Many therapists, myself included, feel that the most potent work in psychodynamic treatment is in what’s called “working with the here-and-now.” Addressing what’s going on in the therapy room—and by that I mean what’s coming up between the person in therapy and the therapist—means we’re really cookin’! It puts the “dynamic” in psychodynamic therapy.
If you are at a place with your therapist where you feel okay about talking about your therapeutic relationship, it likely indicates a healthy level of trust between the two of you. You’ve moved from talking “about” issues (such as describing the latest negative interaction with your boss, the last argument with your wife, or the most recent bout of passive aggressiveness with that annoying neighbor) toward experiencing an issue together.
It can be scary. It takes guts. And it’s where so much amazing work happens.
So if the here-and-now is so important, why do therapists ask so many questions about the past? Why are there so many stereotypes about therapists asking about, say, your mother or father? Heck, why does your therapist want to know about your parents at all? After all, it’s you in therapy, not them, right?
Looking for Patterns
Early on in treatment, many therapists try to get a sense of your early history—questions about where and how you grew up, the family members who were (or weren’t) around, and much, much more. Was Dad down all the time? Did Mom never let you see her cry? Were you the oldest and thus “in charge” of your siblings? Were you always compared to another family member?
Therapists are often looking to suss out patterns, many of which tend to be dutifully followed in a less-than-conscious way. Emotional patterns could be strong feelings that come up for you seemingly out of nowhere. A therapist may ask you if a feeling is familiar. It may lead you to a memory of something small or large, but trusting it and seeing where it takes you can lead to uncovering and healing a long-held wound you didn’t know was still there.
Therapists are also attuned to relationship patterns and how they may be affecting you now. These may be recurring types of relationships (“Why am I always dating the same type of person who treats me this way?”) as well as patterns in your family’s history. For example, a man who feels he needs to hold the family together without showing emotion may have been modeled that by his father, who may have been modeled that by his father, perhaps instilling an unconscious limitation regarding what a father can be.
Using Patterns to Promote Change
In this way we are moving back and forth, examining how your past was the forerunner to who you are now. It dictates nothing. Someone else with your exact past wouldn’t necessarily be in the same place you are now, but we can often connect dots that led to the issues you may be struggling with.
Someone else with your exact past wouldn’t necessarily be in the same place you are now, but we can often connect dots that led to the issues you may be struggling with.
The past can provide some insight. It’s a reminder that your mental health is not all about “you” because there’s a larger picture of you in an environment, a greater context. The past can help put all of this together to better understand who you are. When you look at a pattern that has led to “you” and realize you’ve been using what you were given the best you could, you invite room for self-compassion. Positive change is very difficult without allowing yourself some of that.
It’s not about the insight, though. Insight-only therapy would make treatment an interesting intellectual exercise, but one that led to little actual transformation. Once we connect with past issues, uncover patterns, and unpack how strong emotions elicited by passing thoughts are actually learned responses to old hurts, we can finally heal those hurts.
That’s what we do when we work with the here-and-now.
We can finally let out anger that previously found its voice as depression.
We can finally cry about something that had been manifesting as resentment in every power dynamic we were on the less empowered side of.
We can truly, deeply laugh at something we once held as morbidly sacred.
Using the present to connect with the past, and then the past to connect back to the present, is how we move forward.
© Copyright 2016 GoodTherapy.org. All rights reserved. Permission to publish granted by Justin Lioi, MSW, LCSW, GoodTherapy.org Topic Expert Contributor
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