In this video interview, Paul Salvage demystifies psychoanalytic psychotherapy and explains what clients can expect from the process. Paul is a UKCP registered psychoanalytic psychotherapist who works with individuals from our Hove practice.
In second of two video interviews, Paul Salvage discusses who may benefit from psychoanalytic psychotherapy and explains how it has evolved since the days of Freud. Paul is a UKCP registered psychoanalytic psychotherapist who works with individuals from our Hove practice.
In this blog, I want to write about post-natal depression, revisiting and summarising a classic paper by Lawrence Blum, an American Psychiatrist and Psychotherapist. The paper was written originally in relation to post natal depression in mothers, however, because it essentially explores the conflicts aroused in becoming a parent and caregiver, particularly in relation to our own experiences of caregiving. I think it applies also to fathers and to same sex couples and heterosexual couples where the caring of the infant is more equally shared.
Blum’s paper, titled the, “Psychodynamics of Postpartum depression”, is available on the web.
The paper draws a distinction between baby blues which he defines as the hormonal induced depression resulting from pregnancy and childbirth, and post-natal depression, which has typical features of depression, – ‘sadness, crying, insomnia, or excessive sleep, low mood, low energy, loss of appetite, agitation and self-critical thinking.’
He describes the external factors that can contribute, such as prior anxieties and depressions, low external support, difficult relationships, difficulty conceiving, stressful life events, etc. He summarises the studies at the time into the results of different therapies and concludes that supportive counselling, CBT and Psychodynamic Psychotherapy were all superior to the control and that the Psychodynamic therapy had the biggest impact on depression, as defined by the DSM 111.
The focus is then on the possible ‘psychodynamics’ of the depression and these are what I shall briefly outline here as these are what can really be usefully explored and alleviated by Psychotherapy. Three principle emotional conflicts are outlined; Dependency conflicts, Anger conflicts and Parent conflicts.
Dependency Conflicts
In order to care for a baby, there is a need to be utterly depended upon, this is tiring and emotional and benefits from support. If there is a conflict about receiving support, a self-denial of the caregivers own needs, they can seek to repress their own essential vulnerability and needs and get depressed.
Often people manage this part by becoming carers and end up in caring roles, such as therapists (a good a reason as any why therapists need their own therapy!) This counter-dependent strategy can work until it doesn’t. Someone who seems to be managing everything well, suddenly finds the balance has tipped too far. A baby can stir up the caregivers previously unconscious or sleeping wishes to be cared for, hidden by a display of independence.
Anger Conflicts
A conflict with feelings of anger, which can feel counter to the role of caregiver. Parents can feel they don’t have a right to be angry, feel guilty about it or frightened of it, yet may have experiences and histories, which have left them feeling angry. Anger can be felt towards the baby, either as a projection of past hurts, or for the very real things it has done to the parents lives; tuned them upside down, deprived them of sleep, money, jobs, sex, etc, while carrying on with its incessant demands obliviously. The danger apart from depression in all of this, is that these feelings are denied and controlled and ‘loss of control can follow from over control as internal pressure builds up”, and has to be released, either threatening the relationship with the baby or more commonly being displaced onto partners.
Feeling the anger, tolerating it, and judiciously putting it into words, easy for the clinician to say, is the difficult and essential task for the person who is looking after the baby.
Parenthood conflicts
Caring for baby can stir up unresolved and unprocessed feelings about the caregivers own experiences of being cared for, whether a mum or a dad by a mum or a dad. Although a negative experience of being cared for can positively inform the ways in which the caregiver feels they don’t want to be, it doesn’t necessarily translate into clear ideas of how or what to be. In addition the caregiver, giving the baby what it didn’t receive, can be gratifying but can also stir up the wounds of what they, the caregiver, didn’t receive.
I would like to finish with Donald Winnicott,’s, (a British paediatrician and Psychotherapist), funny but true reasons why a mother, (or father or caregiver), hates their baby, with the intention in which they were written, to provide relief from the day to day conflicts, that can be felt in the rewarding, important but by no means easy job of nurturing an infant:-
Winnicott, D.W. (1949). Hate in the Counter-Transference. Int. J. Psycho-Anal., 30:69-74.
Paul Salvage is Psychodynamic Psychotherapist trained to work with adolescents from 16-25 and adults across a wide range of specialisms including depression, anxiety, family issues, self awareness and relationship difficulties. He currently works with individuals in our private practice in Hove.
