Jeff Fine-Thomas @jefffinethomas Twitter profile

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Jeff Fine-Thomas

@jefffinethomas

2 years

If you're a therapist in training, do yourself a huge favor by finding a therapist for you. You will thank yourself and you will be better for your future patients.

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Jeff Fine-Thomas

@jefffinethomas

1 month

Psychotherapy is not a friendship. It is not a relationship in which we rescue the patient or one in which they rescue us. It is, of course, impossible to hide ourselves from our patients. 🧵

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Jeff Fine-Thomas

@jefffinethomas

1 month

Psychotherapy is an experience, especially an emotional experience, rather than an intellectual exercise.

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Jeff Fine-Thomas

@jefffinethomas

11 months

"Carl Rogers commented toward the end of his life that he felt he did his best therapy when he found himself in a kind of meditative state in the presence of his clients (1989). 🧵

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Jeff Fine-Thomas

@jefffinethomas

8 months

I'm humbled and ecstatic to share that I signed a contract with @guilfordpress yesterday to co-author a book with Nancy McWilliams! More details to come...

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Jeff Fine-Thomas

@jefffinethomas

2 years

When people enter graduate school to become a therapist, they are often told it is important to choose a theory. I’ve found that one of the most important functions of theory is that it serves as an emotion regulator for the therapist. 🧵

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Jeff Fine-Thomas

@jefffinethomas

1 year

Psychoanalytic therapists are looking for patterns. They want to understand how people behave, think, feel, etc in patterned ways. Locating those patterns can help patients to decide for themselves whether their patterns are what they want for their lives.

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Jeff Fine-Thomas

@jefffinethomas

8 months

If you're interested in learning about psychoanalysis, don't bombard yourself with reading Freud. Start with Nancy McWilliams, Glen Gabbard, Karen Maroda, @jonathanshedler , or Cabaniss (if you want a textbook).

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Jeff Fine-Thomas

@jefffinethomas

2 years

In 2010, @jonathanshedler published an article in the flagship journal of the American Psychological Association, The American Psychologist. 🧵

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Jeff Fine-Thomas

@jefffinethomas

6 months

I sometimes hear a critique of psychotherapy that therapists just keep patients in therapy forever so they can get paid. If those critics knew what the average therapist gets paid, they would know therapists are not in it for the money.

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Jeff Fine-Thomas

@jefffinethomas

11 months

"A psychodynamic perspective suggests that most of us are consciously confused and unconsciously controlled." - Gabbard

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Jeff Fine-Thomas

@jefffinethomas

11 months

"An anchoring principle in psychodynamic psychotherapy is that the patient is ambivalent about change." - Gabbard

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Jeff Fine-Thomas

@jefffinethomas

17 days

I’ve mentioned before that I am very excited to be co-authoring a book with Nancy McWilliams! I thought it would be fun to share what it’s like to write since I’ve never published and the whole process was a mystery to me prior to now.

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Jeff Fine-Thomas

@jefffinethomas

2 months

To paraphrase McWilliams, researchers deal with averages, clinicians deal with individuals. Each psychotherapy must be specific to the needs of the person seeking help.

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Jeff Fine-Thomas

@jefffinethomas

6 months

When did so many people in the psychotherapy professions become concerned with limiting treatment length to 8 to 12 sessions? I recently looked at a practice website that specifically said treatment ends in 12 weeks. What happens when the patient needs something different?

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Jeff Fine-Thomas

@jefffinethomas

1 year

“Falling in love is one of the few common experiences that makes most people aware of how remarkably lacking in control they are over the emotionally powerful situations in which they find themselves.” - Nancy McWilliams

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Jeff Fine-Thomas

@jefffinethomas

1 year

Psychoanalysis persists partly because therapists who want to be of real help to people need complex models of how the minds and relationships of people really work. 🧵

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Jeff Fine-Thomas

@jefffinethomas

6 months

The psychotherapy profession is in the midst of "disruption" by big tech, who see the dollars in the market and want to capture them. The only way they can make money is to remove the one-to-one relationship between therapist and patient. Meaningful relationships don't scale.

