Illustration by Drew Shannon
Thomas R Verny is a clinical psychiatrist, academic, award-winning author, poet and public speaker. He is the author of eight books, including the global bestseller The Secret Life of the Unborn Child and The Embodied Mind: Understanding the Mysteries of Cellular Memory, Consciousness and Our Bodies.
As luck would have it, today is Halloween. Historically, Halloween marked the transition to winter and a time when the boundary between the living and dead was believed to be frail.
Halloween, with its playful embrace of darkness, masks, and transformation, offers a compelling metaphor for psychotherapy that I planned months ago to explore in today’s column. In psychotherapy, patients or clients (depending on who is treating them) are invited to uncover and confront the “masks” they wear in daily life – the defences, roles, and narratives that conceal deeper emotional truths. In both settings, the partition between summer and winter, the conscious and unconscious, become more permeable.
There is hardly any person among us who at some point in their life has not felt depressed or unusually anxious. Maybe they finally noticed that their relationships always ended badly. Or, one day, a friend or their partner suggested that they needed anger management. At this point, the chances are they thought, “That’s ridiculous, I’m just a bit tired. Nothing a holiday or a new job couldn’t fix.” And they readjusted their mask.
But then, over time, things got worse, and this person, perhaps even you, decided to look for a therapist. And that’s when you discovered that finding a therapist who is right for you is not easy. It’s like walking through a Marrakesh souk faced with a bewildering array of therapists loudly hawking their approach as best suited for what ails you.
Can science solve the puzzle of consciousness?
For purposes of clarity, I have created two categories to help the reader make informed choices. The first one, Psychotherapy I, is largely focused on “then and there with a bit of here and now” therapies. It is classic talk therapy based on Freudian and Neo-Freudian concepts aiming to help the person develop their full potential and become mentally and physically healthy. It is usually long term. I shall discuss it in this column.
The second one, Psychotherapy II, will appear next month in this space. I refer to it as “here and now with hardly a hint of there” therapy. The primary object of these therapies is symptom relief and behaviour change. It encompasses the wildly popular Cognitive Behaviour Therapy (CBT), coaching, and counselling. It is typically short term, sometimes even with a preset number of sessions.
Practitioners in the Psychotherapy I group hold a wide range of theories and methods. Nevertheless, they agree that certain fundamental elements are central to effective therapy. These include establishing a strong therapeutic alliance, exploring early family relationships, examining and reshaping thought patterns often related to low self-esteem, identifying self-destructive behaviours, and inquiring into current stressors.
If you enjoy reading, watching movies or live theatre, think occasionally about spirituality, philosophy or history and are introspective or willing to be more so, one of the therapeutic approaches in this section may fit your interests and personality.
The gold standard of therapy used to be, and in some quarters still is, Freudian psychoanalysis. Trying to get a better grip on the current status of psychoanalytic therapy, I spoke to Dr. Doug Weir, president of the Toronto Psychoanalytic Society. I asked him what he thought about the apparent decline of interest in psychoanalysis. While acknowledging the reality of this, he was optimistic about the future, pointing out that there is a resurgence of interest in psychoanalysis, likely because symptom-focused therapies fail to address underlying issues.
I asked him to explain to me the differences between psychoanalysis and psychoanalytic psychotherapy. Dr. Weir noted that psychoanalysis involves more frequent sessions, often five times a week, and a deeper focus, while psychoanalytic psychotherapy is more modest in its goals and is typically offered once or twice weekly. He emphasized that psychoanalysis today is broader, more relational, more culturally sensitive and more open to dialogue with other disciplines than it was 50 years ago. It retains its core commitment to unconscious life, the importance of early relationships, and the transformative power of interpretation, as well as the significance of transference and countertransference.
Related to Freudian psychoanalysis is Carl Gustav Jung’s analytical psychology. Jung, a Swiss psychiatrist and contemporary of Freud, considered individuation to be the main task of human development. He created some of the best-known psychological concepts, including synchronicity, archetypes, the collective unconscious and extraversion and introversion. While Freud put much emphasis on sexuality, Jung focused on spirituality and the creative elements in the unconscious.
From the times my grandmother read me fairy tales before bed time, I acquired an enduring love for them. Not surprisingly, when I first discovered one of Jung’s colleagues, Marie-Louise von Franz’s books, Shadow and Evil in Fairytales and The Psychological Meaning of Redemption Motifs in Fairytales, I took to them like fish to water. There is much to like about Jungian analysis.
Another contemporary of Freud was Alfred Adler, an Austrian medical doctor, psychotherapist, and founder of the school of individual psychology. His emphasis on the importance of feelings of belonging, relationships within the family, and birth order set him apart from Freud and others in their common circle.
The complex crisis facing men today
Lacanianism or Lacanian psychoanalysis is a theoretical system developed by Jacques Lacan in the 1950s to the 1980s. Lacanian perspectives contend that the human mind is structured by the world of language. Dr. Lacan stressed the importance of desire which he believed to be perpetual and impossible to satisfy. His theoretical framework and clinical practices, like sessions as short as five to 10 minutes, remain controversial and a subject of debate within the psychoanalytic community.
Gestalt therapy, created by Fritz and Laura Perls rose to popularity in the golden age of Humanistic Psychology, the 1960s and 1970s. Abraham Maslow, Carl Rogers, and Rollo May were the most influential of the many psychologists involved in developing Humanistic Psychology. Fritz Perls’s approach emphasized personal responsibility, heightened self-awareness, and living fully in the present rather than being preoccupied with the past or future. Dr. Perls gave many public demonstrations employing methods such as the “empty chair” exercise and dream exploration. At its core, the therapy holds that genuine healing arises through direct experience and by resolving “unfinished business” or unresolved emotions carried from the past.
