Technique and mechanisms of change

The therapist should take the role of a professional but sympathetic listener, avoid asking too many questions, and avoid imposing his or her own feelings and opinions through making moral judgements or giving direct advice. In contrast to cognitive and behavioural therapies, there is no explicit planned agenda in the sessions. While improvement of current symptoms may result simply from the opportunity to talk and express feelings, more fundamental change usually requires the use of interpretations designed to help the patient be more aware of emotions and express them more clearly, as in the following:

• Identifying and challenging defences against unacknowledged feelings: use of mental defence mechanisms (see Glossary).

• Pointing out discrepancies between stated wishes and actual behaviour; for example, a patient may repeatedly say that he wishes to end an unsatisfactory relationship, but take no practical steps to do so.

• Pointing out links between earlier life experiences and current problems; for example, a patient's silence in the face of marital problems might parallel his response as a child to difficulties between his parents.

• Comments on the transference between patient and therapist as revealed by the patient's behaviour within the session itself. Transference means that the patient feels and behaves toward the therapist as toward important figures in the past. Transference can develop more easily if the therapist's real personal attitudes and circumstances are not revealed.

• Counter-transference: the therapist's feelings and behaviour toward the patient, may also be utilized constructively if properly recognized. If not recognized, they can hinder the therapy.

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