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Jeff Fine-Thomas

@jefffinethomas

2 years

When I was a young therapist, I tried to listen very carefully. At first, I was completely overwhelmed by all that was being said in session. I didn’t know what to focus on and got stuck trying to focus on everything. 🧵

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Jeff Fine-Thomas

@jefffinethomas

7 months

"Falling in love is one of the few common experiences that makes most people aware of how remarkably lacking in control they are over the emotionally powerful situations in which they find themselves." McWilliams

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Jeff Fine-Thomas

@jefffinethomas

2 years

The therapeutic relationship relies, in part, on the attempt to build trust between therapist and patient over time. As a young therapist, I made the mistake of thinking establishing trust would go quickly. But, the truth is that many people enter therapy 1/4

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Jeff Fine-Thomas

@jefffinethomas

1 year

“Psychotherapy is not simply about changing one’s behavior; it is also about accepting what cannot be changed.” - Nancy McWilliams

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Jeff Fine-Thomas

@jefffinethomas

1 year

There is a simple and profound idea in psychoanalysis that the first things people say to us in their first contact with us will likely contain the seeds of what pains them. 🧵

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Jeff Fine-Thomas

@jefffinethomas

2 years

If you’ve been around psychoanalytic ideas long enough, you’ll eventually run into the notion that psychoanalysis aims to restore capacities of love, work, and play. This is the title of the 10th psychological vital sign in McWilliams’ work. 1/7

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Jeff Fine-Thomas

@jefffinethomas

1 year

Psychoanalysis also persists because it is the antithesis of the immediate gratification dilemmas we all encounter. Psychoanalysis encourages thinking deeply, understanding deeply, feeling deeply. 🧵

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Jeff Fine-Thomas

@jefffinethomas

1 month

There is a simple and profound idea in psychoanalysis that the first things people say to us in their first contact with us will likely contain the seeds of what pains them.

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Jeff Fine-Thomas

@jefffinethomas

9 months

“Mentalization is the capacity to understand that other people have thoughts and feelings that are different from one’s own.” - Cabaniss, Cherry, Douglas, Graver, Schwartz

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Jeff Fine-Thomas

@jefffinethomas

8 months

Psychotherapy is not just the effort to help patients alleviate symptoms but also to improve their experiences of agency, affect regulation, self-esteem, insight, connection with others, and acceptance of what can't be changed. (paraphrased from McWilliams)

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Jeff Fine-Thomas

@jefffinethomas

4 months

I’ve been neglecting to post in the last few weeks. I’ve been writing and now have drafts of the preface and the first 3 chapters of the book Nancy McWilliams and I are working on. I’m very excited!

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Jeff Fine-Thomas

@jefffinethomas

2 years

Projective identification is one of the most difficult concepts in psychoanalysis. But, it is very important because it describes a phenomenon between people. In projection, an unwanted thought/feeling is attributed to someone else. In projective identification, 1/4

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Jeff Fine-Thomas

@jefffinethomas

2 years

When I was a young therapist, I wanted to help people. In retrospect, helping others was reinforcing my self-esteem. If I could be good at it, then I could feel better about myself.

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Jeff Fine-Thomas

@jefffinethomas

3 years

1/6 The next few tweets come directly from the Psychodynamic Diagnostic Manual 2 as well as Nancy McWilliams’ fantastic new book Psychoanalytic Supervision. She describes these 10 concepts as the psychological vital signs. Perhaps one of the most important tasks for any

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Jeff Fine-Thomas

@jefffinethomas

1 year

When people reach out to begin psychotherapy, they tend to describe their problems in language that is meaningful to them. They often are vague in their descriptions: they want to improve their life, fix their marriage, or become a better parent. 🧵

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Jeff Fine-Thomas

@jefffinethomas

2 years

Sometimes things are said so that other things can be avoided. Listening carefully involves deeply understanding the experience of another in order to explore the things that aren’t said aloud. #therapistsconnect #therapiststwitter #psychoanalysis #psychstudent

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Jeff Fine-Thomas

@jefffinethomas

1 year

Psychoanalytic therapists pay attention to how people may want to avoid certain topics. No subjects are taboo in therapy, but there may be many subjects the patient feels uncomfortable with. 🧵

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Jeff Fine-Thomas

@jefffinethomas

1 month

Patients don’t care about our theory. They want help with their problems.

