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

The Nature of Psychotherapy

The four basic psychotherapeutic postures, ways in which the doctor relates to their patient, are: the analytic posture, during which the patient's life is explored and understood; the relationship posture, during which the patient's mistrust is diminished and their basic trust is strengthened; the supportive posture, during which the patient's existing healthy modes of relating are strengthened; and the replacement posture, during which the patient's inadequate ego capacities are re-developed to greater maturity. Of these the analytic posture, the interpretation of troubling thoughts and feelings, has the oldest historic roots, it being Freud's mode of treatment after abandoning hypnosis. The analytic posture comprises several beliefs: that there is an unconscious conflict between different parts of the patient's mind of which they are unaware, its history deriving from childhood; and that interpretation can eliminate their distress. A process that is complicated by the therapist's need to interpret in installments as therapy proceeds, modulated by the therapist's own conscious and unconscious goals for the patient's development. The work of psychotherapy is not simple since it involves creating a patient's new life narrative, and one for which objective factual data from the past is lacking..

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How A Psychotherapist Should Speak To Their Adult Patients

The historic psychoanalytic model of silently listening to patients interrupting only with an occasional cogent interpretation is rarely useful, lacking as it does much of a living experience. Nor is offering gratuituous hoary wisdoms like "all people have problems" helpful. Instead, the clinician should, by providing psychological information and enlightening anecdotes, educate their patient on the complexity of life, and the need to experience a "good-enough" parenting during childhood to avoid adult emotional difficulties, and their tendency to persist,.

A crucial fact is the power of fantasy, enjoyable even if sometimes fearful and threatening, to disrupt life, and the limited power ot the ego's defenses against the unconscious.

While brief psychotherapy is possible for a recent and isolated life problem, the treatment of deeper discontents must be lengthy (though not interminable), sometimes persisting intermittently for decades, since psychological limitations are long in development and the mind resists change, being inherently conservative.

Many patients deny the harm caused them by their parent(s), being unable to conceive they were not loved as a child since this belief serves as the bedrock of the human personality and is essential to survival. Yet there is also the mind's thrust toward psychological health and life fulfillment, evidenced by nightmares which communicate unconscious awareness of the need for change and its fear.

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The Fear of "Going Crazy"

While the fear of "going crazy" is widespread, in reality it is a very difficult state to achieve requiring either drug/alcohol abuse or long term overwhelming stress. This fear contains several elements: becoming unable to control oneself; having impaired thinking; and an inability to care for oneself resulting in hospitalization. For most people what underlies this fear is the fear of losing control because of realization of unconscious hostile feelings or dependency needs, both of which are controlled during hospitalization. Yet this fear of loss of control may be caused by something innocuous, as becoming tearful by one who rarely does.

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University Procedure And A Teenager's Suicide

While any youth's suicide is shocking, that of Stanford University's soccer star/college senior Katie Meyer was particularly upsetting. While every suicide reflects complex emotions, the action causing her great stress seems particularly illogical and unwarranted. According to a November 27, 2022 article in The Wall Street Journal, Ms. Meyer had been accused of spilling coffee on a fellow student who was accused of sexual assault by another student, an accusation that was not found worthy of action by either the school or the police. An administrative charge was filed against Ms. Meyer by the University's Office of Community Standards. Six months later Ms. Meyer was sent notice of a formal disciplinary charge which could result in "removal from the university" and that her diploma  was being placed on hold. She replied to this e-mail that she was "shocked and distraught" and immediately killed herself.
In hindsight, she should have informed her parents who likely would have hired a lawyer to quash this nonsense but great stress inhibits rational thinking. What is clear however is that the federal 1972 Title IX civil rights law prohibiting sex-based discrimination, which was intended to protect students from harm, is now being used to bully them.

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Healing Schizophrenia

The crippling behaviors termed schizophrenia arise in infancy and toddlerhood when the child's capacity to distinguish themself from the surrounding world fails to develop normally because of faulty interaction with their mothering figure, who can be the father or another continually involved person. Thus basic perceptual abilities ("sense of self" or who one is; ability to distinguish reality from fantasy; ability to modulate mood) are deficient, causing later problems in the social, education, and vocation spheres of life. Treatment, which is not simple or brief, consists of providing the supportive interpersonal experience which enables re-negotiation of the early differentiation failure, during which ego capacities are strengthened. Drugs cannot accomplish this; only humans can.

