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Archives for Psychotherapy

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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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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Psychotherapy

The Narcissistic Father

During a session yesterday, I was shocked when Jeff told me that his former pastor and friend was charging him for their "sessions," calling to tell Jeff when he needed a session, and going so far as to ask Jeff to pay off his credit cards. It seemed unethical, and a betrayal of trust.

This got me thinking about relationship dynamics, and what happens when the person who's supposed to be the one giving...
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Psychotherapy

The Indifference Defense

In our first session following last week's break, Julian began by speaking about a feeling of pointlessness at his job and went on to question the value of therapy: what had been accomplished so far, and was it unrealistic to believe he could really change? It's not unusual for clients to minimize the importance of the work during breaks, as a way to cope with feelings of unbearable need or...
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Psychotherapy

Fight or Flight

Ryan was telling me about the rage he sometimes feels when people get into his space, or "impinge" on him, linking it to the trauma of a forceps birth and spending his first weeks of life in an incubator, tubes stuck into his head.

He also feels enraged when he enters a crowd with too many people around him. Upon entering Walmart, and seeing all the other shoppers, the thought will come...
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