Le blog d'une psychothérapeute à Montpellier

Combien de temps dure une thérapie?

jerome.arnaud5@wanadoo.fr (Gorana Arnaud) — Wed, 17 Dec 2025 20:30:14 GMT

La question préférée des nouveaux patients

Cette question est posé très souvent en cabinet. La réponse est un peu frustrante, c’est-à-dire: « Ca dépend. » Ca peut aussi bien durer deux séances que trois ans à un rythme de deux séances mensuelles.

Il peut y avoir une prise de conscience importante après une seule séance. Ici nous ne parlons plus de thérapie brève, c’est une véritable thérapie éclair. Ensuite, se pose le choix de continuer, poursuivre les séances pour creuser encore plus, ou de s’arrêter là, pour laisser le temps à l’inconscient d’élaborer ce qui est venu à l’évidence pendant cette séance unique.

Pour résoudre certaines problématiques telles que par exemple les crises de panique, cinq ou six séances sont nécessaires. Ici nous parlons de « thérapie brève ».

Cela suffit pour que la cause des angoisses soit comprise, ce qui dans la grande majorité des cas permet arrêter les crises aiguës. Les résultats sont donc impressionnants, mais la racine de l’angoisse n’est pas coupé pour autant. Certains préfèrent s’en tenir là: à trop creuser, d’autres peurs pourraient surgir. Il est très important pour le psychothérapeute de respecter l’intuition de son patient. S’arrêter, faire une pause pour mieux repartir après.

Enfin, il y a les thérapies plus longues, celles qu’on appelle « thérapies analytiques » ou psychanalyse, qui peuvent durer plusieurs années. Cependant, il est très important de souligner que si un patient reste en « cure » pendant plusieurs années, c’est justement parce qu’il perçoit une amelioration tangible tout au long du processus, et que cette nouvelle « santé psychique » lui donne une envie d’aller encore plus loin, d’être de mieux en mieux. Cette situation est comparable à, par exemple, à la pratique du sport de haut niveau: si on veut viser très haut, quelques mois ne suffisent pas. Mais tout au long de la pratique, les résultats sont là.

Le temps nécessaire dépend aussi du permispsychique instauré avec votre thérapeute — pour choisir le bon, voyez Comment choisir un bon psy .

Pour comprendre en détail les différences entre psychothérapie, psychanalyse et hypnose, consultez notre page sur la psychothérapie intégrative et hypnose .

Meditation versus therapy for stress management

jerome.arnaud5@wanadoo.fr (Gorana Arnaud) — Wed, 17 Dec 2025 19:32:46 GMT

What is meditation?

What is therapy?

Therapy is essentially, healing through talk. Yet, the talk that goes on in therapy is very different than talking to a friend, over coffee let’s say. When we voice our innermost hopes and fears in front of someone who is impartial, and yet completely on our side, as a kind of « cheerleader » this creates the necessary space for miracles to happen. We can let go of old habits, old relationships, old weaknesses that make us « stuck » and prevent us from living to our full potential. This is the magic of therapy.

But how exactly does this « magic » happen? Like I said above, the therapist is not our friend, they are someone who is at the same time « neutral » and completely on our side. They will help us figure out and act on the things that we WANT. The things that we « want » are exactly the things that are in our best interest in the long term, but it is us who decides and chooses what they are, and not some outside authority. This is why a therapist is different from a priest or a rabbi. They are not concerned with morality, or the « right » thing to do, they are only concerned with the selfish acts that will make us a happy human being.

Therapy unfolds over time, sometimes the change happens very quickly, in two or three sessions at most, and sometimes it takes much longer. But with perseverance, the results always, always follow. There needs to be a feeling between therapist and patient, and there needs to be sufficient motivation on the part of the patient for the change to occur. These are like the ingredients when baking a cake, without them, the dough won’t rise and the cake simply won’t happen. But when all the necessary elements are there, the result is astounding. I am often surprised how, after a certain amount of sessions, my patients look better rested, healthier, younger. They start dressing better and their posture improves. The wommen look prettier, the men more handsome and self-assured. It’s difficult to pinpoint exactly why, and over the years I have stopped trying to; it is simply the miracle of therapy.

Which is more effective for stress and other conditions?

Meditation has become hugely popular in recent years. So much so, that there is an increasing confusion as to what exactly the difference is between meditation and psych otherapy, if meditation is actually a form of psychotherapy, and if so, why actually see a therapist at all? After all, if meditation provides us with the peace of mind and serenity needed to put a distance between us and our worries and troubles, surely this is more than enough we can hope for? Better yet, meditation is something we can do on our own, whenever or wherever we choose, it is a truly autonomous and independent practice.

Yet there is a clear difference between meditation and psychotherapy. Yes, meditation does indeed help us accept certain things we cannot change, but therapy gives us the motivation and strength to radically transform our lives, that is to change the things that can be changed. And therapy also provides us with a safe space to distinguish the two.

For example: My mother keeps bombarding me with unexpected phonecalls several times a week, sometimes several times a day. I obviously cannot change my mother. But what I can change, is to receive those phonecalls or not. So therapy will provide me with the opportunity to discuss gentle ways to get the message across to my mother; for example picking up the phone only at certain times, or even gently blocking her number for a week at a time, until the message comes across. I can discuss my options with the help of a kind yet firm therapist. The therapist can also help me identify underlying emotions, for example guilt (I am being very cruel to my poor mother) or anger (doesn’t she understand I have a life too?!).

And then, outside the therapy session, in the peace an d comfort of my own home, I can meditate on the guilt, on the anger, and see them as emotions that are painfully unpleasant, but that are ultimately not part of me, not part of who I really am. As in the Boudhist philosophy that teaches us to observe our emotions as we would observe clouds passing by in a blue sky, we can take some necessary distance from our emotions. And they can thus become a little less painful every time we sit down to meditate.

So, meditation and psychotherapy are wonderfully complementary, yet there essence is very different. Ideally, we would engage in some form of the two combined in order to get the best results, in the quickest amount if time.

Comment l'hypnose peut vous aider

jerome.arnaud5@wanadoo.fr (Gorana Arnaud) — Wed, 17 Dec 2025 17:19:44 GMT

Mon intérêt dans les thérapies alternatives a commencé quand je me suis rendu compte que même si une bonne thérapie ne pouvait pas se passer des outils psychanalytiques, parfois la cure par la parole ne suffisait pas. Au début, je plaçais beaucoup d’espoir dans les thérapies dites « scientifiques » mais très rapidement j’ai vu les failles de ces thérapies qui promurent une méthode universelle, utilisable même par des thérapeutes novices sans expérience. Ayant pratiqué la danse, le yoga et la méditation depuis plus de vingt ans (et aussi pendant mon séjour au Japon) j’ai décidée de voir ce que pourra apporter l’hypnose, cette technique thérapeutique ou plutôt cet art ancestral. Je me suis retrouvée littéralement stupéfiée ! En effet, beaucoup dans la communauté psychanalytique lacanienne ont essayé de nous faire croire qu’un symptôme, c’était « pour la vie » ; après tout, le symptôme fait le sujet, n’est-ce pas ? Avec l’hypnose, nous pourrions aborder ces symptômes en quelques séances à peine. En plus, se mettre « en transe » était relativement facile, procurait une détente incroyable, et avec un peu d’entrainement, tout le monde pourrait en tirer des bénéfices. Les victimes de trauma peuvent éprouver des abréactions puissantes qui finalement mettent fin aux années d’anxiété et dépression ; dans ces cas, revivre la scène traumatique sous l’hypnose peut procurer une abréaction puissante qui est nécessaire à arrêter une fois pour toute la peur et la douleur qu’y sont associés.

Cependant, attention : l’hypnose n’est pas, et ne devrait pas être vu comme une « solution miracle ». C’est un adjoint, ou pour le dire plus précisément, une catalyse très puissante qui peut énormément booster la psychothérapie conventionnelle .

Avec l’hypnose plusieurs mécanismes d’auto-sabotage peuvent non pas être éliminés (oui, je sais, mes collègues lacaniens ont un peu raison quelque part), mais déplacés. Pour expliquer : tout comportement négatif est une façon de faire, mal adapté, qui sert à satisfaire un besoin tout à fait légitime. Par exemple, un besoin de se sentir aimé, de se sentir connecté à l’autre, et caetera. L’hypnose permet de trouver un autre, nouveau, moyen qui permet de faire face à ce besoin. Un exemple pourrait être la pause cigarette : la seule façon d’obtenir un petit moment de tranquille solitude. Mais si nous pouvons donner à notre cerveau une alternative plus saine qui nous permettra d’obtenir quand même ce petit moment de solitude, la cigarette devient superflue. Nous devenons libres ; nos mauvaises habitudes cessent de nous contrôler. L’hypnose est l’art de la sémantique qui guérit et qui nous aide à pleinement réaliser notre potentiel. L’hypnose peut vous aider à :

Surmonter un trauma qui gêne votre quotidien et cela malgré les années de thérapie
Arrêter une mauvaise habitude, par exemple le tabac, ou maintenir un poids stable
Vaincre l’insomnie, ainsi que :
L’anxiété
La dépression
Les soucis d’ordre psychosomatique (voir site)

N’hésitez pas à m’appeler pour déterminer si l’hypnose peut aider à soulager votre difficulté particulière.

Pour approfondir comment certains comportements répétitifs s’ancrent et comment on peut les travailler en psychothérapie ou avec l’hypnose, voyez Compulsion de répétition .

