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“Treatment goals include areas that are influenceable by work on the self; life goals depend heavily on factors outside one’s control. 🧵
Therapy goals thus might include reducing perfectionism, increasing realistic self-esteem, resolving an internal conflict, making a difficult choice, mourning a painful loss, and so on.
Life goals include, for example, finding a partner or spouse, getting a good job, or becoming a parent. They may be attained more easily when therapy goals have been met, but they are not themselves treatment goals.
In 2010, @JonathanShedler published an article in the flagship journal of the American Psychological Association, The American Psychologist. 🧵
At the time, it was controversial because his article argued that psychodynamic psychotherapy, long derided as irrelevant and ineffective, is empirically supported as effective.
One of my favorite parts of the article was his reference to the work of Blagys and Hilsenroth (2000) who identified by empirical means 7 techniques used by psychodynamic therapists that are different than those of other therapies. They are:
I find Alonso’s conceptualization of the foundations of psychoanalytic thinking very helpful. But, a lot has changed since she wrote her chapter on the basics of psychodynamic theory in 1989. 🧵
Since she wrote there have been significant shifts in thinking about the structures of the mind, what is motivating people, developmental theory, what constitutes problems in living (pathology),
what might be the source of change in people, how the therapy relationship works and the role of the therapist in the treatment, and the importance of and conceptualization of relationships among other things.
The last of Alonso’s foundations of psychodynamic theory is the idea that there is an assumption that our mind is in conflict. While we may not be aware of this conflict, parts of our minds are working against each other. 🧵
For instance, we may have needs for closeness while also having needs for separation. These conflicts are often not in our awareness and sometimes experienced as ambivalence or anxiety.
To resolve these conflicts, sometimes we use a defense mechanism (I posted definitions for about 30 of them back in May/June). And, sometimes the cost, in the form of symptoms, make the defenses used less than pleasant.
Dissociation is of special importance in the 2nd psychological vital sign of self and object constancy. Dissociation serves to protect one’s self from the pain (physical and/or emotional) one is experiencing now. 1/6
2/6 To do that, a person unconsciously and automatically shifts their attention somewhere else. We’ve all driven from A to B, arrived at our destination, and wondered why we can’t remember the path we took. Our thoughts were somewhere else.
3/6 When this happens as a response to severe pain that occurs repeatedly, it sometimes becomes difficult to be aware of or control the shift in state of mind. In severe instances, the states of mind can become segregated so they don’t seem to drift from one to another.
In the avoidant type of attachment insecurity, the child ignores the caregiver who inconsistently shows attunement. They literally avoid their caregiver. But, this does not mean they lack feelings. In some instances, children with this 1/5
2/5 style appear to approach their caregiver when they’ve been separated and then sometimes, at the last moment, attempt to ignore them. Adults with this type of insecurity often experience themselves and are experienced by others as independent.
3/5 They can appear confident and accomplished. When in relationships though, they sometimes struggle to find closeness and can get to a point in the connection where they feel compelled to distance themselves or break up.
There are 3 types of insecure attachment: ambivalent, avoidant, and disorganized. In the ambivalent type, the child feels conflicted about being in the presence of the caregiver. It is relatively common to see a child in this situation become angry when a 1/5
2/5 caregiver has left and then returns. It is also common to see that they may be passive or helpless. Adults often experience this insecurity as a sense of low self-worth. When a partner is not attuned to them, even if just occasionally, they can feel as
3/5 if they are not worthy of love and be self-blaming. They sometimes need persistent reassurance that they are loved and lovable. Fear of abandonment can sometimes be overwhelming and sometimes they will cling to the relationship to try to solve their fear.
Sometimes therapists, especially those new to the field, have a powerful wish to be good at their job. And, sometimes this wish clouds their view of their flaws and mistakes. The shame that comes from recognizing one has made a mistake that hurt a patient can be 1/3
2/3 overwhelming. And, it’s common to try to avoid that shame. But, it is important to stay open to the aspects of ourselves that we don’t like. Being aware of the kinds of mistakes and flaws we may have allows us to avoid defensiveness and validate the experience people
3/3 may have of us when we are not at our best. Patient’s often find it a relief when we acknowledge our mistakes and painful when we don’t. #psychoanalysis #psychotherapy #psychology #psychstudent #psychtwitter #therapistsconnect #TherapistTwitter
