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. (View Highlight)
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. (View Highlight)
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.
investigación crítica homo_sapiens psicoterapia complejidad salud_mental
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. (View Highlight)
While many brief approaches cross their fingers for simplicity, psychodynamic theory honors complexity (View Highlight)
diferencias cbt reduccionismo psicoanálisis complejidad
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). (View Highlight)
Sin memoria ni deseo, wei wu wei.
the relentless pressure for productivity makes receptivity all but impossible. This typically results in therapists who become disconnected from their work. Much (View Highlight)
eficiencia psicoterapia presión desconexión
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 (View Highlight)
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 (View Highlight)
psychodynamic therapy isn’t even popular enough to be unpopular (View Highlight)
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 (View Highlight)
psicoterapia curiosidad neutralidad psicoanálisis relación
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. (View Highlight)