Mythes et réalités

Mythe: Nous sommes sous le contrôle de l’hypnotiseur.
Faux

Ce n’est pas le cas. Dans notre culture qui est obsédée par le contrôle, ce point est important à souligner. L’hypnose nous donne, ou redonne, le contrôle, la maitrise sur nos pensées, notre esprit, notre corps…

L’Ego, le Moi, est présent pendant l’hypnose. C’est un mécanisme de protection. C’est la raison pour laquelle nous n’agirons jamais en dehors de nos principes éthiques. L’émotion la plus forte gagne toujours, donc nous ne révèlerons aucun secret que nous n’avons pas envie de révéler. Nous ne pouvons être « contrôlés » par l’hypnotiseur. Nous pouvons être en hypnose et choisir d’arrêter le processus quand nous le souhaitons. Nous ne rendons pas notre volonté à l’hypnotiseur, car notre esprit n’est jamais complètement dissocié. Donc, nous ne pouvons rien faire que nous n’avons pas envie de faire.

Mythe: Les personnes très fortes ne peuvent pas être hypnotisées.
Faux

En fait, c’est l’inverse : les personnes qui sont très intelligentes et créatives sont d’habitude plus suggestibles à l’hypnose.

Mythe: L’hypnose, c’est le lavage du cerveau et la manipulation.
Faux

Le lavage du cerveau nécessite un isolement et des dépravations. Si quelqu’un pouvait être manipulé pendant des séances d’hypnose, l’hypnothérapie aurait un taux de réussite de 100%. Mais ceci n’est pas le cas. Par exemple, l’hypnose, pratiquée par un praticien habile, présente des taux de réussite de 70- à 80% quant à l’arrêt du tabac.
L’hypnose est un état dans lequel nos sens fonctionnent en mode améliorée. Nous entendons et sommes conscients de tout ce qui se passe autour de nous. Dans la plupart des cas, nous sommes plus conscients que d’habitude, au quotidien.

Traitement de l’anxiété

jerome.arnaud5@wanadoo.fr (Gorana Arnaud) — Tue, 16 Dec 2025 20:02:31 GMT

Les troubles de l'anxiété

Environ quatre-vingt pour-cent de ceux qui viennent consulter à mon cabinet souffrent, en parallelle à d’autres soucis, de troubles d’anxiété aigus.

En general, le patient arrive chez le psy après une periode longue et pénible d’anxiété qui devient de plus en plus pesante. Il y a les fameuses « crises de panique », qui bien sur vont de pair avec l’insomnie, des troubles digestifs, des douleurs, et toutes sortes d'afflictions psychosomatiques.

Sans exagérer, je peux dire que dans mes longues années de pratique, même les formes les plus aigus de l’anxiété trouvent un réel soulagement après deux mois de psychothérapie hebdomadaire. Six à huit séances sont nécessaires pour qu’un cas dit « grave » cesse d’avoir des crises de panique qui sembleraient « venir de nulle part »; imprevisibles et inexplicables. A partir de là, il peut arriver une de deux choses:

Le patient, dont les crises d’anxiété ont cessé et n’exercent plus un contrôle sur leur vie, ressent un profond soulagement et choisi d’arrêter la thérapie et de continuer leur vie comme avant, avec quelques modifications apprises au cours des séances.
La deuxième option est que le patient choisi de continuer la psychothérapie et d’embarquer dans un voyage merveilleux d’auto-exploration. Et se transformer d'une personne anxieuse, fragile, à fleur de peau et influençable, en une une personne forte, apaisée et calme, avec une assurance et une dignité contagieuse.

Malheureusement le cas décrit ci-dessus arrive seulement dans environ cinq pour-cent des cas. La majorité des personnes veulent seulement eliminer l’anxiété, sans forçement l’attaquer à la source, soulever le couvercle et voir ce qui se cache au dessous. Ceci est parfaitement ok, et l’intuition de chacun devrait toujours etre respectée, parce que cette intuition est toujours juste.

Le point le plus important que je voudrais souligner ici est que les troubles anxieux sont relativement faciles à traiter, pourvu que la personne souffrante ait le courage de prendre contact avec un psy. Il est vrai que nous ne pouvons pas éradiquer l’anxiété à cent pour cent (plus sur ceci dans un article ultérieur), mais nous pouvons définitivement traiter l’anxiété paralysante qui nous empêche de vivre.

Donc, il y a toutes les raisons pour garder espoir.

Six à huit séances

Dans ce paragraphe, je vais expliquer ce qui se passe pendant les six à huit séances qui sont nécessaires pour que le patient sente qu’il peut encore une fois maitriser son monde émotionnel et psychique et pour que l’anxiété diminue considérablement.

Le thérapeute commence par décrire les émotions. Il y a deux catégories: les émotions positives, et celles qui sont négatives. Les émotions positives sont super, nul besoin de les modifier. Les émotions negatives sont majoritairement deux: la tristesse et la colère. Il y a la peur aussi, bien sûr, la peur et/ou l’angoisse. Et, ce qui est fascinant, dans la majorité des cas c’est cette peur qui a pour fonction de masquer les deux autres émotions.

Il est plus facile d’avoir une angoisse généralisée que d’être déprimée, par exemple. La tristesse est très difficile à assumer. La tristesse touche à un malaise existentiel, à une difficulté profonde à faire face à la vie et au monde qui nous entoure. Mais, encore plus difficile à assumer est la colère. Surtout pour des gens « bien », des hommes « gentils », des femmes « bien élévées ».

Il est intéressant de se demander: « Si je n’étais pas anxieux, je serais comment? » Au premier abord, le patient répond: « Ah, je serai trop bien, ce serait génial… » Mais si on creuse un tout petit peu, on touche à la tristesse ou à la colère…. Et c’est là où est le point pivotant de la thérapie. Le patient se rend compte que son monde émotionnel est vaste et complexe, et n’est pas limité à la peur. Et à partir de là, petit à petit, il se rend compte aussi que c’est lui qui est le maitre à bord son navire psychique, qu’il n’est pas impuissant, et qu’il peut controler ce qui lui arrive, et ce qu’il ressent. Ce sentiment de controle est primodial, je le décrirai dans le prochain article.

Seeing results from psychotherapy

jerome.arnaud5@wanadoo.fr (Gorana Arnaud) — Tue, 16 Dec 2025 19:35:29 GMT

What is psychotherapy?

During psychotherapy, the patient and therapist are seated in armchairs opposite one another. Through talking, we can quickly and efficiently resolve an issue or « symptom », for example a relationship struggle, or a panic attack. Sometimes, however, the difficulties a patient encounters are more profound and deep seated, and so more time is needed. In psychotherapy, the patient and therapist simply « talk », and so on the surface it may look like chatting to a friend. It is not as simple as it appears, however. The therapist is very skilled and through years of education, training and clinical practice knows how to steer and guide the conversation so that the patient, through questioning and self-awareness, gains insight into their own internal struggles and starts solving them.

Treating complex trauma

Treatment of complex trauma is a delicate process that needs to be managed carefully and with skill in order to be successful. Many of my patients come in after having consulted numerous other therapists and having tried a multitude of different therapies. Sadly, despite initial dizzy promises, nothing ended up working. This is where being a « senior » therapist really helps. The therapist treating complex trauma, especially that which stems from childhood, needs to be stable, reliable and not easily frightened. Moreover, they need to be containing yet « non-directive » in order to give the patient sufficient autonomy and stength to build their self-esteem.

Complex trauma generally involves violence, abuse and/or neglect in the home. As a rule, these experiences are not isolated, i.e. they only happenned once or twice, but are a string of experiences that often unfolded over years if not decades of a person’s life. This affects not only the victim’s reactions, but their whole outlook on the world, their whole biology. Their are massive trust issues, there is a very fearful attachment style, and there is often a whole string of psychosomatic complaints.

The symptoms are many, some manageable, and some so intense they make daily functioning in the work place and at home extremely difficult if not impossible. They can include persistent sadness, difficulty regulating emotions, chronic anxiety, chronic guilt, flashbacks, hypervigilance and dissociation. Moreover, the symptoms can be trigerred by seemingly innocent situations, such as not responding to a text message quickly enough, being five minutes late for a meeting, or speaking in a loud voice.

To give a typical example, one of the things I see often in my office is when a female client sends a text to her boyfriend and doesn’t get an immediate response. The first reaction is anxiety, if not panic. Then, when the initial stage of severe anxiety subsides, she is easily trigerred to anger, outbursts and oppositional behaviours, even in the case where the boyfriend or husband replies to the text half an hour or so later, after his work meeting is over. My clients, being so extremely sensitive and jumpy, are using these extreme reactions as their only available defense mechanisms to feeling under threat. But under threat of what? Of abandonment, neglect or abuse, often all three. Because it’s what they experienced as a child, they are constantly relieving the experience, even recreating it although there is no threat in sight.

How long does it take?

Oftentimes, patients ask me, "How long will it take until I begin to see results? How long before I start to see tangible, real changes in my life?" This is a fair question. Therapy, even though it has become more and more accepted in recent years, is still a challenging business. If our health insurance or "Mutuelle" doesn’t reimburse the sessions, they may have to be paid out of pocket. This means that for many, therapy is a considerable investment. A financial investment, but moreover, a time investment too. We have to carve out of our already too-busy days not just the hour spent sitting in a therapist’s office but also the transportation time to go there and back. On top of this, good therapists have few available slots, so if they have an opening in the middle of the day that isn’t quite ideal, we take it anyway, cutting back on time elsewhere. When all this adds up, committing to therapy can mean quite a few sacrifices. Therefore, when and how do we see a return on our investment?

The answer is: it depends. Because each one of us is unique, it’s on a case-by-case basis. Many of my patients have reported feeling massive relief after a real "A-ha!" moment that occurred during the very first session. So is one session all it takes? For some, the answer is a definite yes. However, even those lucky ones may, if they so choose, come back and explore further the eye-opening experience they had at the very beginning of therapy. Others prefer a more regular rhythm, once every two weeks or once a month. If a patient is undergoing a particularly stressful period in their life, I am, of course, available for weekly sessions. These never last long, luckily, because as soon as there is palpable improvement, the sessions are spaced out.

