Developing Psychodynamic Counselling

Brendan McLoughlin

• Publisher: SAGE Publications Ltd
• Year: 1995
• Print ISBN: 9780803989801, 9780803989795
• eBook ISBN: 9781446226490
• Edition: 1
• Topic: Psicología
• Subtopic: Historia y teoría en psicología

`This book deals with many aspects of psychodynamic counselling from the minutiae of the extrinsic context, such as decor, through the "therapeutic stance of attentive reserve" on to an elaboration of the elements of a therapeutic relationship... the book is liberally garnished with case studies... informative and thought-provoking... a useful resource to those teaching psychodynamic principles... If you are new to psychodynamic work, this book could be a safe and helpful guide... The ideas and techniques offered by the author may also prove intriguing and even inspiring to those (like me) from a different therapeutic orientation? - The International Journal of Social Psychiatry

Psychodynamic counselling has developed from the psychoanalytic tradition inaugurated by Freud. At its core is a belief in the role of the unconscious in the development of conflict and disturbance, which may be resolved through the careful unfolding of the therapeutic relationship via the transference/counter-transference dynamic and within a defined setting.

Integrating theory and context, this book explores the opportunities for counsellors to develop their own practice of psychodynamic counselling. The author encourages readers to look carefully at the way they work and to think about strategies to improve their skills in a specialized form of relating. He examines areas crucial to the psychodynamic approach, including internal and external settings, working with issues around boundaries, and transference and counter-transference.

I	Developing Work with the Internal and External Setting

1	Establish and maintain the therapeutic setting

It will be clear from the Introduction that the physical setting in which psychodynamic counselling takes place is an important matter and the responsibility of the counsellor (Storr, 1979). Whether you are working in your own room or in a room provided by an agency, you are trying to contrive a therapeutic space. A first consideration is the integrity of the room, that is, the extent to which it is free from intrusion or impingements from outside or from within. External impingements might be noise in adjoining rooms or perhaps the telephone ringing during a session. Clearly the phone should never be answered while a session is in progress since to do so would be to break the integrity of the therapeutic container. If there has to be a phone in the room it might be best to unplug it. If noise from outside the room becomes intrusive it may be necessary to take steps to address the problem with those responsible. However, only in exceptional cases would it be appropriate to interrupt the session to deal with the intrusion. In the first instance it is better to wait to assess the impact of any external impingement on the client before raising the matter yourself.

It is possible that the source of impingement may be within the counselling room. For example, a counsellor may introduce family photographs or perhaps posters that indicate a particular religious or political stance. While it may be helpful, especially in institutional settings, to give a room a personal note, it is a disturbance of therapeutic space for there to be accidental disclosures about the counsellor’s life.

If you are working in your own room it will be simple enough to maintain the character of the room. You will choose and arrange the furniture and the decoration. You will also be able to safeguard the reliability of the setting by ensuring that the room and its contents are not subject to unnecessary changes. For example, you will ensure that the chairs that you provide for your own and your client’s use are not removed from the room, nor moved about in it. These may seem small matters but they are in fact significant elements in the maintenance of a therapeutic setting. It may be helpful to remember the complex nature of the therapeutic relationship which finds its expression in both inner and outer reality. If we invite our clients to enter the multilayered space of the therapeutic setting, they rely on us to ensure the security and reliability of that setting. When we fail to do so by not attending to the constancy of the room and its contents, we simply provoke the resistance of the client and his withdrawal from the therapeutic relationship.

If you are counselling in a room in an institutional setting, it will be important to check things out before the client arrives. Other counsellors may prefer a different disposition of the furniture or lighting in the room. Take time in advance of the session to make sure you are comfortable with the room and that things are as you want them to be. For example, is there a clock in the room and can it be easily seen? As counsellor it is your job to hold the pace of the session and you want to be able to do this without making your client feel that you are clock-watching.

These are of course basic matters, but as you will see throughout this book, consistent and professional attention to things that are basic will develop and enhance your ability to practise.

Case examples

A male counsellor is working in an agency setting. Additional rooms have been created by converting the top floor of the building. A client already established in counselling is moved to one of the new rooms. The client is a woman of 25, who does not find it easy to trust people and who finds the reality of other people difficult to acknowledge. She arrives for the first session in the new room and settles herself in the normal way. She makes no direct allusion to the change of room but becomes angry when she hears the sound of a typewriter coming from along the corridor.

