I am reluctant to reduce psychotherapy, at least as I understand the practice, to one word. Could one be more reductionist? Psychotherapy is a complex relationship between two people and their unconscious worlds. It is anything but simple. And yet, that is what I feel like doing at the moment: reducing the scope of psychotherapy to just one word – “restructuring.” Psychotherapy is fundamentally a process of restructuring. The aim of psychotherapy is to help the client grow, to unfold, to continue the developmental process of becoming more of who he really is. And to do that, some restructuring, particularly changing the structures that inhibit the person’s genuine expression, is in order.
The process of development can be understood as a process of taking on a structure. Structure comes in many shapes and sizes: one’s identity, one’s personality, one’s physical features. And whereas we all need structure (it would be some formless existence without one), all structures are limiting as well. While one grows in one direction, one is stifled or stagnant in another. The aim of psychotherapy is to help the client form new structures that allow for a fuller experience and expression of oneself and a greater engagement in the world.
The earliest experiences of structuring (development) take form in the crucible of one’s family beginning at the beginning of life. Of course, there are genetic factors that influence the unfolding of what is scripted along the lines of DNA. But a person is also molded to a significant extent by his environment. There are countless expectations (explicit and implicit) to intuit and respond to, rules to follow, demands placed on the young child. The child takes on the caregivers’ beliefs and perspectives and incorporates them as his own. I was once visiting a large family, comprised of a number of children. It was truly astonishing to me to see how bonded and cohesive a group they were. One of the older children admonished a younger sibling about how “we” do things. There was certainly a sense of “we.”
I am thinking about how this process of structuring is influenced to a large degree by adaptation. That is to say, that inevitably a person unconsciously makes decisions in order to adapt to the situation to create some safety or avoid some conflict. The results from adaptation, while perhaps guaranteeing some form of safety, are not particularly favorable to the person’s overall development. A young child for example, whose energy and enthusiasm may be challenging and unwelcome to a depressed parent, learns to hide that energy and enthusiasm. This person may develop a more withdrawn, introverted structure. She has learned, perhaps through the experience of powerful and painful rebukes, to shield that side of herself. Another person may have received messages in childhood, sometimes literally, that selfishness was bad and that the result of being selfish will be to remain lonely and shunned by others. That person may, therefore, develop a compliant structure and a primary focus on taking care of others. This adaptation again serves a defensive purpose: since the message has been that selfishness leads to isolation and loneliness, he is trying to prevent that outcome through his compliance.
There are many different forms of structure that are adaptive attempts to create safety and avoid conflict. With any adaptation, parts of the self are lost. In the examples above, the one person has banished his excitement and enthusiasm because he did not feel those energies and emotions welcomed by a significant other. In the other example, the person’s self-expression is hindered and as he lives a more subservient and compliantly structured life. It is the goal of psychotherapy to deal with these adaptations. Our goal is to open up and free those aspects of the self that have gotten boarded up and hidden away. By freeing those aspects of the self and encouraging a greater range of self-expression, a person may live a fuller life with a fuller sense of oneself.
That process happens in psychotherapy through the relationship with the therapist. Change and development are always throughout one’s life interpersonally oriented. Through the process of being witnessed by another and through the interaction with the other change becomes possible. In therapy this process begins through insight and new awareness: first observing and becoming aware of what one’s structures and patterns actually are and from what situations they originated. Once there is this level of insight, then the client and therapist can think about what changes the client desires. The two think together about what other possibilities exist. And finally there is the opportunity to enact change in the moment, in the psychotherapeutic hour. The previously compliant person becomes less compliant. That person may assert more of what he wants in therapy, voicing more of his emotions and sometimes even complaints. A self-reliantly organized person, whose adapted structure has purposefully hidden his needs in order to prevent the disappointment of not having them met, now allows himself to recognize those needs and to express them to another person (the therapist).
Change takes place in the therapeutic encounter. And then, of course, we see changes taking place for the client out in the world. That is the possibility with psychotherapy: that possibility of restructuring and building a fuller you.