Introduction
Nowadays, psychotherapy is becoming recognized by many as an essential element to understanding one’s genuine emotions and finding guidance and support. For the psychodynamic psychotherapy assignment, a psychodynamic-interpersonal theory (PIT) was used. The goal of psychodynamic-interpersonal model therapy is to treat patients whose symptoms and issues stem from interpersonal relationship problems or disruptions (Barkham et al., 2017). Because of this, it is not problem-specific and, in its most basic form, can assist people with a wide range of clinical issues (Barkham et al., 2017).
As for the client, Anna is a female Australian Caucasian student pursuing a master’s degree in counseling psychology at the Australian College of Applied Professions. Throughout two sessions, several competencies were displayed, with a focus not only on the client’s verbal messages but also on non-verbal cues, making the individual’s emotions, behavior, and replies crucial elements to consider during sessions.
Session One
During the first session, Anna discussed issues at her job and with her student placement. During our conversation, it was evident that Anna felt disappointed, humiliated, and frustrated. Among the most prevalent techniques used during the session were the use of statements instead of questions, the application of the language of mutuality, a focus on “here and now,” and the picking up of both verbal and non-verbal cues.
Statements
In general, therapy sessions should never be one-sided, and it is the psychotherapist’s responsibility to guide clients and encourage them to reflect on their emotions and experiences. The first PIT competency focuses on the use of statements, which “creates an atmosphere of reflection” and validates the client’s feelings (Barkham et al., 2017, p. 58). While questions can limit the client’s focus, a statement not only contributes to a shared understanding but also invites the individual to relax and reflect (Wiger, 2020).
For example, at the beginning of the first session, Anna reflected on her feeling overwhelmed and exhausted due to having many responsibilities. As a therapist, my response was with the use of a statement instead of a question, with me stressing, “There’s a lot of pressure and exhaustion there” (2:18). Such an approach was practical since the reply of the client was as follows: “Yeah, yeah. Feels as if everybody wants a piece of me” (2:22). Therefore, with the application of this skill, it was feasible to create an experience of understanding and build rapport.
Language of Mutuality
Another crucial skill for successful therapy outcomes is the use of the language of mutuality. Such a skill helps the therapist use the first-person pronouns “I” and “we” to refer to the therapeutic alliance between the client and the psychotherapist (Barkham et al., 2017). This competency aims to serve as a tool for enhancing reciprocal participation between the therapist and the client in the therapeutic process (Greenberg, 2020). Consequently, this approach reinforces therapeutic alliance through trust and understanding (Ogden et al., 2021).
When reflecting on her being torn between responsibilities, Anna shares: “I’m dealing with two things at the same time, and it’s like… Oh… Suddenly, it’s like when you make a faux pas, you know, and you have to recover from that but really I can’t” (8:29).
Meanwhile, my response was the following: “So yeah, sometimes it’s tough for you to be that person” (8:48). Here, the approach was practical since it helped convey empathy and understanding, with the client reacting, “Yeah, always. Yeah” (8:30). Overall, the skill was crucial in the process of creating a safe space for Anna to express herself.
Focus on “Here and Now”
Moving forward, it was vital to focus on Anna’s current experiences and emotions, particularly in relation to her workplace challenges. This is the skill that “involves focusing on what the client is experiencing during the session” (Barkham et al., 2017, p.67). This competency aims to comprehend current emotions and social responses, with little emphasis on the past (Gabbard, 2017).
After asking Anna to reflect on how she felt when being abandoned and not recognized for her efforts, she replied, “My body was so sore, my shoulders hurt and my hips hurt, you know, and so on” (11:56). At the same time, Anna was encouraged to speak about her emotions now, as she was reflecting on the experience. The competency was adequate since, after guiding Anna to focus on the present, she replied, “Now that I’m being present with it, it feels as if it’s come to my lungs where I don’t have space” (11:56). As a result, the given method in therapy allowed the client to discover what immediate thoughts were.
Picking Up Verbal Cues
Although therapists should not provoke clients’ reactions, they should remain attentive to them, whether positive or negative. For this purpose, a skill related to picking up cues is essential, as it helps the therapist “appreciate, understand and tune into what the client is saying in his/her words, tone of voice and behaviour” (Barkham et al., 2017, p. 59). Active listening enables people to participate fully in discussions by requiring them to attend to both verbal and nonverbal cues (Solomon & Theiss, 2022).
In one part of the session, Anna reflected on her relationship with the residents, highlighting that “it is not just the fact that they taking my time… It’s because they’re tapping into skills that they are not paying for” (11:56). My reply was that she was “feeling like she was kind of being used,” which helped me validate the client’s feelings (11:56). The approach can be seen as an effective one since Anna said the following: “That’s right, that’s right. And because of my position in the home, I have to show respect more than others” (11:56). In other words, my message encouraged the client to share her emotions further, exploring her perspective.
Picking Up Non-Verbal Cues
At the same time, while verbal cues convey the client’s opinions and emotions directly to the therapist, nonverbal cues reflect the individual’s genuine reactions. All other forms of behavior that the client may display throughout therapy are considered non-verbal clues (Del Giacco et al., 2020). These include the client’s behavior outside of the therapy session, clothes, personal belongings, body language, eye contact, and facial expressions and mannerisms (Barkham et al., 2017).
