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Posted: January 12th, 2022

Therapist

Question Description

I need help with a Psychology question. All explanations and answers will be used to help me learn.

If you were looking for a therapist, would you consider going to the one in the video? Why or why not? (This concept will not be tested.)

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This is the Transcript-

Hi, Tracy.

Hi.

Thanks, again, for being with us. And I want to spend a few minutes talking about the session that you did with Amanda.

Mm-hmm.

Actually, I just want to get a little bit of information about why psychoanalytic theory, why psychodynamic therapy?

So one of the benefits of doing psychodynamic work is really understanding how someone was raised, and looking at their primary caregivers, looking at the relationships in which they grew up in, and seeing how some of those patterns actually continue on later in life and relationships. So with Amanda, we see that she feels somewhat abandoned by dad, and then actually, I think even by mom– even though mom was around– emotionally feeling abandoned by her when she started drinking and whatnot.

And so I think that as the therapist going on vacation, again, even though I wasn’t actually leaving her, that’s sort of the same feeling that came up for her. And so it’s important to make those connections. Or where she said– felt like I might be cheating on her.

And so it’s really important to have those insights, to make those connections, to see– OK, is this something that’s actually happening now? Or is this the internal world that I’m working from that’s actually based really in my childhood? And then being able to separate that, and then, again, with a focus on looking at how is she feeling, I think that all of that comes together to produce insight, which eventually will hopefully bring some behavioral change about.

Mm-hmm. And I noticed that in the session, you did make those connections for her. And I’m curious about, as a therapist, how you knew where and when, at what point in the session to make that conclusion?

I mean, if there were only like a simple road map, I could say at the five-minute mark or the 10-minute mark. But I think I noticed, a lot of times, looking at her body language I would point out when there were shifts in her affect. And so I thought that was an important, telling sign that something was going on for her internally. So I would be really mindful of pointing that out for her.

And then also, I think she also demonstrated some insight in connecting that, feeling like all people leave her. And I think that for me, paying attention to my own experience as the therapist and responding to some of those cues actually gives me information about not just what’s going on in the room, but potentially how other people might experience her as well. So it’s both paying attention to the transference, which is sort of how she feels about me, and then also looking at the counter-transference– is there anything coming up for me– and being curious about what that is. So when I noticed a feeling maybe coming up for me, that’s when I would say, oh, this is something to maybe pay attention to.

The other thing that I noticed, where there were many times where it was pauses or more periods of silence, and especially even in the beginning, as you started the session. And was that intentional?

Yeah, so silence is actually a technique that’s used in psychoanalytic and psychodynamic therapy. And part of the underlying reason for that is that free association is so important for part of the process. So it’s really important for the client or the patient to be able to speak what’s on her mind freely, without being primed or suggesting that something is more important, because I think anything that is being said or not being said is actually data. It’s actually information for us.

And so when I start the session really open-ended, that’s for her to generate what’s coming out for her. And that gives me more information about where she is.

It’s very, very interesting. How do you find that clients respond to that?

I think that it can be a little bit off-putting at first, because how much of the time are we in social situations where we try to fill in this awkward gap of silence? So it might seem a little bit uncomfortable for people. But I think, again, in that discomfort we can see– what is coming up for someone? Why is it so difficult to sit with the silence?

And really what, to me, it means is, I’m sitting with a feeling, right, a difficult feeling, usually. And so looking at what is that feeling for you, and being able to process that in hopefully a healthy reparative relationship is part of the therapy.

I’m wondering, from the session that you did with Amanda, is there anything that you would do differently?

That’s a good question. I could certainly share that one thing that we didn’t really talk about– we talked about this idea of cheating. But what we didn’t talk about, really, was tying it back in to the abandonment piece, which I think is so, so crucial.

And really, I think that it would be really important to address that she might actually be feeling sad that I’m going out of town, and what that means to her. And we didn’t get a chance to fully flesh that out. But that’s where we would have gone.

And I think it’s really important to address a transference or how the client feels about the therapist. And so I think, again, that would have been something to focus.

OK, so yeah, my last question I was going to ask is, what would be the next steps?

So really focusing on what is coming up for her in terms of me going on vacation, what does that mean to her? How does that make her feel? She kept saying, it’s fine. It’s fine.

So that’s another thing that I could have pointed out, was saying– and I did a little bit. But this sort of rejection of her experience by using a very nondescript feeling word– I don’t think “fine” is actually a feeling. But that, I think, real focus would be on processing probably the fact that she feels, actually, really abandoned, and that this might be similar to how she feels about dad leaving her, and then, again, about how mom was emotionally unavailable.

Because as a therapist, I’m unavailable to her, right? And that’s coming out for her a lot. And really validating that for her, but then also being able to hold space for her to see that I’m not really abandoning her, even though her experience and her feeling– which is valid– that that’s what’s coming up for her, that this is actually a different experience for her.

Thank you. So any last words of advice or thoughts for new, emerging counselors who are interested in psychodynamic therapy?

Yeah, I think in graduate school there’s a lot of push towards evidence-based treatment, such as cognitive behavioral therapy or dialectical behavior therapy, ACT. And those are all wonderful treatments. I think psychodynamic or psychoanalytic can sometimes get a bad rap, because how we learn it is from this very traditional way of Freudian psychosexual stages and the Oedipal complex, and all of this theory that may not be as applicable today.

But I actually think the way in which psychoanalytic theory has evolved into more psychodynamic treatment to me is actually my primary orientation, because I think that there’s so much power in allowing someone to have a reparative relationship with the therapist, to have insight in a way that maybe helps them live the life that they want to live and allows them to really focus on their inner experience. Not to invalidate it or change it, but just to be OK with it. And to me, I think it’s just such a wonderful orientation to have a basis from.

