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Psychotherapy

The Hopeless Inner Mess

Alan talked in session about his disappointment over the job interview, odds that he won't get an offer, and feeling "depressed" about it. We've discussed depression before but something about what he was saying felt different this time. He mentioned attempts to rouse himself into action, then sinking back into lethargy. At one point, he was lying on the couch, then got up to clear off his desk. Alan had been neglecting that particular chore for a very long time: his desk was dirty and stacked with old papers, books, cups, etc. He described it as a complete mess. He did his best, then fell back onto the couch, feeling despondent about his future. The messy, long-neglected desk jumped out at me from all the other details in the session; I felt the little mental "click" that happens when you suddenly understand something in a new way.


Video #3 – “Tne Transference Begins”

I've now uploaded the third installation in my series on psychodynamic psychotherapy, which you can access through the video frame below. This one covers early manifestations of the transference and includes a lot of examples from recent sessions in my practice. It's a useful counterpart to my earlier post on the subject, fleshing out the ways that an understanding of the transference can shed light on a person's "outside" relationships and internal dynamics. Can I ask a favor? I know that everyone dislikes receiving endless email notifications from all the websites we visit, but the number of people who subscribe to my channel has an impact on my standing in the YouTube community and how my channel ranks; if you watch the video and like it, would you mind subscribing? Many thanks.


Psychotherapy

Lethal Ideals

As he left the office last night, Naomi's boss gave her some instructions that struck her as ridiculous, betraying a lack of understanding for the flow of work during the evening shift. As she talked about him, she sounded scornful. Because she felt so angry, she wound up doing virtually nothing, which in the end made her feel "guilty" because she'd wasted time that she might have used to develop other projects. She went on to talk about one of her colleagues, a highly ambitious man a few years her senior, who has recently enjoyed some rather public success. Whenever one of his projects receives attention, he gets very excited and tells everyone at work about it. Naomi said she looked down on him for caring so much, that it really wasn't such a big deal. Again she sounded scornful.


Psychotherapy

The Client as Colleague

Just before our session, David had his monthly consultation with the psychiatrist in charge of his medication. Prior to that meeting, David had spent hours researching his various meds, their indications and side-effects, new drugs on the market, etc. He presented a written report with all this information to the psychiatrist during their consultation. "He basically did what I told him to do," David said to me, at the beginning of our session (meaning that the psychiatrist wrote the prescriptions that David had suggested to him). Then he mentioned how much he enjoyed doing medical research and would like to start a business doing this kind of work for other busy psychiatrists, even though he has no medical degree or background in science. As David continued, he explained to me what he needs at this juncture in his life: community, a sense of purpose, etc. He had various ideas about what he ought to do and outlined some plans. He sounded very pragmatic and upbeat, in contrast to last week when he felt despondent about the possibility of real or lasting change. Throughout the session, he sounded very sure of himself.


Psychotherapy

Empathy vs Sympathy

Things I heard myself say during sessions yesterday: I think you feel so screwed up that there's no hope you could ever do anything to get better ... that you might as well throw yourself onto the trash heap. Sounds like you're saying none of these apartments will make things any better -- one's as good as another -- because wherever you go, you'll take yourself and all your pain along with you. I think you feel completely alone in the world, and that no one cares about you. Seems like when you get to that point, you want to give up and hand yourself over to the snakes, because you feel that there's no goodness left anywhere in the world, inside or out.


Psychotherapy

The Mouth-Breast Rupture

Janice continues to struggle with this new awareness of having a mouth. It isn't only symbolic or metaphorical -- a way to describe coming alive to her needs; she feels it on a quite physical level, too. When I returned from my vacation break, she talked about feeling as if her mouth had been cut away from her face. Now, she feels as if her mouth is like an ugly wound, full of blood and shit. In today's session, she talked about the very old feeling of wanting to murder her husband for the way he chews. As a result of our earlier sessions, she has come to realize that the smacking sound he makes turns him into a "smug mouth" -- the mouth that "has it all." The smug mouth has no needs but instead gloats over what it already possesses (the breast-mouth, all in one, as she later pointed out). Janice connected this to hearing my last radio interview. She made clear up front that she knew I hadn't actually sounded that way, but she heard me as saying I was so incredibly wonderful, such an amazing person, and that I had it all. She wanted to kill me, too. Like her husband, I'm a smug mouth with no needs of my own, and a superior feeling that I have everything already.


Psychotherapy

Of Fees and Cancellation Policies

During our first session, I began by telling Deanna that the lead-up to the appointment had felt like chaos -- the "forgotten" session, her difficulties in getting the forms to me in a timely way, taking days to reply to emails, the incomplete information on the new client questionnaire, etc. She agreed right away and I suggested it was a good place for us to start our discussion. Deanna went on to tell me that her physician had finally refused to continue seeing her because of so many missed appointments; she begged him to let her continue coming and promised she'd make the next appointment ... then went on to forget that one, as well. This led her to discuss a lifelong history of problems with self-discipline, respect for rules and limits, as well as a feeling that she hadn't fulfilled her potential. As a precocious, highly intelligent child, she'd managed to skate through grade school, doing as little effort as possible. When she reached college, she worked extremely hard for the first year but then began to slack off. All this of course reminded me of my own struggles at that age, and the shock I felt when I got to college and found I actually had to work!


New Video Series on Psychodynamic Psychotherapy

In lieu of my usual Friday post, I'm taking this opportunity to announce a new series of YouTube videos that I've initiated. Over on my After Psychotherapy website, I asked my site visitors for input/suggestions about what I should do next with my videos; one regular reader suggested something about "what to expect in psychotherapy" and I realized that a series on that topic would allow me to address just about all the suggestions I received, and all the clinical issues that are near and dear to my heart. This first video concerns the intake, the natural anxiety that arises and how both client and therapist cope with it.


Psychotherapy

Self-Injury: A Dream

Adrienne said she’s having difficulty holding to our agreement that she reach out to me before cutting herself. The drive to self-injury feels “insatiable,” as she put it. She then told me the following dream: She was outside with her son, and they were having a great time together. She suddenly realized there were snakes everywhere, on all sides. Most of them were small and harmless but as the dream went on, there were more and more of them. She tried very hard to remain calm, in order to get her son to safety, and finally succeeded. But Adrienne couldn’t go inside along with him. She felt sad but oddly at peace, resigned to that fact. As she left her son behind, Adrienne knew there were too many snakes now for her to escape with her life. She walked directly toward the biggest, “most aggressive” one. As it struck her, she woke up.