Every therapist is unique and different too. Personally, I never impose a rhythm on my patients. At the end of every session, I will ask them if and when they next want to come back. Some people book the next appointment there and then; others wait until they can figure out their agenda for the next couple of days or weeks and let me know by text later on. My personal philosophy is that each patient should feel two things: free and secure, both at the same time. To feel free means to not feel constrained or smothered as they may be feeling in other relationships in their life. As long as each session is paid for, patients may come and go as they please. To feel secure means that the patient must feel the therapist is stable and dependable and that they are always there should they be needed, sometimes even at an extremely short notice. These two things contribute to cementing a solid therapeutic alliance, the key ingredient for sessions to be optimally successful.

Can psychotherapy help with physical illness?

Psychosomatics is basically everything to do with illness, being sick. Therapists, even though most of them are not medical doctors, are no strangers to sick people needing care. Whether it is to navigate the jungle of the medical system, to cope with debilitating side effects of treatment, or simply to ask: what does this illness say about me, as a person? How can I speed up my healing process? How can I deal with the possibility of the treatment not working and the worst case scenario coming about? All this, and much more, is talked about in the intimacy of the therapist’s office.

At first, a patient comes in ill. After some time, in the large majority of cases, they get better. Sometimes the progress is spectacular, sometimes it is slow and laborious yet undeniably there. Often the simple act of talking to an empathic human being in a safe setting suffices to bring down the psychic tension and alleviate numerous physical ailments. Once the improvement is felt, some patients choose to stop therapy, and some keep coming back. These patients want to understand why they fell ill in the first place, so they can prevent an eventual relapse, and feel safe and secure knowing it is them who have some control over the illness and its consequences. Therapy has the following benefits:

Understanding why we fall ill
Understanding what we can do do get better
Understanding how to heal completely
Adopting a new attitude to life, new behaviours and a new identity that will prevent a relapse
Being comfortable in this new identity as a healthy person.

The treatment of anxiety

jerome.arnaud5@wanadoo.fr (Gorana Arnaud) — Thu, 11 Dec 2025 18:43:55 GMT

Anxiety disorders

About eighty percent of all those that come to my office suffer from, amongst other complaints, of acute anxiety disorders. this series of blog entries will therefore focus on trying to demystify the causes and treatments of anxiety.

Usually, the patient will come in after a prolonged and painful period of gradually building-up anxiety, which will usually culminate in full-blown panic attacks, tied in with insomnia, digestive disturbances and all kinds of psychosomatic complaints. The disturbances will no longer be in the realm of the purely psychological, they would have crossed over into the body, i.e. physical.

It is then, and only then, in this « peak » or acute stage of anxiety, that a person will contact a therapist, often after having been advised to do so by the médecin généraliste, or GP. There might also be, more often than not, various scans, IRMs, blood tests, urine tests and whatnots to eliminate any underlying organic illnesses. The verdict being; everything is alright. But everything is not alright, and the feeling is one of utter misery, loneliness and despair.

Without exaggeration, I can say that in my many years of practice, even the most acute forms of anxiety have found massive relief after two, or, one-and-a-half months of once a week therapy. This means from six to eight sessions. Six to eight sessions are necessary for an acute case to stop having unexplained panic attacks which leave them completely bewildered as to where their anxiety is coming from. From here on, one of two things can happen. The patient, having finally acquired the relief that the panic attacks are no longer happening and controlling their life, chooses to stop therapy and continue their life as before, with some adjustments of course, or, they choose to continue therapy and embark on a journey of self-exploration and a complete fortification and turn-around of their former anxious, fragile self, into a calm, composed, self-assured and strong individual, capable of holding their own in our demanding world.

The latter only happens in about five percent of cases. Most people only wish to get rid of anxiety, without necessarily tackling it, lifting the lid off and seeing what is underneath it. This is perfectly fine, and everyone’s intuition about how far they dare to go should be respected because it is always spot on.

However, what should be emphasized is that anxiety disorders are not that difficult to treat, despite the presumptions. Yes, eliminating anxiety completely is impossible for anyone aside from Arnold Schwarzenegger’s character in Robocop. Anxiety, especially existential anxiety, is part of what makes us human beings. Yet extreme, debilitating forms of anxiety and panic attacks are relatively easy to get rid of. Across a wide spectre of therapies, the six-week to two month mark seems to be a constant.

So yes, there is definitely hope. In the next blog entry, I will explain what happens in the six to eight sessions that makes so much of a difference in lowering anxiety levels.

Anxiety and control

I have had many anxious patients tell me the same story. Well meaning relatives, friends, even therapists, tell them to just « let go of control », « stop trying to control everything » and « just go with the flow ». The arguments given by these well-meaning people are that the world we live in, and life in general, is by far unpredictable and so it makes no sense worrying about a possible catastrophic future scenario. Yes, our world and our lives are unpredictable indeed, and the recent lockdown situation and the COVID pandemic have once again shown us that. And so, yes, technically, worrying amounts to nothing more than waste of precious mental and physical energy. And yet, telling an anxious person not to worry is so counterproductive it is borderline criminal.

Any therapeutic approach dealing with anxiety must, in my firm opinion, focus on regaining more, and not less, control. Control over events, over emotions, over life in general. An anxious person often feels like a leaf in the wind, the slightest breeze sending them swaying this way or that, unable to decide or choose anything relating to their destiny. Feeling this weak is no way to live.

When we increase control over our environment, anxiety diminishes. This is a fact. In fact, the most terrifying anxiety is that of the helpless infant or baby, who is entirely dependent upon the care of another. If the adult is responsible, warm and dependable, this forges a strong personality for life. But if the adult is whimsical, abusive and/or neglectful, this sets the tone for an anxious predisposition, possibly life-long, unless treated.

So, with any kind of anxiety symptom, the therapist must teach the patient how to have more control over their life, not less. This can be done in small, practical steps. For example, preferring reliable friends over unreliable ones. Taking an active rather than a passive approach over diet, exercise and physical health in general. Standing up to oneself in the workplace and demanding clear communication from clients and superiors. In this way, as anxiety diminishes, self-esteem will rise.

Who is anxious and why? Where does it come from?

Anxiety has its roots in childhood. And, as always, it is hard to demantle what is genetic and what is due to upbringing. This means it is probably fifty/fifty. From what I have been able to observe in my clinical practice, for a child to develop into an anxious adult, he or she needs two genetic « suitcases » or « bagages » as we say in french. The infant needs to be blessed with an above average intelligence, and an acute sensitivity. These two traits are very positive ones. The problem arises when fate, or life, or watever we want to call it, puts that same child in the midst of a very unstable, constantly changing environment. This can be an environment of violence, substance abuse, or repetitive neglect from a parent or primary caretaker. If the parent is unstable, the environment the child takes for granted cannot be stable and conducive to a calm and carefree existence.

Thus the highly intelligent and sensitive child, already blessed with more neural connections than is the average norm, needs to « overdevelop » these connections in order to have some perceived control over their fragile and unstable surroundings.

Therapy can be amazing at turning an anxious temperament from a curse into a blessing, whilst greatly diminishing anxiety at the same time. Anxious people make excellent employees and great friends; they never forget a single detail and so are trustworthy and dependable. Very often through therapy we get to become really aware of these positive traits and this produces a dramatic rise in self-esteem. And as confidence goes up, so obsessive overthinking, insomnia and digestive disturbances go down. All of these diminish in order to eventually disappear alltogether. And then, the person who used to be crippled with excess anxiety becomes who they were always meant to be: intelligent, sensitive, filled with joy and an amazing inner strength, capable of meeting the ups and downs of life with calm and confidence.

Treating anxiety

Let's talk about what happens in the six to eight sessions that are (approximately) needed for the patient to start feeling significantly better, and to start feeling in control of their emotional world again.

First, the therapist starts off by simply explaining what emotions a human being has. So there are good emotions, and bad emotions. Good emotions can range from happiness to awe to gratitude to a feeling of inner peace, to you name it. Good emotions are good, they feel great so we don’t need to do anything about them except enjoy them when they arise. Bad emotions, or negative emotions, fall into three categories, and three only. There is anxiety, or fear. There is sadness, and anger.

So: fear, sadness and anger.

Over the years, I have found that very often, anxiety is an emotion that has the very useful function which is to mask one of the other two negative emotions. So, if we succumb to sadness, how do we prevent ourselves from going down the scary black and possibly bottomless hole of depression? Anger is even more complicated. Good people don’t get angry. Good, well brought up girls, especially; anger not being very ladylike. Men either; a little anger is ok, but not anger directed to those around us we are supposed to love and protect: spouses, parents, children… bosses and superiors at work whom we are supposed to revere and look up to.

In therapy, a simple approach that often dissipates anxiety in a very short amount of time is to tackle emotions such as sadness, anger (and frustration, a close cousin of anger), scrutinizing them and asking the question: « If I wasn’t feeling anxious, how would I feel? » To this question very often the patient replies: « Oh, I would feel great. I wouldn’t have a care in the world », but after spending some time on it we start to see either sadness or anger emerge. It is then that a turning point in therapy happens. The patient starts to be aware of their emotions, not just anxiety but others, too, and starts off on the road to realizing that it is we who control our emotions, and not the other way around.

How and why it works

Eliminating anxiety is extremely rewarding work. When the brain and body are no longer in “fight or flight” anxious mode, an incredible amount of energy is freed up, energy that can be used to laugh, play, create, work, love, and simply enjoy life.

In very acute cases, and with the patient’s accord of course, it might be beneficial to introduce the patient to some form of relaxation techniques, such as mindfulness, or hypnotherapy.

The setup of hypnotherapy is fairly simple: the patient, in a reclined position, closes his eyes and lets the therapist’s soothing voice and skilled manoeuvres transport him elsewhere, to a place that is anxiety-free. The neuroscientific reasoning behind this is straightforward- in order to drive anxious thoughts out of the brain, we must saturate the synapses by filling the brain with positive suggestions. Thus the patient can allow himself to calm down and get over the immediate crisis.