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Jeff Fine-Thomas

@jefffinethomas

26 days

One cannot un-ring the bell of a self-disclosure, so caution is warranted. I have a rule of thumb to wait and reflect on a possible self-disclosure. Impulsive or spontaneous self-disclosures can go awry quickly. 🧵

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Jeff Fine-Thomas

@jefffinethomas

1 year

Psychoanalytic therapists are interested in a person’s experience. We learn over time and exploring a patient’s history is a way to understand the conclusions patients have made as a result of what they’ve learned. 🧵

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Jeff Fine-Thomas

@jefffinethomas

8 months

Psychoanalytically oriented therapists tend to do the following: Focus on affect and expression of emotion, explore attempts to avoid distressing thoughts or feelings, identify recurring themes and patterns, 🧵

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Jeff Fine-Thomas

@jefffinethomas

6 months

The idea that patients only want symptom reduction is just not accurate. They want their relationships to improve, increased agency, to manage their feelings, reliable self-esteem, to develop resilience, to understand how their minds work and the minds of others, and much more.

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Jeff Fine-Thomas

@jefffinethomas

1 year

@DrCamiloOrtiz I think the patient is allowed to think of the therapist any way they want. If the therapist treats the patient as if they're friends, then I would say they are not in good therapy.

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Jeff Fine-Thomas

@jefffinethomas

18 days

I’ve noticed over the years that there are therapists who are exceptional and those that are not so great. Generally, though not always, those that are exceptional are humble and seem to have an ethic of keeping the beginner’s mind. 🧵

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Jeff Fine-Thomas

@jefffinethomas

8 months

"A therapeutic relationship is likely to get off to a good start if the client feels the clinician's curiosity, relative lack of anxiety, and conviction that the appropriate treatment can begin once the patient is better understood." McWilliams

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Jeff Fine-Thomas

@jefffinethomas

2 months

To paraphrase McWilliams: Meaningful psychotherapy goes beyond symptom reduction to help patients improve relationships, understand themselves and others better, feel more agentic, develop resiliency, improve self-esteem,

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Jeff Fine-Thomas

@jefffinethomas

2 years

When I was a young therapist I relied heavily on offering empathy to the people I was trying to help. Mostly that was because I knew how to be empathic but wasn’t sure how to do much else. 🧵

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Jeff Fine-Thomas

@jefffinethomas

1 year

“All relationships, not just familial ones, require us to contain contradictory feelings fro the same person. As the poet Molly Peacock has observed ‘There must be room in love for hate.’” - Luepnitz

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Jeff Fine-Thomas

@jefffinethomas

7 months

"It seems to me that the overarching theme among psychodynamic approaches to helping people is that the more honest we are with ourselves, the better our chances for living a satisfying and useful life." McWilliams

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Jeff Fine-Thomas

@jefffinethomas

1 year

“Healthy self-esteem comes from internalizing caregivers’ nonshaming attitudes toward our authentic feelings, thoughts, and behaviors.” - Nancy McWilliams

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Jeff Fine-Thomas

@jefffinethomas

2 years

Do you remember Piaget’s idea about object permanence? It’s the idea that at a specific developmental moment, a child can imagine that an object still exists even though it passes out of view. 1/7

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Jeff Fine-Thomas

@jefffinethomas

1 year

To cultivate the psychoanalytic attitude, it is important first to go to your own therapy. 🧵

