Dissociation is of special importance in the 2nd psychological vital sign of self and object constancy. Dissociation serves to protect one’s self from the pain (physical and/or emotional) one is experiencing now. 1/6
2/6 To do that, a person unconsciously and automatically shifts their attention somewhere else. We’ve all driven from A to B, arrived at our destination, and wondered why we can’t remember the path we took. Our thoughts were somewhere else.
3/6 When this happens as a response to severe pain that occurs repeatedly, it sometimes becomes difficult to be aware of or control the shift in state of mind. In severe instances, the states of mind can become segregated so they don’t seem to drift from one to another.
4/6 When this occurs, sometimes people feel fragmented or not whole. Imagine how frightening it might be to not have the ability to shift your state of mind away from something that feels uncomfortable or even unbearable.
5/6 When this sort of severe dissociation occurs, it is very difficult to feel “together” or to imagine that others are “together.”
Projective identification is one of the most difficult concepts in psychoanalysis. But, it is very important because it describes a phenomenon between people. In projection, an unwanted thought/feeling is attributed to someone else. 🧵
In projective identification, the person pro
jecting behaves in such a way as to elicit the thought/feeling being projected. In other words, the person receiving the projection is so perturbed by it that they begin to behave in accordance with the projection.
The projecting person may say over and over, “You’re so angry! Why are you being so angry?!” The person receiving the projection is calm and not angry. But, after being told 10 or 15 times that they are angry, they eventually are irritated for being inaccurately accused.
I don't think it's a surprise that there is a continuum of clinical skill among therapists. Some fall at the bottom of that continuum because they are new to training and some because various factors make them not good at their work. Some are at the top of that continuum. 🧵
Dunning and Kruger suggest those with limited skill at some task overestimate their skill. When therapists overestimate their skills, bad things happen.
The first of those is that the therapist applies technique without paying attention to its impact on the patient. They don't learn from the patient's reaction to technique because they erroneously believe the technique must help.
Difference between research and psychotherapy (paraphrase of Seligman): 1. Research in psychotherapy efficacy has a fixed length, usually eight to 12 sessions. When the predetermined length is reached, treatment does not continue.
In clinical work, the limiting factor is much more likely to be related to payment. If a patient has good health insurance, treatment will continue for as long it is helpful and funded.
2. Psychotherapy is “self-correcting” in the sense that if the therapist or patient believe that the work is not helping, they discuss necessary changes. In research, the treatment is manualized and those providing the care cannot change its course.
"Even though psychoanalysts are not supposed to admit to deliberately telling their clients what to do, I feel free to confess I have often done so - 🧵
typically when my client is about to embark on an obviously disastrous course, for example, taking up gambling as a response to money troubles, planning to cut or otherwise harm themselves in response to a stressful event,
or continuing poor eating habits after being diagnosed with borderline diabetes. With one client who did not have a drivers license, I periodically brought up the issue of getting a licensed as one of independence.
"The capacity to have relationships is central to the way people develop and function. 🧵
This is more than just the ability to form and maintain relationships; rather, it is the ability to sustain relationships that are stable, trusting, intimate, loving, and mutually gratifying, in which others are viewed as whole, separate, and three-dimensional.
When we say three-dimensional, we mean that people can think about themselves and others as having:
"Carl Rogers commented toward the end of his life that he felt he did his best therapy when he found himself in a kind of meditative state in the presence of his clients (1989). 🧵
This quieting down of the self - the allowing of a slower, less pressured kind of cadence, this letting go of the ordinary rules of conversation in favor of creating the space for the therapist-patient dyad to
linger with the crescendos of evoked feelings - these are all parts of the art of listening deeply.They take time to develop as a therapist, and in particular they take the quelling of one's own anxious need to be 'helpful.'