Netflix is the Royal Road…

Young adults need an active and engaged therapist. A gulf continues to exist between the theory that psychodynamic trainees are taught – still largely derived from the holy books of psychoanalysis and an assumption of five times a week open-ended analysis – and the realities of providing therapy and counselling on a time-limited, once a week basis to students.

These comments were originally given at a talk for trainee and volunteer counsellors and therapists embarking on clinical placements at a University counselling service. Adopting a cross-modality approach, three qualified practitioners from different modalities presented outline models from psychodynamic, cognitive analytic therapy and cognitive behaviour therapy perspectives.

The following points are not definitive or prescriptive. Rather, some stars to sail by, that I find helpful in approaching short-term psychodynamic work with university students.

Listening

Symptoms: Classical psychoanalysis contends that an unacceptable impulse or idea is met with repression. Conflict ensues and a compromise symptom is produced. Symptoms are therefore meaningful – a form of disguised communication. One way of looking at what we do using a psychodynamic approach is an attempt to turn symptoms back into ideas. Ideas can be malleable. Symptoms tend not to be.

The Past: I am interested in the client’s past but only in so far as it sheds light on the current problem.

Listen closely to the opening story: Links may be present even between the choice of course and personal narrative. A student of law, for example, may be attempting to rework a sense of injustice suffered in their own lives.

Listening behind the problem: This is obvious but do not necessarily take things at face value. Remember to listen out for what is not being said.

Listening beyond the problem: Try to make contact with the person beyond the problem. As we go along, I am less interested in a client’s dreams than I am in their transitional objects. Updating Freud, Netflix is the royal road to the unconscious. I have learnt much about a person’s conflicts and identifications when discussing their favourite characters in a film such as Little Miss Sunshine or boxed set such as Designated Survivor.

Framing

Delimiting the horizon: In short, what is it we are going after? What is it we agree not to discuss?

Curb your own narcissism: Though it is gratifying to be thought an expert, debunk idealisation. We want the student to export what works well out of therapy and into life. Go with the better idea. Comments such as ‘What you’ve said is better. Let’s go with that’ recognise the other’s resources. Wherever possible, work collaboratively.

Intervention

Language: I aim to make my language simple and effective. I avoid clichés where possible. I never use the words ‘journey’ or ‘safe space’. Make a space too safe and you’re in danger of making it dull.

The pattern behind the content: I tend to home in on general patterns of thought and behaviour, not the particular case. The underlying belief that ‘Nothing I do is good enough’ tends to be repeated across a range of environmental and relationship situations.

Defence mechanisms: Consider the secondary gains and losses. Social avoidance cuts down on the risk of further disappointment, for example, but it also increases the risk of isolation and loneliness. Phrase it simply: ‘Given your experiences, we might well understand how your avoidance has developed. At this point, however, we are increasingly mindful of the cost’. Offer compassionate understanding – curiosity not moralisation. 

The student’s intervention: I aim to help the student to recognise the pattern, not compel them towards immediate action. By midway, a natural review point in time-limited work, what use is insight without changed action? I encourage them to conduct their own research into the problem by playing a different card, take a modest step forward and report back. Almost predictably, there will be a spike in their levels of anxiety.

Anxiety

I am not offering to give someone the tools to manage their anxiety. In all seriousness, I am looking to help them find new and interesting things to worry about. Anticipate certain forms of anxiety – not the most acute kinds – as a sign of things going well. Just as there is good cholesterol and bad cholesterol, the same may be said of anxiety. Anxieties about the changes we make in our lives confer a sense of movement, some light at the end of the tunnel, but bearing them requires courage. Paralysing anxiety, where no movement seems possible, has a tendency to become depressive.

Happiness is not the goal

Unless we are sadists or masochists, emotional pain is not pleasurable. But it is inevitable. The contemporary and widespread notion that unless we are happy we are failing in some way is profoundly unhelpful to good mental health in the student population and needs to be contested.