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Jeff Fine-Thomas

@jefffinethomas

2 years

When I was a young therapist, I thought it was important to find and master the techniques of psychotherapy. I imagined them like tools in a toolbox that I might pull out and use when needed. 🧵

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Jeff Fine-Thomas

@jefffinethomas

8 months

Psychoanalysis teaches a specific and nuanced therapeutic attitude. It is a mixture of curiosity and careful listening. 🧵

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Jeff Fine-Thomas

@jefffinethomas

2 years

McWilliams’ sixth psychological vital sign (insight, reflective function, and mentalization) includes some important comments on the ability to create a models of one’s own mind as well as the minds of others. 1/5

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Jeff Fine-Thomas

@jefffinethomas

11 months

"A hallmark of psychodynamic thinking is that the patient and therapist have two separate subjectivities that interact in a meaningful way during the course of the therapy." - Gabbard

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Jeff Fine-Thomas

@jefffinethomas

2 years

Meaningful psychotherapy is a relationship between people, not a series of steps implemented by one who knows while the one who doesn’t just sits there. #therapistsconnect #therapisttwitter #psychoanalysis #psychstudent

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Jeff Fine-Thomas

@jefffinethomas

1 month

Thus, our personalities, histories, identifications, injuries, preferences, opinions, needs, etc. are either explicitly or implicitly in the room with the patient. These parts of ourselves leak out even when we wish they wouldn’t.

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Jeff Fine-Thomas

@jefffinethomas

6 months

AI "therapy" is already here. It will become much more prominent and it will harm people. A real human relationship with a competent therapist cannot be scaled. But tech companies are going to make a lot of money trying.

Austen Riggs Center

@AustenRiggs

6 months

“We must increase access to therapy, but a chatbot administering skills is no replacement for a human relationship with a skilled therapist who can promote lasting change, and simulated empathy is a contradiction in terms.

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Jeff Fine-Thomas

@jefffinethomas

1 year

Psychoanalytic therapists pay attention to the relationship they are creating with their patient. Being able to talk about the relationship, often as some dilemma has arisen, can model for the patient ways of managing problems while maintaining connection.

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Jeff Fine-Thomas

@jefffinethomas

8 months

"...psychotherapy is the art of the possible." McWilliams

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Jeff Fine-Thomas

@jefffinethomas

10 months

"In psychodynamic psychotherapy, one of the things that we think helps our patients is making the unconscious conscious... 🧵

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Jeff Fine-Thomas

@jefffinethomas

1 year

A central idea in psychoanalysis is that we all experience internal conflicts. We want to lose weight and we want to eat chocolate cake. We want to be close to others and we fear being close will make us too vulnerable.

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Jeff Fine-Thomas

@jefffinethomas

2 years

Psychoanalysis traditionally values three ongoing learning pathways: get into your own therapy, consult with a senior clinician, and read constantly. 🧵

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Jeff Fine-Thomas

@jefffinethomas

2 years

If you have a favorite book or article on Attachment Theory, please share it!

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Jeff Fine-Thomas

@jefffinethomas

2 years

The therapist is not a machine, devoid of personality, history, opinions, pains, etc. The therapist does not enter the therapeutic moment from a place of nothingness. 🧵

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Jeff Fine-Thomas

@jefffinethomas

7 months

"The diverse therapeutic approaches within the psychoanalytic pantheon share the aim of cultivating an increased capacity to acknowledge what is not conscious - that is, to admit what is difficult or painful to see in ourselves." McWilliams

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Jeff Fine-Thomas

@jefffinethomas

1 year

Have you ever noticed that many therapists shy away from talking about money? Why do you think that is?

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Jeff Fine-Thomas

@jefffinethomas

8 months

Psychoanalysis offers an understanding of how personality, development, one’s history, and one’s relational patterns interact – an understanding that allows a clinician to imagine what the client’s experience might be like.

