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A Psychologist's Thoughts on Clinical Practice, Behavior, and Life

´╗┐Missing Appointments During Psychotherapy

Central to psychotherapy is the concept that behaviors can have symbolic, often unconscious motives. For example, a potentially dangerous road rage action can indicate both annoyance at another's driving but also anger from another situation: a workplace happening, an interaction in a relationship, or a lingering emotion from childhood.
Thus, missing several psychotherapy sessions without reasonable cause (illness, hazardous driving weather, death in the family), especially if the therapist isn't notified but left waiting, can reflect diminished interest in treatment, be an indirect expression of anger, or indicate excessive narcissism, the feeling that the world revolves about them.
 The therapist then has two choices: to accept that, in their patient's current level of emotional development, they cannot behave differently; or, if excessive, to end treatment. It is not unreasonable to expect simple courtesy from all.

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The Limits of Adult Personality Change Through Psychotherapy

Even with the best medical treatment the survivor of a serious medical condition is rarely as healthy as before their affliction overcame them. Similarly, while psychotherapy can effect profound improvement of behavior and capacities, a patient will never be as well developed emotionally as if they had experienced a "good-enough" parenting during their formative years.
Their healing can never be total since early life experience is the bedrock of the adult personality and the unconscious is powerful. Yet there are healing events outside therapy too: nurturance from a loving spouse; and helping others and identifying with them, as can happen with parents and health workers, creating interactions which foster the emotional growth of both
Having regrets, feeling guilt for past mistakes is part of the human experience and cannot be avoided when living a thoughtful life.

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Autism is Vastly Misdiagnosed

An August 31, 2023 article in The Wall Street Journal ("My Son Sam Doesn't Need Special Ed - His autism demanded it, experts said.") aroused several thoughts. My first book, Troubled Children/Troubled Parents, the first chapter can be read on my website, included my lengthy treatment of an accurately diagnosed autistic child. The current frequent misdiagnoses are caused by widespread inadequate understanding of child psychological problems by school personnel and doctors. To treat an autistic child the therapist must enter their personal world, which is their protective shell but can be relinquished with proper treatment. The belief they are uncommunicative is false and as erroneous as relating to them with behavioral modification (reward-punishment) methods. These children do communicate but in their way. With rare exception, schools do a poor to disastrous job of interacting with or advising parents about their troubled children.


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