Winnicott essentially said that the disaster you're trying to avoid already happened a long time ago.
Under the right relational conditions, you can finally experience it so you don't have to fear it anymore.
The other day a patient told me that he was really missing his mom but that he was still really angry with her.
You know what I said?
Nothing. Because I made that up. Don't talk about your cases online.
Psychotherapists:
I'm curious, which theorists or writers of any kind OUTSIDE of the field of psychotherapy or mental health have influenced your work as a therapist the most?
Reading Essentials for Beginning Dynamic Therapists:
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acceptable period of time to spend in psychotherapy:
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• couple of months
• six months
• one year
• multiple years
• decade
• multiple decades
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In sum, teaching psychoanalysis is a paradoxical affair: someone who is supposed to know teaches someone who wants to know what it means not to know.
Thomas Ogden
In sum, teaching psychoanalysis is a paradoxical affair: someone who is supposed to know teaches someone who wants to know what it means not to know.
Thomas Ogden
If your sister died when you were five, then your brother died when you were 20, then your analyst got ill and died, then your son died in a hiking accident, you'd probably talk a lot about the death instinct too.
In psychotherapy, you don't become some new utopian version of yourself; you become more yourself with some enhancements.
So it's less like buying a new Porsche, and more like giving your Honda Civic a nice upgrade: new tires, new engine, new sound system.
An extremely practical (and underrated) “how to” or “what to say” book for psychodynamic geeks featuring hundreds of commonly encountered clinical issues and obsessively cross-referenced is Nat Kuhn’s ISTDP reference guide.
I once met a person who seemed depressed, one who couldn't stop talking, someone who was shy and withdrawn, a perfectionist, and a person who seemed overly accommodating.
For a group of therapists, though, everyone was pretty nice.
For anyone interested, here's my syllabus for Personality Development and Clinical Assessment I, which I'm teaching to first year analytic candidates in the Fall.
Dear Therapist,
My life has improved dramatically. I can live with ambivalence & take actions despite uncertainty. My work life is better. I trust myself more. I have a very close relationship for the first time. And I accept that some things about me may never change.
While psychedelic medicine taken within the context of long-term relationship could catalyze sustainable change, there's no such things as "5 years of therapy in just a few sessions".
Last time I checked 5 years of therapy takes...5 years of therapy.
It's important for therapists to think twice before tweeting anything remotely related to a particular patient/client/case. "Oh, but I have their permission!" Permission or not, how is it related to the treatment advancing? It's not. And since it's not, why are you doing it?
Prefixes that enhance the patient's reflectiveness toward what you’re about to say:
•This may be off…
•Tell me what you think about this…
•I could be wrong…
•Tell me if this resonates at all…
•You probably already know this…
The silence of the analyst opens a suspense. It is not a nonresponse or a nonreception; it is an engagement with the nonresolution of an act, an invitation to take further risks, to hold unbearable contradictions within oneself and bring them alive.
Anne Dufourmantelle
However, after reviewing the scientific literature, it appears that your methods are not, in fact, evidence based and I regret to inform you that I will have to renounce all of these developments immediately and start over with a more evidence-based treatment.
Thank you.
Never sleep. Never eat. Never drink. Don't do anything but push yourself constantly. Ever. Until you drop. Dead. Then keep going. From the grave. Working. Striving. Hustling. Death is no excuse for outworking the competition. Don't stop. Keep going. Faster.
“Even though psychoanalysis has clearly been discredited, analysts continue to rationalize its efficacy in order to make a living—almost as if they have this inferiority complex from childhood or like they’ll have an identity crisis without it, neither of which they're aware of.”
If your psychotherapy practice is based solely on other people's theories, that means it's based primarily on other people's clinical observations. This leads to a kind of zombie theoretical approach that negates the aliveness of 𝘆𝗼𝘂𝗿 unique clinical observations.
That the therapist must feel trustworthy to the patient is obvious. What is less self-evident is that the therapist must also learn to trust the patient: to see the growth edge of the defense, the advance predicted by the step back, and the nascent order within the chaos.
Every five years when I look back on the work I was doing five years earlier, I am horrified. How could I have practiced, understanding so little by comparison with what I have come to understand now?
Erich Fromm
A quantitative questionnaire measuring distress and therefore treatment deterioration might not account for how psychotherapy is helping someone access more freedom in their lives precisely *because* they can tolerate more uncomfortable feelings.
There are some therapists who never had formal analytic training who are great analysts.
And there are some therapists who completed formal analytic training who are terrible.
I'm reading The Impossible Profession (1980) by Janet Malcom where she writes that 89 percent of people looking for low-cost analytic treatment at New York Psychoanalytic were turned away as unanalyzable. That's nuts!
The brilliant interpretation you formulated in your head about the patient a few minutes ago is now old news compared to what is happening in the room now, which you stopped paying attention to a few minutes ago.
Psychotherapists:
Do you know what your "maximum patients seen daily/weekly before efficacy plummets and can barely manage to say more than 'how does that make you feel' and 'sounds hard' because you're basically just phoning it in now" number is?
I know other modalities make use of the "rupture and repair concept", but I think psychoanalysis is singular in it's theoretical understanding of inevitability of failing the patient in a significant way and the value of living through that together and making sense of it.
It's natural for the therapist, in varying degrees at various times, to:
• be afraid the patient will stay
• envy the patient
• prefer to not look inward
• hate doing therapy
• dread getting more deeply involved
It's called ambivalence.
I'm teaching Evolution of Technique I this semester at The Psychoanalytic Psychotherapy Study Center and I made a syllabus.
If you're curious here it is:
I was reading this immersive, moving and perspective-shifting novel, but then I learned there had been no systematic empirical research done to support its efficacy so I had to stop.
The most successful cases are those in which one proceeds, as it were, aimlessly, and allows oneself to be overtaken by any surprises, always presenting to them with an open mind, free from any expectations.
Freud
It's easy to forget, but interpreting a patient's behavior without referencing (or understanding) its adaptive context is usually received as a criticism.
Key therapy ingredients:
-linking past & present
-generative (but uncomfortable) silence
-unglamorous sessions followed by breakthroughs
-shift from fixing to accepting
-changes in real life
-developing self-reflective capacities
-knowing when to stop