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I agree entirely. I did enter into therapy before I began my psychotherapy training, purely to comply with the course requirements. Although I did not feel to have any huge issues that needed addressing I was aware of several recurring problems that I intended to share & work on with my therapist. You probably won’t be surprised to learn that those problems went a lot deeper than I had anticipated. My therapist, who worked psychodynamically, was a very astute man who always knew if I was avoiding facing up to difficult feelings and, although he was gentle enough, I knew there were no real hiding places.

Once the course of therapy had finished (2 years) I felt the benefit both as a practitioner and in general. However, I still experience difficulties in certain areas of my life, just like we all do – but if I were to enter therapy for the rest of my years I would never come anywhere near being ‘fully analysed’. Nor would I want to. There are certain little foibles and defence mechanisms that I would prefer to hold onto.

Do you believe that in order for a therapist to help someone, the therapist has to be ‘helped’ during the process too?

Yes I do. I strongly believe that to practice as a therapist without receiving regular supervision from an experienced and qualified supervisor is both irresponsible and potentially dangerous. All therapists are susceptible to reacting back to their patients’ *transference reactions (*transference in psychotherapy is an unconscious process where the attitudes, feelings, and desires of our very early significant relationships get transferred onto the therapist) and it is vital that there is someone whom they can trust who is capable of identifying and interpreting such reactions. As therapists, we all carry our own agendas & we are all susceptible to projecting them onto our patients. Additionally, we are also prone to accepting & carrying our patients’ projections. Supervision provides a safe and confidential space where the therapist can sit and analyse his work whilst also feeling supported.

How did you deal with frustration, in regards to the time spent with a client, where the client was unable or reluctant to change. Do you feel that your frustration should be voiced during the session, or does this depend on the person?

That’s a really good question. I think I learned to deal with such frustrations much better as the years rolled by. In a way, this question links to the previous one. In reality, there is no logical reason to feel frustrated if it is our patient who is resistive or reluctant to change. But, of course, we still do – which can result in us either feeling angry with our patients or, alternatively, over-sympathetic & desperate to ‘make things better’ for them.  All such feelings are fine if we remember to sit & work out where they are coming from – but we do not always do that. Instead, we fail to separate our own issues from our patients and become embroiled in a messy and unproductive relationship with them.

A good example is the patient who has brought an issue of loss to therapy but who seems to be avoiding and sabotaging all attempts by the therapist to help her develop insight and move on. The therapist begins to feel frustrated and begins to lose patience with the patient. Having taken the issue to supervision, the supervisor discovers that this therapist suffered a broken relationship that he had never recovered from. He had never managed to accept the break-up & still grieved for the loss of his partner. Consequently, he had been projecting his own frustrations at not being able to work through his grief onto his patient.

As for voicing such frustration during the session – yes, I think that’s fine … but, of course, there is a particular way of doing it. The rule of thumb is that any such frustrations should be aired in a way which is likely to help the patient develop insight. The other rule, just as important, is always be tentative – in other words, always give the patient a ‘way out’ if they are not ready or unwilling to accept your hypothesis.

For example, the therapist might say: ‘I’m very aware that, whilst you were explaining to me about your partner’s reluctance to talk about his illness, I began to feel my stomach tightening … I can actually feel a huge knot of tension in it … right here *points to his stomach & taps it with his fist* … you know, I could be entirely wrong about this, but … I wonder if I’m feeling some of the frustration that you felt when your partner refused to let you in … you being unable to tell him how that made you feel?”

If the patient is ready to hear the tentative interpretation, a response might be: “I desperately wanted to let him know how frightened I was about losing him … but he just didn’t want to hear. I used to feel so angry with him (begins to cry) … & so wound up that I couldn’t eat.’

What are your thoughts on individual and creative therapy, which may be quite unorthodox, in terms of extending the 50 minute hour or adults taking part in play therapy or even switching seats with the therapist?

Ah! Well, if the therapist is practised in such ‘alternative’ techniques (e.g. in Gestalt therapy) & the patient has been fully briefed about the mode of therapy, then I am all for it. I used to employ similar strategies myself when working with families. I remember a specific session of ‘couples’ therapy when I asked one person to turn her chair round & direct all her answers to the wall. She was baffled at first, until she realised that this was how it felt for her partner when he tried to talk to her, as she never seemed willing to listen to him.