Client: If I can hear the typewriter so clearly, surely they can hear me?

Counsellor: [trying to reassure the client and also deal with his own discomfort over the new arrangements] I think you’ll find that we are speaking too quietly to be overheard.

Client: You’re lying. I knew I couldn’t trust you. There’s someone out there listening. You don’t care.

Counsellor: The change of room is disturbing. You haven’t had time to settle into it yet. The sound of the typewriter makes you feel the room may not be suitable for counselling and that by moving you here, I’m showing that I don’t care about you.

Here the counsellor is trying to do too much at once, probably because he has been put on the defensive by the client’s attack and because the client has unconsciously addressed some of his own ambivalence about the move.

Client: You don’t care. If you did you would not have moved me here!

Counsellor: [allowing some time for reflection] The sounds from outside the room make you feel unsafe and remind you of how difficult it is for you to feel that you are safe from intrusion.

Client: [angrily] That’s right!

Counsellor: [tuning in to what he knows from previous material] When people push you around and dominate you, like when you were a child or when you are at work, you feel bad and that you don’t matter. I think you feel the move here is like being pushed around and that it must mean that you don’t matter to me either.

Client: That’s how it always was, somebody else calling the shots.

In this example we can see the disturbing impact of change on both the client and the counsellor. Because he is not yet accustomed to the room and because of his own unresolved feelings about having to move, the counsellor is initially unable to hear what the client is actually telling him. It is only when he has allowed himself time to listen to the client’s unconscious prompting that he turns his attention to her experience of being used and to the way in which this is being evoked by the move to a new setting.

In the second example we see how the client directs her female counsellor’s attention to the arrangement of the room, in order to feel more connected with her. The client is a woman in mid-life who is no longer sure of her direction, suffers chronic and severe pain and is very depressed. The consulting room is quite large and the chairs are arranged in front of two french windows to the side of the room.

Client: I feel this room is so large and formal. You seem to be a long way from me. I want to talk about some of the problems at home but I don’t feel I can begin.

Counsellor: You feel something about the room gets in the way of you talking?

Client: I don’t know, I don’t feel I can reach you. You seem so far away, so cold and impersonal. [Long pause] Perhaps if the chairs were either side of the fireplace rather than in front of the windows, I wouldn’t feel so far away.

In this particular case the counsellor tried a number of interpretations to try to deal with her client’s difficulty but without success. When it seemed that the counselling might founder over the question of coldness and distance, she took her client’s suggestion and placed the chairs either side of the fireplace but at the same distance as before. The client warmed to the new arrangement and the counselling was able to go further.

While it may not often be practicable to rearrange the consulting room to suit every client, this case illustrates the fundamental importance of getting the therapeutic setting right. It also demonstrates that as counsellors we have to make ourselves available to meet our clients before we can sensibly begin to interpret their material.

Key point The physical environment in which psychodynamic counselling takes place should not be taken for granted or ignored. Sensitive management of the constancy of the counselling room and attention to the client’s relationship to it provide valuable references to the therapeutic dialogue.

2	Cultivate and develop your therapeutic stance

Having got the setting right the question arises as to how you should conduct yourself within it. The essence of psychodynamic counselling is that the counsellor should make herself available for the client’s use in ways that become accessible for interpretation. The idea of the blank screen, so often associated with the psychoanalytic tradition, does not always meet the needs of a particular client, as we saw in the previous point. Clearly then, the practitioner needs to be flexible within a defined setting. She will move within that setting enough to indicate to the client her capacity for genuine involvement at conscious and unconscious levels and to a point where it becomes possible for her to address the client in terms that bring relief.

The therapeutic stance of a psychodynamic counsellor might be thought of as available reserve. By this I mean that the counsellor certainly agrees to meet the client at meaningful levels but she does so without intruding herself in that meeting. In practice, I believe this means that the counsellor holds herself at a respectful distance, facilitating the client’s entry into therapeutic space but not directing it. This respectful distance allows the counsellor the space she needs to pay attention to the client as he enters the setting. She will allow him to settle himself in his own way and accept that in doing this he has already begun to communicate within the therapeutic relationship. The counsellor actively attends to the impact of the client’s behaviour and his words without immediately responding. In a sense she gathers the impressions the client offers her of himself and allows these to speak to her at different levels. The client may be saying very little or speaking a great deal, by reserving a space within herself to attend to his communication, the counsellor actively listens for the key concern. The reliability and consistency of her attention encourages the client to feel held within the therapeutic relationship.

