In psychoanalytic psychotherapy, the patient is expected to freely verbalize thoughts and feelings to examine the present and re-examine the past. In the process, the patient is guided towards greater self-awareness and understanding, and his/her capacity to deal with painful psychic conflict is bolstered alongside. This insight oriented approach, though a relatively long process, results in the removal of symptoms and unlike other types of therapy, brings about a more lasting change. This method of psychotherapy, which people often confuse with other ‘talking cures’, is grounded in a rigorous theoretical and empirical understanding of the working of the psyche that is being further validated through recent breakthroughs in neurobiology and cognitive science. A shorter version, brief psychodynamic psychotherapy, is used when the focus is on a very specific problem that is the cause of psychological distress. This is most useful when the problem is related to recent stressful life circumstances allowing for a narrow focus and when the patient has the capacity to tolerate rapid engagement and confrontation, working through, and disengagement from the treatment process.
2. Psychoanalytic Play Therapy for Children
Children have difficulty in verbalizing and understanding their internal conflicts, and the emotional turbulence they are passing through gets expressed as inappropriate behaviour that gets labelled as psychopathology. But they can communicate internal material using the symbolic language of play and psychodynamic play therapy recognizes and understands this language. It is used to bring to the fore the internal conflicts of the child and the psychological problems are resolved through verbal and non-verbal interactions. More often than not, children with certain psychosomatic illnesses inadvertently get involved in the conflicts of their parents and families. Conflicts in the parental unit trigger stress and symptoms in the child, and a typical sequence of interactions recurs in the family. The child’s symptoms may then become the focus of concern for the parents diverting the attention from the root problems – thus the child’s symptoms are both a reaction and solution to stress. Since the child can only be fully helped by breaking this unhealthy pattern of interactions within the family, parental counselling sessions also become an integral part of child psychotherapy.
3. Family Therapy
The fundamental assumption of psychoanalytically oriented Family Therapy is that disturbed psychological functioning is not limited to a single individual – it reflects the disturbed interactions between persons who have significant relationships with each other. Psychological disturbance most likely originates during childhood as a result of participation in dysfunctional patterns of parent-parent and child-parent interactions. These dysfunctional patterns persist into adulthood through the continuing influence of the family of origin in the new relationships established. The patterns of interaction, if potentially destructive to the family unit, are the primary target within the therapeutic setting. The emphasis is on the here and now of the family pattern that currently acts to sustain the existing problem. The goal of family therapy is not to change the individual per se but to set right the system of relationships in which the individual is involved. Changing the interpersonal context can then also bring about individual change.
4. Couples and Marital Therapy
Couples or Marital Therapy is similar to family therapy except for the fact that it is confined to one generation of adults, whereas family therapy deals with two generations [parents and children] and sometimes three [including grandparents]. Couples therapy is quite effective in marital conflicts arising due to sexual dysfunction, infidelity, substance abuse, and domestic violence. Psychoanalytic orientation allows the therapist to look at the underlying dynamics and sexual dysfunction may only be one of several significant components of the disturbed interpersonal system. Similarly, in cases of alcohol and drug abuse, the spouse may inadvertently play a role that reinforces addictive behaviour and hence, involvement of the spouse becomes crucial for a successful outcome. Conventional methods of treatment of domestic violence focus on the victims of abuse and the perpetrators of violence are considered to be resistant to change. But Couples Therapy is successful in inducing individuals to enter treatment voluntarily and in bringing the violent interactions to an end. The therapist can help the couple unmask the complex dynamics of a seemingly simple dispute. Marital conflicts arise because the partners adopt polarized positions and become ensnared in a repetitive sequence of interactions that does not allow them to experience or choose alternative ways of responding. Couples Therapy helps the couple get out of this tedious and unhealthy pattern, and helps them recognize and explore together the immense potential, or its absence, in their relationship.
Family therapy and Couples therapy can also be successfully used to treat psychotic and affective illnesses that do not respond to traditional approaches since patients living in stressful family situations are prone to frequent relapses despite carefully monitored drug therapy. Involving the families of patients with schizophrenia frequently reduces the frequency of psychotic episodes and the need for re-hospitalization. It also increases treatment compliance in cases of serious and chronic medical illnesses.
To make an appointment for psychiatric and psychotherapeutic consultation, please contact:
Dr. Shyamsundar Kotagal
Dean of training(Academic and Clinical)