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Jeff Fine-Thomas

@jefffinethomas

2 months

I get tired of arguments by therapists that they need to finish therapy quickly so they can see as many people as possible. I think our job is to help the patient in front of us with the psychological change they hope to make.

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Jeff Fine-Thomas

@jefffinethomas

2 years

McWilliams’ 3rd psychological vital sign is agency. As always, she says it very nicely: “Psychodynamic therapists want clients to feel increasing power to influence their own lives, to find their own tools, to question any sense they carry around of 1/6

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Jeff Fine-Thomas

@jefffinethomas

5 months

Clinicians are not technicians. Psychotherapy creates a space for the patient to have an experience that is often emotionally charged. We are not mechanics who dole out techniques.

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Jeff Fine-Thomas

@jefffinethomas

2 years

Focus on the therapy relationship Exploration of fantasy life I find these plain English ways of thinking about psychodynamic technique incredibly helpful, especially since technique can be exceedingly complicated.

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Jeff Fine-Thomas

@jefffinethomas

2 years

With good supervision, I eventually started to follow the lead of the people I was working with. After a ton of good supervision and my own therapy, I eventually began to notice what was not being said.

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Jeff Fine-Thomas

@jefffinethomas

4 months

Just watched this again. It's worth watching over and over.

The 7 Principles Of Psychoanalytic Psychotherapy

Jonathan Shedler, PhD is a clinical professor of psychiatry at the University of California, San Francisco (UCSF), faculty member at the San Francisco Center...

www.youtube.com

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Jeff Fine-Thomas

@jefffinethomas

11 months

"The first few minutes of a therapy are that blank space of meeting that set the tone for the whole of it. As much as our social training has taught us the trade of dispelling anxiety, our job at the outset of a therapy is the opposite: 🧵

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Jeff Fine-Thomas

@jefffinethomas

2 months

To paraphrase McWilliams, in most cases working slowly and deliberately is the fastest way to help patients.

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Jeff Fine-Thomas

@jefffinethomas

8 months

Psychoanalysis has a rich and deep literature that offers a path to engage with what is hidden from us, including our inner conflicts, wishes, and needs. 🧵

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Jeff Fine-Thomas

@jefffinethomas

10 months

Great interview with Nancy McWilliams

Intent to Understand with Nancy McWilliams — THE ART OF LISTENING

Episode 3 Intent to understand: Embracing human limits as our ultimate guide with Nancy McWilliams We’re looking forward to reading your comments and thoughts.

www.theartoflistening.me

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Jeff Fine-Thomas

@jefffinethomas

1 year

“Therapist qualities that correlate with patient improvement and satisfaction: Accurate empathy, acceptance, positive regard, genuineness, focus, hope and expectation, emotional evocation, offering of information.” - Nancy McWilliams

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Jeff Fine-Thomas

@jefffinethomas

11 months

"As therapists we often ride two horses at once. The theory, research, and clinical guidelines that characterize the particular orientation with which we identify are essential; 🧵

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Jeff Fine-Thomas

@jefffinethomas

10 months

"One of the therapist's responsibilities is to help the client know and understand how he acts out of past experience, and how this colors his view of the present." - Maroda

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Jeff Fine-Thomas

@jefffinethomas

6 months

Psychotherapy has a dose response. More is actually better. Competent clinicians understand this does not mean most people should be in psychotherapy forever. 🧵

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Jeff Fine-Thomas

@jefffinethomas

2 years

Focus on affect and expression of emotion Exploration of attempts to avoid distressing thoughts or feelings Identification of recurring themes and patterns Discussion of past experience (developmental focus) Focus on interpersonal relations

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Jeff Fine-Thomas

@jefffinethomas

1 month

Patients want more than symptom reduction. They want better relationships, more agency, to feel understood, improved self-confidence, better insight, etc. And, they know these things take time and won't happen in 12 sessions.

