Espousing the psychodynamic orientation

It has been my understanding through my learnings so far that being comfortable with a theoretical orientation is as much about being comfortable with oneself and one’s presence in the therapy room as it is with resonating to the key principles a theory has to offer.

With the ever-growing emphasis on quantitative empiricism and the nature of managed care, it is difficult to pursue theories that do not fit that mould. Rigidity, compartmentalization, and classification stifle human development and yet as humans we are drawn towards these to reduce ambiguities and create meaning. Clients and clinicians alike are thrown into the world, something they understand by creating meaning around it. This meaning, in turn, differs for every individual as does their trajectory of growth and evolution. We, therefore, are best understood in our context, in the givens of our existence, with the capacity to make choices in the present, governed by our past experiences and future expectations. What makes us unique as individuals influences what makes us unique as clinicians. And what makes us unique as clinicians is influenced to some extent by the theories we espouse. Looking back on my encounter of stumbling upon and assimilating psychodynamic theory, I often find it analogous to the experience of falling in love. At some levels, all beginners might go through these stages (more or less) when trying to figure out the clinical equivalent of “love of one’s life.”

1. Admiration: This is the first stage. It’s the “aha” moment you have with a theory. For me, this was when I was studying Freud’s defence mechanisms. I was sitting in my first introductory psychology class when my professor started talking about Sigmund Freud. Like most classes that attempt to distil the fundamentals of psychoanalysis in 60 to 120 minutes, this class mocked the psychosexual stages, the overemphasis on sexual urges, and the supposed inapplicability of Freud’s theories to the current times. The discussion in this class, however, changed dramatically from an oversimplification of Freud’s theories to a deep conversation about defence mechanisms. I remember my professor explaining displacement, repression, and regression with examples she had encountered in her clinical practice. I remember questioning my own use of those defences and what triggered them. Ever since that day, I consider defences to be an important part of understanding human behaviour. Sometimes, I have to be careful to not over analyze them in personal interactions. Nevertheless, it was a beautiful moment - this first encounter. I admired the simultaneous simplicity and complexity the theory offered. It pulled me in. It was gripping.

My undergraduate professors were certainly not fans of Freud but that didn’t prevent me from being intrigued by his work. It wasn’t that I was completely absorbed by psychodynamic work the very moment I read about it. I understood the criticisms that were offered and probably agreed with a lot of them myself. However, you can grow to love things that do not fulfil all your checkboxes and the same applies to theories. Maybe, my professors’ nonchalance towards and occasional mockery of psychoanalysis were important reasons why I was drawn to Freudian concepts and those of his successors. My admiration (mostly unconscious at that point) had a starting point in rejecting and questioning the popular notion of psychoanalysis that floated around me. I often wonder if I would be as interested in the psychodynamic approach as I am today if I was surrounded by people who strongly believed in it. Admiration, this first stage of falling in love with a theory, just like the first stage of falling in love with a person, is influenced by personal sensibilities and traits.

2. Interest: If admiration lasts for more than a few weeks then it develops into an interest. In my case, the more I read about Freudian concepts and works of Neo-Freudians such as Sullivan, Jung, Horney, and Adler, the more I wanted to read and know about everything that existed within the realm of psychoanalysis. The unconscious, the structure of personality, the analysis of dreams, and the techniques of interpretation and free associations were ideas that resonated with me. I was interested in instincts, ego, and morals. These concepts seemed readily available to be applied to real life. As I further studied Horney’s work on neurotic needs, Erikson’s psychosocial stages of development, and Adler’s individual psychology, I realized that neo-Freudians had much more to offer. There was more ground to cover. There was a thirst to know more about the theories and the theorists.

When admiration moves on to interest you seek out more information about the theory that gripped you. If you are like me, you will want to know about not just the theory but it’s creators too. You basically try to get to know everything there is to know. You also begin experimenting with the theory’s applications. It can feel all-powerful and all-consuming. It is like visualizing a future with the theory for the very first time.

3. Passion: Passion is persistent enthusiasm and desire. This is not just being consumed by the theory but also thinking that it is “the best”. This happened for me during my years in my Master’s program. I had read quite a few psychodynamic theories by that point and was ready to shoot down any criticisms put forth by those from other orientations. I was eager to learn how to “use” psychodynamic therapy. I remember attending a psychodynamic pre-conference seminar by Dr Nancy McWilliams and thinking to myself how in the world was everyone not a psychoanalyst. Dr McWilliams’s conceptualizations made such perfect sense to me that I had a hard time understanding why anyone would choose an alternative conceptualization. During this time, I tried to fit every client into the psychodynamic mould and truly believed that it had the answer to every question. It is not uncommon in this stage of passionate frenzy to seek out other people with shared interests. There is, however, the danger of looking solely for confirmatory evidence. This is the stage where you look at the theory through a lens of positive delusion.

4. Love: This is when you realize that your theory may not have the answer to every question or be translated in every clinical situation. I know now as I start the second year of my doctoral training that I may not be able to use the psychodynamic approach with every client I encounter. I accept that sometimes to find the answer I may have to step aside from the psychodynamic stance. I acknowledge the problematic conceptions in some of the older theories proposed. I recognize the potential cultural limitations of my theory. And yet, I have a strong desire to assimilate it and understand it better. I am always interested in reading about new developments in the field, particularly in neuro-psychoanalysis , interpersonal analysis, attachment theory, and brief psychodynamic treatment. When you acknowledge that a theory might have flaws and yet you chose to commit to it, accept it wholly, and love it for what it is, that’s when you know it’s your primary orientation. After all, everyone and everything can be argued to be flawed. Similar to the classic Wabi Sabi artwork of filling in the cracks in a ceramics pot with gold to accentuate it’s charm, you begin to understand the core of your theory and occasionally integrate it with other theories making it imperfect and wonderful.

What we believe about falling in love might be true about falling in love with theories (at least based on my own very subjective experience). Love starts with a jolt, a sudden attraction. Or it may start with friendship, admiration, or mutual likes and dislikes. Irrespective of how it starts, it moves on to a sustained interest that develops slowly and gradually over time. These initial stages can often be ambiguous and undefined. These are stages of confusion where you seek clarity and reject it, both at the same time. There are moments where you question reciprocity, practicality, and fit. However, the best part of love happens when you move on from these important yet challenging stages. It happens when you let yourself be engulfed and vulnerable. When the positive is so overpowering that it can become black and white. And yet in its most final stage, we experience a reconciliation of different aspects of the object of our initial admiration. We not only acknowledge the good and bad but accept it. There is a certain warmth that develops when confronted with the essence of love. A whole acceptance - that’s rare, and that’s what makes love special.

If you think simultaneously about the love of your life (or an approximation to the love of your life) and your primary theoretical orientation, you can see for yourself how there might be some striking similarities between the trajectories for both. If you don’t yet have a primary theoretical orientation, you may find yourself stuck at one of these stages. If you don’t find yourself stuck, it is possible that you reject the notion of espousing a theoretical orientation. Like falling in love with the wrong person for the wrong reasons, we can also fall in love with the wrong theory, especially when we introject ideas as opposed to carefully inspecting them. Dogma can also be a barrier in finding what we truly love. Luckily, it is much easier to alter our theoretical stance than it is to mend a heartbreak.