Laurence Spurling illustrates in great detail principles and elements that encompass psychodynamic counselling. The relationship between therapist and client is paramount to the counselling process and is a defining feature in psychodynamic theory. The therapeutic dialogue between client and counsellor is vital for this therapeutic process. Through adopting an attitude of mutuality the counsellor aims at creating sanctuary and meaning for the client so they will gain an experience of containment. The setting, made up of the actual room, psychic boundaries as well as physical boundaries created by the counsellor are an essential part of the therapeutic process and is a place in which containment can take place. Spurling incorporates many examples to aid understanding and gives clarity to various concepts. An approach whose influences are strongly rooted in Freud’s work, psychodynamic counselling is an ever evolving approach to psychotherapy.
Before therapy can take place, the counsellor must deal with their own feelings as this will in turn help their ability to listen, to respond, and the enhance quality of attention given to the client. This attention will radiate reassurances for the client. The nature and importance of reassurance is reflected in Tolstoy’s 1960 story, “The Death of Ivan Illyich”. The façade held by a dying mans family was intolerable to him and his only solace was found in a male servant (Gerassim) who wasn’t frightened or disgusted by Ivan’s pain. Gerassim’s acceptance of death being ultimate shows elements of free-floating attention, a clinical invention of Freud. Here there is no need for explanation as understanding is mutual.
Spurling explores the principle of ‘Therapeutic Action requiring a Therapeutic Process’. Ritual and Repetition are elements in today’s psychodynamic counselling as well as pre-modern ritual healing which led the way for modern day therapy. Going over material repeatedly helps find clarity for both counsellor and client. Winnicott termed this element “working through” (pg. 18).
The Setting is essential to the therapeutic process and acts as a skin wherein containment can take place. It provides instant sanctuary for the client and the way in which they adopt to the setting can give meaning or insight to her behaviour. The Temporal aspects allow for a fixed length and frequency of sessions. A regular schedule and duration of counselling adds to this structure and allows the client to feel a sense of security. The unpredictability of counselling is given a predicable framework. The Spatial aspects stress that counselling is conducted on an individual basis that the counselling room is quiet and unchanging. The idea of ritual and repetition is reverberated here. The Contractual element of the setting allows for a sense of security of both the client and counsellor. The agreed contract reflects the aim and purpose, clarifies the financial side of things as well as highlighting confidentiality and acknowledging that no relationship exists outside of the room for both parties. The counsellors conduct and attitude is the final part of the setting and brings attention to the therapist’s role. An attitude of neutrality is adopted, focus is always on the client, speech is understanding in nature and recognising the difference between symbolic and real, wish and deed is essential for the counsellor.
Freud adopted an attitude of listening to his patients as he was at a loss to what was wrong. He acknowledged his ignorance and listened to his patient’s speech and observed behaviour in an attempt to determine meaning. He found that the real significance was the therapeutic dialogue between patient and therapist. This has become the fundamental principle for psychodynamic counselling. “nothing takes place….but an interchange of words between the patient and the analyst” (Freud 1915 pg.17). A process of mutual interaction is crucial to psychodynamic counselling. The interaction...
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