A desire for connection and understanding is deeply wired into the human psyche. From the moment of birth, we are neurologically primed to seek out close attachment bonds with others, as human babies cannot survive without someone to take care of their basic needs.
Most psychological and interpersonal difficulties stem from unfulfilled needs in these early attachment relationships and are thus ‘relational’ in origin. Caregivers usually do their best but, because of their own historical issues and inevitable human flaws, they cannot ever be the perfect or ideal parents or custodians. Failures in connection and understanding are thus common experiences and most of us will suffer the fallout from these failures at some point in our lives. There is much truth in psychologist Alfred Adler’s adage that the only normal people are those you don’t know very well.
We can be highly successful in our careers, and even in our social circles, and yet be concealing significant internal anxiety and angst. For those who have had less than optimal childhood experiences of attachment, this distress can be particularly intense and troubling. This is especially so in the context of relationships in which we may unwittingly repeat painful patterns. A glaring example of this is the abused child who, in adulthood, may unconsciously choose an adult partner who will re-enact an abusive relationship with her. Of course, consciously she would not wish this for herself. Nevertheless, unconsciously she seeks out a familiar relationship pattern in which she subjugates herself to an abusive other because this is what she knows, expects and feels she deserves. Alternatively, she may defensively assume the role of the aggressor and bully others.
Truly understanding these patterns is the first step to being free of them. But we struggle to achieve this understanding alone, as our approach to relationships tends to be driven by our unconscious mind. By definition, we cannot be conscious of our own unconscious.
Even if we do manage to gain an intellectual understanding of our patterns, a deeper, more experiential recognition is generally required for us to practice and achieve meaningful change in our lives. For this reason, we often need the help and understanding of another to make real progress. As children, we intuitively seek understanding and wisdom from our caregivers. In the right circumstances, we learn that telling our stories to an attentive, concerned and (hopefully) wiser older person amplifies our joys, soothes our sorrows and calms our terrors, allowing us an alternative perspective. As children, we are also primed to trust our caregivers, although some children are more naturally inclined to trust, and some caregivers are more trustworthy than others.
However, some parents, even with the best of intentions, may be incapable of providing for the emotional needs of their children because of their own psychological baggage. For example, a child’s anxiety may provoke an anxious response in her mother. This may result in either an escalation of the child’s fears or an internalized message that her mother would feel better if these fears were masked. In later years, she may not feel safe enough to trust that her partner will continue to love her if she reveals her fears, fragility or vulnerability. As we grow older, and are under pressure to ‘grow up’, many of us lose the capacity to turn to others in a relatively uncomplicated way. We become worried about how we will be perceived or judged, especially if our early experiences of turning to others have been less than ideal. We also lose our capacity to tell our stories authentically and honestly as we increasingly feel the need to shape our images and to hide our true feelings. This seems to be particularly the case in the contemporary world where social media has become a dominant medium for connecting with others. Social network services such as Facebook, Twitter and Instagram encourage us to manicure and curate our images to the point that we often feel ashamed of the less than perfect aspects of ourselves. We are tempted to photoshop our images and to present our lives as glamorous and cool, and our relationships as untroubled. In doing so, though, we risk losing contact with what to realistically expect from ourselves and others.
In highlighting common psychological struggles and how they emerge and are ameliorated in psychotherapy, we reference a type of therapy that we will refer to as relational psychotherapy. Relational psychotherapy is a form of talking cure which has its origins in the work of Freud.
Interestingly, the term was coined not by Freud but by his patient Bertha Pappenheim, underlining again the importance of what the patient brings to the field. It has largely been forgotten that the term ‘the talking cure’, which is now used to refer to many psychotherapies, was invented not by a therapist but by a patient, to whom we are duly grateful.
Relational psychotherapy is like psychoanalytic therapy in that there is a focus on understanding the role of the past in determining the present, and on bringing unconscious processes into conscious awareness. However, it differs from traditional psychoanalysis in that the therapist and patient
work more collaboratively. The therapist–patient relationship is used to understand more about the patient’s troubles and their origins. This increases the capacity for the patient to change relationship patterns that are obstacles to leading a fulfilling life.
