The intention for maintaining a blog as a therapist is for marketing, education, advocacy, and providing content in a technologically changing field. I want to do this while making patients aware of the risks and benefits of engagement on technological and social media where therapists are present. A therapeutic relationship is a professional relationship and in today’s technological climate, a social media presence or following your therapist on social media is not to be confused with a relationship outside of therapy. Ethical, professional, and therapeutic boundaries must be followed and honored. 

This blog is not psychotherapy, a replacement for a therapeutic relationship, or substitute for mental health and medical care. It is not seeking an endorsement, request, or rating from past or current clients. Nothing stated in any post should be considered professional advice. The information contained in posts is general information for educational purposes only.

Please consult your physician or mental health provider regarding advice or support for your health and wellbeing. 

If you are suicidal, please call your local 24-hour hotline or 911 or emergency services.

therapeutic intent: why we do what we do

An analytic treatment is first established by a clear understanding of the intent or purpose of the analytic endeavor.

Roy Barsness, Core Competencies of Relational Pscyhoanalysis (CCRP)

Relational psychoanalysis – the discipline on which my work signficantly relies – is a historical movement within psychoanalysis that, in part, brings increased suspicion of prescribed technique. By the second half of the 20th Century, the dominate trend in psychoanlysis in the USA was a rigid adherence to technical purity, theoretical orthodoxy, and therapeutic abstinance. While there are certainly other trends in the history of psychoanalysis that challenged this practice (e.g. Harry Stack Sullivan), the dominate approach in America tended to conform to this rigid application.

The relational turn injected a dose of doubt into analytic conceptualization. That is not to suggest that the therapist does not have a mind about what is going on in the relationship and in the treatment. But it acknowledges that the mind of the therapist is as impacted by the patient as the mind of the patient is impacted by the therapist. There is no pure stance, no objective viewpoint that is immune to the dynamics that are unfolding between the patient and the therapist. Any given certainty is conditioned by a mind that is interacting with another mind. The mind of the therapist about the treatment is contextually conditioned by the therapeutic relationship.

Insights from social constructionism, post-structural continential thought, and interpersonal neurobiology all converge to offer psychoanalysis a heaping portion of humility in regards to the possibility of certainty – or even assurance – of knowing what is going on in the consulting room. This uncertainty produces a new freedom to the therapist, even if the cost of that freedom is the (illusory) comfort of certainty. As Steven Tublin states in Core Competencies of Relational Psychoanalysis (2018):

To being with, contemporarty relationalists embrace a radical eclecticism that denies them the comfort of a consensually acepted theory of mind upon which to build a set of technical principles…Whereas the mid-century Freudian faced strict limits in both the theoretical positions from which he might approach the clinical moment and tight restrictions on how he might then engage his patient, the contemporary relationalist has community sanction to borrow from a borad family of theoretical traditions and the techniquest that correspond to them.”

Tublin, S. (2018). Core competency one: Therapeutic intent. In R. Barsness (Ed.), Core competencies of relational psychoanalysis: A guide to practice, study, and research (pp. 67-86). Routledge.

Tublin goes on to describe, in multiple paragraphs, the “broad menu of technical choices that can be exhiarating in its plenitude or panic-inducing in its boundlessness.” (2018). The freedom that relational psychoanalysis enjoys creates a tension between remaining within the relational context of each unique patient-therapist dyad and maintaining a discipline of mind that keeps the conversation psychoanalytic. The remainder of Tublin’s chapter focuses on the tension between freedom and discipline that exists for the relational analyst, and the ways four specific analysts have navigated this tension (Hoffman, Renik, Mitchell and Stern).

I was introduced to relational psychoanalysis through CCRP during my supervision. As a masters level clinician-in-training, and a therapist who did not receive traditional psychoanlytic training in my program, the technical freedom that Tublin describes as either “exhilarating” or “panic-inducing” tended to produce the latter within me. The tenets of contemporary relational psychoanalysis were deeply resonant for me. But I found myself regularly asking, “but what do I do?”. In the face of this freedom, what is the discipline? What makes the extended conversation between patient and therapist psychoanalytic?

Tublin provides an answer. “It becomes psychoanalysis only when it is structured around a coherent theory of therapeutic action that defines the analyst’s therapeutic intent” (2018). It is the therapeutic intent that provides the necessary discipline that balances the technical freedom enjoyed by relationalists.

