Clinical Psychologist, author and speaker - Patricia Coughlin is on the leading edge of psychotherapy practice and research. Check out these videos and get more information at www.patriciacoughlin.com
Dr Patricia. I emailed you a few days ago. I am Cesar. I want to know what to do when clients say I don't know how I feel or I don't know how to feel, despite of me saying that feeling is in the body. How do you approach this? Thank you
I start by asking, "Do you want to know?" Spark their curiosity. If a patient doesn't know how he feels he has no intimate knowledge of himself, can't make good decisions and doesn't have what it takes to forge emotionally satisfying relationships. Also, it's not about learning how to feel. That is built in. No one has to teach an infant to cry, to get red in the face and make fists or to shriek with joy. We learn not to feel. It's about reconnecting with their essence.
Very interesting and helpful video. I especially appreciated your point about the full and unchecked bloom of feelings leading to the therapist becoming the focus and motivation to do therapy, while the rest fades into the background. I seem to recall reading that studies have found the relationship/alliance with the therapist to be the key to successful outcomes. So I guess it may be a fine line between deepening this relationship in order to address the problems that brought the client into therapy in the first place, or alternatively locking into a desperate clinging to therapist as a kind of “reason to live”.
Excellent! Thanks again Patricia for doing this video request. Do you ever notice as your doing proper technique before you can get all three elements online, a defense comes up and disrupts the portrait? For example, The first two factors get activated (ie cognitive and the physiologic). However, as you start to go towards the motoric (e.g. hands make fist) The patient becomes self-conscientious at that point and engages in a defense. For example someone to the left of the spectrum might start to rationalize and use a more repressive and tactical. Where someone more in the middle might use more character and heavier tactical defenses with some regressive to maintain Resistance against emotional closeness. Perhaps, someone on the right who you thought might be ready and built enough capacity (through an initial graded approach) you start to do a portrait with and pt starts to use more regressive defense such as projection, splitting or acting out because the feeling or unconscious anxiety comes too quick for them and they're trying to maintain not going fully immersed into CPD. Correct me if I'm wrong but if I interpreted the information correctly and this occurs, the course of action is to pause the portrait and work through the defense. Maybe with a more psychoneurotic PT on the left of spectrum, do defense work via blocking then helping them see and overcome the syntonicity. Eventually helping them go back to another figure on the triangle working back through portrait once ready. Perhaps somebody who's more to the middle via heavy resistance and repression to the right who's more fragile we might adjust fire through continue graded interventions by restructuring that defense that comes up, work through to assist in making more dystonic well simultaneously doing some anxiety restructuring and recapping all with efforts to build more capacity before further engaging in portraits. Thanks again for your time and wisdom shared. Such a valuable resource these videos you share with us
Hello, Patricia! Thanks for your work! In some of your interviews, you mention that to work successfully in iSTDP the therapist must know the psychoanalytical basics solidly. Is there a selected number of works that you would advise to study to make sure the basics are understood? Thanks
Certainly but I would urge you to do your own research as well. Your own curiosity and thirst to learn is key. If you email me at drpcoughlin@gmail.com I can send you a reading list to get you started.
Thanks Patricia, such a great reminder ~ I have to admit I’ve unintentionally“dragged” a few patients through a portrait. Your advice is so helpful, as always. 🙏🏼
We treat people, not problems, so there is no one size fits all approach. We need to assess the entire personality and determine the nature of the conflicts responsible for the symptoms.. Ultimately a trail therapy is required to evaluate response to intervention and develop an approach that suits the patietnt in question.
An intriguing slip of the tongue at 7:35 - you didn't deserve that; you were just trying to HURT me. Is this a case of countertransference with narcissistic clients? 🙂
Great video Patricia. I'm wondering if you could do a video at some point with an example or script of a therapist dragging the patient through the portrait. Further pitfalls associated in engaging with this dragging process (eg. ? Misalliance). Thanks again for sharing your wisdom.
