What is Psychotherapy?

In general the psychotherapies aim to clear blocks to a satisfying life. Broadly defined, psychotherapy is a process through which you can discover a deeper understanding of your feelings, thoughts, and behaviour. It is not about getting rid of, getting control of, or finding solutions to, your life problems. It is about understanding your problems - learning how to listen to them more and fear them less, and discovering the ways in which you have protected yourself from your fears. This leads to greater self awareness of those desires, needs, beliefs and motivations that lie just out of consciousness, but which still influence and even control your life. The kind of wisdom gained in this endeavor can profoundly enhance your sense of meaning and satisfaction in life.

A psychotherapist may have specifically trained in psychotherapy, or may be a psychologist or psychiatrist who has elected to specialise in psychotherapy. In NZ, the government has now established Psychotherapy as a Registered profession. Alongside registration, membership of a professional organisation such as the New Zealand Association of Psychotherapists is one of the main indicators of ethical and professional practice. Such psychotherapists have engaged in extensive specialist post graduate study, and are required to undergo their own personal psychotherapy.

What is Psychodynamic Psychotherapy?

Psychodynamic Psychotherapy is particularly aligned with psychoanalytic principles, using the basic assumption that everyone has an unconscious mind, and that feelings held in the unconscious mind are usually there because they are too painful to be faced. Thus we come up with defences to protect us from knowing about these painful feelings. Psychodynamic therapy assumes that these defences have become overdeveloped or gone awry, and have ended up being a problem, rather than the solution to pain that they began as. It tries to unravel them because experience has shown that once there is an awareness of what is really going on in your mind the feelings - and the blockages created by them - can be freed up. The therapist tries to develop a relationship with you, to help you discover what is going on in your unconscious mind. This relationship evolves from a combination of theoretical understandings, clinical experience and personal knowledge of themselves.

Although a psychotherapist can guide you, no one can do the work for you - any change that happens in your life can only ultimately come from you and your own efforts. And while treatment is an interactive process this does not mean that the psychotherapist's job is be a friend or to give advice; rather, the psychotherapist must help the client understand his or her unconscious motivation. This is therapeutic neutrality, in which the therapist holds a strong awareness of keeping the therapeutic relationship deliberately focused on the clinical process of healing.

How might I know that I could benefit from it ?

• If you know you are unhappy but don't know why
• If you know why you are unhappy but feel stuck with it
• If you know you are repeating unproductive, unsatisfying, even self-destructive
  patterns but can't seem to stop
• If you have lost track of something in yourself
• If you feel driven by apparently irrational behaviour, feelings, or beliefs
• If you simply want to understand yourself more deeply
• If you have been diagnosed with depression

How long does it take?

Psychodynamic Psychotherapy generally consists of between one and three 50 minute sessions per week, at the same time, over a period of months or years. Patients may sit up or lie down. It can seem a long time, but this kind of deep work cannot be achieved by rushing. To put it in perspective, you could say that 12 sessions are really about equivalent to a weekend workshop, or a full year of once weekly psychotherapy is about equivalent to an intensive 10-day seminar. Learning to navigate and understand your interior world - just like any intensive course of study - is a process that takes hard work, commitment, and a considerable investment of time and money.

How much does it cost?

Fees in NZ range from approximately $90.00 - $130.00 per session for individual, couples, child and family work. Group fees may be from $40.00 - $60.00. Training organisations or agencies may offer lower cost therapy, between $30.00 - $55.00. Government subsidies are sometimes available in special circumstances, such as for sexual abuse, for traumatic events, for those on benefits, and for children.

Cost can be off-putting, but many patients see their psychotherapy as being an investment that repays itself over and over again through many years of improved quality of life.

So what can I reasonably expect to gain?

• sustainable positive change in your self esteem
• more satisfying relationships
• meaningful work
• smoother transitions of life and greater capacity to cope with change
• discovery/rediscovery of your own voice and choices and capacity to assert them
• atmosphere of trust, confidentiality and collaboration - if you have come from an environment where the process of revealing your private thoughts, feelings and beliefs was discouraged, you may believe you should be able to handle your problems alone. This can make it difficult to imagine that psychotherapy has anything to offer. In fact these very beliefs may be part of what is tripping you up, and moving beyond them becomes a substantial gain in itself.
• Improved quality of emotional life and relationships for future generations
  
  What are the limitations of psychodynamic psychotherapy?

Not all conditions can be "fixed" by psychotherapy or counselling alone. Clinical experience and research show that many conditions, such as clinical depression, chronic severe anxiety, attention deficit disorder, bipolar disorder and schizophrenia are significantly influenced by neurobiological processes. Even though we now know that the brain is not static and nerve cells can change, grow, and rejuvenate under the influence of psychotherapy, new learning, stress reduction and exercise, the enormity of such change can sometimes be assisted with appropriate medication.

What about Psychoanalysis?

Although the current practice of both psychiatry and psychology has been deeply influenced by the theories of psychoanalysis, all three practices have separate roots. Psychiatry is rooted in medicine and psychology in the academic study of animal and human perception. Psychoanalysis, both a theory of mental functioning and a specific type of treatment philosophy, was developed by Sigmund Freud in the early 1900s. The basic premise of psychoanalysis is that most psychological problems are the result of our unconsciously avoiding many of the unpleasant truths about ourselves. Classical psychoanalysis consists of five or six sessions per week at the same time every day, with the patient lying on a couch. Treatment length is usually years rather than months.

What are the differences between these other similar fields …..?

…. Counselling
A counsellor may become qualified through various avenues, and may specialise in different areas. Membership of the New Zealand Association of Counsellors is a good indication of appropriate skills and training. The primary goal of counselling is to assist you to ventilate feelings and discuss issues around your current problems, in order to enable you to make valid and appropriate decisions. Counselling can be beneficial if you need short term support for an issue or crisis which has suddenly intruded into your life.
Counselling offers a safe place to explore aspects of your life and the ways you interact in the world. It may support you to make changes in your life. The counsellor will listen, reflect back, and provide a framework in which you can achieve what you need for yourself.

….. Psychiatry
A psychiatrist has attended medical school and is a physician who has received specialized training in the field of psychiatry. As with other fields of medical practice, psychiatry tends to focus mainly on the use of medications for treatment. Psychiatric training does not necessarily encompass training in psychotherapy and psychiatrists are not required to complete any personal psychotherapy. Psychiatry is important to those suffering moderate to severe mental illness which requires pharmacological management.

….. Psychology
A psychologist usually holds a degree from a university or professional school. Psychology is the science of behaviour and mental processes. It uses systematic methods and its goals are to describe, explain, predict, understand and control behaviour. Psychologists have had extensive training in research and are trained to administer various psychological tests. Psychologists often offer short term therapy based on Cognitive Behavioural principles which can be helpful in reducing troublesome symptoms when the need to explore underlying causes is not considered desirable or necessary.

…..however ...
In practice the lines between the different fields of practice often blur and overlap, or clinicians may consult each other in particular areas of expertise.