In the original research that forms the soil out of which CCRP grew, Barsness found that participants “held to a particular belief system and clearly oriented their work toward particular outcomes informed by their understanding of what constitutes change.” By articulating our intent, relational therapists make explicit (to themselves and their patients) the criteria by which they evaluate their therapeutic action within the unique context of each therapeutic relationship.

The competency of therapeutic intent – knowing what we believe contributes to lasting change – provides us a rationale for how to engage our patients. Several purposes of analytic treatment emerged in Barsness’ research, including:

  • Increased capacity to experience and manage multiple affective states and to enjoy the full range of emotion
  • Incrased access to multiple aspects of the self without shame
  • Ability to comfort and soothe oneself and to be self-reflective
  • Ability to accept responsibility
  • Ability to tolerate ambiguity and uncertainty
  • Ability to be more truthful with oneself
  • Ability to think more creatively and openly about one’s past rather than continue to repeat it
  • Relief from internal constraints and rigidities that have become problematic
  • A more imaginative and creative mind
  • Increased capacity to love and to work; self-efficacy
  • To engage in more meaningful and redemptive relationships
  • Hope

By having a clearly defined understanding of what we hope to accomplish and towards what direction we are working, we are provided guidance amidst the freedom of theoretical and technical pluarlism that relational psychoanalysis has produced. While it may not have provided the answer to my question of “but what do I do?” (which is explored more in subsequent chapters of the book and will be explored in future posts on this blog) it does provide the rationale for why I am trying to do anything in the first place.

By way of conclusion, I quote Tublin’s summary at length:

It is intent, not the objectivist-tainted notion of correctness, that should guide the analyst’s participation in the consulting room. An intent-driven conceptualization of technique, while limiting the analyst’s moment-to-moment actions, would force the analyst to be explict about how his communicative acts – his interpretations, questions, empathic expressions, as well as the various jokes, reminiscences, and lexical gestures that establish his unique presence – are meant to drive a therapeutic process…Rendering his intent explicit compels the analyst to know, as much as possible, what he considers essential to a satisfying human existence, what sort of mind he believes allows for the creation of such a life, and what he is capable of doing, via the ritualized application of his craft, to advance that aim.

Tublin, S. (2018). Core competency one: Therapeutic intent. In R. Barsness (Ed.), Core competencies of relational psychoanalysis: A guide to practice, study, and research (pp. 67-86). Routledge.

core disciplines of relational therapy: introduction

This last spring, I flew to Seattle to participate in the final retreat of a two year, post-graduate continuing education certificate program through the Seattle School of Theology and Psychology. The program – Relationally Focused Psychodynamic Therapy (RFPT) – is based on the research conducted by Dr. Roy Barsness on Relational Psychoanalysis, and the subsequent book, Core Competencies of Relational Psychoanalysis: A Guide to Practice, Study and Research.1 In the book, Barsness consolidates his research on what relational psychoanalysts do in their treatment of patients, and outlines seven core competencies or disciplines that emerged from the study.

These disciplines include (1) therapeutic intent, (2) therapeutic stance/attitude, (3) deep listening/affective attunement, (4) relational dynamic: the there and then and the here and now, (5) patterning and linking, (6) repetition and working through, and (7) courageous speech/disciplined spontaneity. The final core competency that contains all seven disciplines is love.

These seven disciplines are the focus of the RFPT program, and have become guiding practices in my work of treating patients. Through twice-yearly, in person retreats, and regular bi-weekly consultation, my cohort and I gained the opportunity to learn these disciplines experientially and emersively together. As the program came to a close this spring, the experiential learning I had gained over the past two years began to crystalize.

In order to continue the crystalization process, I have decided to write my own thoughts, reflections, and experiences with each of these disciplines in a series of posts over the next several weeks. Much much use will be made of Core Competencies as the primary text of my learning process. But I hope to organize the information through the lens of the last two years of my personal process in the program, and my work with patients.

  1. Barsness, R. (2017). Core competencies of relational psychoanalysis: A guide to practice, study and research. (First Edition). Routledge.

relational psychodynamic therapy

Until you make the unconscious conscious, it will direct your life and you will call it fate.

C. G. Jung

Psychodynamic therapy can be simply (perhaps too simply) summarized as an attempt to make the unconscious conscious. While most psychologists, psychotherapists, and other mental health professionals will agree that there is a part of the mind that is unconscious, the psychoanalytic and psychodynamic therapies emphatically proclaim that there is dynamic processes at play beneath our awareness. It is not just that we are thinking and feeling things that we don’t know we are thinking and feeling (although that is also assumed). Rather, we have various drives, needs, desires, fantasies, images, memories, and beliefs that are in tension with each other, or even battle each other. And the numerous battles are waged outside of our conscious expereince.

