My Approach to Psychotherapy

 

          Life as a human being is no easy task.  From whatever way you look at it, life is hard.  For some of us, the weight of this leans toward depression, self doubt, shame or feelings of worthlessness.  For others, these pressures lead to anxiety, obsession, compulsion or simply an ongoing state of terror just beneath the surface.  Adapting to life and to the often disappointing or traumatic nature of early experience causes us to build defenses and protections against future emotional harm or injury.  We wear armor, we keep our truest selves hidden, we avoid intimacy, we devalue others, we attack what we fear and, most importantly, we avoid wanting too much from life.  We wind up afraid, unfulfilled and endlessly repeating our early patterns of disappointment.  

          In my experience, there are several important layers to consider in addressing ongoing psychological pain.  The first step, often, is to recognize that something isn't working.  Beginning to see patterns of repeated unhappiness in our lives is a central part in the process of bringing about change.  This is where psychotherapy often begins: coming to sit with a person who is trained to offer care and acknowledging to them, not only the pain that we feel, but also, the desire for things to be different.  

          Another layer in the work of healing relates to how we address emotional injuries from the past.  Many clients question the usefulness of talking about the past.  "What good will it do," they often ask, "nothing can change the past.  Why wallow?"   The psychotherapeutic work of healing past injuries is anything but wallowing.  Our unresolved experiences from the past live on inside us, very much a part of the present. Many of our struggles with the present stem from the ways in which these hurt parts of us continue to repeat the same experiences of fear and longing.  Psychotherapy is about noting the parallels between present and past and attempting to meet those past parts of us in a new way in the here and now.  It is not just about knowing what happened to us, it is about returning to the past experience as a way to help those injured parts of us to heal.  We can't change what happened to us, but we can change our relationship to what happened.  If a child falls and skins their knee, addressing the injury with cleaning, medicating and bandaging doesn't change the fact that they fell, but it does help the child to feel better and it certainly helps the body to heal.  

          Contemporary neuroscience has recently been able to better understand what happens in the brain during psychotherapy and why long term psychotherapy works.  When we talk in therapy about past developmental experiences, we are in essence bringing these memories out of long term memory and holding them in our minds, working with them emotionally and cognitively.  What is now clear to neuroscientists is that when this is done under a therapeutically controlled situation such as psychotherapy, the contents of memory becomes positively altered as we work with them emotionally and experientially.  When we then return these past experiences to long term memory, they are subtly different. We have changed them.  Now, needless to say, the amount of change that comes from one instance of talking about a painful experience, is quite small. But, little by little, things begin to change.  This is one of the reasons that healing takes a good amount of time.  

          This approach to treatment is what is often called psychodynamic psychotherapy.  It refers to an approach that rests upon the assumption that what we experience growing up shapes our personality to a significant degree. This approach is quite different from what is referred to as cognitive behavioral psychotherapy (CBT). CBT does not necessarily require a client to deal with the past.  And instead of working from the inside out as we do in psychodynamic psychotherapy, CBT works from the outside in.  The basic idea of CBT is that if you can get a client to change how they think and act, the symptoms of depression or anxiety will cease.  I highlight this difference between CBT and my approach to emphasize that there are many roads to Rome.  What is important in finding a therapist is sensing what feels right for you.

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