Friday, 9 March 2012

A Psychiatrist says....

Unwrapping Psychotherapy and Abstract Realism.. say what?

I truly wanted to speak about Saul Bellow's book, Herzog, today. Mr Bellow's portrayal of Herzog was a man tormented by his crippling relationship with himself and the various people in his life. His letters read like a confession of experiences as though he was lying on a couch, facing a white wall in a Psychiatrists office. In his case, the white wall is his letter pad. The language between Herzog and himself is loaded with abstracts and realism not too dissimilar to the psychotherapy process. Suffice to say, I love this book. 

Keeping the abstract in context of realism when having someone disclose difficult experiences is a skill. A reason  why Psychiatrists themselves are subject to intense supervision is to enable separation  from the intensity of the psychotherapy experience. Sometimes we share similar life experience, identifying with the patient can  colour our perception of the problem, supervision helps  pick up on these issues. This transaction of experience and evocation of emotion is gold dust to therapists. Some Psychotherapists are medically trained Psychiatrists by the way.

Being able to pick up on symbolic language and metaphors used to describe painful life experiences requires the Psychiatrist to identify the boundaries of where he/she ends and the patient begins.

The mechanism of transference or counter transference is a language not solely dependent on the sophistication level of the patient. In fact, it is also determined by the quality of the transaction taking place and the swift recognition of the patterns that create distress or dis-ease within the patient  by the therapist. The abstract of an experience in itself can traverse various situations in life and there are different versions of the truth re-enacted time and time again like a self fulfilling prophecy. The abstract is the impact of an experience on the subconscious and the reality is the prophecy, that is if the pattern remains unbroken. 

The role of the therapist is unlikely to be the one who force feeds the recognition of the disruptive pattern. Rather, the therapist enables the internal voice of the subconscious to interact with the conscious being to enable constructive links to be made. The breaking of the dysfunctional pattern is painful and requires expert handling and support. Realisation that ones life is a pattern stemming from events of the past is a judgement that rarely brings instantaneous relief. It is a medicine that's bitter initially but may become sweet some day if you accept that it is good for you. A language too flowery for my liking but it is a metaphor that matters.

I have learnt some important lessons regarding psychotherapy. Over analyzing mundane issues can be crippling and the 'worried well' do this all too well. The same way that an antidepressant is not a prophylactic treatment to everyday annoyances that gets you down. I would consider also that friends give exceptional counsel when there are no vested interests in the problem  that is being shared. 

Having therapy is not easy and I  respect those who brave my office, have the courage to take a mirror to their lives and commit to the process, metaphors aside of course. 


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