20 Key Concepts from Psychotherapy Flashcards
1/ Symptoms and Causes
The goal of therapy is to go beneath the surface ‘presenting problem’ in order to locate (and treat) what is really at stake. Sigmund Freud, the inventor of psychoanalysis and its twin, psychotherapy, deserves his place in 20th century history because of his immensely subtle grasp on the devilish way symptoms get disconnected from their real causes.
Psychotherapy is the discipline that promises to guide us back to our troublesome past in order to give us, once we can address the real causes of our sorrows, the chance of a more liberated, less anxious and more hopeful future.
2/ Childhood Trauma
Psychotherapy is built round the idea that every childhood involves an inevitable degree of emotional wounding.
In his Outline of Psychoanalysis Freud defines childhood trauma as ‘an inability to deal with early emotional challenges that a person could endure with utmost ease later on.’
In other words, a trauma needn’t sound at all bad to our adult selves for it to have had a severe and lasting impact on our development. Maturity means getting to know our traumas before they are able to spoil too much more of our adult lives.
3/ The Unconscious
The idea of the unconscious is central to psychotherapy. The mind is pictured as divided into two zones. A tiny, intermittent area called consciousness and a vast, complicated, obscure, timeless terrain named the unconscious.
The central aim of therapy is to properly reconnect us with our unremembered histories: to give us mastery over lost provinces of mental life and extend our knowledge of our unconscious experiences.
4/ Sexuality
Psychotherapy is deeply alive to how rare and difficult it is to be able to have satisfying genital sex over the long term with someone one loves. Unwarranted degrees of guilt and shame easily get attached to the body, which then makes intimacy impossible.
By explaining soberly and reasonably how we end up here, therapy makes the stranger zones of our erotic life less humiliating and embarrassing. It also allows us to see that a degree of sexual unhappiness may well be an entirely natural and unavoidable part of a good life.
5/ The Fundamental Rule
When he was trying to describe the process of therapy, Freud said that it required really only one thing of patients: that they must ‘say everything that comes into their head, even if it is disagreeable for them to say it’. Freud called this ‘the fundamental rule’ of therapy – and the only route to successful treatment.
Of course, the rule flies in the face of all our impulses. Civilised life constantly requires us, in order to be deemed good, to censor what we say.
For their part, therapists are properly unshockable and without any desire to moralise: they know human nature, and their own minds, deeply enough never to be surprised.
As we watch them accept our darkest secrets with calm and patience, we grow more confident about our own acceptability. We no longer have to keep so many things from ourselves and grow at ease with our underlying strangeness and wondrous oddity – which we share with pretty much everyone on the planet.
6/ Parapraxis = Freudian slip
‘Parapraxis’ is the specialised, technical name for a bungled or faulty action which nevertheless reveals something fundamental about our deeper selves. More popularly, the concept is known as a ‘Freudian slip’.
7/ Transference
Transference is a psychological phenomenon in which an individual redirects emotions and feelings, often unconsciously, from one person to another. This process may occur in therapy, when a person receiving treatment applies feelings toward—or expectations of—another person onto the therapist and then begins to interact with the therapist as if the therapist were the other individual. Often, the patterns seen in transference will be representative of a relationship from childhood.
8/ Defence Mechanisms
Psychotherapy understands that we like to keep away from ourselves because so much of what we could discover threatens to be painful.
In order to hide our thoughts, we make use of a range of what psychotherapy calls ‘defence mechanisms’. We get addicted to something; we are addicts whenever we develop a manic reliance on something, anything, to keep our darker and more unsettling feelings at bay.
A defence is a response to fear, so an important part of the work of therapy is to create an environment in which we feel sure we won’t be attacked in our tender spots so we can finally risk examining our defences – rather than deploying them.
9/ Splitting and Integration
Melanie Klein (1882 – 1960) was a Viennese psychotherapist who studied the deep-seated human tendency for splitting. Frustrations can feel so intolerable, we defend ourselves by splitting people into the purely good and the purely bad. Everyone that annoys us becomes evil, everyone who gratifies us is perfect.
The therapeutic response to splitting is to gently move us towards what is known as integration. With the help of a therapist, we learn sympathetically to see why we made a split but then slowly and painfully start to acknowledge a more complex reality. A parent can be annoying in some ways yet loveable in others; someone can criticise us, without being mean or stupid; we ourselves can have many genuine failings and yet still be quite good people.
Splitting is often observed in romantic life, where we can move from person to person, always falling deeply in love and then abruptly detaching ourselves when we discover a flaw. Therapy teaches us to tolerate the ambivalent nature of everyone – not least ourselves. We can admit we’re wrong without feeling too humiliated. We can properly apologise and and accept the apologies of others. The world becomes a little greyer, but also a lot more bearable.