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Psychological Ignorance and Bliss in Modern Society

The number of unsophisticated beliefs about behavior in today's society is astounding due to widespread public ignorance about psychological functioning and development. But these come from the lips of clinicians too. Consider treatment acronyms like DBT, "Dialectical Behavior Therapy" which I thought to mean "Diabolical Behavior Therapy" when I first heard it. This and others are mere abbreviated corruptions of the basic long-held treatment postures of psychoanalytically oriented psychotherapy (Relationship, Replacement, Supportive, Analytic).
An enthralling Netflix documentary series about a Hollywood teenage burglary ring that robbed celebrities is "The Real Bling Ring." I usually watch only the first episode of these series before reading what happened on Wikipedia but watched this in entirety. As crazed (but clever) was their robbery planning is the celebrity culture they hungered to join.
And as far as being "traumatized" by a scene from a book or film or a comment. When one doesn't know the technical definition of "traumatized" it can mean "feeling upset" or "not liking it" or having "hurt feelings." Development requires learning to cope with such human failings as jealousy and envy and sadism, on jobs and elsewhere.
Long ago a woman told me that her therapist said, "I love you." "Wow! That's a pretty unusual thing for a therapist to say," I responded. "Well, he didn't say exactly that. He said, 'You're lovable.'" When words can mean whatever the speaker wishes them to mean and belief becomes fact, we are in a world in which everything is OK and acceptable, or perhaps a psychotic one. Nuff said.

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On Achieving A Happy Marriage

As a psychologist, I have known of world-class devastating marriages and divorces, experiences too improbable for a novel, lived by people who felt that personality doesn't matter in a relationship if there is attraction to each other. Emotional immaturity and impulsivity are key warning signs, as are a history of abusive relationships and lacking independence from parents.

But it can take time to know someone too. In 1930s Vienna, before an unmarried American psychiatrist departed after completing his training analysis, Freud said he hoped the doctor had the good fortune to achieve a happy marriage. "Does one need luck with all your psychological knowledge?" the doctor asked, and Freud replied, "Of course, for only after living with someone for a long time does one really know them." 

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How To Insure That An Adult's Psychotherapy Will Fail

In addition to the therapist lacking talent and training, certain professional practices will insure that a patient's treatment fails. (1) Using a vague unintelligible diagnosis will make the patient be considered untreatable. One like "Borderline Personality Characteristics reflective of Post-Autistic Development" would be excellent. To insure confusion and professional acceptance, a biologic or genetic phrase can be added like "A possible malformation of the patient's adrenal medulla causing irregular production of the epinephrine and norepinephrine hormones may influence the patient's moods." (2) Advising that psychological deterioration is inevitable unless many years of twice-weekly individual treatment is obtained since this is rarely possible. (3) Having the most disturbed patient be treated by the clinic's least experienced worker. A beginner trainee would be a wise choice. (4) Making life decisions for the patient. This will further lower their self-esteem by indicating how inadequate their doctor believes them to be. (5) Never responding directly to a patient's question. Thus if asked why their symptom exists the doctor should reply, with an air of condescension and omniscience, "Severe problems like yours take a long time to understand." This, even if the symptom has been long understood since psychotherapy is least likely to fail when a patient receives explanation.

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The Childhood Origin of Anorexia Nervosa

Though the psychodynamics of Anorexia Nervosa are well understood, it remains the deadliest of mental health disorders with the highest death rate. Its origin lies in parental failure to encourage their child's independence with the child's only possible autonomous behavior being to control what they eat.

Symptoms begin at a time of expected independence for this child who is socially immature and has little awareness of their feelings, the family power struggle around eating being a substitute for the normal developmental struggle of separating from parents and entering adult relationships. Thus symptoms arise when personal autonomy is required: beginning school, entering puberty, or leaving for college.

The initial treatment goal must be to restore and maintain the patient's healthy nutrition. Starvation affects the central nervous system causing increased irritability, hyperactivity, and an obsession with food. Individual psychotherapy can then help the patient resolve their dependency issues and rage toward parental figures, with their low self-esteem naturally rising as normal developmental goals are achieved.

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When Creative Management Deteriorates Into Paranoia

A newly installed manager's initially successful behavior has the potential to deteriorate into paranoia. Their positive abilities of extreme alertness to business change and goal directedness may descend into rigidity, with delusions of grandeur fostering unrealistic projects and irrational suspicion causing scapegoating, poor morale, and high staff turnover. Having the checks and balances of a conscientous corporate board can enable the needed organization change, protect staff against the abuse of power, and rescue the manager from what Plato described as "convulsive fear and distractions" by forcing them to abide by reality rather than fantasy.

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