OK, thank you again, so much.Hi, Tracy.

Hi.

Thanks, again, for being with us. And I want to spend a few minutes talking about the session that you did with Amanda.

Mm-hmm.

Actually, I just want to get a little bit of information about why psychoanalytic theory, why psychodynamic therapy?

So one of the benefits of doing psychodynamic work is really understanding how someone was raised, and looking at their primary caregivers, looking at the relationships in which they grew up in, and seeing how some of those patterns actually continue on later in life and relationships. So with Amanda, we see that she feels somewhat abandoned by dad, and then actually, I think even by mom– even though mom was around– emotionally feeling abandoned by her when she started drinking and whatnot.

And so I think that as the therapist going on vacation, again, even though I wasn’t actually leaving her, that’s sort of the same feeling that came up for her. And so it’s important to make those connections. Or where she said– felt like I might be cheating on her.

And so it’s really important to have those insights, to make those connections, to see– OK, is this something that’s actually happening now? Or is this the internal world that I’m working from that’s actually based really in my childhood? And then being able to separate that, and then, again, with a focus on looking at how is she feeling, I think that all of that comes together to produce insight, which eventually will hopefully bring some behavioral change about.

Mm-hmm. And I noticed that in the session, you did make those connections for her. And I’m curious about, as a therapist, how you knew where and when, at what point in the session to make that conclusion?

I mean, if there were only like a simple road map, I could say at the five-minute mark or the 10-minute mark. But I think I noticed, a lot of times, looking at her body language I would point out when there were shifts in her affect. And so I thought that was an important, telling sign that something was going on for her internally. So I would be really mindful of pointing that out for her.

And then also, I think she also demonstrated some insight in connecting that, feeling like all people leave her. And I think that for me, paying attention to my own experience as the therapist and responding to some of those cues actually gives me information about not just what’s going on in the room, but potentially how other people might experience her as well. So it’s both paying attention to the transference, which is sort of how she feels about me, and then also looking at the counter-transference– is there anything coming up for me– and being curious about what that is. So when I noticed a feeling maybe coming up for me, that’s when I would say, oh, this is something to maybe pay attention to.

The other thing that I noticed, where there were many times where it was pauses or more periods of silence, and especially even in the beginning, as you started the session. And was that intentional?

Yeah, so silence is actually a technique that’s used in psychoanalytic and psychodynamic therapy. And part of the underlying reason for that is that free association is so important for part of the process. So it’s really important for the client or the patient to be able to speak what’s on her mind freely, without being primed or suggesting that something is more important, because I think anything that is being said or not being said is actually data. It’s actually information for us.

And so when I start the session really open-ended, that’s for her to generate what’s coming out for her. And that gives me more information about where she is.

It’s very, very interesting. How do you find that clients respond to that?

I think that it can be a little bit off-putting at first, because how much of the time are we in social situations where we try to fill in this awkward gap of silence? So it might seem a little bit uncomfortable for people. But I think, again, in that discomfort we can see– what is coming up for someone? Why is it so difficult to sit with the silence?

And really what, to me, it means is, I’m sitting with a feeling, right, a difficult feeling, usually. And so looking at what is that feeling for you, and being able to process that in hopefully a healthy reparative relationship is part of the therapy.

I’m wondering, from the session that you did with Amanda, is there anything that you would do differently?

That’s a good question. I could certainly share that one thing that we didn’t really talk about– we talked about this idea of cheating. But what we didn’t talk about, really, was tying it back in to the abandonment piece, which I think is so, so crucial.

And really, I think that it would be really important to address that she might actually be feeling sad that I’m going out of town, and what that means to her. And we didn’t get a chance to fully flesh that out. But that’s where we would have gone.

And I think it’s really important to address a transference or how the client feels about the therapist. And so I think, again, that would have been something to focus.

OK, so yeah, my last question I was going to ask is, what would be the next steps?

So really focusing on what is coming up for her in terms of me going on vacation, what does that mean to her? How does that make her feel? She kept saying, it’s fine. It’s fine.

So that’s another thing that I could have pointed out, was saying– and I did a little bit. But this sort of rejection of her experience by using a very nondescript feeling word– I don’t think “fine” is actually a feeling. But that, I think, real focus would be on processing probably the fact that she feels, actually, really abandoned, and that this might be similar to how she feels about dad leaving her, and then, again, about how mom was emotionally unavailable.

Because as a therapist, I’m unavailable to her, right? And that’s coming out for her a lot. And really validating that for her, but then also being able to hold space for her to see that I’m not really abandoning her, even though her experience and her feeling– which is valid– that that’s what’s coming up for her, that this is actually a different experience for her.

Thank you. So any last words of advice or thoughts for new, emerging counselors who are interested in psychodynamic therapy?

Yeah, I think in graduate school there’s a lot of push towards evidence-based treatment, such as cognitive behavioral therapy or dialectical behavior therapy, ACT. And those are all wonderful treatments. I think psychodynamic or psychoanalytic can sometimes get a bad rap, because how we learn it is from this very traditional way of Freudian psychosexual stages and the Oedipal complex, and all of this theory that may not be as applicable today.

But I actually think the way in which psychoanalytic theory has evolved into more psychodynamic treatment to me is actually my primary orientation, because I think that there’s so much power in allowing someone to have a reparative relationship with the therapist, to have insight in a way that maybe helps them live the life that they want to live and allows them to really focus on their inner experience. Not to invalidate it or change it, but just to be OK with it. And to me, I think it’s just such a wonderful orientation to have a basis from.

OK, thank you again, so much. 

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