This part of therapy is very relaxing and fun; and the results are incredibly quick. In my own practice I have often been astounded by the speed at which anxiety is tamed in only one or two hypnotherapy or mindfulness sessions, as opposed to traditional talk-therapy.

The therapist will not only administer these techniques (i.e. relaxation, mindfulness techniques and/or hypnosis) to the patient, but will teach him how to do these techniques on her own, at home, so he is independent and does not need the therapist, and can thus gain control over the anxiety attack if and when it may arise. In many cases, having a sword to slay the monster with, and knowing how to use the sword, metaphorically speaking, is enough to keep the monster at bay.

Once the immediate crisis is over, a more psychoanalytical, or psychodynamic approach takes place. In plain English this means= we just talk. In the safe setting of a therapist’s office that is perceived as a strong and trustworthy cocoon, we can gradually begin to explore the underlying roots of anxiety. How quickly this is done depends on the skill and experience of the therapist, but most importantly on the rapport between therapist and patient. There must be an intuitive feeling of safety, understanding and trust.

I firmly believe that in order to heal our deepest wounds, talk therapy is more than enough, and remains the best remedy to date. Yet, even though we may get an intellectual grasp of the causes of our anxiety in two or three sessions, getting to the point where we are truly anxiety-free emotionally and physiologically may take a little longer.
The roots of anxiety may go back to an earlier traumatic experience, but often originate in childhood.

I often tell my patients: “Only children are scared. Adults don’t suffer from anxiety.” Adults assess a situation, and make choices. A child often reaches a point where he is painfully aware of the menacing world all around, and the future which is at best uncertain. An adult is tall and strong. Adults must learn to handle disappointments in life, and let go of unrealistic expectations, but an adult is in control. An adult knows that every action is a choice, and that every action has its consequence. An adult sleeps well, has a healthy appetite, and is full of lust for life, looking forward to every hour of every new day.

Yet, the journey from being a child to being fully an adult is a lifelong journey, and biological age is no indication of maturity. This is excellent news, because it means we can learn new skills at any age. After successful completion of therapy, we should get to a point where we consider anxiety as our best friend- a kind of barometer or signal that tells us what to watch out for, when to slow down, and how best to trust our intuition and ultimately ourselves. The first turning point in therapy comes when the patient says: “Huh. I never saw things that way before.” Yet the real triumph comes when he says: “Wow. Had I not been so exhausted and pushed up against the wall by all this anxiety, I would’ve never asked for help, and would’ve never realised how strong I really was. I have the confidence to really go after my dreams now.” And the huge beaming smile on their faces is the therapist’s best reward.

Compulsion de répétition

jerome.arnaud5@wanadoo.fr (Gorana Arnaud) — Tue, 09 Dec 2025 18:59:38 GMT

Ou pourquoi nous faisons toujours le mauvais choix

Le concept de « répétition » a été tout d’abord élaboré par Freud en 1914 déjà, et c’est à lui qu’on doit sa découverte. Mon intention ici n’est pas d’élaborer sur le concept de répétition théorique, mais de l’illustrer tel qu’on le voit en clinique, c’est-à-dire au sein du cabinet. En effet, un nombre important, pour ne pas dire la majorité des nouveaux patients qui franchissent le seuil du cabinet psy, viennent avec la plainte qui concerne directement la compulsion de répétition.

Voici quelques exemples. Une jeune femme de vingt-huit ans souffre du comportement jaloux et narcissique de son compagnon. Ils sont en processus de rupture, cependant la jeune femme retourne chez son compagnon dès que celui-ci l’appelle en suppliant de revenir, avec la promesse de changer et tout remettre à zéro. La patiente dit : « Je sais, je sais intellectuellement qu’il ne pourra pas changer, mais… je l’aime. Je sais qu’au fond de lui c’est quelqu’un de bien.»

Ou, un monsieur de soixante-huit ans subi au quotidien les injures et humiliations de sa femme qui lui accuse d’être un « faible, quelqu’un sur qui on ne peut pas compter » et menace de le quitter avec son amant. Mais, le mari persévère stoïquement à vouloir à tout prix sauver le couple, et cherche toutes les astuces possibles pour apaiser sa femme. Il avoue : « Je sais, je sais au fond de moi qu’on est trop différents, ma femme et moi, mais c’est mon troisième mariage. Les deux précédentes se sont finies de la même façon, et je n’ai pas envie de me retrouver à nouveau seul à soixante-dix ans. »

Tous ces patients viennent demander de l’aide à travers la psychothérapie quand ils prennent conscience que la même histoire se répété, et se répète. Les villes changent, le lieu de travail changent, mais les personnalités toxiques qu’ils attirent s’avèrent être étrangement les mêmes, dans le sens où ces personnalités ouvrent la même plaie, réactivent la même douleur. « Pourtant, au début, c’est-à-dire les premières quatre mois, il semblait si diffèrent, tout était si beau, si parfait… Et là, c’est reparti… »

Le mécanisme psychique qui opère derrière tout ça est le suivant. Un enfant nait dans une famille, il a une mère et un père. Comme l’enfant en tant que nourrisson est dépendant de l’adulte qui prend soin de lui, il est en quelque sorte biologiquement programmé pour « aimer » ses parents. Ce mécanisme complexe assure sa survie pendant la période où il est encore trop petit pour ne compter que sur lui-même. Le bébé grandit, et, un beau jour, il se rend compte du comportement bizarre, anormal, de l’adulte à son égard. Ou l’adulte rentre complètement ivre le soir, ou l’enfant est ou témoin ou récepteur des humiliations, des injures, des coups, des attouchements. Ou, l’adulte n’est tout simplement jamais là ; c’est la maltraitance de l’abandon.

Pour résumer, l’enfant, quand il a atteint un peu près l’âge de la compréhension, se trouve témoin d’un comportement de la part de l’adulte qu’il a du mal à expliquer. Et là, il a deux choix. Le premier choix qui se présente à l’enfant est : « ce comportement est inexplicable, injuste, donc : cet adulte est fou. » Le deuxième choix est la pensée qui dit : « cet adulte me fait du mal ; c’est justifié puisque c’est de ma faute. » Quasiment tous les enfants choisissent la deuxième option. Pourquoi ?

Tout d’abord, il faut expliquer que quand nous parlons d’un âge bas, disons entre deux et sept ans, il est difficile de parler d’un « choix » ; l’enfant « choisi » tout simplement la solution la plus économique possible, c’est-à-dire qui lui cause le moins de peine psychique.

Donc, la première option « l’adulte en face de moi est déséquilibré, fou » n’est pas accepté par la psyché infantile. Ceci pour la simple raison que l’enfant est dépendant de cet adulte « fou ». La ligne de pensée peut être la suivante : « Maman, ou papa, ou tante X, ou Monsieur Y, réagissent de manière instable, sans aucune considération pour moi. Donc, le monde est un monde de fous, les « grands » ne sont pas stables, je ne peux compter sur eux, ni sur personne d’ailleurs, le monde dans lequel je vis est un monde sans loi, sans fondation, je suis complétement seul et je ne peux compter sur personne ni sur rien. » Cette pensée est tout simplement trop affolante pour un enfant. Comme l’enfant est, je ne peux pas le répéter assez, dépendant de l’adulte, il a besoin de croire que l’adulte réagit d’une manière cohérente, juste, sinon il y a risque d’effondrement.

Mais comment est-ce que l’adulte peut être juste ? Sauf si… sauf si, et c’est ici qu’advient la pensée qui sauve l’appareil psychique immature et fragile de l’enfant: « C’est de ma faute. C’est moi qui suis mauvais, et je mérite ce qui m’arrive. » Alors le plus souvent l’enfant s’efforce d'être le meilleur enfant possible ; le plus sage et le plus obéissant possible. Entièrement rentré dans lui-même, l’enfant idéal que nous voyons mais n’entendons pas. « Si j’aide plus dans la maison, il (l’adulte) sera plus gentil, si j’apporte que des bonnes nouvelles, j’éviterais peut-être les coups… » Et caetera. Avec cette acrobatie de pensée, l’enfant à l’impression qu’il peut contrôler la situation, qu’il a le contrôle sur ce qui lui arrive, sur son sort. Et c’est beaucoup, beaucoup mieux que la première option, où il ne contrôle absolument rien et est à la merci d’un adulte…fou.

Bien, maintenant nous allons appuyer sur le bouton accélérateur et retrouver cet enfant quelques décennies plus tard. Malgré ses efforts, l’adulte formateur (formateur pour le meilleur et pour le pire) qui l’a élevé n’a pas changé. Cependant, l’ancien enfant est indépendant, au moins de point de vue matériel. De point de vue émotionnel, c’est une autre histoire.

Le trauma, n’étant pas digéré, est comme un disque cassé qui tourne et tourne sans cesse autour du même socle, et n’arrive pas à avancer. L’être humain se retrouve dans la même situation.

Notre « petit adulte » a besoin de se prouver qu’il peut maitriser la situation, et il essaiera jusqu’à la fin de sa vie (sauf s’il entreprend une thérapie) de « prouver » aux personnes rencontrées qu’il vaut la peine d’être aimé. Les personnes rencontrées, choisies (encore, peut-on vraiment parler d’un choix, puisque c’est l’inconscient qui commande ?) sont forcément semblables à celles qui l’ont tant blessé dans son enfance. Et s’il arrive à leur prouver qu’il est une bonne personne digne d’amour et de respect, le trauma sera maitrisé, effacé, guéri. Sauf que tous ses efforts sont vain.

Mais tout n’est pas sans issue. Comme mentionné avant, la plupart des plaintes en cabinet concernent exactement ce dilemme, et un bon thérapeute est très apte à traiter ce sujet. Une fois que le patient a compris les mécanismes qui le sabotent, et que grâce à la relation thérapeutique (ceci est primordial : la guérison n’advient pas que grâce à la compréhension intellectuelle) il est capable de faire d’autres choix, des choix plus sains, plus adaptés. Et là, la vie peut commencer. Une vie ou le patient profite et joui de son bonheur, au lieu de constamment lutter pour une place au soleil. ☺

Pour vraiment changer ces schémas de répétition ancrés, il est souvent nécessaire de faire un travail thérapeutique structuré , comme la psychanalyse ou la psychothérapie — et cela commence par bien choisir son psy et comprendre les différentes approches disponibles.

