Insight, uncovering approach in Therapy or Supportive approach

By: Roya Sakhai. Ph.D. MFT

There are different approaches to provide therapy.  If a therapist uses Insight, uncovering approach to therapy the focus of the therapy will be to make the unconscious conscious.

Insight, uncovering approach in Therapy, making the unconscious conscious

In psychodynamic psychotherapy, one of the things that we think helps our patients is making the unconscious conscious.  This idea was the basis for Freud’s first theories drawing on his clinical work.  Freud hypothesized that some patients developed symptoms because thoughts and feelings that were not accessible to consciousness nevertheless exerted a pathological effect on their conscious functioning.  Freud’s idea was that many of these thoughts were memories, and thus he said that these patients “suffer mainly from reminiscences”, Although Freud used hypnosis to bring the sequestered memories into consciousness, he and his patients soon realized that simply talking freely brought unconscious thoughts and feelings to the surface.  Since that time, ideas about therapeutic action have been more complex.  However, the basic ideas that:

• Thoughts and feelings that are out of awareness can effect ad motivate people, often leading to habitual but maladaptive ways of thinking and behaving; and
• Becoming aware of these thoughts and feelings can be therapeutic

Why should becoming aware of unconscious thoughts and feelings be therapeutic?

• Cloistered off thoughts and feelings can be harmful and releasing them can be cathartic. This is called abreaction.
• Freud said an element from the unconscious “proliferates in the dark” if it is not brought into consciousness through speaking, meaning that it will grow to enormous, inappropriate dimensions.

We have all had the experience of being less afraid of something once we’ve talked about it.

• If the forces that govern our thoughts, feelings, and behavior are unconscious, we cannot control them.

How do we help people to become aware of things that are out of awareness?

The unconscious mind is governed by what we call primary process, which is non-linear and non-verbal (like dreams), while the conscious mind is governed by secondary process, which is linear and verbal ( like conscious thought).  Thus, in order to understand unconscious thoughts and feelings, we have to translate them into a form that the conscious mind can understand.

To understand the unconscious mind we need to also understand the division of the mind into three basic parts- the id, the ego, and the super-ego.

• The id consists of wishes and desires
• The super-ego contains conscience and personal ideals
• The ego manages the person’s inner mental life and relationship to the world.

To create new growth help can occur by:

• Development of new ways of thinking about oneself and of regulating sef-esteem
• Development of new ways of relating to others
• Development of more flexible, adaptive coping mechanisms.

Supportive approach in therapy

In supportive approach we assist our patients in various functions that are impaired.  For example shyness can greatly hinder a person’s ability to engage in relationships with others and can lead to tremendous loneliness.

Supporting strategies

If we think that a person’s relationship problems stem from gaps in social functioning.  Then our interventions have to be aimed at supplying missing functions or assisting weakened functions.

Supplying interventions for improving relationships may include praising, empathizing, and nurturing, soothing, validating, and offering hope, focus on:

• Advising
• Correcting misperceptions
• Reinforcing
• Suggesting
• Modeling
• Collaborating
• Jointly exploring alternative ways of thinking about and perceiving interactions
• Jointly thinking through consequences of an intended behavior