Hi Dr. Couglin Thank you for the amazing videos. I have learned a lot from you. Could you please name a couple of journals that you have found beneficial
Please make a video on overcoming instant repression! It's always quite confusing. My understanding is to keep exposing the patient to the emotional trigger in greater and greater detail, while inviting feeling, recapping then going again until the instant repression is overcome, but I am still unsure.
Oh dear - is someone is repressing impulses you don't want to keep fanning the flames, as they will only get worse. I will certainly do a video on this important topic. Thanks for raising it.
Thank you, i have a question What if a patient couldn't link his current problem to the past? And if there is some links, they are not definie and obvious. Could it be raleted to his early stages of childhood that he cant remember? What can we do with traumatic events of early childhood that cannot be remembered? Thank you so much
Hi Patricia, thank you for this amazing congtent! 💕 Can you do videos on childhood OCD, Bipolar, and cognative disengagement syndrome or perceptual disruption. The OCD and Bipolar is for a friend. But the Cogantive problems are for me, scatterbrained, disorganized, visual spatial issues. Also i saw in one of your interviews you had stated how impressed you were by Habib Davanloo, do you have the footage of his sessions? Where can i find it. Thank you so much!!
Sounds like a good neuropsychological assessment is in order. I was fortunate enough to train with Dr Davanloo and to observe his work on videotape. Needless to say, these tapes are highly confidential and are not available. Dr Davanloo has died so that window has closed. Many of those he trained continue the work, both with patients and therapists. If you are interested in finding an ISTDP practitioner, a list is available on www.istdpinstitute.com.
Would I be right to think that the way anxiety is discharged would give us an idea if the patient is repressive or regressive? Say his anxiety tends to go into smooth muscles, then his tendency is to use more regressive defences? I hope I made sense. Thank you. Cesar Bueno
This is a complex question and I don't have enough information. You would have to assess baseline to determine whether defenses are primary or regressive. Anxiety pathways don't necessarily correlate with defensive structure. All elements must be assessed and integrated in order to determine the patient's ego adaptive capacity. In any case, we endeavor to intervene at the patients HIGHEST level of capacity and to block regression.
Hi Patricia! I’d like to get your recommendation for an online training course, since I live in Singapore at the time and there’s no ISTDT training available here. Thank you! PS. I'm binge-watching all your videos! 😄
Thanks Patricia! Your videos are always very enlightening 👏 It would be possible for you to make a video about "stage fright" or public speaking anxiety. It is a topic that is difficult for me to work with patients... especially from a psychodynamic perspective. It's as if anxiety stole the movie and I have a hard time identifying the feelings beyond fear... Thank you very much in advance!
fear of what? Fear is a response to a threat to life and limb. Obviously neither is an issue when speaking in from of others. So it is anxiety - anxiety about flopping or being ridiculed. Both evoke feelings, anxiety and defense. Investigate when it first started and you will get clues. thanks for the suggestion - I will put it on the list!
@@patriciacoughlinphd1852 Perfect, thank you very much! I'll be watching 😄 And how do we understand when a vicious circle is generated in which after having experienced those anxious symptoms while speaking in public, then a fear of them being experienced again is generated, ruminating thoughts about it and avoidant behaviors... There are cases in which they recognize a fear of failure or ridicule but that does not eliminate the anxious response when exposing themselves... Sorry for deviating from the topic of your video 🙏
@@Pedro-ew1dj There was an interesting experiment that speaks to this. Public speaking is the #1 fear, even higher than death! In the experiment, subjects were asked how they felt in their body as they got ready to speak. Everyone talked about tensions, butterflies, dry mouth, etc. In the experimental condition, they were taught to label those sensations as excitement, while the others were labeling it as anxiety and dread. The audience knew nothing about the experiment but were asked to rate speakers for engagement, authenticity, interest, etc. Those who labeled their sensations as excitement were rated far more interesting and engaging than those who labeled them as anxiety.
@@patriciacoughlinphd1852 I don't think it is always the case being anxious about messing up a speech or being laughed at , sometimes people are genuinely so afraid of public speaking that they think, incorrectly, that they will drop dead of a heart attack or similar.