Et pour comprendre combien de temps peut prendre le travail thérapeutique nécessaire pour sortir de ces schémas répétitifs, consultez Combien de temps dure une thérapie? .

Sophrologie vs psychanalyse : des approches thérapeutiques complémentaires

jerome.arnaud5@wanadoo.fr (Gorana Arnaud) — Fri, 05 Dec 2025 21:25:45 GMT

Entre la sophrologie et la psychanalyse, il existe des différences notables. Mais c’est aussi, je pense, à cause ou en raison de ces différences, que ces deux disciplines peuvent s’allier et se compléter dans le cadre d’une perspective thérapeutique. L’une peut s’appuyer sur l’autre et réciproquement. Elles sont toutes les deux comme les 2 versants d’une même vallée : elles ont toutes les 2 le même objectif, celui de faire, acquérir (ou ré-acquérir) au patient la possession de lui-même.

De manière tout à fait sommaire et générale, la sophrologie se présente comme une méthode pédagogique et psychocorporelle. Elle est inspirée du yoga et des différentes techniques de méditation. Elle a le Corps pour plaque tournante, et c’est en voulant agir sur celui-ci qu’elle tend vers ses objectifs thérapeutiques. En ce sens la sophrologie est une sorte de gymnopédie. Mais une gymnopédie avec ses mots clés, sa panoplie de concepts et d’idées majeures. Elle est aussi une technique bien précise reposant sur une multiplicité d’exercices simples et pratiques.

La sophrologie peut être particulièrement efficace pour les personnes qui souffrent de symptômes psychosomatiques (difficulté à gérer ses émotions, maux de ventre, angoisses, palpitations cardiaques, stress, tensions musculaires, acouphènes, insomnies…). Elle agit sur les manifestations de ces symptômes de la souffrance pour les amoindrir – voire les supprimer.

Pour savoir combien de temps un accompagnement par sophrologie et/ou psychanalyse peut durer, consultez notre article Combien de temps dure une thérapie?

Pour en savoir plus sur la sophrologie, ou pour un accompagnement sophrologique de qualité, qui pourrait venir en complément d’une psychothérapie ou d’une psychanalyse, je vous recommande une excellente sophrologue avec qui j’échange souvent : Céline Ther, sophrologue à Montpellier .

Qu’est-ce qu’un bon thérapeute ?

jerome.arnaud5@wanadoo.fr (Gorana Arnaud) — Thu, 04 Dec 2025 17:19:40 GMT

Ou, les qualités à chercher chez un psy

Ce pourrait-il qu’il n’y ait pas de bonne ou des mauvaises thérapies ou « outils thérapeutiques », mais seulement des bons ou des mauvais thérapeutes ? Comme Freud l’a déjà remarqué en 1905 : « Ce n’est pas la médecine qui guérit, mais le médecin, c’est-à-dire la personnalité de celui-ci ; par sa personnalité il est capable d’influencer le patient, pour le meilleur ou pour le pire. »

Quand j’ai commencé à voir mes premiers patients il y a maintenant des années, je travaillais pour une institution qui utilisait exclusivement une thérapie qui s’appelle l’EMDR, et j’ai placée énormément d’espoir dans cette méthode. (Vous connaissez peut-être l’EMDR- c’est une thérapie qui utilise des mouvements oculaires ou des tapotements pour traiter le trauma…) Mais, avec le temps, j’ai remarqué une chose plutôt étrange ; chaque patient avait sa propre méthode thérapeutique préférée, et c’était la méthode préférée de son thérapeute aussi. Donc, quelqu’un avec une histoire d’abus et de dépravation émotionnelle pendant son enfance ne jurait que par l’EMDR, celui avec une histoire quasi-pareille était très contre l’EMDR et idéalisait la psychanalyse traditionnelle, la troisième personne argumentait que la psychanalyse était sans intérêt et qu’elle avait essayé toutes les thérapies jusqu’à trouver le salut dans l’hypnose, ou le Gestalt, etc.

Ce phénomène m’a obsédé pendant longtemps. Et s’il n’y avait pas une thérapie qui était meilleure qu’une autre, tout ce qui comptait étant le thérapeute lui-même ? Si c’était le cas, alors quelles qualités font qu’un thérapeute est bon ? Ceci est extrêmement difficile à préciser, cependant, voici quelques qualités que j’estime être indispensables.

La première qualité est l’empathie. Un bon thérapeute communique à son patient le désir de comprendre et de partager son vécu. Il ou elle communique que le patient n’est pas seul- quand une personne se sent comprise et véritablement « vue », elle peut réussir à trouver la force pour se regarder en face courageusement.

Une autre qualité d’un bon thérapeute est le respect. Ceci veut dire pouvoir accepter que le patient a le droit de choisir, de faire des erreurs, de souffrir, ou de guérir. Ceci veut aussi dire pouvoir enseigner les principes du fonctionnement du cerveau et de la psyché, pour encourager l’autonomie et éviter toute éventuelle dépendance.

Un bon thérapeute est entièrement sincère et honnête ; il n’utilise jamais le jeux de la manipulation. Il développe une relation appropriée avec le patient, et sait quelles limites à mettre à des confidences mutuelles.
La chaleur humaine est une autre qualité à avoir. Le bon thérapeute montre qu’il tient à son patient, avec des mots et de manière non-verbale aussi.

Un thérapeute efficace est également très concret ; il n’utilise pas un langage technique et des termes que le patient risque de ne pas comprendre et il n’hésite pas à se lancer au cœur de la problématique très rapidement.

Ensuite vient la confrontation. La chaleur et l’empathie sont certes nécessaires, mais un bon thérapeute doit pouvoir dévoiler toutes les éventuelles distorsions, contradictions ou évitements dans le récit du patient. Par exemple, « souffrir » de migraines peut signifier que je ne dois peut-être pas aller au travail, ni d’ailleurs faire l’amour à mon conjoint. Le bon thérapeute accepte que la confrontation puisse soulever la colère ou la frustration, et au même temps il reste très chaleureux et emphatique envers la problématique de son patient.

Une autre qualité importante est un tout petit-peu de la révélation de soi. Le thérapeute efficace partage un tout petit peu de lui-même. Ceci a pour effet d’inspirer et motiver le patient à guérir. C’est fait au bon moment pendant la séance, et a pour effet que le patient entend : « Je te comprends. Tu n’es pas seul. »

Ensuite, le bon thérapeute fait en sorte que c’est ok pour le patient à exprimer ses émotions ouvertement ; le plus important est des éventuels sentiments négatifs envers le thérapeute. La remarque que j’ai entendu plusieurs fois est : « Vous ne tenez pas vraiment à moi- vous ne faites que votre travail. » Ceci adresse avec courage la relation entre le thérapeute et le patient, et apprend au patient, via l’honnêteté du thérapeute, à pouvoir travailler sur ses propres relations interpersonnelles.

Il est également indispensable que le thérapeute communique un sens du pouvoir personnel, verbalement et non-verbalement. J’appelle cette qualité « puissance » ou « autorité emphatique ». Le bon thérapeute montre un engagement très confiant envers le patient, et ceci communique qu’il n’est pas dangereux d’être authentique et « vrai » en la présence du thérapeute. Tôt ou tard, la confiance en soi du thérapeute va se transférer sur le patient, et celui-ci va se sentir capable de profiter pleinement de la vie.

En dernier, il se peut que la qualité la plus importante du bon thérapeute soit l’auto-actualisation. Ceci veut tout simplement dire que le thérapeute est activement engagé dans son propre travail d’auto-croissance. Le thérapeute doit agir comme un modèle, un exemple pour le patient : fort, fiable et optimiste. Le bon thérapeute a du développer sa propre philosophie qui lui permet d’avoir une paix d’esprit. Il doit pouvoir partager ses sentiments ouvertement et honnêtement avec sa famille et ses amis, et sa vie personnelle devrait être une oasis d’amour, confiance et acceptation. Le bon thérapeute devrait être capable d’incarner ce qu’il prêche. Si cela n’est pas le cas, alors tous nos diplômes, formations et expériences professionnelles n’ont aucune valeur. Si nous ne sommes pas capables d’assumer nous-mêmes, alors c’est encore un cas de « fais comme je dis, mais ne regarde pas comment je fais. »

Pour aller plus loin dans le choix d’un professionnel adapté à vos besoins, vous pouvez lire notre article sur comment choisir un bon psy .

English language therapy

jerome.arnaud5@wanadoo.fr (Gorana Arnaud) — Sun, 21 May 2023 07:58:15 GMT

What are the advantages of having therapy in English?

Mental health is of utmost importance, but often finding peace of mind is far from straightforward. There is no magic recipe that fits everyone. This is precisely why therapy is done on a one-to-one basis, because each one of us is so unique, and even though there might be similarities, no two experiences are exactly the same. If this was the case, reading self-help literature would suffise to « fix » each and every one of us. Often, self help literature is very informative and helps us to understand our triggers and reactions, but true healing remains elusive.

So how exactly does counselling and psychotherapy bring about relief? What is the magical ingredient that « heals »? The answer is surprisingly simple. Counselling and psychotherapy are what is called « person centered ». This means that the focus is on three things: the client, the therapist, and the relationship between the two. It is precisely the intimacy of the therapeutic encounter that is so unique and special. And for this intimacy to function optimally, therapy preferably needs to be in our own language.

