The Real Work of Therapy: From Looking Inwards to Connecting Outwards
What does building a better life truly mean? For many, it's a complex picture of deep fulfilment shadowed by the fear of fragility. This internal conflict is precisely where meaningful therapy, particularly psychodynamic psychotherapy, can intervene. Contrary to popular belief, this process is not an indulgence of self-absorption; it is a guided journey out of it.
People often mistake psychoanalysis and its descendant, psychodynamic therapy, as purely inward-looking pursuits. While it's true that good therapy provides the essential time, space, and safety to listen to ourselves, that is only the beginning. The ultimate goal is to understand the internal barriers that prevent us from engaging with the outside world and other people in a healthy, ordinary way.
How Unprocessed Trauma Fuels Narcissism
Many individuals struggle without understanding why they cannot form meaningful connections. Often, this stems from unprocessed traumas or unconscious conflicts that keep them psychologically trapped in the past. When we lack the capacity to digest our own difficult feelings, we certainly cannot bear or relate to the emotions of others.
This emotional intolerance can lead to dangerous coping mechanisms. People may fend off spontaneous feelings with screens, substances, gambling, other forms of self-harm, workaholism, or by sabotaging relationships. Without proper psychoanalytic help, individuals can remain stuck in what is described as an ordinary but devastating narcissism, unable to relate to themselves or others in any meaningful way.
If we are blind to our internal world, we cannot genuinely look outwards to find solace and meaning in community, nature, work, and love. Meaningful therapy doesn't indulge narcissism; it lights the way out of it.
The Fight for Accessible Therapy on the NHS
One common criticism of psychotherapy is that it is a privilege for the wealthy. While it is true that private treatment can be costly, it is not exclusively for the well-off. Reputable clinics and training organisations often run low-fee schemes, and the British Psychoanalytic Council now allows therapists to advertise these reduced-cost vacancies on their profiles.
However, not everyone can afford even these lower fees. This is why many clinicians are fighting for the provision of sustained psychodynamic psychotherapy on the NHS. Tragically, this is a battle that is being lost. Provision has been consistently diminished over decades, and there is now very limited access to this evidence-based treatment within the national health service.
Every time an NHS service is forced to cut psychodynamic psychotherapy, it acts against its own stated values of equality, quality care, and patient choice. These cuts make a mockery of the supposed parity of esteem between mental and physical health. This is an unacceptable situation that demands louder protest.
The effectiveness of this therapy has little to do with a patient's wealth, education, or profession. It is a universal tool for building a better life. For the author, an NHS psychotherapist, psychoanalysis was foundational. It allowed her to save her marriage, become a parent, and build a fulfilling career by moving beyond a brittle intellectual defence and confronting a deep-seated emptiness.
The goal is clear: this highly effective treatment should be available to anyone who needs it and can use it, not just those who can afford it. Building better lives and a better society depends on making mental health support like this accessible to all.