To be able to feel ambivalent about someone is, for Kleinians, an enormous psychological achievement and the first marker on the path to genuine maturity.
10/ Breakdown
Having a breakdown is not, in the eyes of psychotherapy, the problem it often seems like to the rest of the world. A breakdown is not merely a random piece of madness or malfunction, it is a very real – albeit very inarticulate – bid for health.
If we can put it paradoxically, it is an attempt to jumpstart a process of getting well, properly well, through a stage of falling very ill.
In the midst of a breakdown, we often wonder whether we have gone mad. We have not. We’re behaving oddly no doubt, but beneath the surface agitation, we are on a hidden yet logical search for health. We haven’t become ill; we were ill already. Our crisis, if we can get through it, is an attempt to dislodge us from a toxic status quo and an insistent call to rebuild our lives on a more authentic and sincere basis.
11/ Avoidant Attachment
The English psychotherapist, John Bowlby (1907-1990) was the prime force behind the development of ‘attachment theory,’ the study of the way in which children form an emotional bond with their carers, which becomes the basis upon which they later manage relationships as and with adults.
As part of his work, Bowlby identified an ‘avoidant’ attitude in which we habitually push away or act coldly towards people who, in fact, we would very much like to be close to. We do this, Bowlby argued, because our capacity to trust others was damaged in childhood and we learnt a technique of shutting down engagement as a way of preserving our integrity.
At the precise moment when we want to be close, we say we’re busy, we pretend our thoughts are elsewhere, we get sarcastic and dry; we imply that a need for reassurance would be the last thing on our minds. We might even have an affair, the ultimate face-saving attempt to be distant – and often a perverse way to assert that we don’t require a partner’s love,
Therapy offers us the chance to recognise the pathos of what we’re doing and to return and treat the original wound. For Bowlby, the therapist enacts a new and better model of relating: one in which we are carefully listened to and our tentative revelations are warmly received and from this we derive a life-saving lesson: that it is in fact possible to make demands on someone we love.
12/ Anxious Attachment
Anxious attachment refers to a pattern of relating to lovers whereby, when there is difficulty, we grow officious, procedural and controlling.
We feel our partners are escaping us emotionally, but rather than admitting our sense of loss, we respond by trying to pin them down administratively.
A tragic cycle then unfolds. We become shrill and unpleasant. To the other person, it feels like we can’t possibly love them anymore. Yet the truth is we do: we just fear rather too much that they don’t love us.
John Bowlby didn’t see this unfortunate pattern as fixed. We learn a lesson that our childhoods may have denied us: that someone we can’t control can still be loyal to our needs.
13/ Feeling rather than Thinking
Thinking is hugely important – but on its own, within therapy, it is not the key to fixing our psychological problems.
It’s only when we’re properly in touch with feelings that we can correct them with the help of our more mature faculties – and thereby address the real troubles of our adult lives.
Oddly (and interestingly) this means intellectual people can have a particularly tricky time in therapy. They get interested in the ideas. Therapy demands that we not try to be too clever and accept the need to feel lost and confused.
14/ The Super Ego
The superego incorporates the values and morals of society which are learned from one’s parents and others. It develops around the age of 3 – 5 during the phallic stage of psychosexual development.
The superego’s function is to control the id’s impulses, especially those which society forbids, such as sex and aggression. It also has the function of persuading the ego to turn to moralistic goals rather than simply realistic ones and to strive for perfection.
The id is the primitive and instinctive component of personality. It consists of all the inherited (i.e. biological) components of personality present at birth, including the sex (life) instinct (which contains the libido), and the aggressive (death) instinct.
The id is the impulsive (and unconscious) part of our psyche which responds directly and immediately to the instincts.
15/ The True and the False Self
This psychological theory of the True and the False Self is the work of the English psychoanalyst Donald Winnicott. We are all, in Winnicott’s eyes, born with a true self.
Winnicott added that if a person is to have any sense of feeling real as an adult, then they have to have enjoyed a period of letting the True Self have its way. Gradually, a False Self can develop, which has a capacity to submit to the demands of external reality (school, work etc.).
Unfortunately, many of us have not been given a chance to be our True Selves. The result is that we will have learnt to comply far too early; we have become obedient at the expense of our ability to feel authentically ourselves.
Therapy gives us a second chance. We are allowed to regress before the time when we started to be False, back to the moment when we so desperately needed to be true.
16/ Sublimation
In therapy, ‘sublimation’ covers the way a usually unhelpful impulse can be converted into a noble ambition. So for example, aggressive instincts to kick or hit can be channeled into sporting prowess; the desire to show off can become the basis of a capacity to address an audience on something of real worth to them; a feeling that no one listens can give birth to a literary career.
Freud was particularly interested in the way in which artists turn the often chaotic reality of their lives into something of public use. The artist or writer adapts their ‘private flight from reality’ into the creation of public objects that move, interest and inspire other people.