This type of psychotherapy is influenced by the notion that what brings about change for patients is a deep feeling of their inner worlds being understood, coupled with an empathetically communicated view from the outside.
We believe that self-help strategies and virtual relationships can only go so far, and that more significant psychological struggles are best addressed in the context of a person-to-person relationship of a therapeutic kind. In relational psychotherapy, the therapist offers hypotheses to the patient based on careful observation, experience and thought about the patient’s style of relating in the consulting room as well as by an analysis of the patient’s story. These hypotheses are designed to help the patient understand the meaning of their unique way of being – comprising their unconscious and conscious thoughts, beliefs and fantasies about themselves and others, their emotional states, and the way in which they automatically ‘do relationships’ – and how it might impact themselves and others in unintended ways.
A self-help book or an online support forum might well provide cognitive insights, but a ‘lived experience’ is more likely to lead to lasting change. We would encourage the reader to take the step of entering therapy and embarking on a guided inner journey that is every bit as interesting and engaging as exploring new countries and terrains. There is much to be gained for those who are prepared to engage in this process, as it promotes personal authenticity along with in-depth relational understandings. An ability to look inwards offers us a moment of pause between the impulse and the act, so that we are less quick to react. Looking inwards also enables us to value ourselves without the constant need to have our value affirmed by others. In short, we become more dependent on ourselves and less dependent on others. At the same time, we become more deeply connected to others and more prepared to exist openly and authentically in the give-and-take of affirmation and affection. But to truly understand what drives us, and to interrupt and shift this, is no mean feat. The first step involves a desire to understand and to value our inner lives.
THE MENTAL HEALTH FIELD
The desire to look inwards is on the wane, not only in contemporary society at large, as we have indicated, but also among many mental health professionals. There has been a trend in mental health circles to increasingly define psychological distress in terms of visible symptoms and external behaviours which can be categorised into diagnoses. Unquantifiable internal meanings and feelings receive little attention in such a model. Alongside this, there has been a growing tendency to pathologise what in the past would have been considered ‘normal’. In 1952 there were 106 diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (DSM) used by mental health practitioners. In the latest edition, published in 2013, the number of potential diagnoses has more than doubled. In the run-up to the publication of this edition there were even debates as to how many months a person could grieve a loved one before being diagnosed as mentally ill. This attempt to define when grief crosses the line from being a painful and universal human experience into becoming a mental health disorder epitomises what we see as a shallowing and narrowing of psychological understanding. It represents a movement away from an in-depth engagement with the complexity of the individual human psyche and encourages an ‘us and them’ approach to mental health. It also pathologises the ordinary madness we all have as human beings. We all struggle to be our full, authentic, real, complex selves – and so we should. This search for a deeper understanding of our psychological selves is a core part of being human. All too often, though, our attention is directed away from our own self-development, and our own contribution to difficult relationships, to a focus on how to survive the other person’s shortcomings.
Of course, strategies for dealing with the problematic behaviours of others are helpful. But in our experience, there is no substitute for understanding the effects of our own difficulties on others with the aid of an empathetic therapist who can both understand our pain while also offering a trained outsider’s perspective. Similarly, focusing on behaviour change without addressing underlying issues has its limits. We can refrain from eating chocolate if we try hard enough, which is helpful if we are trying to lose weight but feeling less desire to eat chocolate in the first place would be a more positive outcome. Relational psychotherapy addresses both the behaviour and the desire, and this is done within a context that affirms that to struggle is human.
Prof Gill Straker is a highly experienced clinical professor at the School of Psychology at Sydney University. She is a passionate believer in the transformative power of authentic relating and is firmly of the belief that we are all engaged in psychological struggles that we tend to hide, including from ourselves.
Dr Jacqui Winship has more than 20 years of experience as a clinical psychologist, psychotherapist and supervisor. She works with adults, adolescents and couples, and believes in the power of the therapy relationship to enable individuals and couples to grow, heal and thrive.
Prof Straker and Dr Winship are the authors of The Talking Cure, published by Pan Macmillan and available for R330 at leading bookstores.