Many famous psychoanalysts, including Freud and Lacan, advocated that if therapy is to be effective at all, it needs to be in the patient’s mother tongue. The theory behind this is as follows. Our most traumatic experiences all stem from childhood. In therapy, we talk about them, often cry about them (there is an emotional discharge) and through this emotional discharge the intensity of the traumatic experience slowly but surely diminishes. We never forget, of course, but the pain gradually gets less and less. So, for this emotional discharge to be truly effective, the words we use in the therapist’s office must ideally be identical to the words we used, or heard, when we were a child. If the phrases that, for example, we heard from an abusive parent, are translated into an another language, the intensity of feeling will necessarily diminish, and therapeutic results will be less impressive.

Another important element is what psychoanalysts call « transference ». This simply means the projections, positive and negative, that both patient and therapist place on each other. For therapy to be successful, there needs to be strong transference. We need to feel that the person sitting opposite us « gets us » on a deep level. And if our therapist not only speaks our mother tongue, but if we also know that she lived in or was raised in, our country of origin, and understands our cultural hangups and quirks, this guarantees a strong bond from the very first session. We feel far more at ease, and difficult and unspeakable things from our emotional world and our innermost feelings have an easier way of coming to the surface in words.

Many scientific studies have highlighted the dangers of suppressing our emotions, which in the long term leads to resentment being stored in our bodies through all kinds of inflammation. This is the famous « mind-body link », over which so much has been written about. A simple, first and foremost step to remedy this would be by talking to someone we trust. Someone we trust because we share something fundamental with them. Someone who speaks our own language.

The meaning behind "Negative Payoff"

jerome.arnaud5@wanadoo.fr (Gorana Arnaud) — Tue, 14 Dec 2021 16:01:42 GMT

Why being ill is sometimes convenient

The term « negative payoff » first started in use amongst the psychoanalytical community in the 19th century. It is the idea that each symptom, each illness, actually pr otects us from what is perceived by the body to be an even greater danger.

So for example: a woman who repeatedly has severe and violent migraines, which seem to appear late in the evening, and mostly on weekends or her days off work. Upon a little digging in therapy, it becomes clear that these migraines, however painful, give her an excuse not to have to engage in intimacy with her husband. After prolonged therapy this young woman finally summons the courage to file for a divorce, and the migraines disappear.

Another example: a young woman has debilitating endometriosis, giving her painful and long periods, making her tired and anemic. But this is not really what bothers her; what she suffers from the most, as she says in our first session, is her incapacity to get pregnant. Her husband really wants children, so do the g randparents, and it is very difficult for the young woman to come to the realisation, in therapy, that she is actually very ambivalent about being a mother. If she ever did get pregnant and have to take care of a child, it would jeopardise her dream career of being a writer and travelling intensively. Yet she is unable to assert herself and say NO, so her body does it for her. Her endometriosis, however much it makes her suffer, is actually a defense mechanism that protects her from an even greater evil; or what her subconscious perceives to be an even greater evil: motherhood.

In this above example, two issues are possible. First we would gave to assume that the young woman has the courage to persevere with her therapy sessions and find out her true desire, or what she really wants, not what her surroundings want. in the « happy end » version, she would assert herself vis-à-vis her husband, her parents and societal expectations, start using contraception, and her endometriosis would fade away, no longer serving its purpose.

In the not so « happy end » scenario, even though she could admit to herself that motherhood maybe wasn’t for her, her endometriosis would continue, becoming more and more severe. Why? simply because of guilt. In this example, the « negative payoff » of an illness is simply to punish us, in a very primal masochistic way. In this example, the young woman doesn’t want or is afraid of motherhood, but she feels extreme guilt. She feels that a woman who doesn’t want to become a mother is simply a bad person. And bad people must be punished. So, sadly, the endometriosis is her way of punishing herself.

Transgenerational psychoanalysis

jerome.arnaud5@wanadoo.fr (Gorana Arnaud) — Sat, 28 Dec 2019 10:53:32 GMT

or trans-generational therapy

No, it’s not about gender issues, for once. Transgenerational therapy is an important branch of psychoanalysis, first introduced at the end of the 1950’s by two Hungarian analysts who met, lived and worked in Paris; Maria Torok and Nicolas Abraham. They talked about the notion of « phantom » or something « haunting » the patient that he or she is only vaguely aware of and doesn’t seem to come from childhood but from somewhere further back, more long ago. The theory has since been expended by numerous writers and analysts, so much so that there are many therapists in France trained specifically as « trans-generational » therapists; i.e. they deal exclusively with the patient’s « family tree ». This means looking not only at the oedipal triangle (childhood, mother, father) but at past generations from both the mother’s and the father’s side, for as long as there is information available. So for instance, the grandmother, great-grandmother, great-great grandfather, uncles, aunts, and so on. Of special interest would be dates that coincide, such as birth, death, and wedding dates, personality traits that overlap, etc.

Many of these therapies function as brief therapy; that is: usually about five to six sessions maximum. This brief therapy can be done on its own or as a complement to a longer standard analysis.

The french clinical psychologist and author, Bruno Clavier, in his book Les fantomes familiaux, brings a very interesting point of view to this theory. In the first chapter, he describes many young women who come to se him because « prince charming » seems always around the corner, mostly on the next internet meet-up or ad, only to remain forever unattainable and out of reach. (Yes, this is something I have often seen in my office too). But Clavier claims that a large majority of these women have a special « sweetheart » from years ago, someone that they either had a platonic or consummated relationship with, but whom for whatever reason fate distanced from them. According to Clavier, this old sweetheart from years ago is idealized and seen as the perfect « if only » and the man chosen as a husband or life partner is often taken as a last option, because « no-one better was around », or « he was a good provider » or « he wanted a family too » or « he wan’t terribly exciting but was just stable ». These women sometimes leave their husbands once the children have grown, sometimes they stay, but if they stay it is in a somewhat lifeless mariage. And sometimes they can’t bear to settle for one partner at all and prefer to invest their energy in their career and friends.

Clavier introduces the hypothesis that this behavior might have a trans-generational cause. He rightly points out that women marrying or choosing their partner for love is a very recent phenomenon. Our mothers married very young and were thrust into maternity almost as soon as they left their parental home, and as for our grandmothers generation… Even if our grandmothers may have officially made a « choice », arranged marriage was implicit. And explicit for all the generations that came before them. And the young woman in an arranged marriage would often fantasize about the innocent crush she had as a teenager or the glimpse she caught of some other « could be » Romeo who was so very different than her dry, often indifferent husband.

So the dissatisfied woman of today is suffering from sole kind of trans-generational « phantom »…? It is an interesting hypothesis, but one that seems to me to be a little bit far-fetched. Again, according to Clavier, the solution would be to unmask all this ancestral suffering, and the present hardships of the modern woman would just fade away. This is the same argument Freud made over and over again, that once the unconscious becomes conscious, all symptoms would often disappear. Yet in clinical practice we know this to be an unusually optimistic claim.

Nevertheless, Clavier’s book is very interesting. In each of the seven or eight chapters he describes a different set of symptoms such as the one above and sets out to explain them using trans-generational analysis. For instance, chapter two deals with the typical « Don Juan » figure of the charming but eternally unhappy womanizer. Much has been written about this but again, here we have a refreshingly new insight.

All that said, however, although looking at ancestry, cultural factors and genealogy in therapy is of huge and not to be underestimated value, it seems to me that Clavier’s thesis is far too simplistic at times. Especially the claim that if one profound and in-depth therapeutic approach failed, then another, flash « brief-therapy » can get rid of stubborn symptoms which years of work couldn’t undo. But this again opens up another discussion altogether: the validity of « brief-therapy » in itself…

Book review: "The state of affairs"

jerome.arnaud5@wanadoo.fr (Gorana Arnaud) — Sun, 15 Jul 2018 19:28:45 GMT

I just finished reading the long awaited book of renowned couples therapist Esther Perel; « The state of affairs », translated in French by « Je t’aime, je te trompe ». Esther Perel is the famous author of the international bestseller « Mating in captivity », which came out in 2006 and propelled her to stardom as « the » couples psychotherapist. Her first book looks at marriage, long-term monogamous relationships that is, and asks questions about whether commitment rhymes with sexy. Can we desire what we already have? Does good intimacy always make for hot sex? in her first book Perel examines what the New York Times calls « the most time-honored institution in the Western world »; i.e. the sexless marriage.

I loved the book; as I imagine every couples therapist did who on many occasions had the following speech delivered on their couch: « We love each other. We love our kids, the holidays, the house, the pool, our friends, the parties. We want to stay together. It’s just that… we’re not having sex, and even though this isn’t a big deal for me, it is for him/her. »

in her second book, which twelve years later immediately became a bestseller in the US and was translated into 24 languages, she tells us how she has narrowed down her area of specialization even more. From the sexless marriage, she has evolved onto infidelity and the scary but exciting world of THE AFFAIR. So, the four hundred pages of the book treat solely this topic. When I picked up the book in Sauramps it sounded very promising, but left me slightly confused and ambivalent in the end.

To be fair, Perel does make some very interesting anthropological observations on how infidelity has evolved in recent years. Firstly, with the internet, it is easier than ever before to cheat on the unsuspecting spouse. However, whereas a few decades ago the unsuspecting wife would find a lipstick stain on her husband’s shirt, or the husband would have mere suspicions that shopping was taking a tad too long on Thursday afternoons, nowadays when we discover a secret e-mail account or a string of text messages the wronged party is immediately exposed to all the intimate, crude, gory details.

The societal outlook on how an affair should be dealt with has also evolved. Whereas in the past, it was reprimanded when a wife left her husband simply because of his « indiscretions », nowadays it is exactly the opposite. The examples given are Hilary Clinton, and in France we have Anne Sinclair, wife of DSK. Both women were severely judged for the fact that, despite an affair, they stayed with and supported their husbands. (Apparently Madame Sinclair did leave in the end, but long after media attention had died down.) In 2018, if a woman is not consulting a divorce lawyer immediately after she finds out about some vague screwing around, she is seen as weak, a doormat, or someone with « Stockholm syndrome », a prisoner infatuated with their sadistic jailor that is.

