I wish they all had some psychodynamics in their trainings.) Psyd-practitioners do not say going in and going out should happen, or should not happen. They accept that it will happen. In the space of the sessions with the other person (most often deliberately and protectively kept to a specifically agreed time) they work as well as they can to make this transfer of mental ‘stuff’ ONE-WAY ONLY. They say ‘welcome’ and ‘come in’. They may then say, or simply allow it to become known in unconscious process, ‘this is the way you are, and unlike you I know other ways to be’. Or, they could say ‘now I see/feel the experience which has put you where you are, in this corner. Unlike you, I can see a way out’. Trainings are often long and expensive. They are imperfect. People are imperfect.
This is however a huge and important difference in the manner of intervention. Other interventions, particularly medication, are directly applied inside the mind of the person, the practitioner can remain (relatively) untouched. They will however have experience of the person, and to avoid draining or burn-out many practitioners work in ways which maintain or even raise their personal defences, and work organization can also reflect this necessity to maintain defences. Hence – the important difference between psychodynamic practice and other sorts of intervention asks a different kind of question from the one about ‘outcomes’. To find this difference, ask:
Where does the intervention for change take place?
Or, you could ask: Whose mind is being guddled in?
A psychodynamic practitioner consciously allows his/her own mind to become a place where change happens.
The other person can live in less fear, that alone creates a space for change that can be the change wanted.
Would all those who apply medication or other kinds of advice/help, those methods which push change into the other person, please think about how they too could work in this way.
As the song says “Be the change you want to see…”