Some confusing terminology.. in what ways is long term psychodynamic therapy different from a relational type of therapy? Maybe, in certain important aspects, they are one in the same? Possibly, certain therapists, unable to meet all of our relational needs, though should they?
I may be incorrect about some things, so this answer is as much about my current understanding as factual information. I’m open to more education so feel free to weigh in if something I’ve written here is inaccurate.
There are two broad models of therapy and therapists can be lumped into one or the other. They are the one person model and the two person model. The one person model aims to have the therapeutic space be exclusively about what’s going on inside the client’s mind. The therapist is there to support that process but not be part of it. The therapist also tries to keep his own thoughts and feelings out of it, and only reflect what the client is saying. That therapist is kind of a sounding board, someone to listen while the client (or patient) is sharing whatever comes to mind, but does not believe himself to have much impact on the client. If the client has feelings towards the therapist it’s all assumed to be transference and from the client’s own life. In other words, the belief is that no new significant dynamics are created in the room.
Psychoanalysis operates under the one person model. The idea there is that the patient or psychoanalysand shares whatever comes to mind in a type of free association and the therapist witnesses it all. The therapist or analyst supports this process but tries to remain inconspicuous to it and impact this process as little as possible.
Psychodynamic therapy is also analytical but makes more use of the therapist’s countertransference in the analysis. For example, if the therapist is feeling annoyed with the client in that moment, the therapist might share that with the client and wonder with the client if other people in her life have mentioned (or acted upon) feeling annoyed in this way and if so, under what circumstances. Because the therapist’s countertransference is involved there may be enactments but I haven’t figured out yet if this type of therapy is truly relational or if it’s still technically a one person type of therapy. The therapist isn’t supposed to act on his feelings or feature them… but does share them as a tool for analysis.
All relational therapies fit into the two person model. In this type of therapy, the primary means of healing is the therapeutic relationship. This relationship has a specific frame and boundaries, and it’s focused on the client’s inner world, so it’s a sanitized and limited relationship but other than that it’s allowed to live and grow as any other human relationship. The dynamics within the relationship are very much significant and often what’s being analyzed. While the topic of conversation is always going to be the inner world of the client, the therapist very much brings his thoughts and feelings about this topic to the space. In my therapy, for example, I’ll hear M say “This feels right to me” or “What you say makes sense to me” a lot. In other words, how he engages with what I bring is just as important as how I feel about it. Relational therapy can include elements of analysis as well as psychodynamic and often includes other modalities as well. In that sense it’s a bit more well rounded, but the analysis won’t be “pure” in the way one person psychoanalysis would be.
The most interesting and powerful aspect I have found in my own relational therapy is this concept called enactment. An enactment is when for a brief time, a dynamic from the client’s life is lived out in the room between the client and the therapist. The best enactments are symbolic, where the resemblance is just enough that it can be talked about and connections with the client’s life can be made. If the therapist forgets himself and acts out of his feelings too much, then the enactment can become quite real. If it lasts too long it can be harmful, but when it’s for a brief amount of time and the therapist can step outside of it, then the healing to the client from exploring together all that happened can be truly profound.
If an enactment is hurtful to the client, because they have a relationship, the situation should be worked through as a rupture in the relationship. Responsibility should be taken and apologies made when appropriate. Once the relationship has been repaired, then much can be gained by exploring the similarities between what took place in the room and what has been going on in the client’s life.
M and I have had a number of small and larger enactments over the course of our work, and at times I was activated in ways very similar to what happens when that same dynamic plays out in the rest of my life. I can usually make the connection pretty quickly. One thing I like to do is analyze the enactment itself with M. We talk about what took place between us. It’s usually cleaner and more straightforward, plus M was actually there when it happened so doesn’t need to rely on my he said/she said account. We work through what happened and what I learned… and often that is enough for me to begin to try something different at home.
Similar to an enactment but with a twist is a corrective emotional experience. This is when a dynamic starts to play out in the room but instead of the usual hopeless helpless cycle I might be on at home, M responds to me in a different way, a more nurturing way. And having that experience not only heals a wound but helps me to go back home and think, feel and behave differently when that dynamic comes up again.
Sometimes an enactment can also be a corrective emotional experience. There’s enough symbolic similarity to the dynamic going on at home to be helpful in understanding that dynamic, but overall the interactions were kinder or handled more maturely. Also, when an enactment is worked through in therapy, that is a corrective emotional experience. It gives the message to the client that when we run into snags in our relationship, we work through them and our relationship gets stronger as a result. For many clients who have had very poor quality relationships, that working things out afterwards can be a huge change from what they knew prior to entering therapy.
What I have found is that analysis of either my own mind or some interaction that took place in therapy is super helpful in gaining insights into my issues. Insights are really helpful, but they are not enough. I need the lesson to sink into the deeper parts of my mind, the feelings and unconscious activity that lies under all the cognitive analysis. That’s where I find it necessary to be in a relationship with M and having actual relational experiences in every session—to drive these cognitive insights deeper, to where I can more consistently act on them, changing the dance in my other relationships where unhealthy dynamics have set in.