Further reading by Paul Salvage –
The Therapeutic Relationship and the Unconsious
Adolescence: the trials and tribulations
Therapy is often referred to in terms of it being relational, or as a relationship, albeit a particular type of relationship, one that has very specific parameters, particularly around money, time, touch, and about whose inner life is there to be explored.
Despite this, in some ways, very one-way relationship, an awful lot of what goes on is a kind of relating. The therapist will encourage the client to speak as freely as possible and through a careful listening to the client’s words and to what is evoked in themselves, through this listening, they will try and relate as closely as possible to the clients experience and will feed this understanding back via their own comments, or interpretations.
What makes this different from other listening conversations, is that the therapists understanding and feedback will be influenced by the therapists training, specifically their own therapy and their learning of theories, which provide maps of mental structures and types of human experience and distress.
The therapist as well as listening to the stories, will also listen for patterns, for words, they will try and be attuned to what is going on emotionally for the client and also pay attention to the actions of therapy, to the how the client goes about relating to the therapist. When the therapist feels something useful has been understood, they will share this.
Sometimes this may not have been consciously known by the client, and this is why it can be useful. However, it can also be unnerving, as we like to believe we are the masters of our own houses, independent and not in need of the help of another.
Freud said there have been three great blows to man’s ego, the Copernican discovery that the solar system didn’t revolve around the earth, Darwin’s discovery that we are descended from animals, and share an essentially mammalian brain structure and Freuds own discovery that we have a dynamic unconscious, that the rational beings we like to believe ourselves to be is only one part of the story.
Part of this unconscious is the repressed unconscious, the place where we store the things we don’t want to know about ourselves, however these things are known at some level and we can expound a great deal of energy trying not to know them.
Getting to know and understand these parts of ourselves although often frightening to begin with, can actually be a huge relief as we come to know and accept these parts of ourselves, parts of ourselves that may seem like monsters under the bed and cast scary shadows but are usually essentially human characteristics.
Paul Salvage is Psychodynamic Psychotherapist trained to work with adolescents from 16-25 and adults across a wide range of specialisms including depression, anxiety, family issues, self awareness and relationship difficulties. He currently works with individuals in our private practice in Hove.
Further reading by Paul Salvage –
Adolescence: the trials and tribulations
Does the male mid-life crisis exist?
I’m in agreement with Brett Kharr who argues that unfortunately we have a strange situation in therapy where there are an almost innumerable different types of therapies to choose from. I think this reflects the consumerist, swipe right, swipe left age we live in and actually makes starting therapy more confusing for clients.
Richard Chessick, a Psychoanalyst, writes that;
“It is the experience of the therapists personality and the encounter with the therapist as a human who is truly present, rather than any verbal exchange, that makes the fundamental difference in therapy. It forms a link, that brings the patient in consistently over years of treatment, even at times when the patient is very angry or upset. (85).”
If, as a client, you are serious about wanting to change things and about wanting to engage in therapy then it does pay to think a bit about which therapist and therapy may be a good match for you. Sometimes you may feel comfortable with the first therapist you meet after perhaps doing some online research or obtaining a personal recommendation. Sometimes you may want to have a few initial consultations with different therapists. As a therapist I would always be more than happy for you to do this. As a client I would advise on being as honest as possible with the therapists you meet about this, as it’s a good chance to gage their reaction. A therapist where you feel you might have to worry about hurting their feelings, may not be the best choice.
When I began my training the course leader, in one of our first seminars, talked about the therapists needing to have personal therapy and how to choose and get the most out of therapy, said one thing that has stuck with me –
“Make sure to give your therapist hell”.
I have often thought about that statement and have come to appreciate, that I think at essence, its saying how important it is to be as honest as possible in therapy, especially about the things you don’t want to say and especially about the things you don’t want to say to your therapist.
This may feel strange. You may feel your therapist is annoying, a disappointment, etc. What’s useful about this and I believe unique to therapy is that the therapist who has had a thorough therapy themselves won’t take it personally, they will be able to reflect on the bits that may be true, but also may be able to help you think about the bits you may be bringing that you may also bring to other areas of your life. Is the experience of finding your therapist annoying/boring/uncaring or whatever, something you experience in other areas of your life in relation to other people? If so the special circumstances of the therapeutic relationship can be a unique chance gain insight into these recurring patterns as they are happening, not just in an intellectual way but also at a deeper more affective level. It is at that level that I believe change can really occur.
Paul Salvage is a Psychodynamic Psychotherapist trained to work with adolescents from 16-25 and adults across a wide range of specialisms including depression, anxiety, family issues, self awareness and relationship difficulties. He currently works with individuals in our private practice in Hove.
