Many articles and books have been written on the therapeutic process. How does psychotherapy help?

There are many schools of psychotherapy, including psychoanalysis, and many ways of explaining the mechanisms that promote change and the resolution of symptoms and conflicts.

Within psychoanalysis itself there are different theoretical tendencies. For Freud, the founder of psychoanalysis, the key mechanism to achieve psychological change is to make conscious the unconscious.

To make conscious the unconscious facilitates a new form of feeling, thinking and behaving. Even so, psychoanalysts have discovered that the process of exploration of unconscious mechanisms takes place in the context of the relationship between patient and therapist. In optimal conditions, the therapeutic relationship produces significant changes in the way one can relate with oneself and others.

Fundamental and common to all different schools of psychoanalytic thought is the principle than early interpersonal experiences exert a strong and durable influence on adult personality.

According to Bowlby, a productive therapeutic relationship constitutes a secure base from which the patient can explore his emotional life as well as his past and present relationships with those who had played and - even today - play an important role in his life.

For the relationship to be secure certain conditions are necessary, such as confidentiality and regularity of sessions.

The patient needs to be sufficiently motivated and emotionally involved to be able to establish what we call “therapeutic alliance”.

On his part, the therapist should have experienced a personal analysis that would allow him to know himself well and make a clear distinction between his personal problems and those of the patient.

An essential part of the therapy consists in analysing the way these early experiences manifest themselves in the present, in relation to others and particularly in relation to the therapist.

An important mechanism in this process consists of establishing a reflective dialogue with the therapist. Through this dialogue, which I also call “co-thinking”, it is possible to work through personal problems in a spiral. Often we feel stuck because we think in a “close circle” and after going round an issue we find ourselves back at the starting point. A reflexive dialogue allows us to think “in spiral”: every time we go round a topic we have made a new opening.

In some cases the therapy of choice maybe couple therapy, family therapy or group therapy.