For instance, as we discussed how Anna was often manipulated into doing something that was not part of her direct responsibilities, she said, “They can pull me into pretty much everything, you know.” At the same time, I noticed that she was expressing her feelings with a smile, which made me ask her the following: “I can hear you smile and I’m wondering if this is coming from a place…?” (18:12). She replied: “A place of ridicule? I think. Yeah, it’s ridiculous, you know and it’s it’s not really because I didn’t set my boundaries” (18:12). Anna’s reply helped not only determine where her feelings came from but also the reason for this, which is why the skill proved to be effective.
Session Two
During the second session, Anna talked candidly about her formative years and her anxiety. In addition, Anna spoke about the high standard of care she would like to give her clients and her dissatisfaction and disappointment with the limitations at her student placement that keep her from creating a safe setting where her clients can work deeply. Several competencies, such as a “here and now” approach, hypotheses, and metaphors, were frequently applied.
Focusing on the Feelings
While reflecting on past experiences is crucial, a therapist needs to recognize the importance of understanding the client’s emotions in the moment. In a session, the “here-and-now” method emphasizes comprehending current feelings and interpersonal interactions as they happen (Gans, 2021). Efforts are made to either recreate or foster the expression of sentiments in the immediate therapeutic environment, rather than discussing emotions in an abstract or past context (Barkham et al., 2017).
During the second session, Anna recalled: “As a child, I was anxious…My mum had a book she gave me, I didn’t like the book,” which emphasizes a lack of support during her formative years (10:24). My reply aimed at delving deeper into how her memories make her feel at the given moment: “I can definitely hear and feel that it’s not a very comfortable space, and when that happens, you seem to avoid it” (12:20). As a result, the approach was practical since it allowed Anna to admit the following: “Yes, I don’t want to be there” (12:33). By recognizing the issue, it can be easier to address it by focusing on what made her uncomfortable and seeking solutions.
Linking Hypotheses
By using this competency, one can establish significant connections between the therapeutic alliance and other significant relationships in the client’s life, both past and current (Barkham et al., 2017). The use of hypotheses during therapy sessions allows professionals to connect the client’s current emotions or experiences to their previous encounters or issues and to delve deeper into the issue (Kelly, 2020). For instance, at one point, Anna was reflecting on situations involving her career and how important it is for her to stay connected to her clients. As she mentions, “when I serve people, I feel that get that connection,” implying bonding and understanding (9:08).
At the same time, I noticed the following: “As you shared with me earlier about how you want to show up for your clients and care for them, I noticed your gaze shifted,” relating the current part of the session to previous remarkets (10:24). The reply of Anna was as follows: “it is because it is becoming real” (11:00). The technique was effectively given in that in her reply the client recognized that she herself felt like she needed support, which is why she yearned to help others.
Using Metaphors
Finally, in psychotherapy, the use of metaphors can help relate the client’s emotions and experiences to specific concepts and ideas. The combination of multiple visuals and/or ideas to create a new experience, order, and meaning is known as a metaphor (Barkham et al., 2017). Therapists can assess their comprehension of the client’s views and represent the client’s current state using metaphors (Stewart-Spencer & Dean, 2021).
In one part of the second session, Anna reflected on her strained relationship with her peers, which left her feeling drained. As she recalled, “I already have a degree, and I can counsel; this role is a post-degree role, and I am a counselor, but they try to interfere. That is how I feel anyway” (0:15). To show her my understanding of how she felt, I responded with the following: “It sounds like a kindergarten” (4:10). By using a metaphor, it was feasible to unlock the perspectives of Anna, showing her how it might look from the side. Overall, the application of this technique was practical since it helped the client focus more on the pressure she experienced.
Conclusion
In summary, multiple competencies were demonstrated across two sessions. These included a focus on nonverbal cues alongside the client’s vocal communication, making the individual’s emotions, behavior, and responses essential factors to consider throughout sessions. Anna discussed problems with her employment and her student placement in the first session. In the second session, Anna opened up about her anxiousness and her early years.
The particular strength evident from the sessions was a successful validation of the client’s emotions through empathy and understanding, with Anna emphasizing that my observations were correct. At the same time, some areas need more strengthening, such as elaborating on my observations and articulating what I noticed. My future learning goals include exploring cultural diversity and its impact on the therapeutic relationship, as well as deepening my understanding of trauma and its effects on individuals.
References
Barkham, M., Guthrie, E., Hardy, G. E., & Margison, F. (Eds.). (2017). Psychodynamic-interpersonal therapy: A conversational model. SAGE Publications, Limited.
Del Giacco, L., Anguera, M. T., & Salcuni, S. (2020). The action of verbal and non-verbal communication in the therapeutic alliance construction: A mixed methods approach to assess the initial interactions with depressed patients. Frontiers in Psychology, 11, 234.
Gabbard, G. O. (2017). Long-term psychodynamic psychotherapy: A basic text (3rd ed.). American Psychiatric Publishing.
Gans, J. S. (2021). Addressing challenging moments in psychotherapy: Clinical wisdom for working with individuals, groups and couples. Taylor & Francis Group.
Greenberg, T. M. (2020). Treating complex trauma: Combined theories and methods. Springer International Publishing.
Ogden, N., Boyes, M., Field, E., Comer, R., Gould, E. (2021). Psychology around us. Wiley.
Kelly, G. (2020). The psychology of personal constructs. Taylor & Francis.
Solomon, D., & Theiss, J. (2022). Interpersonal communication: Putting theory into practice. Taylor & Francis.
Stewart-Spencer, S. E., & Dean, C. J. (Eds.). (2021). Metaphors in counselor education and supervision. Routledge.
Wiger, D. E. (2020). The psychotherapy documentation primer. Wiley.