It seems that affairs don’t just « happen ». Every affair has a source in the insatisfaction or the lack of communication in our official couple. Sometimes this malaise is conscious, and sometimes it isn’t, and the affair helps to bring it to the surface.

So, according to Perel, every affair is an opportunity for growth. One of her famous lines often repeated in her TED talks, is that, when asked « Would you recommend to anyone to have an affair? », her answer is « No more than I would recommend to anyone to get advanced cancer ». But then, she adds: « And yet many people with advanced cancer have found this experience to be life-transforming, and for the better. »

Although the book makes very interesting reading, what I didn’t like was a vague, almost moral stance behind it. Just like in the first book, when I had the impression that the couples Perel values the most are those who have been married for a loooooong time, have no sex, and then through genius creative ways do manage to reignite the spark. In the second book, on infidelity, it was the same; the best, almost « spiritual » couples were the ones that managed to stay together and thrive despite the affairs(s). To me this smelled more of codependency than of spirituality. As if the success of a couple was based on its longevity. Maybe I’m too cynical, but a little voice inside me kept nagging at the question as to why all these couples don’t simply split up and start over, with someone who is capable of making an honest commitment.

Yet these negative thoughts are precisely what Perel says she is trying to dispel. But is this not too ambitious of a task? As always, it seems that all this brings us back to the question of therapeutic neutrality. Can a therapist ever be neutral and unbiased, and not favor one moral stance over another? Or are therapists simply human beings who can pretend to cover up their bias but somehow this bias always manages to rear its ugly head? And is this necessarily a bad thing?

Anyhow, this book is an important contribution to the field of couples and family therapy, and certainly deserves a place on the shelf. Perel’s writing style is light, flirtatious and engaging, filled with examples from her own private practice. So, yes, I would definitely recommend it, especially as a late night read ;-)

Psychanalyse ou psychothérapie ?

jerome.arnaud5@wanadoo.fr (Gorana Arnaud) — Thu, 07 Dec 2017 20:44:05 GMT

Ou, la différence entre psychothérapie et psychanalyse

Quelle est la différence entre une psychothérapie et une psychanalyse ? C’est la question qu’on entend le plus souvent en tant que clinicien. La différence est en effet majeure, mais elle n’est pas facilement reconnaissable.
Souvent on entend : « La psychanalyse, ça prend des années, la psychothérapie est très brève ». Ceci n’est pas vrai, car un bon psychanalyste peut, dans la première séance, par son écoute et les questions qu’il pose, bousculer notre rapport au monde et les vérités qu’on tenait pour acquises. Et le patient sort de cette séance littéralement transformé et là, nous ne sommes même plus dans une thérapie brève, nous sommes dans une thérapie « éclair ».
Il est aussi souvent dit que la psychothérapie permet au patient de mieux s’insérer dans la société ; ceci est vrai…mais : la véritable insertion vient quand on se sent tellement bien dans sa peau qu’il n’y a pas de doute qu’on est à sa place, à sa place singulière de sujet. C’est la reconnaissance qu’il n’y a jamais eu quelqu'un comme nous sur la planète Terre avant nous, ni qu’il y aura quelqu'un comme nous après notre mort ; nous sommes un être unique dans la grande fraternité des hommes et c’est là qu’on peut vraiment jouir de la vie et de tout ce qu’elle a à nous offrir. Et cette jouissance, ce bonheur pur et simple, la psychanalyse peut nous en indiquer le chemin. Mieux que la psychothérapie.
Alors la question qui se pose naturellement après, est : comment choisir son psychanalyste ? Le mieux c’est « au feeling », c'est-à-dire en suivant son intuition. Un bon psychanalyse se doit d’être non seulement très cultivé, intelligent et empreint d’une grande empathie, mais surtout, il doit y avoir la petite étincelle qui nous dit : « Cet homme, cette femme, comprend ce que je traverse parce qu’il l’a traversé aussi, et parce qu’il connait le chemin, il est apte à me guider pour que j’atteins mon destination. »
Une excellente psychanalyste à Montpellier que je recommande vivement est Berlende Lamblin .

Book therapy

jerome.arnaud5@wanadoo.fr (Gorana Arnaud) — Sun, 22 Jan 2017 19:48:00 GMT

Reading as a form of meditation

There is a lot of buzz at the moment about meditation, yet meditation does not necessarily mean going to a class, sitting upright on a cushion for an hour, and forcing our minds to be “empty” and to “think of nothing”. This is actually very hard to do, and reserved to the elite few who have had the patience and the perseverance to go through years of training and practice. Also, the goal is not necessarily to empty our minds of everything, just of anxious, obsessive thoughts that do us no good. And this can be much more easily done if we fill up our minds with something else. Cooking, gardening, knitting and any sort of manual work obliges us to concentrate on what we are doing at the very instant, and so there is simply no room for anxious thoughts to spoil the moment.

Yet, a very interesting form of meditation is reading. Reading forces us to transport our minds and imagination elsewhere then on our bills, taxes, family disagreements and fears about a hypothetical future which will probably never happen anyway. Whilst reading, the mind can rest, precisely because it is occupied elsewhere. When the mind is creatively employed instead of “empty” (as many new-age fads would like us to believe) meditation happens naturally, without us having to force things or “train” our minds to obedience.

Interestingly, there is an entire courant of psychotherapy called “book therapy” developed precisely around this idea. But there is a simple way to reap the benefits of book therapy instantaneously. This consists of getting a cup of tea and snuggling up on the sofa with a good book.

A great choice of reading in a confortable setting, in Montpellier, can be found at Le Bookshop : besides an impressive bilingual book collection, they have a great choice of drinks and cakes, as well as various book club and language exchange activities.

Comprendre la lecture des archives akashiques

jerome.arnaud5@wanadoo.fr (Gorana Arnaud) — Sat, 31 Dec 2016 18:43:16 GMT

Ou, une lecture de notre potentiel

Comme psychothérapeutes, nous avons plusieurs obligations. L’une entre elles est l’obligation de toujours se tenir informé de dernières nouveautés dans l’évolution des psychothérapies. J’ai donc testé une séance d’archives akashiques avec Jonathan Yahimi, car j’entendais sans cesse parler autour de moi de ces « archives ». C’était une expérience très intéressante. Jonathan possède une empathie très intuitive, et il a su rapidement me mettre à l’aise. Sa bienveillance et son professionnalisme sont évidentes. La séance se déroule de la manière suivante : le client apporte une liste de dix questions, auquel il aimerait avoir une réponse, et Jonathan fait une lecture des archives pour voir le potentiel ou les possibilités que la personne assise en face de lui est capable d’atteindre. C’est une description simpliste pour une expérience qui est plutôt de l’ordre de l’indescriptible. Beaucoup des problématiques psychiques, comme les angoisses, la faible estime de soi, etc., se trouveront réconfortés par une telle approche.

Yahimi Jonathan
Thérapeute et Consultant Archives Akashiques
Site: www.archives-akashiques.fr
Tel : 07.68.02.34.73
Montpellier (34)

Parler pour vous aider à aller mieux

jerome.arnaud5@wanadoo.fr (Gorana Arnaud) — Sat, 31 Dec 2016 18:41:33 GMT

La thérapie psychodynamique

Il est de plus en plus courant d’entendre, même dans le milieu des thérapeutes, que la bonne vielle psychanalyse « ne sert à rien », que « parler, ça ne change rien », etc. Il est parfaitement vrai que beaucoup des psychanalystes eux-mêmes prétendent que le mot « guérir » est un gros mot. Combien de fois n’ai-je pas entendu, dans les soirées, un collègue dire sur un ton confidentiel : « Aller mieux, oui. Guérir, non. » De ce fait, la psychanalyse Lacanienne nous dit que le but ultime d’une cure est que le patient accepte son symptôme, apprenne à vivre avec, mais qu’il n’essaye surtout pas de l’éradiquer, car le symptôme et le sujet sont liés ensemble pour toujours.

Dans l’autre camp, nous avons les thérapies alternatives : hypnose, thérapies par mouvements oculaires, thérapies par médiation corporelle, thérapies brèves, etc. : ici, « guérir » devient un impératif, de préférence dans un lapse de temps entre une et cinq séances. Mais, malgré ces promesses miraculeuses, la bonne vieille thérapie par la parole persiste… Pourquoi ?

Il faut tout d’abord faire la distinction entre la psychanalyse classique et la thérapie dite « d’inspiration psychanalytique » ou « psychodynamique ». Dans la psychanalyse classique, le patient est sur le divan, ne voit pas son analyste, et celui-ci fait peu de commentaires et surtout pas d’ « interprétations ». L’émotion de la part de l’analyste est vue d’un mauvais œil et le silence est loué, car le patient doit apprendre à « gérer la frustration ».

La thérapie d’inspiration psychanalytique ou psychodynamique est tout autre, malgré la confusion que suscite son appellation. (Cette approche est en effet, issue de la psychanalyse, mais a beaucoup évolué à partir de là.). D’abord, le thérapeute et son patient sont assis face-à-face, à une distance pas trop éloignée, la communication non-verbale, c’est-à-dire le contact visuel étant primordial. Ici, le thérapeute est beaucoup plus impliqué que dans la cure psychanalytique. Il écoute, mais il soutient, pose des questions, dirige la séance, explique et surtout informe le patient avec toute son expérience et capacité, pour que le patient se sente le mieux armé possible de confronter avec succès sa problématique.
Cette thérapie humaniste est non seulement très efficace, mais nous avons peut-être au jour d’aujourd’hui la preuve scientifique que parmi toutes les thérapies sous le soleil, c’est celle-ci qui est la plus efficace. Et qui tient dans le temps, longtemps après que la dernière séance soit terminé.

