How can I keep from being boring by focusing on feelings?

I am a beginning therapist in ISTDP with a question that is probably due to my lack of experience with the approach. When I’m with patients, I can’t stop worrying about how they might find my sessions repetitive as I keep working with their feelings, anxiety, and defenses every session, starting from revealing the feeling, to trying for showing an impulse and going for a breakthrough. This concern sometimes leads me to get a little distanced from the approach, as if it will bore the patient if I go on with the same process (although the content is different every time). Am I totally misunderstanding something here?

Things are already getting clearer in my mind as I’m going further with your book, Co-Creating Change, and hopefully I will soon get more comfortable with this very interesting approach. Thank you very much for your time.” Thanks for an excellent question!

Of course, the last thing we want to do is “bore” the patient with our obsessional disorder masquerading as therapy:-)

An important way to avoid this problem is to make sure you and the patient agree on the problem she wants help with. Second, make sure the two of you develop a consensus on what is causing the patient’s problems. If you don’t have this consensus, the patient won’t understand why you focus on feelings. Third, make sure you get consensus on the therapeutic task.

If you get consensus on these three things, the patient knows what the problem is, what causes it, and why a focus on feelings will help. Then she will not feel bored, but, in fact, encouraged by your systematic focus on what she has trouble focusing on. Another thing you can do is continually mobilize her will to the task: “would you like to take a look at the feelings so you don’t have to feeling anxious instead?” Frequent mobilizations of will to the task remind the patient of what we are here to do and why we do it. Then, neither she nor you will be bored.

Often, when we are afraid the patient will be bored, we are ourselves unsure of where we are on the triangle of conflict. As a result, we can’t feel confident we are exploring the right area of the triangle. This is a normal phase in learning ISTDP or any therapy, really. To get better on that, in your self supervision, examine each patient response to see if it is feeling, anxiety, or defense. Then say out loud to the videotape how you would respond to the patient now, given your better information. When you go through your videotape this way, you can improve the speed of your psychodiagnosis and the speed of your response.

 

One thought on “How can I keep from being boring by focusing on feelings?

  1. George Williams

    How can I keep from being boring by focusing on feelings?
    I am a beginning therapist in ISTDP with a question that is probably due to my lack of experience with the approach. When I’m with patients, I can’t stop worrying about how they might find my sessions repetitive as I keep working with their feelings, anxiety, and defenses every session, starting from revealing the feeling, to trying for showing an impulse and going for a breakthrough. This concern sometimes leads me to get a little distanced from the approach, as if it will bore the patient if I go on with the same process (although the content is different every time). Am I totally misunderstanding something here?
    Things are already getting clearer in my mind as I’m going further with your book, Co-Creating Change, and hopefully I will soon get more comfortable with this very interesting approach. Thank you very much for your time.” Thanks for an excellent question!

    Hi.
    This is George Williams,
    Are the clients bored? Or is it that they are not on Board?
    You want to make sure you both are going in the same direction and have the same goal. Dr. Frederickson’s introduction video on the ‘home’ page with him pointing towards the word “detour” is excellent, and I got some new insights from it myself. He makes the message amazingly simple in his presentation but very fundamental and profound in its meaning. I would suggest that you watch it again. Repeated viewing is helpful. It is short but to the point.
    I can see you are a caring, sensitive person and those are good attributes to have as a therapist. The most important thing is to be in tune with the client’s unconscious, and I think you are well on the way as you have picked up that the client is not happy about something. I think it is unlikely that they are bored.
    I think there is a communication problem and they do not understand something. So you may be missing something but it would not take long to help you get on track with the client.
    As I mentioned to the person from July 23, 2018 “No wonder the patient gets angry with you! You are irritating!!” it is important to provide as much relevant information to help me understand your problem better.
    If you feel it would help I would be happy to offer you some free help online with advice, problem solve or supervision. I know it is challenging when you are just starting to do ISTDP, and there are so many places to make mistakes since you are just beginning.
    I have some more questions for you to help deal with your problem. Is there any particular group that you find that this is more of a difficulty, men, women, older people, teenagers? It is so important to determine a diagnosis of the client first. Without the determination of knowing where the client roughly is on the spectrum of patients, you are in the dark and can quickly make serious mistakes causing a misalliance.
    You show the good common sense to back off if you are not sure. I do not think you are boring the client, but maybe your unconscious is trying to tell you that you are missing some fundamental issues that Dr. Frederickson may have already highlighted for you. So it is good that you are asking and great that you are going with your sensitive instincts and not following some voice or rule saying you should be doing better.
    I have said that the breakthrough is not the most important thing. You can get breakthroughs without being repetitive. The key is to be in tune with your client consciously and unconsciously. You have already started to do this.
    When you start learning this technique, you can only see it in simple terms. The process is incredibly complex like playing a musical instrument. My friend plays the violin. She makes it look easy, but it is very complex and complicated.
    It would be helpful to know what form of therapy you were doing before and how you are making the transition with clients who have known the experience of your previous therapy. They need time to adjust, and you would need to go slowly, especially if they have a low tolerance for unconscious anxiety.
    I think it is part of your character to worry about other people’s feelings and needs and that may be a pattern you have in life. Other than that I think you are picking up that the client is not yet on board with you and you need to review the goal and get on the same track as them. Maybe it is more time to listen to your clients and gather insight into what they are saying consciously and unconsciously to you and less time talking and doing interventions. Dr. Frederickson is an excellent therapist partly because he is an excellent listener and pays attention to every detail of the client. Remember in this technique, we are trying to monitor the patient on many different levels at once, so it takes time to learn.
    It sounds like you need some more feedback and supervision to give you more understanding. That is good, and it is way better to be uncertain and cautious than overconfident.
    George Williams

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