1/ Inexperienced therapists often confuse therapy goals with life goals. They're different. The goal of psychotherapy is *psychological change.*
“Treatment goals include areas that are influenceable by work on the self; life goals depend heavily on factors outside one's control.
2/ Therapy goals thus might include reducing perfectionism, increasing realistic self-esteem, resolving an internal conflict, making a difficult choice, mourning a painful loss, and so on.
Life goals include, for example, finding a partner or or spouse, getting a good job,
3/ becoming a parent. They may be attained more easily when therapy goals have met, but they are not themselves treatment goals. Clinicians cannot promise that at the end of the therapy there will be a partner, a job, or a baby; for those aspirations, too much depends on external
4/ circumstances.
Newer therapists need supervisory help in not signing on to pursue a client’s life goals, but instead reconceptualizing and reframing the clinical task as internally directed work that may increase the probability of achieving such goals.”
—Nancy McWilliams
5/ I would have preferred it if she had said “Treatment goals include areas that are influenceable by work on oneself” (not the self)
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1/ Sixteen psychoanalytic concepts for our time (updated) 🧵
Splitting: Perceiving others in black-and-white categories; seeing them as one-dimensional, as good or bad
2/ Denial: Refusal to acknowledge or accept reality when it does not fit your wishes & preferences
3/ Omnipotent Control: Seeking to control others’ behavior, speech, and even thoughts; insisting that others should think your thoughts instead of their own
1/ I’ve never had a “noncompliant” therapy patient. I don't even find the word helpful. It implies therapist brings an agenda for patient to follow, but that’s not how good therapy works. Good therapy means a “working alliance”—a shared understanding & agreement about the purpose
2/ of therapy and methods used to achieve that purpose. The initial sessions (the “consultation phase”) are devoted to developing that shared understanding
That takes two—it takes collaboration to reach a meeting of minds about the purpose and the methods of therapy
3/ The purpose must fit the therapist’s understanding of what is going on psychologically that’s giving rise to the patient’s difficulties, that is realistically possible to change in psychotherapy, that the patient recognizes (with the therapist’s help) is causing difficulties
1/ “The available data suggest that the majority of carefully selected patients who undergo 16 sessions of cognitive or interpersonal therapy for depression (the treatment length prescribed in the manuals) administered by highly trained and supervised therapists in clinical
2/ trials fails to improve, remains symptomatic at termination, and relapses or seeks further treatment within 18 months. In light of these dismal outcome statistics, and the fact that no one has ever compared these treatments with treatment in the community by expert
3/ practitioners, the assertion that clinicians should start with one of these manuals seems [indefensible]. It is unfortunate that researchers made the collective decision over the last 20 years to study only brief trials of only two treatments for a subset of poorly
At first appointment with a new patient/client, there are three things you want to find out
1️⃣ What's wrong?
2️⃣ How are they hoping therapy can help?
3️⃣ Why now?
Some elaboration on these 3 things...
➡️ People don't come to therapy for sport. They
2/ come because they’re in pain. Something is wrong. An understanding of what’s wrong is the starting point for any work you will do
➡️ It's crucial to find out their ideas/hopes about how therapy can help them. This is an invitation to start to think together about how things
3/ could be different, what that might look like, and their initial ideas about how therapy might help them get there
The patient’s/client’s ideas about how therapy can help may be realistic or unrealistic. They may be vague or specific. They may have trouble even imagining how
In every successful therapy, there is a period when the patient feels more lost than ever. They are relinquishing old ways of being & have not yet consolidated new ways
We are changing life patterns. There is no path from point A to point B that does not pass through the unknown
2/ Real transformation occurs when patient and therapist embrace the unknown
But this is also the point when inexperienced therapists get anxious & want to rush in with solutions—instead of continuing the shared work of exploration, and accompanying the patient into the unknown
3/ This is the point where therapists, in an effort to manage their own anxiety, can derail the successful work of the therapy that has led them to this point
1/ “A strikingly cyclical effort to sanitize speech has contributed to widespread misunderstanding of psychoanalytic tradition. Over time, whatever the original intentions of those people who coined any specific psychological term, labels for certain conditions ineluctably come
/2 to have a negative connotation. Language that was invented to be simply descriptive—in fact, invented to replace previous value-laden words—develops an evaluative cast and is applied, especially by lay people, in ways that pathologize. Certain topics seem inherently
3/ unsettling to human beings, and however carefully we try to talk about them in nonjudgmental language, the words we use to do so attain a pejorative tone over the years.