Dr. Jonathan Shedler, chercheur à la faculté de médecine de l’université de Colorado, Denver, a comparé huit méta-analyses comportant 160 études sur la thérapie psychodynamique, avec neuf méta-analyses d’autres approches thérapeutiques et les médicaments antidépresseurs. Selon le Dr. Sedler , les autres approches thérapeutiques avaient des résultats qui étaient limités dans le temps, mais la thérapie psychodynamique était la seule qui instiguait des changements et une évolution dans la psyché du patient qui s’intensifiait et croissait longtemps après que la dernière séance fut terminée.

La psychanalyse classique à longtemps renié les études statistiques, et ceci à son propre détriment. Le résultat inévitable a été que des autres formes de traitement, par exemple les thérapies comportementales et cognitives, les fameux TCC’s, ont su s’établir sur le prétexte qu’ils étaient « scientifiquement validés » et appuyés par des « recherches empiriques ». Cependant, les nouvelles donnés comme celles du Dr Shedler, confirment ce que maints thérapeutes et patients savaient par expérience : la thérapie par la parole, la thérapie « classique » marche, marche très bien, et en terme d’efficacité, c’est ce qu’il y a de mieux.

The benefits of talking to someone

jerome.arnaud5@wanadoo.fr (Gorana Arnaud) — Sat, 31 Dec 2016 09:22:13 GMT

The benefits of psychodynamic psychotherapy

It is becoming more and more common to hear, even amongst therapists, that old-fashioned psychoanalysis is simply too long and the results too negligible, worse, that simply “talking” doesn’t solve anything, especially deep-rooted psychological ailments. This is made worse by the fact that many “old-school” psychoanalysts, especially in Europe, see the word “healing” as an almost dirty word. There have been a number of times at conferences or networking events that I have heard a colleague psychoanalyst say in a half-whisper: “The patient can get better, sure, but they cannot “heal”.

On the other side of the ring, we have the so-called “alternative” therapies: hypnosis, eye-movement therapy, brief-therapy, body-centred therapy, etc. Here, “healing” becomes implicit, preferably in the lapse of time between one to five sessions. Yet, despite these miraculous promises, good-old talk therapy still persists… Why?
First, it is necessary to make the distinction between classical psychoanalysis and “psychoanalytically inspired” or “psychodynamic” psychotherapy. In classical analysis, the patient is on the couch, facing away from the analyst whom he cannot see. The analyst makes very few comments and mostly listens; any emotion on his part is not seen in a very positive light, indeed the best intervention is silence, because in this way the patient can “learn how to handle frustration” and “face reality”.

Psychoanalytically-inspired, or psychodynamic therapy, is very different, despite the confusion of the label. (Actually, psychodynamic therapy did originally evolve from psychoanalysis, but has come very far since its nineteenth-century relative).

Here, the therapist and the patient sit in armchairs facing each other, at a not-too-far-apart distance. Intimacy and non-verbal communication, thus eye-contact, are of the utmost importance. The therapist is much more engaged than he would be in a classical analytical cure. He listens, but he also supports, asks questions, structures each session, explains, and most of all informs or teaches the patient using all his experience and know-how so that the patient feels as equipped as possible to deal with issues in the outside world.

This “humanistic” therapy is not only very effective as far as patient testimonials go, but we might actually have scientific proof that amongst all the different psychotherapies under the sun, it is precisely this one that yields the best results. Best of all, benefits of this therapy continue to grow even after the end of treatment.
Jonathan Shedler, PhD, of the University of Colorado Denver School of Medicine, compared eight meta-analyses of 160 studies on psychodynamic therapy, with eight meta-analyses of other therapeutic techniques as well as antidepressant medication. According to Dr. Shedler , other therapies showed patient improvement but the improvement was limited in time, whereas psychodynamic therapy was the only one that initiated changes and an evolution in the psyche of the patient that grew even long after treatment was terminated.

Classical psychoanalysis has always looked down upon statistical findings, and this has been to its own detriment. The inevitable result of this was that other forms of treatment, for example the cognitive behavioural therapies or CBTs have been able to gain limelight by the pretext that they were “scientifically approved” and supported by “empirical evidence”. However, new research such as that of Dr Shedler, confirms that which numerous therapists and patients knew by experience: classical “talk therapy” not only works very well, but in terms of efficiency, it’s the best there is.

Adoption therapy

jerome.arnaud5@wanadoo.fr (Gorana Arnaud) — Sun, 18 Dec 2016 17:39:51 GMT

Issues to consider when working with the sensitive issue of adoption

Perhaps the most important thing to consider when working with adoption is attachment issues.

However, even though parents and therapists must be aware of and educated about attachment styles and difficulties, it is primordial to stress that the adoptee child or adult does not suffer from “attachment disorder”. She suffers from full-blown, all-out PTSD. “I am not good enough for Mummy to keep me. I was rejected, given away. And because it happened once, I have no guarantee it won’t happen again.” This is the core belief of an adoptee, and persists until, and if, she has children of her own.

As a parent, expect the adoptee to attach too quickly, almost too easily to you, whilst at the same time quite possibly not attaching at all. Once you become aware of this inevitable distance, it might help to undergo some therapy of your own in order to come to terms that her idea of and tolerance to intimacy might not be the same as yours. It might be incredibly painful to realise that even though she will give you the maximum that she can, she cannot, at least for now, give you what you wanted so desperately. This is especially poignant in the case of mothers who adopt. You wanted a child so much, you went through horrific physical and emotional hardship trying to become a mother, you waited for so long, now she is finally here, except that- sometimes you have a feeling deep inside your gut as if she wasn’t really here. As if…she didn’t really want to be here, but is almost too afraid of upsetting you if she admitted it.

Be patient. Give it time, lots and lots of time. Be very careful of suffocating (smothering) her. This will only create more distance. Eventually, she will mirror your smile and smile back. Let her take the initiative in everything, and let her come to you.

What makes a good therapist ?

jerome.arnaud5@wanadoo.fr (Gorana Arnaud) — Sun, 20 Nov 2016 13:18:27 GMT

or what qualities you should look for in your counsellor

Could it be that there are no good or bad therapies or “therapeutic techniques”, but that there are only good or bad therapists? As Sigmund Freud already remarked in 1905: “it is not medicine that heals an ailment, but the doctor, which indeed means the personality of the doctor; by his personality he is able to influence the patient, for better or for worse”

When I started practicing as a zealous young counsellor years ago, I worked for a public institution which used almost exclusively a therapy called EMDR, and I placed an incredible amount of hope in this method. (Some of you may know EMDR, it is a therapy which uses either eye movements or acupressure like “tapping” to heal trauma…) As time went on, I remarked something bizarre: what seemed to bring patients relief and put an end to their symptoms wasn’t so much the type of therapy used, but the personality of the counsellor. So, someone with a history of abuse and emotional deprivation swore by EMDR therapy, another person with a quasi-identical experience was very against EMDR and idealised traditional psychoanalysis, the third person claimed that psychoanalysis was useless and that she tried all existing therapies until she found salvation through hypnosis, or Gestalt therapy, etcetera. This made me very curious, and I tried to get my head around this phenomenon. The conclusion I came to was that, as said in the first line: there are no good or bad therapies- there are only good or bad therapists. So what qualities make a therapist good? This is extremely difficult to pinpoint, however here are some traits I believe are essential.
Number one is empathy. A good therapist communicates to the patient a desire to understand and share in their experience. He or she communicates that the patient is not alone- when someone feels understood and really “seen” they can gather the strength to explore themselves courageously. Another quality of a good therapist is respect. This means acknowledging that the patient has a right to choose, to make mistakes, to suffer, or to heal. It also means teaching the patient the principles of how the mind and psyche work, and how to be their own therapist, so that there is no unhealthy dependence. A good therapist is genuine: openly authentic with no phoniness, and also absolutely sincere- this means no game playing. He develops an appropriate relationship with the patient, and knows what limits to put on any personal sharing. Warmth is another quality. The good therapist shows care, concern and affection for the patient, verbally and non-verbally. An effective therapist is concrete: he must not use any fancy language or technical jargon in order to avoid the core of the problem, and must dive into the issue as soon as possible.

Next comes confrontation. Warmth and kindness are all very nice, but a good counsellor must be able to explore any inconsistencies, distortions, or avoidance patterns in the patient’s story. For example, being a “victim” of migraines might mean I don’t have to go to work, or have sex with my husband. The good therapist acknowledges that confrontation may bring up anger, frustration, or defensiveness, whilst at the same time remaining warm and empathetic to the patient’s issue. Another quality is self-disclosure. The good therapist shares something of himself that relates to and inspires the patient to heal. This is done at the right time during the session, and communicates to the patient that “we are in this together.”

Next; the effective therapist makes it okay for the patient to openly express emotions, most importantly, negative emotions towards the therapist. The remark I hear most often is “You don’t really care about me- you’re just doing your job!” This courageously addresses the therapist-patient relationship, and teaches the patient, through the therapist’s example of honesty, to work out his own interpersonal relationships. Next, it is absolutely essential that the therapist communicates personal power, both verbally and non-verbally, through his actions. I call this quality “potency” or “emphatic authority”. The good therapist shows self-confident commitment to the patient, and thus communicates that it is safe for the patient to be authentic in the therapist’s presence. Sooner or later this confidence will rub off on the patient, and self-esteem will soar.

But perhaps the most important quality of a good therapist is self-actualization. This means that they must actively be doing his or her own personal growth work. The therapist must act as a role model for their patient; dependable, trustworthy, kind, and optimistic. The good therapist must have developed their own personal philosophy which allows them to have peace of mind. He or she must be able to share openly and honestly with family and friends, and their personal life should be a calm haven of love, trust, and acceptance. The good therapist should be able to “walk the talk”. If this is not the case, I believe that all our degrees, training and experience are actually quite useless. If we can’t assume this, then it’s just another case of “do as I say, but not as I do.”

For a list of English speaking therapists in the Languedoc region, visit AngloInfo LanguedocRoussillon .