Psychodynamic Psychotherapy 102: Questions to Guide Case Conceptualization and Intervention

Psychodynamic Psychotherapy 102: Questions to Guide Case Conceptualization and Intervention

Each year I sit down with trainees to review our goals for supervision and collaborate around areas of growth. For many, learning about psychodynamic psychotherapy is often at the top of the list.

This post discusses different dimensions of psychodynamic therapy that present-day practitioners think about when they work with their patients and provides practical questions to aid in addressing these dimensions in practice.


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The Millennial Therapist: How Social Media Affects Our Lives and Work

The Millennial Therapist: How Social Media Affects Our Lives and Work

The millennial generation, born roughly between 1980 and 2000, is a generation categorized by the digital age. An overwhelming majority owns a computer, a smartphone and uses the internet daily. Coined “digital natives,” millennials are a generation raised on using social media as a primary way to communicate and express oneself. This is the generation that is now entering into the field of psychotherapy.

The social media obsession has significant implications for this generation of psychologists, both relationally and professionally. We are entering into the field with a perspective of the world much different than our predecessors. We deal with public exposure in a way that has not yet been faced. There can be some harmful consequences of our lives being so public. As we enter into this field, we must be thoughtful about our social media use and the implications it has for both our work as therapists and in our personal lives.


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Mental Health Care for Older Adults is Necessary – Here’s Why

Mental Health Care for Older Adults is Necessary – Here’s Why

By the year 2030, one in five Americans will be 65 years or older. The demographic of those aged 80 and older is growing faster than any other age group [1]. There is also a prevailing stereotype of older adults as dependent, depressed, and possibly demented [1].

Taking into consideration this stereotype of the aging population, is there a case to address their mental wellness in addition to the population’s huge demand for basic medical services?


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Big Boys Don’t Cry: Navigating Masculinity in Therapy

Big Boys Don’t Cry: Navigating Masculinity in Therapy

I remember being in grade school and hearing the age-old cliché “Big boys don’t cry” whenever a male peer began to show he was upset about something.

At the time, I didn’t think twice about it, and I’m sure there were moments when I repeated those very words, not realizing the harm I was doing. Regardless of intention, I now see that these types of subtle messages convey a normative stance of stoicism, invulnerability, and detachment that contribute to toxic ideals of masculinity.


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Familismo: The Unseen Family in the Therapy Room

Familismo: The Unseen Family in the Therapy Room

(Please access full text for link to article in Spanish.)

The number of Mexican immigrants is growing rapidly in the United States. While culturally sensitive psychological services may be a luxury in United States clinics, they are a necessity in places where Spanish-speaking people live.

Unfortunately, the number of Latinx and/or Spanish-speaking therapists is below the minimum needed. Thus, even if you do not speak Spanish, the odds are considerable that a Spanish-speaking Latin American will cross your path.

In this series, I will cover some issues that may help you in being more culturally appropriate regarding Latin Americans, especially those from Mexico. I will first explore the term familismo, a value that refers to the development of close ties within the immediate and extended family of many Mexicans.


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Adverse Childhood Experiences: Traumas That Set the Framework for Life

Adverse Childhood Experiences: Traumas That Set the Framework for Life

Growing up in a home with physical abuse, emotional neglect, mental illness, alcohol use, or drug use are some examples of childhood adversities. The seminal work of Dr. Vincent Felitti and colleagues asked over 17,000 adults to answer questions about adverse childhood experiences — or ACEs — and current health [1]. Results were shocking: More ACEs led to poorer health in adulthood and early death.

It is important to understand that ACEs do not directly cause poor outcomes; there are likely many mediating mechanisms such as maladaptive coping, unhealthy interpersonal relationships, negative health behaviors, dysfunctional thinking styles, and insecure attachments that contribute to these outcomes. In addition to prevention efforts, these are all potential areas that therapists can intervene to mitigate the long-term effects of adversity.


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Breaking Up with OCD: Avoiding Common Treatment Barriers

Breaking Up with OCD: Avoiding Common Treatment Barriers

It takes a lot of guts for patients to make the decision to break up with obsessive-compulsive disorder. They have been living many years with tormenting thoughts and fears, dictating how they go about their days. When your patient is on board with breaking up with their OCD, you want to encourage them not to DRIFT away from OCD, but rather to look forward to how they want to live in the future, and to break up with OCD. Exposure and response prevention (ERP) is the gold standard for treating OCD. [1] The procedure is simple, but the task of breaking up is always emotionally difficult. Let’s examine the DRIFT treatment barriers (my made-up acronym) so we can support our patients in officially kissing OCD goodbye. OCD is a complicated disorder that includes intrusive thoughts, images, and urges that cause people to feel extreme distress, anxiety, disgust, and/or fear. [2] Many recognize that these thoughts are illogical. In order to cope with the distress, people generally use compulsions to reduce the experienced distress. These take the form of rituals, reassurance questions, neutralization, and avoidance behaviors. [2] Over time, compulsions become tightly linked to the initial fear, and behaviors are performed nearly instantaneously. Colloquially, some patients have...
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Working with Suicidal Clients: 6 Things You Should Know

Working with Suicidal Clients: 6 Things You Should Know

One of the scariest things therapists work with is suicidality.

Suddenly, therapy feels like, and sometimes is, a life-or-death situation, one where clinicians hold a great deal of responsibility.  To make matters worse, suicide continues to be one of the leading causes of death in the U.S. [1], and many believe the prevalence rates are a gross underestimate [2].

The numbers highlight the inevitability of encountering suicidality in our line of work.  Early-career psychologists and practicum students may feel overwhelmed by the intensity and risk of working with suicidal clients.


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Nervous about Psychosis? A First-Timer’s Guide to Treating Clients with Psychotic Disorders

Nervous about Psychosis? A First-Timer’s Guide to Treating Clients with Psychotic Disorders

I vividly remember my first experience providing psychotherapy for a patient with psychotic symptoms. In fact, not only was this patient my first with psychosis, but they were my first individual therapy patient ever. As a practicum student at a partial hospitalization program, I was caught off-guard when my patient endorsed auditory hallucinations during an initial intake. Thoughts and doubts such as “I don’t know what I’m doing” and “Could I make my client’s symptoms worse?” flooded my mind.

Ultimately, it was a rewarding experience, and I enjoyed bearing witness to my client’s growth, impressive resilience and resolve. However, there are many things I wish I had known ahead of this first experience. Therefore, this article aims to use my experience as a reference point to provide a brief snapshot of important domains to consider when treating psychosis for the first time.


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Psychodynamic Therapy 101: An Introduction

Psychodynamic Therapy 101: An Introduction

A new client recently asked me where I would be traveling for an upcoming trip as we looked at our schedules to make her next appointment. When she expressed further curiosity about the conference I would be attending, I explained that it was an annual conference of the society for psychoanalysis and psychoanalytic psychology. A fairly surprised look appeared on her face, and she questioned, “like Freud?”

I readily picked up on her discomfort with the thought of psychoanalysis or being psychoanalyzed. I clarified that she was not meeting with me for psychoanalysis and offered some explanation of basic psychodynamic principles and how these applied to our initial goals for therapy. She seemed to accept my explanation, but mostly just seemed glad to know she wasn’t meeting for psychoanalysis.

Psychodynamic therapy is one of several approaches to therapy used today. However, it is often misunderstood and dismissed as an outmoded approach or historical artifact. It is also often misrepresented in popular culture and sometimes seen as irrelevant to the quick-fix demands of the public and the limitations of insurance.


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