A healthy and effective psychotherapy

When we receive a patient who has resistance to psychotherapy because he does not want to antagonize his parents or loved ones around him, we are faced with the most common erroneous fantasy surrounding our profession. Perhaps it would be interesting to tell in a clear, accessible and pedagogical way, how a healthy and effective psychotherapy should be, or at least, what we are talking about when we say that a therapeutic process is working.

How does psychotherapy begin?

The first thing to say is that we must “historicize”, that is, work with our history to move from forgetting to remembering. In this process resistance will appear, since we will release emotions linked to traumatic scenes or repressed situations, and the ego resists this because it considers it dangerous. Being able to make conscious the unconscious linked to those emotional elements that were forgotten, repressed or split will be key throughout the whole process. And then to be able to link the old elements of conflict with the current ones, will close the cycle. In this process, sometimes the psyche opens and sometimes it closes. When it opens we can historicize, link, detect conflicts and release emotions. When it closes, the psyche resists. We have encounters and misencounters in each session and this configures the architecture of a real process. The ego functions, which are those of registration, memory, thinking, synthesis and elaboration, are activated at a key moment of this process. When these are activated, we move from a predominantly defensive self, to a creative, reflective, elaborating self.

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How do we conceive our loved ones?

My patients know how important it has been for them to learn to distinguish between a “real mother” and a “symbolic mother”. The real one is the one who is having tea with her friends right now or the one who is sadly no longer there; and the symbolic one is the real one but as I have interpreted her, as I have introjected her. It is not a question of changing the real mother (or the real father, or the real brother, or the real referent), but of changing the symbolic, that is, changing our interpretations of reality. We are talking about the great movements that make up a psychodynamic therapy process. Finally, all this that has been seen in the perspective of history, must also be seen in the perspective of the present, of today. And, in addition, it has to be seen in relation to the dimensions of the project. That is to say, where this life intends to go, or where it is going. The project dimension is as important as the history dimension. All these mechanisms will be deployed in each session in a particular way and at some point may be linked or raised from another point of view, a new point of view. This new point of view will be an indicator that the therapy is progressing.