My goal as a therapist: to make myself obsolete

Traditional psychodynamic therapy is often caricatured as endless, with a complacent therapist silently growing cobwebs, listening to a patient who never plans to leave. This isn’t completely unfounded: there are therapeutic advantages to losing track of time, “swimming in the material,” and letting one’s therapeutic focus be broad. The patient’s chief complaint, i.e., the […]

Resistance: "I have nothing to talk about today"

There comes a time, fairly early in many psychotherapies, when there is nothing left to talk about. The identified problems have been named and discussed, there is no more need to bring the therapist up to speed on one’s history. In essence, the patient’s conscious agenda for coming to therapy has been exhausted. I tell […]

“Do you analyze everyone you meet?”

People sometimes wonder whether I “analyze” everyone I meet. This is usually asked with some fear that as a psychiatrist I can “see right through them” and instantly know things about their innermost thoughts they’d prefer to keep hidden. Although this is true (just kidding), I try to reassure them with the following analogy.

Imagine […]

Psychiatric anosognosia

This post was inspired by an article in the May 30th issue of The New Yorker, “God Knows Where I Am” by Rachel Aviv. Full-text online is only available by subscription, but a free abstract is available here. In the process of telling a riveting and ultimately very sad story, the author discusses psychiatric insight.

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Talk doesn't pay: Comments on the NY Times article

I’d like to take this opportunity to comment on the article that appeared in today’s New York Times: “Talk doesn’t Pay, So Psychiatry Turns to Drug Therapy.” Gardiner Harris writes about psychiatry’s shift from talk therapy to drugs, and profiles psychiatrist Donald Levin of Doylestown, PA (a suburb of Philadelphia), who felt financially unable to […]

Should therapists accept holiday gifts?

December brings the annual pleasures and challenges of holiday gifts and how to deal with them in dynamic psychotherapy. Although it is relatively easy to follow a simple rule about this, ideally a good deal of thought goes into a therapist’s decision about whether to accept a patient’s holiday gift. Below I will give a […]

If I accused you of being a Martian...

Cross-posted from “Sacramento Street Psychiatry“.

In dynamic psychotherapy, patients often say how hurt and victimized they feel as a result of unkind judgments or criticisms by others:

“My coworker called me a hypocrite!”

“My mother told me I neglect her by not visiting enough.”

“My husband complains I’m too self-centered.”

Although sharing such complaints with […]