Addressing Challenging Moments in Psychotherapy: Clinical Wisdom for Working with Individuals, Groups and Couples

Description

This practical and helpful volume details how clinicians can work through various common challenges in individual, couple, or group psychotherapy. Chapters draw upon clinical wisdom gleaned from the author’s 48 years as a practicing psychiatrist to address topics such as using countertransference for therapeutic purposes; resistance, especially when it needs to be the focus of the therapy; and a prioritization of exploration over explanation. Along with theory and clinical observations, Dr. Gans offers a series of "Clinical Pearls," pithy comments that highlight different interventions to a wide range of clinical challenges. These include patient hostility, the abrupt and unilateral termination of therapy, the therapist’s loss of compassionate neutrality when treating a couple, and many more. Many of the "Clinical Pearls" prioritize working in the here-and-now. In addition to offering advice and strategies for therapists, the book also addresses concerns like the matter of fees in private practice and the virtue of moral courage on the part of the therapist. Written with clarity, heart, and an abundance of clinical wisdom, Addressing Challenging Moments in Psychotherapy is essential reading for all clinicians, teachers, and supervisors of psychotherapy. Cover Half Title Series Page Title Page Copyright Page Dedication Page Contents Foreword Acknowledgments Part I Introduction Introduction Part II Clinical observations 1 There are no completely objective data in interpersonal relations. The way I am with you partly determines the way you are with me 2 Many natural reactions are not helpful and many helpful reactions do not come naturally 3 With some patients there is no risk of ever establishing the truth 4 In most cases, all things being considered, people are doing the best they can. If you don’t think so, you probably don’t have enough information or you do not fully understand the information you do have 5 It is at the boundaries that meaningful psychotherapeutic work takes place 6 In chronic marital discord, each partner is contributing approximately 50% of the problem no matter how asymmetrically they present or seem during the course of the therapy 7 Internal conflict can masquerade as dialogue 8 One of the fringe benefits of being a therapist is all that we learn from our patients 9 Seemingly innocuous patient comments often yield valuable information about the patient, the patient–therapist relationship, and the phase of therapy 10 Shame is a painful, ubiquitous, debilitating, and often hidden emotion 11 Ideas are one of the most powerful medications Part III Clinical Pearls 12 Shifting focus from there-and-then to here-and-now “That is very interesting but unfortunately it is not therapy.” “Isn’t it fortunate that all the objectionable people reside outside of our group.” 13 Employing irony and paradox for therapeutic purposes “Could you be a little more vague?” “Why is it that I get deprived of 50% of your feelings? It doesn’t seem fair.” 14 Using countertransference for therapeutic purposes “I’ve noticed that almost all of what you’ve told me is about things outside of you.” “Was the joke I just told for my benefit or the group’s benefit?” “Tell us one thing about your boyfriend that you wouldn’t want us to know about.” “Get small and talk to the wall.” 15 Responding therapeutically to patients’ questions To a patient who frequently requests that I do something: “How would you feel if I did what you asked and how would you feel if I declined to do what you asked?” “How did you think about the question your patient just asked you?” 16 Securing the patient’s attention “You are a serial killer.” “You don’t treat your help very well.” 17 Dealing with the group’s resistance “I’m concerned about poor Gloria. How outrageous will she have to act before someone recognizes her behavior and is willing to talk with her about it?” “It is at times like this that I am so grateful for our (group) contract.” 18 Encouraging the use of imagination “I don’t object to answering that question. I’m simply concerned that in doing so we might value my answers more than your imagination.” “Reality is very obliging. You can always count on it to serve up something to complain about. But you can choose how you will respond.” 19 Welcoming and deepening the negative side of ambivalence “There are not that many ways to get attention. You can be really, really good or really, really bad.” To patients who accuse me of not caring about them, I DON’T say “It feels to you that you have an uncaring therapist.” Instead, I say, “What is it like for you to have an uncaring therapist?” 20 Employing methods of the Existential School of psychiatry “What do you want me to be sure to hear when you tell me that a comment of mine makes you uncomfortable?” “What is it like coming every week to a therapist who doesn’t answer your questions, repeatedly misses the mark with her comments, and isn’t helping you?” 21 Miscellaneous Assessing suicidality “If your suicidal feelings were to become more frequent and intense, and you were not sure that you could resist acting on them, what do you imagine you would do?” Treating marital conflict in individual therapy “How did such a kind, caring woman like you happen to choose a man like Martin?” Recognizing and acknowledging the emotional pain of patients who are difficult to like and to be with “We all have our preferences for how pain is gift-wrapped. But, no matter how it is gift wrapped, remember, pain is pain.” Index