An underlying assumption in psychodynamic counselling is that the client will seek to place himself or parts of himself within the counsellor, just as he may defend himself against the counsellor trying to do the same to him. The therapeutic stance of attentive reserve is an important element in the counsellor’s technique, allowing her to monitor the interplay of the client’s inner world with her own and vice versa. It is out of this monitoring process that the counsellor seeks to understand the distress of the client at unconscious levels and attempts to speak to him about it through her interpretations. Thus the therapeutic stance of the psychodynamic counsellor is not an arbitrary device but an integral aspect of her technique which supports her in the extremely difficult task of attending to her client at the different levels at which he presents himself.

For these reasons the psychodynamic counsellor waits before responding to direct questions about herself or about the counselling process. She does not seek directly to comfort a client in distress, just as she does not advise or direct a client what to do. It has been shown that accurate empathy, non-possessive warmth and genuineness are vital elements in any therapeutic relationship (Truax and Carkhuff, 1967). It seems to me that these are all elements of what we are referring to here as the therapeutic stance required for the psychodynamic counsellor. In any counselling orientation the counsellor demonstrates by her behaviour the nature of the therapeutic container that she is offering. The consistency of the reserve and the attention, and the relevance of the interpretations which arise out of these, communicate to the client that she is reliably held and thus facilitate the development of the counselling relationship. When the counsellor’s therapeutic stance is altered or wavers she provokes the insecurity of the client and so promotes resistance. Just as the external elements in the therapeutic setting need to remain constant, so the internal consistency of the counsellor’s behaviour and responses is required for the client to feel that he can give his trust. A counsellor, of course, does not remain insensitive to the suffering of her client but she uses her feeling responses to help her understand him so that she can begin to talk to him in a way that helps him to begin to understand himself.

Case example

A very disturbed young woman, psychologically abused by her parents, is seen in an institutional setting by a female counsellor. Sometimes she is silent and looks away, at others she says a great deal, almost overwhelming her counsellor with detail. In a session in which she has been particularly talkative, touching on problems with money, housing, sex and betrayal, she suddenly asks a question, ‘Have you read The Psychopathology of Everyday Life?’ [Freud, 1901], a copy of which is clearly visible on the shelf. She goes on to say, ‘I have, in order to catch you out! I started out today with my umbrella but decided on the way that it was silly as there is no rain. I have to go shopping after the session and so I’ve hidden it behind the door along the corridor. Will it be alright there?’ The counsellor waits before responding. She knows that the theme of the umbrella has appeared in this client’s material before, sometimes forgotten, sometimes lost, and in one dream, hung outside her bedroom window to hide it from her parents. Even without the prefatory question about Freud’s book, the counsellor is aware that this is a complex request.

The umbrella may or may not have been safe hidden behind the door and the counsellor avoids being caught out with a simple answer. She replies, ‘I do not know if it will be safe, as I cannot protect what happens outside the room. But perhaps your question is really to do with the fact that you often use your umbrella to refer to yourself and what you are really anxious to know is whether what you leave of yourself here with me will be safe?’ The client confirms the counsellor is on the right track by reminding her of the dream and by saying that she thinks of the umbrella as being something capable of extension or potential, like a butterfly.

By avoiding immediate answers to direct questions, in a session already full of material, the counsellor gives herself time to consider what the client is actually asking her. On two occasions the client seeks to draw the counsellor from her stance by her questions. In doing so she tests out the reliability of the counsellor to stay with her task. By avoiding the trap and addressing the underlying anxiety, the counsellor helps the client to make her own links and connections.

Key point The counsellor’s own behaviour and demeanour are key elements in the provision and maintenance of a therapeutic stance. A counsellor needs to allow herself sufficient detachment from her client if she is to be able to respond to him rather than merely react.

3	Negotiate and articulate clearly the therapeutic contract

In the foregoing points we have been considering the way in which the formal setting of the counselling room and the formal aspects of the counsellor’s behaviour contribute to establishing a therapeutic conta...

Table of contents

• Cover Page
• Title
• Copyright
• Dedication
• Contents
• Preface
• Introduction
• I Developing Work with the Internal and External Setting
• II Developing Work with Issues around the Boundaries
• III Developments in Understanding and Working with the Transference
• IV Developments in Understanding and Working with Counter-Transference
• V Developments in Working with the Whole Counselling Relationship
• Conclusion
• Bibliography
• Index