@@MrChronos1971 The question for me would be why that individual would scare themselves in that way with such catastrophic thinking. I would be curious to discover what is underneath that conscious thought.
As Is a client, How can I differentiate if i've experienced a rupture or if I'm simply spiraling in my own emotional crisis from something triggering cptsd / [disorganized] attachment trauma.? Ive felt a loss of connection to my therapist this year and have felt utterly gutted w the fear it means our time has come to and end ..not because of her but because of me. I don't know what I'm trying to process or how to talk to her anymore without feeling intense shame and insecurity. I've tried sharing journal entries with her to let her know but nothing seems to have helped. I miss feeling safe with her but also admitredly feel a slight confused resentment as well
All I can do is encourage you to open up to her - tell her you've been feeling disconnected and anxious. Try to put your finger on what happened to trigger this. Clearly something happened in the last year. Instead of feeling what you feel toward her you have gotten anxious and are in retreat. I hope your therapist can respond to this so that the two of your can back on track.
Almost every time I get to the portrait stage. My clients don't seem to have the ability to demonstrate the violence in there imagery that your examples do. It's usually a more muted expression of anger like saying something rather offensive towards the figure in there imagination. I don't know what I'm doing wrong?
Are you in training and supervision? It sounds like there is still defense in operation. You want the patient to turn on defenses before pressing to feeling. Once pressure begins, check on internal activation and wait for a non-verbal sign, like a fist developing or a leg kicking. Then you can ask, "What does your fist/foot want to do?"
Can you imagine self-harm that is less dramatic than cutting or hitting oneself, but still equally self-destructive (such as shaming oneself, being highly self-critical, etc.) also stemming from unconscious anger towards a relationship?
One very important aspect is not mentioned in this video: a global research on trauma in war torn countries and western countries etc showed a shocking discovery that in wealthy war free countries trauma is significant higher. This due to lack of collective support of the trauma like within war torn countries and the notion of "you should be happy"/ you have it all. Trauma survivers cary there burden more alone and feel less validated in there experiance. This leads to more symptoms and deeper longer lasting affects. I wasnt there, but I can see why 911 could result in these test results. Because it was collectively grieved, instead of a sexual abuse situation where the person was very isolated for a long period of time. Yet overal thank you for you videos I've learned a lot! Keep up the good work! :D
You are absolutely right. The fact that everyone acknowledged what happened on 911 and publicly expressed a myriad of feelings about it was a huge factor.
Yes, positive transference can be deleterious. It can preclude some from being efficient and curious due to the fixation of being liked. One might be very cautious to probe or explore something if they feel that the client might not "like" them if they asked questions.
Thank you for posting this. I am late diagnosed autistic and have CPTSD . I suspect I may also have a dissociative disorder but am also aware of overlap with mental health conditions/ASD. More memories have been coming back over the last few years and I am almost 50. I am beginning to own my shame, rage and confusion due to being raised by traumatized, possibly ASD inconsistent parents. I was aware 10 years ago that the shame seemed to be coming from what I internalized as a child.
I would urge you to avoid diagnostic labels, which have a very negative effect. You are a human being with struggles and talents, just like the rest of us! Hope you are getting the help you need to heal.
Of course, it varies person to person but, in my experience, many master's level clinicians have not been trained to conduct and understand research. Good on you for keeping up with the literature.
What does it mean when a patient has "no defenses." I know a therapist who described a patient in this way. Can you talk about this concept of ego with respect to introjection?
We all have defenses. I have no way of knowing what that therapist meant but when folks are fragile and disorganized they quite literally cannot defend themselves against predators and are often used and abused.
Can the "Madonna and the Whore" complex also exist in non sexual of romantic relationships? For example when a father/big brother doesn't want his daughter/sister dating and having sex with boys because he thinks that her viginity should be protected or because he thinks that she is a whore if she does this etc. I am sorry if I didn't axplain the quesstion the right way XD
