What Should We Talk About?

By Kevin Murphy, M.Sc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland

What is it that we are supposed to talk about in therapy? It seems an obvious question, doesn’t it? Presumably the answer is that we are supposed to talk about the very thing that is bothering us most. Or put it another way, the very thing that brings us to therapy in the first place. Yes that makes sense.
But what about someone who, for example, feels bad all the time? Are they supposed to talk about how bad they feel every time the come to a session? Certainly it is necessary to describe it at the outset, and there are times when it is necessary to describe its variations. But if it is the only thing that gets spoken about, is there a value in that?
And this feeling bad need not always be out-and-out depression. Often people can conduct a life for themselves, but there is always a heart-stopping worry going in the background, a fear that something dreadful will happen. Sometimes it stops them going out of the house, or relaxing around their family, and instead makes them irritable all the time and turns them into the kind of people they don’t want to be.
Or what if the thing that someone has come to talk about is the fact that they cannot talk? The very act of saying a simple thing about themselves is too difficult, too fraught with danger and so they cannot risk exposing any detail about themselves. They have, instead, learned over many, many years to say nothing. So what is someone like this supposed to say?
And what about someone who has been severely sexually abused as a child? The thing that brings them to therapy is so painful to talk about that they prefer to say as little about it as possible. Sessions are spent on other details of their lives, how they feel about current experiences, how they manage their relationships, and so great effort is spent not talking about the trauma.
So what then are we supposed to talk about in therapy? Well, as far as psychoanalytic psychotherapy is concerned the best way of looking at this question is to tell whatever stories we feel we can that have happened in our lives, either currently or in the past. The thing we are expected to search for are those scenes from our lives that we gravitate too most easily in our speaking out of our story. Now, the chances are that we don’t have any idea of what these are going to be when we begin the session. But experience shows that when we begin by speaking about the first idea that enters our head, and continue speaking in as uncensored a way as possible, that these scenes emerge, often to our great surprise. And, spoken out afresh, it is constantly surprising how people find a new added detail that they had not realized before that gives the situation or the event a whole new meaning.
You often find some people will want to know why it is so important to talk about these so called obvious details of their lives? Why is that they should talk about scenes from a life that we already know inside out? Surely recounting them won’t make any difference or change anything? Shouldn’t the therapy be focused on what is actually wrong or going wrong or causing the problem?
In the first place, therapy is not trying to change things that happened because there is no way of doing that. What it is trying to change, is our view or perception or understanding or or relationship to those same things. Focusing exclusively on the problem, as it presents itself, is usually a sure way of picking up the wrong end of the stick. What most therapists will tell you is that the act of describing an emotional problem is only half the story when it comes to finding a solution. Someone suffering from anxiety, say, is in the grip of a fear that is there all the time. Describing the many and different ways that this fear manifests becomes a self-defeating exercise. The inventive ways that the psyche can find to be afraid, and the objects which can loom up, real or imagined, to become the cause of that fear, are as varied as the number of individuals in the world. Setting oneself up to describe all these variations and to look for answers in them is a recipe for disappointment.
Psychoanalytic psychotherapy operates on the basis that a person experiences these things, and many other and varied kinds of symptoms and disorders, as a result of their life experiences and the way they have either accepted or rejected those experiences. The answer is not to be found in the end result of these experiences but in the primary experiences themselves, no matter how small or insignificant.
The hard part is staying focused on talking about these often incidental details of our lives. The tendency is to retreat into generalizations, and vagueness and conceptual fuzziness. The test of this is to ask yourself to give an example, a situation or a scene that actually happened in your life that could describe what it is you are trying to say in a general way. That is not as easy as it sounds but persevere because the answer lies in the specifics.
Why? Because the actual things that happened to us or the actual things that were said to us, or the actual ideas that we had about others around us are, no matter how trivial they might seem, specific to us and only us. It doesn’t matter if others might remember things differently or put a different interpretation on things that happened. It is the memory we have, the perception we have, the interpretation we have of real events or situations that really happened to us. And don’t get me wrong, even therapists undergoing therapy fall into this same trap. It is easier to be general and vague and fuzzy with the details.
But the only way of truly examining a lot of our preconceptions about ourselves, our assumptions about who we are and how we came to be where we are today, is to deal with specifics, to focus on things that actually happened and to paint as accurately as we can our place in them. We are unique in that our set of experiences, even if we share many of them with others, are different and specific to us. Psychoanalytic psychotherapy and psychoanalysis give centre stage to this specificity. When we take this notion fully on board then at least we have something concrete to work on.