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135 Chapter 4 The Therapeutic Process: Overview and Getting Started Great is this power of memory, exceedingly great, O my God—a large and boundless inner hall! Who has plumbed the depths of it? Yet it is a power of my mind, and it belongs to my nature. But I do not myself grasp all that I am.Thus the mind is far too narrow to contain itself. But where can that part of it be which it does not contain? Is it outside and not in itself? How can it be, then, that the mind cannot grasp itself? A great marvel rises in me; astonishment seizes me. Men go forth to marvel at the heights of mountains and the huge waves of the sea, the broad flow of the rivers, the vastness of the ocean, the orbits of the stars, and yet they neglect to marvel at themselves. —Augustine, Confessions 10.8.151 Goals of Therapy and Overview of the Therapeutic Process While psychotherapy as such did not exist prior to the nineteenth century, human beings have always sought wise companionship to help them strengthen relationships and to heal from emotional and spiritual distress. The “cure of souls” (cura animarum) and the “cure” or “care” of psyches belong to a long tradition, branches of which include (in Western culture) pastoral care, pastoral counseling, psychotherapy , and spiritual direction. Pastoral psychotherapy is defined in the introduction to this book as a mode of healing intervention that is specifically grounded in psychoanalytic theory and methods—that is, with a primary focus on unconscious mental and emotional processes—and held in a constructive, creation-affirming theology. Its purpose is to help, accompany, and support others in recognizing and healing long-standing psychic wounds and/or patterns of self-defeating relationships to self and others. The psychological aspect of this definition does not differ significantly from a classic description given (in the medical language of the period in which she was writing) by Frieda Fromm-Reichmann in 1960: The goal of intensive psychotherapy . . . as I see it and as it is viewed by [my teachers] . . . is understood to be: alleviation of patients’ emotional difficulties in living and elimination of the symptomatology, this goal to be reached by gaining insight into and understanding of the unconscious roots of patients’ 136 MANY VOICES problems, the genetics and dynamics, on the part of both patient and [psychoanalytic therapist2 ], whereby such understanding and insight may frequently promote changes in the dynamic structure of the patient’s personality.3 What is added in pastoral psychotherapy is, of course, the ongoing process of theological as well as psychological reflection, and the conviction that healing is a sacred process desired and supported by God/the Holy, with a further ideal of freeing and empowering persons to live out their unique giftedness and vocation from God as fully as possible. The main elements of the psychotherapeutic process, however , and the methods involved remain largely the same.There is the initial phase, in which the patient and therapist explore the patient’s hopes and fears for the therapy, begin to understand the contours of the patient’s distress (pastoral/therapeutic assessment ), and establish an initial sense of mutual trust and rapport. This initial phase begins in some sense in the patient’s fantasy before the first phone call to schedule an appointment, and it blends gradually into the next phase until there is a shared sense that the therapy has “quickened.” Often the patient has unconsciously or consciously tested the therapist’s reliability and safety in one or more ways and comes to at least a preliminary sense that there will be sufficient safe “holding” for the patient’s deeper pains and anxieties. There is often also, at another unconscious level, a sense that there is some kind of unconscious match, in which the therapist’s own psychological makeup—neuroses, character vulnerabilities, and all—will be a fertile enough ground for the necessary projective processes to take place in the transference in order for healing and change to occur. Transference is Sigmund Freud’s term for the patient’s projections, or transferring , of experiences of parents and other authority figures from childhood onto the person of the therapist (or helping professional or authority figure). The therapist is also testing his or her own reactions and “gut” responses (countertransference) at this early stage, making sure that the coming psychic demands will be tolerable and that there is an early sense that the work to...

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