Sublimation is one of the goals of therapy. The therapist knows that not all our wishes can come true, but this doesn’t have to mean despair on an ongoing basis. We can redirect our problematic drives in as constructive a way as possible.
17/ Compliance
The very real secret sorrows – and difficulties – of the compliant person are tied to the fact that they behave in this way not out of choice, but because they feel under irresistible pressure to do so.
Eventually, under pressure, these compliant people may manifest some disturbing symptoms: secret sulphurous bitterness, sudden outbursts of rage and very harsh views of their own imperfections. The compliant person typically has particular problems around sex.
As a child, they may have been praised for being pure and innocent. As an adult the most exciting parts of their own sexuality strike them as perverse and disgusting and deeply at odds with who they are meant to be. The compliant person is likely to have problems at work as well. They feel too strong a need to follow the rules, never make trouble or annoy anyone.
But almost everything that’s interesting or worth doing will meet with a degree of opposition and will seriously irritate some people. The compliant person is condemned to career mediocrity and sterile people-pleasing. The desire to be good is one of the loveliest things in the world, but in order to have a genuinely good life, we may sometimes need to be (by the standards of the compliant person) fruitfully and bravely difficult. Therapy is an arena in which we can safely get in touch with our more usefully rebellious, ‘difficult’ and self-assertive sides.
18/ Mourning
In 1917, Freud published an essay called Mourning and Melancholia. In it he made a distinction between two ways of feeling sad.
In the first, mourning, we suffer a loss and consciously recognise that we have done so. We then enter a period where everything seems worthless and deadening and where we think continually of the person, or ambition or hope we have lost. But eventually, mourning comes to an end. We realise that the world, despite the absence of something deeply good we once knew in it, is still worth enduring and exploring.
The second state of sadness, melancholia, is far more open-ended and far more difficult to handle. Here too, we have suffered a loss and the world seems sad and dispiriting. The problem is that we are not consciously aware of what we have lost. In such circumstances, we are no longer merely sad, we are numb.
We cannot pinpoint any specific source of grief and therefore everything becomes hopeless and without meaning. We are depressed.
The goal of therapy is to try to reunite our sad feelings with the forgotten events that will, somewhere in the past, have triggered them.
Therapy knows that, when we can cry over something specific, we are well on the way to recovery.
19/ ‘Good Enough’
The English psychoanalyst, Donald Winnicott, who specialised in working with parents and children, was disturbed by how often he encountered in his consulting rooms parents who were deeply disappointed with themselves. They felt they were failing as parents and hated themselves intensely as a result.
What struck Winnicott, however, was that these people were almost always not at all bad parents. As parents they were – as he came to put it in a hugely memorable and important phrase – ‘good enough.’
Winnicott was putting a finger on a crucial issue. We often torment ourselves because we have in our minds a very demanding – and in fact impossible – vision of what we’re supposed to be like across a range of areas of our lives.
This vision doesn’t emerge from a careful study of what actual people are like. Instead it’s a fantasy, a punitive perfectionism, drawn from the cultural ether. With the phrase ‘good enough’,
Winnicott wanted to move us away from idealisation. Ideals may sound nice, but they bring a terrible problem in their wake: they can make us despair of the merely quite good things we already do and have. By dialing down our expectations, the idea of ‘good enough’ resensitises us to the lesser – but very real – virtues we already possess, but which our unreal hopes have made us overlook. A ‘good enough’ life is not a bad life. It’s the best existence that actual humans are ever likely to lead.
20/ The Goals of Therapy (part 1)
Therapy cannot make us happy every day. But its benefits are tangible nevertheless.
And having taken a measure of the true present situation, we may accept that there could – after all – be other, sufficiently safe ways for us to be.
The therapist’s kindness and attention encourages us to be less disgusted by ourselves and furtive around our needs.
Having once voiced our deeper fears and wishes, they can become ever so slightly easier to bring up again with someone else.
There may be an alternative to silence. And we can be more compassionate: we will inevitably, in the course of therapy, realise how much we were let down by certain people in the past. A natural response might be blame.
20/ The Goals of Therapy (part 2)
But the eventual, mature reaction (building on an understanding of how our own flaws arose) will be to interpret their harmful behaviour as a consequence of their own disturbance.
The people who caused our primal wound almost invariably didn’t mean to do so; they were themselves hurt and struggling to endure. We can develop a sad but more compassionate picture of a world in which sorrows and anxieties are blindly passed down the generations.
The insight isn’t only true to experience, holding it in mind will mean there is less to fear. Those who wounded us were not superior, impressive beings who knew our special weaknesses and justly targeted them. They were themselves highly frantic, damaged creatures trying their best to cope with the litany of private sorrows to which every life condemns us.
