Individual psychotherapy is truly individual in the sense that in psychotherapy, one size fits one. I tell each new client that it will take me a little time to get to know your rhythms, tempo, style, and needs. This is crucial because in individual psychotherapy, an authentic rapport needs to develop, and a client needs to feel understood.
But if I am only for myself, what am I?
And if not now, when?"
Out there and in here
A given individual psychotherapy session will often begin with whatever issues or concerns the person brings in that day. Sometimes some pretty straightforward problem-solving is needed. Our core concern, however, is with underlying dynamics. We tend to move from people and circumstances out there, to the thoughts and feelings going on inside.
- How did such-and-such affect you?
- What do you think made you feel that way or react that way?
- What are various parts of you thinking and feeling about X?
- What tensions or conflicts might be going on inside?
- How can these be resolved? or held differently, with less conflict?
- What constraints are you struggling with?
- Which of them are external (due to unchangeable circumstances and limitations), and which of them are internal (due to emotional blocks and tensions inside)?
- Are the ones you think are external really external?
- Or can they be worked with in ways you have never thought of, or have been afraid to try?
These are some of the many lines of inquiry that may open up in a therapy session.
Heart and Head
Part of the emphasis in individual psychotherapy is on insight, self-understanding, and self-awareness. And as this deepens, people experience changes in their ways of moving through life.
But individual psychotherapy is very much about both head and heart, insight and feeling.
Many of us are a bit imbalanced with respect to these. Some get flooded and overwhelmed by their feelings and have difficulty regaining balance. The ability to make sound decisions based on calm reflection can be impaired because the flood of feeling takes over.
Other people are the opposite. Instead of being overwhelmed by their feelings, they have blocked some of them off. They have learned—usually unconsciously-- that one way to avoid pain is to block feelings in general. But the price of this method can be big: it shrinks the ability to truly experience life.
Individual psychotherapy goes back and forth between heart and head, now offering space for emotional expression, now reflecting on the meanings, sources, and functions of those feelings. Of course everyone is different. We are not after a kind of theoretical or ideal balance, but rather a working harmony within the unique expressiveness of an individual.
Some of the themes that often surface in the course of individual psychotherapy include:
core needs. What do you need in order to feel good about yourself? For instance, relationships of certain kinds, connection with other people; love; admiration; physical exertion/exercise; a feeling of power (in work, in relationships, and other ways); intellectual stimulation; being sexually expressed and desired; making money; spontaneity; looking good (physically and in other ways); spiritual experience/practice. . .
essential fears. For instance, loneliness; injury; exposure as being incompetent; being belittled, abandoned; depression; aging; mental illness; death; responsibility for others; dependence on others; purposelessness, meaninglessness; doing something terribly wrong to someone else, on purpose or not; one’s own rage; one’s own power; one’s own fragility; one’s own. . .
defenses. That is, ways that you keep fears and other unwanted feelings—rage, guilt, shame, others—at a distance and more or less outside of awareness. For instance, by working excessively; denial; regression (to a more vulnerable state, or any other state of less competence); anger; putting on a happy face; intellectualization, or many, many others. Anything can be used defensively—including psychotherapy!
gratifications. What gives you pleasure, contentment, satisfaction? For instance, family, music, sex, work, friends, intellectual pursuits, creative expression, solitude, social action, spiritual experience, community, exercise, power, wealth, travel. . .
chief desires. What do you really want in your life?
What do you feel you deserve, or do not deserve? What do you believe can and cannot be changed in your life?
Do you like yourself? What would you need to be in order to like yourself more? to love yourself?
In individual psychotherapy, problems get solved and symptoms alleviated. But in my experience, the most exciting parts of the journey of therapy are much like travel at its best. The main takeaways are not tangible things. It’s not a readily quantifiable benefit. Instead, new aspects of life have opened up for you; you understand yourself, and therefore the world and other people, differently, and you are a more expansive, richer person for having made the journey.
And like traveling, much that you encounter in individual psychotherapy could not be predicted. In Spanish poet Antonio Machado’s words:
Traveler, there is no path,
Paths are made by walking.
Daniel Lehrman, MA, NCPsyA, LP provides Individual Psychotherapy in New York City, Manhattan, Brooklyn.