Most psychiatrists, clinical psychologists and other psychotherapists offer what is usually described as psychodynamic therapy, that focuses on habits and defences developed earlier in life and assisting the patient/client to live a healthier life free of symptoms. It is eclectic in the sense that the therapist is well versed (or should be) in many of the therapies mentioned above (and others) and selects the method or strategy they believe is best suited to their patient. To illustrate: in one session the therapist may explore a patient’s dream using the two chair Gestalt approach, and in the next session, a psychoanalytic technique of free association.
Research indicates that insight-oriented, psychodynamic, or psychoanalytic therapy works, which is to say that people who undergo therapy have a higher chance of improving their mental health than those who do not. It does meaningfully reduce symptoms, often performing as well as other active psychotherapies. [1,2,3].
For individuals with more complex or co-occurring conditions, such as chronic depression combined with personality disorders, psychodynamic approaches may produce deeper structural changes, enhancing personality organization and relational functioning that extend beyond the effects of therapies focused solely on symptoms. [4,5]. Some studies suggest that although psychodynamic approaches may not always show immediate superiority over other active treatments, they may offer advantages in maintaining gains over the long term. [6,7].
You should know that there exist a very large number, perhaps in excess of one hundred, I have not counted them, derivative types of dynamic psychotherapy with names like Internal Family Systems, Accelerated Empathic Therapy, Accelerated Experiential Dynamic Psychotherapy, Family Constellation Therapy. The other day, I encountered in this paper a new, at least for me, entry: philosophical therapy.
The most significant difference in patient outcomes, according to Bruce E. Wampold, Emeritus Professor of Counseling Psychology at the University of Wisconsin and Director of the Research Institute at Modum Bad Psychiatric Center, Vikersund, Norway, almost always lies in the skills of the therapist, rather than the techniques they rely on. Extensive research has shown that the quality of the therapeutic relationship – marked by trust, a sense of safety, and agreement on treatment goals – is one of the strongest predictors of whether a patient will benefit from therapy. [8, 9].
In my more than 50 years of practice, I have found that successful outcomes are the result of the right combination of an honest, well-motivated patient and a therapist with a deep knowledge of the field of Psychology and a caring stable personality. You do not want to see a therapist who is in the midst of a divorce or who is an alcoholic. In a sense, it’s like dating. You look for good chemistry.
Remember the old joke: How many psychiatrists does it take to change a light bulb? Just one. As long as the light bulb is willing to be changed.
To find a therapist, ask your primary health care provider or a friend for suggestions. Then do your own research. Make certain that any therapist you’re considering is certified and/or a licensed mental health professional and that they treat your area of concern (for example, anxiety, eating disorders, addictions, etc.) Before booking an appointment, do not hesitate to ask questions by calling their office or e-mailing them. Ask about their approach to therapy. Is it insight-oriented or behaviour modification focused, or a combination of these? If indicated, do they prescribe drugs? How long are the sessions? Is there a limit on the number of sessions? What are their fees?
Some people spend more time looking for a new car than a therapist. Finding the right therapist takes time and effort. But it is time well spent. It may help you become healthier, happier and more authentic. It may help you to love and be loved.
References
1.Cuijpers, P., Oud, M., Cipriani, A., . . . & Furukawa, T. A. (2021). Psychologic treatment of depression compared with pharmacotherapy and combined treatment in primary care: a network meta-analysis. The Annals of Family Medicine, 19(3), 262-270.
2.Leichsenring, F., Rabung, S., & Leibing, E. (2004). The efficacy of short-term psychodynamic psychotherapy in specific psychiatric disorders: a meta-analysis.Archives of general psychiatry, 61 (12), 1208-1216
3.Briggs, S., Netuveli, G., Gluckman, N. S., Kangogyere, P., . . . & Lindner, R. (2019). The effectiveness of psychoanalytic/psychodynamic psychotherapy for reducing suicide attempts and self-harm: systematic review and meta-analysis. The British Journal of Psychiatry, 214(6), 320-328
4.Luyten P, Blatt SJ. (2012). Psychodynamic treatment of depression. Psychiatr Clin North Am. Mar; 35(1):111-29.
5.Abbass A, Town J, Driessen E. (2011). The efficacy of short-term psychodynamic psychotherapy for depressive disorders with comorbid personality disorder.Psychiatry. Spring; 74(1):58-71.
6.Gonon F, Keller PH. (2021). L’efficacité des psychothérapies inspirées par la psychanalyse : une revue systématique de la littérature scientifique récente [Efficacy of psychodynamic therapies: A systematic review of the recent literature]. Encephale; 47(1):49-57
7.Kivlighan DM 3rd, Goldberg SB, Flückiger C, . . . Wampold BE. (2015). The enduring effects of psychodynamic treatments vis-à-vis alternative treatments: A multilevel longitudinal meta-analysis. Clin Psychol Rev.; 40:1-14.
8.Wampold, B. E., Mondin, G. W., Moody, M., Stich, F., Benson, K., & Ahn, H. N. (1997). A meta-analysis of outcome studies comparing bona fide psychotherapies: Empiricially,” all must have prizes.“. Psychological bulletin, 122(3), 203.
9.Flückiger C, Del Re AC, Wampold BE, Horvath AO. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy (Chic). 55(4):316-340.