So such creative switches in therapy can work well, although I’m not sure about extending sessions beyond the agreed ‘hour’. For me (working within a very structured timetable) it would have caused problems & inconvenienced people with later appointments. And I believe an hour is ample time at one sitting to address the issues that need to be discussed. Giving a time boundary helps to contain a session by informing the patient that she has a specific amount of time to go wherever she needs to go. If the patient is inclined to wait until the last few minutes before ‘dropping a bombshell’ then this needs to be addressed by the therapist, as it most likely represents a ‘boundary’ problem that needs working on in therapy.

Do you feel it is necessary to share your personal experiences with the client, or again do you feel that this would depend on the person?

Generally speaking, no. I believe the more a patient knows about her therapist, the more that information is likely to pollute the therapy process. To illustrate, if I were to disclose a particular faith or religion, that might prevent the patient from sharing a negative feeling towards that faith or religion. Or if I was to highlight a particular personal difficulty (an illness, a relative’s struggle, an anxiety), that might generate concern & worry for the patient. I know that some person-centred counsellors do share certain personal experiences as a way of empathising but, for me, I think it is inappropriate to do so. There are surely better ways of demonstrating empathy as opposed to revealing personal details.

How important were your initial instincts on first meeting with a client?

Extremely important for two reasons:

Firstly, I trust my instincts. Almost thirty years of clinical practice has honed them to a point where they are pretty sharp at forming an accurate profile of a person.

Secondly, they are a wonderful source of counter-transference for me to explore, either on my own or with my supervisor. Instincts always surface from the unconscious and, on occasions, I will be unwittingly projecting my own beliefs onto the patient. If the therapist is able to identify these counter-transference reactions it can provide him with a rich source of information about himself and his patient.

For example, I may feel inexplicably cool towards a patient in the first assessment session. The reason might be a very simple one, in that she reminds me of someone I know – & if that’s the case I will surely work that out quickly. But at the other end of the spectrum there may be no discernible reason why I should harbour such a negative feeling. So, I would have to explore my instinctual feelings until an explanation surfaced.

A possible explanation might go something like this: the patient lost her mother when she was only a child. She had no father figure to turn to & this caused a multitude of problems for her. Throughout her adult life she has had a string of very brief relationships & only one longer relationship that lasted just over two years. Whilst she insists that she yearns to be in a loving & caring relationship she is also frightened of ‘losing’ any figure that she may get close to. Consequently, she unconsciously projects a rather austere persona that is inclined (& unconsciously designed) to deter people from trying to get close to her.

During therapy, how important are the unconscious or the darker sides of the Psyche. For example, with my analyst, we have adopted a name for the part of me that seeks drama, darkness etc?

What a wonderful question! Very important, I would say. According to Jung the Shadow is an archetype that reflects deeper elements of our psyche. It is, by its name, dark, shadowy, unknown and potentially troubling. It tends not to obey rules, and in doing so may discover new lands or plunge things into chaos and battle. It has a sense of the exotic and can be disturbingly fascinating.

We may see the shadow in others and, if we dare, know it in ourselves. Mostly, however, we deny it in ourselves and project it onto others.

In therapy, if we face up to our shadow side it can help to vitalize our lives. Those fears & anxieties that we suppressed many years ago, when confronted & understood, can lead us to places that we would, otherwise, never have discovered. The negative messages we receive in childhood all contribute towards constructing our shadow sides. If a person is told that they are stupid, or clumsy, or even unlovable, those messages live on in the dark side of the psyche. Shining a light on them is usually perceived as a fearful & risky thing to do. However, exposing them to the light in therapy provides an opportunity to see them for what they really are (hurtful and inappropriate comments) whilst, also, unwrapping potential that, otherwise, would have laid dormant.

For those who would like to learn more about their shadow, there is an excellent article by Denise Linn entitled: ‘Facing your Shadow’

Have you ever given a client advice?

Within a contracted course of therapy, never (as far as I can recall). For me, doing so goes against the whole ethic of offering the patient ‘cues’ (in the form of interpretations & hypotheses) so that she may find her own way through her difficulties. Offering solutions by way of advice disempowers the patient by taking away her potential for finding her own answers.

Of course, if the patient asked me: ‘Is there a train station nearby if I’m ever unable to travel by car?’ then I would answer their question. But suggesting various coping strategies runs against the grain of psychodynamic therapy & may even imply that you have no faith or trust in the patient to find her own way out of her difficulties.

Many thanks for giving me the opportunity to address such thought-provoking questions, Will. Having been retired for several years I had to put my thinking cap back on in order to provide what I hope will be satisfactory answers.