Not everyone of adult chronological age feels or functions like a full adult. This TIFT is about those individuals. I suppose every therapist has a personal list of “syndromes” or patterns they recognize but don’t find in the literature. This is one I have found useful in many circumstances.

Th...

Words are amazingly precise

A patient in her 30s was defending her mother as she heavily blamed herself for her ongoing failure to function. She described how her motherwas sometimes very supportive, buthad been critical and harsh when told of the patient’s plan to attend her friend’s bacheloret...

The pathway starts by narrowing our view to precisely what psychotherapy aims to treat. As discussed in TIFT #11, this leads to identifying Entrenched Maladaptive Patterns (EMPs), as the basic units of pathology treatable in psychotherapy. From there,we bring in evolutionary biology, suggesting t...

In recent posts, I have talked a lot about general application of two change mechanisms, Extinction and Memory Reconsolidation, both implicated in research on how learned fear can be “unlearned” or suppressed. I have been a bit vague about a third foundational change mechanism, New Learning. In t...

The phenomenon of resistance turns out to be more central and more profoundly embedded in the work of psychotherapy than is sometimes recognized. Freud saw this when he said that psychoanalysis is the analysis of resistance. He also gave a clue as to why it has taken a long time to realize why. I...

What clinicians need from research

The psychotherapy research community has produced many good things, but complaints are common about a mismatch between what research produces and what clinical psychotherapy needs. In my view, the problems revolve around two words: Universal and Explanatory. So...

Why is age five so special? And what is it about fairytales that makes them so compelling at that age? Few therapists are aware (and if you are, I’d love to hear about it) of an important event in cognitive development that takes place at about age five. I have alluded to it before, but thought i...

Here’s the secret:

Treating inappropriate shame is one of the hardest jobs in psychotherapy. Knowing this and understanding why will help you know what to do and how to manage expectations. The surprising thing is that, as far as I can tell (and I’d love to know otherwise) no one has noticed how di...

What does that sound like? Perhaps, “I’m feeling a tug to somehow get this therapy moving, but I can’t think of anything successful I could do right now. I wonder if in some way you have been waiting for me?” And indeed, the inner child may have been hoping to avoid painful acceptance or responsibil...

I am not comfortable with the concept of “supportive therapy” and here’s why:

“Insight psychotherapy is an expensive, prestigious treatment conducted by a relatively few highly trained professionals. Supportive psychotherapy, on the other hand, is conducted, in a skilled fashion or naively, by...

A consumer wrote this. I’ll call her Joan:

"How can adults who have never had safe secure attachment, meet these needs and become healthy well adjusted adults? If we are not able to see a good therapist because of being too debilitated by complex trauma to be able to work and therefore have benefit...

The Problem

For the past 11 years I have been blogging about serious psychotherapy, especially about “attachment to your therapist.” Far too often I have been saddened to hear about patients abandoned by their therapists or harshly discharged by clinic administrators when they dared to disclose the...