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[!summary]“The Remaking of a Therapist” is a personal account of a therapist’s journey from relying on cognitive-behavioral therapy (CBT) techniques to embracing a psychodynamic approach. The therapist initially felt pressure to be productive and provide solutions to patients’ problems, but realized that true therapy required a more human, listening-focused approach. Through studying psychodynamic theory, engaging in personal therapy, and seeking supervision and consultation, the therapist found greater fulfillment and success in their work. The article argues for the importance of qualities like empathy, patience, and tact in therapy, rather than relying solely on techniques. The therapist’s adoption of a psychodynamic-integrative approach has led to better outcomes and patient retention. [!note]
En sesión, la clínica a veces nos enfrenta con la dificultad de sentirnos poco productivos solamente escuchando… Y también muchas veces nos muestra que una buena escucha es justo lo que muchas personas necesitan y no encuentran. La autora muestra cómo empezó a transitar desde una formación cbt a una psicodinámica. Este cambio significó cambiar el foco de las herramientas y estrategias hacia ella misma y la relación que establece con la persona que consulta. Tiene fragmentos interesantes que se pueden utilizar para valorizar un enfoque más abierto y menos saturado.
Highlights
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I noticed that the idea of simply witnessing, with nothing tangible to offer, made me incredibly nervous. It dawned on me that in-session busyness was masking a lot of anxiety. I felt a great deal of pressure in the therapeutic role which I coped with by “doing.” Just listening felt unproductive, a bit like slacking-off.
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There was a stark contrast between the types of patients short-term therapies seemed designed for and the patients that actually show up for psychotherapy. Practitioners ought to know that this is indeed the case. Research trials for brief treatments often exclude complex cases, leading many to question their generalizability to real-world patients (Stewart, Stirman, & Chambless, 2012; Westen, Novotny, & Thompson-Brenner, 2004). I used to think that complex people had a map to my office. It turns out that people are complex.
Importante observación crítica sobre la forma en que se desarrollan los estudios sobre psicoterapia: filtrando la complejidad real del mundo. Vinculable con la idea de monocultivos de la mente.
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I had been curious about psychodynamic theory since my undergraduate days, but it was often presented as more of an artifact than a viable clinical approach. Besides, everyone was on the CBT train and I went along for the ride. But Gabbard was my psychodynamic gateway drug. Once I had read one of his papers, I could not wait to read them all.
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While many brief approaches cross their fingers for simplicity, psychodynamic theory honors complexity
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Enrico Gnaulati writes: “It would not be farfetched to claim that the average psychotherapist educated and trained in sanctioned evidence-based methods faces the peculiar dilemma of having to discard a substantial part of his or her learning simply to ongoingly and thoroughgoing be emotionally present with clients, uncluttered with internal demands to be directive and productive” (Gnaulati, 2021, p. 598).
Sin memoria ni deseo, wei wu wei.
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the relentless pressure for productivity makes receptivity all but impossible. This typically results in therapists who become disconnected from their work. Much
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CBT continues to inform my practice, as most effective psychotherapy will involve challenging thoughts and beliefs (Gabbard & Westen, 2003). The difference now is that CBT techniques are woven into my overall understanding of the problem and used only when indicated by the patient
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I sometimes joke that I am training the patient to do my job, which is said only partly in jest. At the end of successful therapy, the patient is able to internalize the therapeutic relationship, continuing to do on their own what they once did in psychotherapy
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psychodynamic therapy isn’t even popular enough to be unpopular
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It has been my experience that approaching patients with a sense of curiosity and neutrality — what Roy Schafer called the “analytic attitude” — engages them in a profound way. This engagement enables them to stay in therapy long enough to derive benefit. Moreover, the ebbs and flows of the therapeutic relationship are not auxiliary to the work — they often are the work. Without the internal prod of an agenda, I have a greater capacity to focus on what really matters in the room — the relationship
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Current therapy trends favor a grab bag of “tools” without giving much thought to the hand reaching in the bag. Once they get into the trenches of practice, many clinicians discover, as I did, that patients are not coming for interventions. They are coming for a professional who understands.