Jon Frederickson - Psychodynamic Psychotherapy: Learning to Listen from Multiple Perspectives

PSYCHODYNAMIC PSYCHOTHERAPY

PSYCHODYNAMIC PSYCHOTHERAPY

Learning to Listen from Multiple Perspectives

By

Jon Frederickson, M.S.W.

Chair, Advanced Psychotherapy Training Program Washington School of Psychiatry

Published in 1999 by

Routledge

Taylor & Francis Group

711 Third Avenue

New York, NY 10017

Published in Great Britain by

Routledge

Taylor & Francis Group

2 Park Square

Milton Park, Abingdon

Oxon OX14 4RN

1999 by Taylor & Francis Group, LLC

Routledge is an imprint of Taylor & Francis Group

International Standard Book Number-10: 0-87630-962-7 (Softcover)

International Standard Book Number-13: 978-0-87630-962-9 (Softcover)

Library of Congress catalog number: 98-47697

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CONTENTS

ACKNOWLEDGMENTS

Any book of this sort synthesizes what one has learned from teachers, supervisors, colleagues, students, and, most importantly, ones patients. Pascal is reputed to have said of those authors who always refer to their works as my book, my commentary, my history, etc., that they sound like solid citizens with a place of their own, always talking about my house. They would do better, this excellent man added, to say Our book, our commentary, our history, etc., considering that there is usually more of other peoples property in it than their own (Pascal 1966:355).

Yet any acknowledgment would be inadequate if I did not highlight the role of the Washington School of Psychiatry in my traininga school dedicated to keeping the questions open. During my training, I was supervised by a former behaviorist, a Sullivanian, a Fairbairnian, and someone who was trained both by Anna Freud and Kleinians! Although my supervisors worked most of the time from a given theoretical perspective, each of them felt free to draw from anything that would help the patient. I entered training looking for answers, but they questioned every answer I had, insisting instead that I learn to think. One day a supervisor asked me what would be five different ways I could respond to a patient at a given moment! And there I had been wondering what might be the one, right, correct response! They were trying to teach me flexibility so l could use any approach rather than be the hostage of one approach, trapped without an alternative. I feel especially grateful to them for their help, their patience, and their insistence on flexibility of approach. I would like to thank Sarah Pillsbury, Michael McDermott, Mike Stadter, Harold Eist, Sue Roth, Louise DeLeeuw, Elizabeth Harper, Irv Scheider, Gerry Perman, Bernardo Hirschman, Elizabeth Buchanek, Damon Silver, Rosemary Segalla, Monroe Pray, Alberto Pieczanski, and Jack Love for their contributions to this book.

In addition, I would like to single out Nicole Lediard, Nancy Griscom, Maggie Silberstein, Terry DiNuzzo, Barton Evans, and Olga Meerson for their close reading of the manuscript and extremely helpful comments. I would also like to thank the students who read previous drafts, raised useful questions, and, most generously, shared case material from early stages of their work. Since some of their early sessions were used here, their names must remain anonymous, so to them I owe a special debt of gratitude.

PREFACE

Crafty men condemn Studies, Simple men admire them, and wise men use them: for they teach not their own use, but that there is a Wisdom without them, and above them won by Observation. Francis Bacon, Of Studies, Essays (1625)

This book is designed to help you develop basic skills of psychodynamic therapy: reflecting the patients feelings, identifying conflict, hearing unconscious communication, and interpreting defenses. Without a solid understanding of basic principles, we cannot understand more complex theories and approaches. Therapists often lack this understanding because our classes emphasized the learning of theories rather than their application. Classes often appear irrelevant because in practical terms they are. What good does it do to be able to define transference if we cant hear or interpret it? Or to be able to recite a list of defenses but be unable to identify them in the session and interpret them? Knowing a theory without being able to use it is like knowing how to identify a car but being unable to drive it. No wonder much of psychodynamic theory as taught today appears to be useless!

This book provides exercises thatif applied in the right waywill show you how to translate four different theories into practice. Its theoretical content has been set forth and explained countless times before. Unfortunately, however, most books present theory in a form accessible only to a fairly advanced therapist already familiar with the theory and technique. Such a therapist will find in them a remarkably good survey of the basic material, but beginners (or experienced therapists new to psychodynamic theory) are unable to digest the material, know what it looks like in practice, or select what is useful. Moreover, the examples given in such books (when any are given) are insufficient.

There is a severe lack of specialized works, full of exercises, that would develop the therapists skills. These studies are designed to fill that lack. Actual therapy sessions are analyzed with possible interpretations to illustrate the relationship of theory to practice.

Some may object that other listening approaches were not included. This is unavoidable in a single volume. Psychodynamic theory serves as an umbrella term covering many different listening strategies. I have chosen four listening approaches because the majority of psychodynamic approaches, whether self psychology, object relations, interpersonal, or relational, require the specific listening skills studied here. Learning these skills will provide you with the background necessary to acquire a deeper understanding of other approaches.

Others may object that this book places too great an emphasis upon technique, ignoring the artistic and intuitive aspects of psychotherapy. Yet this objection would be regarded as invalid to those trained in the fine arts, whether painting, sculpture, or music. Professional musicians, for instance, practice scales and arpeggios every day. They recognize that artistry is possible only when they have technical command of their instrument. They would agree that technique without intuition is not great art; but they would also insist that intuition without technical mastery is always arbitrary, incapable of accurately interpreting the composers intentions. To give voice to the composers intent, the musician must not only be able to hear his intent but convey it through his technical mastery. Every musicians artistry begins with a mastery of techniqueit just doesnt end there. Think of this book as a set of musical etudes designed to enhance your artistry when interpreting the human dramas encountered in therapy. View it as merely a signpost, something that helps you get to your destination but is not the destination itself.