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Psychotherapy

The Face with No Expression

As I continue to read Tomkins and Nathanson, focusing on the human face as the seat of our affects, I'm reminded of clients from long ago whom I didn't fully understand at the time. In particular, I think of Noah and the completely deaded facial expression he presented throughout every session. If I were still working with Noah, I would say to him, "You're terrified that I might read your shame in...
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Psychotherapy

Book Review: Cinderella, A Tale of Narcissism and Self-Harm


Since Adrienne's snake dream, we've been making gradual progress in tapping into her unconscious anger. I've helped her become more aware of the rage often lurking behind self-pity and on several occasions now, she has been able to detect the hidden rage herself. In discussing her repeated insistence that I'd rather get rid of her and take on a less difficult client at my new (higher) fee, I've pointed out the hidden...
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Psychotherapy

Online vs. In-Person Psychotherapy — One Major Difference

When I first began working with clients by Skype, I was surprised (and relieved) to find how similar it is to working in person. Once I began learning more about affect theory and how facial expressions communicate feeling states, I came to understand why I'm still able to empathize so well with my clients.

Now that I've been practicing via Skype for over a year now, I'm also understanding one important way...
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New Discussion Forum

Over on my personal website After Psychotherapy, I've now opened the first topic thread on a new discussion forum. In this first thread, we'll be discussing the Introduction and first chapter of my new book, Why Do I Do That?, then in subsequent threads we'll take up each of the chapters individually. I view this forum as a place for site visitors who are reading the book to ask questions about what they've read and to share their experience of engaging...
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General

Depersonalization Disorder: A Hypothesis

In one of our first sessions, Carl told me that his feelings of depersonalization began several years ago when he was reading a self-help or psychology book (he can no longer remember the name of it) and one of the author's ideas gave him a sudden unpleasant insight into himself. He can't recall exactly what he realized; but at that moment, he felt himself lift out of his body, into his head...
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Psychotherapy

From Shame to Self-Esteem

Melissa continues to struggle with the challenges of her new job, vacillating between fear that she won't be able to master the new skills and contempt for how "stupid and trivial" it all seems to her. We talked about her scorn as a defense: when she can't bear the fear of failure, when it all seems so overwhelming to her, she take flight into contempt. ...
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General

Mother-Baby Music

I've always had a problem with the term attachment to describe what happens between mother and baby. Today, in session with Janice, I remembered the word attunement and felt it was a much better, more accurate descriptor.

Janice began the session by talking about her husband's almost complete inability to read her body sexually and to identify what gives her pleasure. The way he had been touching her the night before...
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