Western medicine has made relentless progress in the use of scientific understanding of disease to develop more effective treatments. In mental health, Psychiatry has ardently desired to follow the same trajectory, but has not made the same kind of progress. In its all out attempt to do...

This is a follow-up to the previous post on how treating symptoms and diagnoses is so often unsuccessful because the real source of trouble is underlying immaturity, a very real problem that, unfortunately, has no diagnosis code. In that post, I described the problem. In this one, I...

One of the most troubling aspects of mental health treatment currently is the tendency to treat diagnoses instead of people. In the meantime we have a mental health crisis among teens and young adults where far too often, the underlying problem is developmental arrest, which isn’t...

A common clinical problem is the adult client who finds him or herself repeatedly overpowered by others. In this post, I’m sharing some thoughts about what we, as therapists, can do to help.

Choosing between survival and power

From TIFT #72, I want to repeat two points. First,...

Teaching a class of trainees and early career therapists got me to thinking about the question of clinical decision making. My co-leader shared the example of a client asking, “If you were in my position, what would you do?” I counted six ways a clinician might make such a...

Many of us, myself included, have tended to think of stress and relaxation as opposing forces. This post is about a different way to look at them, as two stages in a natural cycle. What makes recognition of the cycle important is that, in humans, it can be held in semi-permanent suspension.

We...

For us therapists, the most interesting thing about dignity is that it should be a right, but it can be given, taken away, demanded, defended, and even negotiated. In a way it is a dialog between the self and others. In response to a request and because the subject keeps coming up,...

Yes, as therapists, we seek to change EMPs (Entrenched Maladaptive Patterns), and Memory Reconsolidation is the final common pathway for essentially all enduring change in psychotherapy. But it turns out that the information needing to be modified comes in four quite different flavors. In...

Avoiding uncomfortable feelings is familiar to all of us. How often do we have trouble engaging in those difficult conversations that are often the most productive? Furthermore, the concept has an important place in a number of therapies. Cognitive-Behavioral Therapy has recognized the...

This post is about the ways that therapeutic gains can surprise us and our clients when they lead to painful negative experiences. The bottom line is that being ready to help clients prepare for these events can turn bad experiences into positive ones.

Backlash

That’s the term I...

“I don’t do that.” Wouldn’t it be nice if setting a boundary were that easy? The client would understand that this is simply part of the method and accept the limitation without complaint with no subsequent fallout. Why not? Adults accept all kinds of arbitrary...

The second day of 2023 seems like a good time to think about becoming an even better therapist. We all have doubts and areas where we can grow. In this post, I’ll share some possible directions for deepening our understanding and practice. 

My training, like that of...