In contemporary psychotherapy, particularly in self-psychological approaches, empathy and introspection provide the method of inquiry. The field of inquiry, is the patient’s subjective world, but also the interaction between the subjective worlds of patient and therapist. So the therapist and patient are seen as part of an intersubjective therapeutic system. And of course both patient and therapist are a part of wider social systems as well. The patient’s physical and psychological symptoms, behaviour and subjective experience are all understood from within this broad context.
Contemporary psychotherapy is a meld of relationship and trauma theory. The therapeutic relationship is seen as paramount, one of it’s major functions being, the regulation of affect or emotion. Trauma theory put simply, is that trauma disrupts the process of regulating emotion and integrating experience. Thus the aim of therapy is to allow the regulation of emotion, facilitating the integration of experience, especially traumatic experience.
As a systemic family therapist I also see the therapeutic relationship as a subsystem of the patient’s social network. Whatever occurs in the therapy system whether it be my patient’s subjective experience or mine – is seen as a product of the system and to be understood in that broader context.
When a patient comes in very anxious, distressed or angry – perhaps uncomfortably so – one of the major tasks is to help reduce these emotions to manageable levels so that experiences can then be processed and integrated. If this can’t be done via therapy alone (the verbal and non-verbal aspects of the relationship), then psychotropic medication may be essential – at least as a temporary measure.
When patients find that they can make use of the therapeutic relationship to manage their emotion and make sense of their experience they begin to trust and engage in, the therapeutic process.
What sorts of specific tools do I use?
• Psychoeducation – different epistemological perspectives such as ‘fact vs story’, theory of affect/emotions including theory of shame, role-play, process meditation/mindfulness.
• An empathic-introspective approach – understanding the patient’s life and experience from their own point of view but also from:
• an intersubjective perspective – understanding what happens in therapy from within the context of the particular therapeutic relationship.
• Interventions are usually made on the basis of a thorough understanding of the patient’s perspectives, but can also be used as a way of understanding the patient’s perspective more deeply or accurately – the patient’s feedback is always paramount.