These battles create all sorts of symptoms and neuroses, both directly (anxiety about two unconscious desires in tension) or indirectly (a rigid defensive structure to keep the tension out of awareness). A lot of therapeutic approaches will focus on aleviating these symptoms, and this is an honorable desire. The psychodynamic contention is that if we do not bring into our awareness the conflicts within us, then the same or similar neurotic symptoms will emerge. The symptoms are not the problem; they are guiding us to the problem.

We are born in relationship, we are wounded in relationship, and we are healed in relationship

Harville Hendrix

Symptoms are often guiding us to a problem of relationship. In Western culture, we tend to downplay the importance of relationship. That is not to say they are not seen as important, but they are often treated as facets or aspects of human life, rather than as a condition for human life. Human life is seen as atomistic and individual. I as an individual opt to engage or not engage in human relationships.

Neuroscience and attachment science, as well as an increased influence of non-Western cultures in Western society, have challenged this approach. We know from neuroscience that we are born with an enormous amount of undifferentiated neurons (brain cells), and that starting at age 2 and continuing into early adulthood, the brain removes the unused neurons and reinforces the used ones (a process called synaptic pruning).

The idea here is that we are born with far more neurons than we need, and that our early childhood experiences, specifically before age 2, have a significant impact on our how our neural networks (the conneciton of various neurons to each other) develop. The environment of the first two years of life largely determines which neurons are used, and which are pruned. Once we are about 2 years old, these neurons are fairly set in place.

Attachment science has revealed this process in relationship. The way that our primary caregivers relate to us during the crucial first 2 years of life dramatically affects the way we connect, perceive our self and the world, and experience and regulate our emotions. Few things in the human experience has as significant an impact on our mental health and wellbeing as our attachment relationships early in life. And when we are wounded in our attachment, those wounds are carried throuhgout our lives until they can be repaired.

If we do not transform our pain, we will most assuredly transmit it

Fr. Richard Rohr

Our attachment wounds may go underground, but they don’t go away. Every relationship we form is colored by those essential first relationships. If our parents are “good enough” caregivers, we will enter into the world with a strong sense of self and the world, an ability to regulate our emotions, and self-esteem in our work. If our parents are inconsistent caregivers, we may develop an axious connection with them, and every ensuing relationship that follows. We cannot trust that our needs will be met consistently, and we cling and clutch to our loved ones for fear that they will not be there for us when we need them. Or, we may learn that our needs won’t be met adequately, and become dismissive about our own needs and emotions in order to protect ourselves from inadequate caregivers. If the pain is significant enough, we may struggle to organize our minds about relationships in a meaningful way, and vascilate between different strategies of protection.

This means that our struggle invaribly becomes relational. We find the people in our lives that we think can finally meet our needs. We try to build relationships with them. But we’re unable to form a secure enough bond to be healed, and the original wound is reinforced instead of repaired.

We repeat what we don’t repair

Christine Langley-Obaugh, MD

The assumption of relational psychodynamic therapy is that the past will be repeated in the therapy relationship, as it does in every other relationship. Freud refers to this as the Repetition Compulsion. Our unconscious is directing our life to repeat what has happened in the past in the hope of correcting or healing the original wound. The problem is that we often are defended against the wound, and our relationships are defended against their own woundedness as well, so that the repetition does not reach the intended goal, but rather simply repeats the wounding experience.

Transformation comes when the therapist and patient can “catch” themselves in this sort of enactment. Far from being an expert, the relational therapist expects that they will be “caught up” in the repetition with the patient. But when we catch ourselves, we become conscious of what has been happening below our conscious level of awareness. We can then embody a new way of being together, where the woundedness is not repeated, but repaired.

Neuroscience calls this neuroplasticity: the ability of established neural networks to give way to new ones. In attachment science, we are able to internalize a new relational object that is a “good enough” caregiver. Psychodynamic therapy claims that the unconscious repetition that we play out in all of our relationships produces a new, redeeming experience in therapy. As this repetition continues to produce a corrective experience in therapy, new neural networks emerge and new attachment figures are internalized leading to a greater level of integration, the ability to create meaning, and a healtheir experience of our self and the world.