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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General

A Call for Participants

Now that I've nearly finished my book on defense mechanisms, I'm wondering what to do next. I'll continue with my book on shame and the defenses against it, but I'd also like to work on something more interactive, involving visitors to this and my After Psychotherapy site.

The project I have in mind would last about a year and eventually evolve into a book. At the beginning of each month, I'd post an exercise...
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Psychotherapy

Perceiving the ‘Real’ Therapist

Now that I've mostly recovered from the last few stressful weeks, I'm able to see more clearly how my stress affected my behavior and emotional presence during sessions. I like to think I'm more self-contained than I obviously am; recent experience has shown me otherwise.

The first indication was the email I received a few weeks ago from Adrienne after one of our sessions. She didn't mean to be intrusive, she...
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Psychotherapy

Emotion — Too Little or Too Much

Neil brought in a dream this week. He and his wife Ellen are somewhere exotic, on an island or maybe in a jungle. Everything has been carved in stone -- buildings, statues -- and he talked about the interesting rock faces and their angles.

"I dreamed it all in color," he said, "and that's unusual for me." He and Ellen were holding hands, which even in the dream, he thought was odd (given their...
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Psychotherapy

Anti-Social Personality Disorder and its Roots in Hopelessness

In session with Naomi, we discussed her ongoing moral dilemma about whether to disclose. She vacillated between an agonizing sense of guilt for occasions in the past when she hadn't been honest, to a dry-eyed cynicism in which she'd argue that she might as well go on hiding the truth because she couldn't undo the past.

"I realize that I'm lying to myself. I can hear it, but I don't...
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Psychotherapy

The Importance of Hope

I've been thinking all week about why some people emerge from a horrendous childhood with hope intact. Given the serial abandonment and sexual abuse, it's astonishing that Adrienne has any hope whatsoever that someone might care about her.

Why do some people have the ability to recognize goodness when they see it, to cleave unto it for dear life? Why do others never seek help, or when they find it, so...
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Psychotherapy

ADHD Symptoms and the Dynamics of Distraction

Both of my clients who had received a diagnosis of ADD prior to starting therapy and are now taking meds continue to help me understand the psychological origins of this difficulty.

Later in a session, when talking with one patient about how distracted he gets and the ways he procrastinates, I made the parallel: his urge to "move on" from guilt or remorse, putting those feelings out of his mind, resembles the way...
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