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Jeff Fine-Thomas

@jefffinethomas

1 month

McWilliams listed common unconscious phenomena in her 2004 book titled Psychoanalytic Psychotherapy: “Unconscious phenomena may include a sense of weakness (risk of psychic decompensation, fragmentation, annihilation), vanity (vulnerability to shame,

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Jeff Fine-Thomas

@jefffinethomas

11 months

“As therapists, we are in the business of listening to people’s stories, and listening for their feelings. We somehow know intuitively, or are taught along the way, that the medium of ‘the talking cure’ involves having people move awareness along a gradient within them from 🧵

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Jeff Fine-Thomas

@jefffinethomas

7 months

"It is not difficult for a careful observer to see the evidence for unconscious processes in other people; it is harder to grasp the reality that we ourselves are inhabited and moved by forces beyond our access or control." McWilliams

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Jeff Fine-Thomas

@jefffinethomas

1 year

“Psychoanalysis is most interested in thoughts and feelings that are actively kept from awareness by motivational ‘forces,’ specifically by wishes to not know about these thoughts and feelings; 🧵

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Jeff Fine-Thomas

@jefffinethomas

2 years

For some people, it is difficult to hold in their minds the idea that a relationship they have with an important other continues to meaningfully exist when that person is not in proximity. 🧵

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Jeff Fine-Thomas

@jefffinethomas

2 years

Sometimes therapists have a conscious or unconscious wished for role they prefer to play with a specific patient. For instance, perhaps they prefer or need to be viewed as helpful or smart or right, etc. 🧵

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Jeff Fine-Thomas

@jefffinethomas

10 months

Psychodynamic formulations do not offer definitive explanations; rather, they are hypotheses that we can change over time.” - Cabaniss, Cherry, Douglas, Graver, Schwartz

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Jeff Fine-Thomas

@jefffinethomas

10 months

"Psychodynamic psychotherapy is best defined as a group of treatments, some with greater specifications than others, that focus on human subjectivity and its interplay with both the external and the internal environments. 🧵

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Jeff Fine-Thomas

@jefffinethomas

2 years

In Attachment Theory, insecurity is the experience one has when one’s caregivers are not consistently showing attunement. When one comes to expect that the person who is supposed to love them and on whom they are utterly dependent will not be responding to 3/3

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Jeff Fine-Thomas

@jefffinethomas

2 years

There is a simple and profound idea in psychoanalysis that the first things people say to us in their very first contact with us will likely contain the seeds of what pains them. 🧵

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Jeff Fine-Thomas

@jefffinethomas

2 months

It is a necessary condition of meaningful psychotherapy that patient and therapist understand the purpose of their work together.

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Jeff Fine-Thomas

@jefffinethomas

9 months

“Psychological mindedness, which is related to self-reflection, is the ability to think about possible unconscious motivations for one’s thoughts, feelings, and behaviors.” - Cabaniss, Cherry, Douglas, Graver, Schwartz

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Jeff Fine-Thomas

@jefffinethomas

7 months

"Most fundamentally, psychoanalytic practitioners take seriously the evidence that the sources of most of our behaviors, feelings, and thoughts, are not conscious." McWilliams

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Jeff Fine-Thomas

@jefffinethomas

1 year

Often, patients start therapy at a moment in their life when they just cannot tolerate the problems they are experiencing anymore. They are sometimes at their wits end with the issues they face. 🧵

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Jeff Fine-Thomas

@jefffinethomas

6 months

What would happen, if when you had your first session with a new patient, you put down your typical diagnostic interview skills and just asked them what they wanted from psychotherapy?

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Jeff Fine-Thomas

@jefffinethomas

11 months

linger with the crescendos of evoked feelings - these are all parts of the art of listening deeply.They take time to develop as a therapist, and in particular they take the quelling of one's own anxious need to be 'helpful.'

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Jeff Fine-Thomas

@jefffinethomas

5 months

The idea that therapy is too expensive is a notion health insurance companies promote to protect their profits. Most likely, your therapist needs a raise.

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