how to begin sessions

Make sure your interventions flow from and are internally consistent with the theoretical foundation of the model you employ. In dynamic psychotherapy we endeavour to get to the source of the patients difficulties, which is typically unconscious. This means we must speak to and listen to the unconscious rather than engage the patient's conscisous mind.

[@deadlypalms]

Always super educational, practical and fantastic to watch. Thank you for continuing to make such videos.

[@patriciacoughlinphd1852]

Thanks for letting me know. I appreciate it!

[@Olga-kr3mq]

This is so helpful! I am studying to become a therapist and ISTDP seems like a wonderful approach. Being in personal therapy right now as a client it is so frustrating when the therapist doesn't stay on the problem that I bring to the session. And several session into the therapy I find myself reminding the therapist why I am there and what I need help with.

[@patriciacoughlinphd1852]

Has it changed? If not, you may want to find a new therapist!

[@Olga-kr3mq]

@@patriciacoughlinphd1852 I have changed therapists several times because I felt dismissed and my main concern (dissociation, emotional detachment) was brushed away as something that may go away by itself one day. I think this symptom is so invisible to the therapists that they forget about it quickly, and plus I have learned to function very well with it.

[@elhamzamani8824]

Dr.Coughlin what should we do when patient asks about our method? Is it OK to tell them we are working ISTDP ? because some of them go and read about it and I wonder it may increase their resistance or anxiety... .

[@patriciacoughlinphd1852]

You can if you like but I don't explain. Instead, I schedule a 3 hour trial therapy so the patient can experience the method first hand. At the same time, the therapist can assess suitability.

[@jrti001]

I just started with an ISTDP therapist. The therapist never asked me what I need help with in the first session. By the end of the first session (50 minute session) I brought up what I'm struggling with. Second session the therapist hardly said anything. I felt I had to fill the space with talk so I did and somewhere in there I talked about issues I'm struggling with and all I kept hearing was hmmm, a ha a ha etc.....very frustrating. I shared my frustration with that and it didn't seem to go anywhere. I think the therapist is using more of a psychoanalysis model. I hope I have found a competent ISTDP therapist, might it still be too early to tell?

[@patriciacoughlinphd1852]

That is very odd. In ISTDP we would definitely ask who you are seeking help and why now. Old school psychodynamic therapists often stay silent, which is anything but neutral? If the patient is silent for any period of time, I would intervene and ask how she is feeling right now. We need to reach out to connect without being too directive.

[@christinepetzholtz9019]

From what you describe I at least have the doubt about the competence of the therapist; anyhow it's not just competence what is needed but also connection. You did a very good move to share your frustration and it's a pity that it didn't help your connection. Don't settle for less than feeling to be able to connect and feel safe whatever you are bringing. Good luck!

[@elhamzamani8824]

Thanks, Dr.Coughlin do you mean that when patient comes in we should be silent and wait for patient to start?

[@patriciacoughlinphd1852]

In the trial therapy we achieve agreement about the problems, goals and tasks involved in the therapeutic process. There after, we expect the patient to be actively involved and start sessions with the issues at hand. If the patient is silent, waiting for the therapist to begin, we would bring that to their attention and tie it to the pattern of passivity and subservience elucidated in the first session. We do not cure patients. Active collaboration is required. In dynamic psychotherapy we make use of whatever does or doesn't happen and explore the feelings involved, while assessing anxiety and working with defenses. It's not possible to learn by implementing rules, but intervening in an intentional fashion, based on our understanding of the dynamic forces involved.

[@jrti001]

Patricia and Christine, I had my 3rd and last session with the ISTDP therapist I was seeing. I didn't get the best of impressions of the ISTDP model. Still on a waiting list for another ISTDP therapist. 2nd time's a charm, perhaps?

[@patriciacoughlinphd1852]

Research suggests that the person of the therapist is a more potent variable than the method they use. If you're an "average person" with an "average problem", like getting depressed after a break up, an average therapist will do - but if you have a complex issue and/or haven't responded to other therapies, you need a "super shrink". Make sure to get referrals from a trusted source.

[@jrti001]

@@patriciacoughlinphd1852 I'm in the second category you mentioned, this is why I looked into this model of therapy. Actually these videos came through my feed so I watched one and was impressed with the whole process. In some ways watching ISTDP videos has helped me ask questions of myself and think a bit differently about things in my own life. I've learned a lot about ISTDP, perhaps this may have impacted my lack of connection to the ISTD therapist I just stopped treatment with idk. What is a Super Shrink?

[@patriciacoughlinphd1852]

@@jrti001 You need to be careful about who you see. Make sure to check out the credentials of the person you are seeing and find out where and with whom the therapist did their ISTDP training. In any case, you have to do exactly what you did - try it out. If the therapist doesn't do a 2-3 hour trial therapy, they are not a properly trained ISTDP therapist. The trial therapy is essential.

[@jrti001]

@@patriciacoughlinphd1852 this psychologist had training from Washington School of Psychiatry / ISTDP 3-Year Program received certification in 2014. Looked good to me till we met.

[@patriciacoughlinphd1852]

@@jrti001 Of course the only way to know if it's a fit is to give it a try. That said, if you are not offered a trial therapy of 2-3 hours for the initial consultation, I would not proceed further. Let me know if you need a referral.

[@Pedro-ew1dj]

Thanks for this video! A very practical consultation... Do you take notes during the trial therapy (or the following ones)? I usually do it for the first few interviews but then I stop doing it and write once the patient leaves... There have been periods when I don't write in the first session either but it's too much information to retain (although writing feels like it distances me of the patient... so I have that dilemma). Thank you for your comments!

[@patriciacoughlinphd1852]

No. I do not take notes, as I am intensely involved with and responsive to the patient in front of me. All sessions are videotaped, so there is no need for notes. Reviewing tapes is essential for improvement.

[@Pedro-ew1dj]

Ah perfect, thank you very much for your answer! Do you record your private practice sessions too?

[@patriciacoughlinphd1852]

@@Pedro-ew1dj All sessions, all the time. Of course I have the patient's permission to do so.

[@Pedro-ew1dj]

Ahh perfect, thanks!

[@patriciacoughlinphd1852]

@@Pedro-ew1dj My pleasure.