What would Freud say if he overheard me offering medical advice to a client for a toenail infection? He might be horrified because he'd want to probe for the deeper meaning of the topic. Imagining this conversation with the great psychoanalyst inspired me to address some changes in the practice of psychotherapy and psychoanalysis since Freud's time.
Of course like Freud, the psychotherapist aspires to the motto that, "Nothing human is alien to me." Ideally, we're not shocked by any confession, and we're sworn to honor a client's privacy, except in situations of potential suicide or homicide.
Freud believed that the mind is a blank slate or tabula rasa in Latin. The question then becomes to what extent does heredity, as opposed to the environment, impact the tabula rasa of the developing brain. A simple answer today is that our perceptions of the mind change in accordance with discoveries in neuroscience.
For example, disorders like autism and attention deficit disorder, recognized and treated early in a person's life, portend a more favorable prognosis. This observation connects and supports the hereditary nature of both conditions, and the environmental factors (involved in timing) of treatment. In other words, early intervention has a greater impact on the developing brain, and implies that windows of opportunity close rapidly.
Today psychotherapy is not restricted to an exploration of the unconscious, nor to the wealthy, elite, artistic, or intellectual. The variety of psychotherapeutic techniques has broadened, and the psychotherapist hopes to meet the client's challenges rather than adhering to a theory.
Freud's outlook was decidedly more deterministic than today's open-ended approach. Diagnosis doesn't necessarily determine prognosis. We know we don't have all the answers and expect the unexpected regarding possibilities and potential. Like the stock market, the outcome of psychotherapy is unpredictable: Past performance doesn't predict or guarantee future results.
For example, a patient of mine, whom I refer to as Mr. Z., began psychotherapy following an affair. He questioned whether he should leave his wife. As therapy progressed, he was surprised to realize that he, himself, was the problem, not his spouse. He could barely tolerate his own company. He simply didn't like himself. His outlook changed: Instead of focusing on what his life lacked, he began to appreciate his partner and home life.
For Freud, an objective of treatment was to convert neurotic suffering to the universal suffering of humankind. Today, the psychotherapist is more likely to focus on the positive aspects of life, like transformation and appreciation.
We live longer and recognize the capacity and human potential to change: We have the chance to engage in multiple careers, relationships, hobbies, interests, and travel. The psychotherapist supports change and maintains an open mind regarding the ability of a client to transform his life. Our objective is to help the client become aware of how, when, and why he may get in the way of his goals (for example, fears of change, success, failure).
Regardless of a therapist's orientation -- interactive, relational, psychodynamic, behavioral, cognitive -- the "good enough" psychotherapist conveys a belief in his client, and supports his efforts to improve his life and become the best, authentic person possible. (The term "good enough" originates from the psychoanalyst, D.W. Winnicott, who applied the term to mothering).
Conclusion: The "good enough" psychotherapist adapts theories to relate and collaborate with clients to support their growth and help examine obstacles that interfere with their constructive goals.