"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,

"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.

"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

“Based on our early interpersonal contexts, we all develop beliefs that explain and generalize about our experiences, help us to assimilate them, and provide a template for future interactions. 🧵 These implicit, automatic convictions about the nature of life are inherently neither positive nor negative, rational nor irrational.

“Treatment goals include areas that are influenceable by work on the self; life goals depend heavily on factors outside one’s control. 🧵 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.

In 2010, @JonathanShedler published an article in the flagship journal of the American Psychological Association, The American Psychologist. 🧵 At the time, it was controversial because his article argued that psychodynamic psychotherapy, long derided as irrelevant and ineffective, is empirically supported as effective.

I find Alonso’s conceptualization of the foundations of psychoanalytic thinking very helpful. But, a lot has changed since she wrote her chapter on the basics of psychodynamic theory in 1989. 🧵 Since she wrote there have been significant shifts in thinking about the structures of the mind, what is motivating people, developmental theory, what constitutes problems in living (pathology),

The last of Alonso’s foundations of psychodynamic theory is the idea that there is an assumption that our mind is in conflict. While we may not be aware of this conflict, parts of our minds are working against each other. 🧵 For instance, we may have needs for closeness while also having needs for separation. These conflicts are often not in our awareness and sometimes experienced as ambivalence or anxiety.

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.

In the avoidant type of attachment insecurity, the child ignores the caregiver who inconsistently shows attunement. They literally avoid their caregiver. But, this does not mean they lack feelings. In some instances, children with this 1/5 2/5 style appear to approach their caregiver when they’ve been separated and then sometimes, at the last moment, attempt to ignore them. Adults with this type of insecurity often experience themselves and are experienced by others as independent.

There are 3 types of insecure attachment: ambivalent, avoidant, and disorganized. In the ambivalent type, the child feels conflicted about being in the presence of the caregiver. It is relatively common to see a child in this situation become angry when a 1/5 2/5 caregiver has left and then returns. It is also common to see that they may be passive or helpless. Adults often experience this insecurity as a sense of low self-worth. When a partner is not attuned to them, even if just occasionally, they can feel as