Psychotherapy

A Journey Learning Psychotherapy, with Randy Stinnett, Psy.D

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This week I (David Puder), had a discussion with Randy Stinnett, Psy.D, regarding his journey to become an excellent therapist.  Randy shares aspects of his journey and insights.  His enthusiasm is contagious.  He discusses formative influences including Habib Davanloo, Donald Kalsched, and Todd Burley.    

I asked Randy to give a summary of his 5 recommendations for someone aspiring to be an excellent therapist, which compliment the dialogue on this podcast:

  1. Find teachers and mentors early on in your training as a psychotherapist who have demonstrated mastery and effectiveness as therapists and learn as much as you can from them. The most valuable impact on your training as a therapist will not come principally from textbooks and research on psychotherapy (though you should be an avid consumer of these), as much as it will come through a relationship with a teacher or mentor who skillfully embodies the knowledge and craft of a psychotherapist. Don't try to copy that person but rather be yourself, and be open to learning from many teachers.

  2. In addition to the content of the patient's speech and thought processes, focus on the interpersonal process level of the therapeutic interaction. Periodically ask yourself when working with a patient "What is happening right now between the two of us that may be re-enacting an important relationship or relational pattern pertinent to their presenting problem?" In addition to the patient's verbal and thought content, focusing on the non-verbal/bodily/behavioral/relational level of experience in the moment will often provide a doorway into the conflicts and struggles the patient is really there to address.

  3. Read literature and research on psychotherapy theory and technique related to reprocessing emotional memory as a potent change-factor in psychotherapy. The "common-factors" of the psychotherapist are necessary but not sufficient to bring about lasting change. You have to understand how to facilitate a reprocessing effect of the emotionally-based relational trauma memory in the context of an empathically attuned therapeutic relationship. Never stop learning about how to creatively do this.

  4. Position yourself to receive quality feedback on your work as a therapist. This includes having skilled supervisors/mentors view your actual therapy work and provide you with useful critiques to improve your craft. Feedback can come through a traditional supervisory relationship but can often come through belonging to a formal psychotherapy institute such as a regional psychoanalytic training institute, and others. My own experience training for several years with the Gestalt Associates Training of Los Angeles (GATLA) was priceless for the quality feedback I received while doing real life work in front of a group of fellow therapists as well as a master level trainer.

  5. Pursue your own psychotherapy. Your own unaddressed conflicts, traumas, and personality features will undoubtedly influence what you focus on in therapy. Your own internal reactions while working with the patient (i.e., "countertransference") can be of great help while working with a patient. However, your internal reactions can also hinder your effectiveness as a therapist if you end up avoiding what should be focused on during the session. Personal psychotherapy will be invaluable in identifying and reprocessing these vulnerable areas in our own selves, as fellow human travelers on the same road as our patients, so as to be as effective as possible for our patients.

Download: PHQ-9

Download: GAD-7

Link to Randy Stinnett, Psy.D Short CV

Cognitive Distortions and Practicing Truth

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This week we discussed cognitive distortions with Adam Borechy. Usually cognitive behavioral therapists deal with cognitive distortions by helping their clients identify habitual negative thoughts and and putting those thoughts on trial. We don’t have to accept every thought that passes through our brains as truth. When we have distressing thoughts, it can be helpful to consider if we might be telling ourselves the full truth about a situation.

We refer to common cognitive distortions—depression, anxiety, feelings of failure, negative thoughts when interacting with people, social anxiety—and we see how they are applying to our thought process.

For a PDF of the cognitive distortions and a 8 days journal task towards better identifying them in your life, please see my resource page. In this 8 day journey you will better identify your own troubling thoughts and move towards gratitude.

  • All or nothing thinking: things are black and white, completely without shades of gray.  For example you may think, “If I am not perfect, I should not try at all, because then I would fail completely.” Or you might think, “My significant other is completely evil.” And then the next day, “My significant other is perfect.”  

  • Overgeneralization: generalizations are made without context, experience or evidence.  “I am always alone.”  Or “Everyone hates me.”  “I never win.” Always? Never?  Everyone? It happens absolutely all the time, without exceptions? In the moment, it can feel like that, but those statements are actually rarely true. Speaking truth to yourself in this case might look like: I am sometimes alone, several people are upset at me, I win sometimes, even if I didn’t this time.

  • Mental Filter: focusing on the negative rather than the whole picture. After receiving multiple positive statements and one negative statement, all you focus on is the negative statement.  

  • Disqualifying the positive: When you do something good like get a compliment or award, you instantly find ways to make less of it! For example, if someone says, “You are looking good today,” but instantly you assume that person is giving you a false compliment.  

  • Jumping to conclusions (without evidence): reaching conclusions (usually negative) without little evidence.

    • Mind reading: assuming you know what the person is thinking about you. Connection occurs from accurately knowing another, and with mindreading you blind yourself without evidence.

    • Fortune telling: predicting negative things in the future. For example you think “I am going to fail this test even if I study,” so you don’t try, don’t study, and don’t even show up.

  • Magnification or Minimization: you make some weakness of yours much larger than it is or a strength much less than it really is. For example you see your friends as beautiful whereas you see your own beauty as very average.

    • Magnification of self and minimization of others (narcissism)

  • Emotional Reasoning: believe that your feelings reflect reality. For example, “I feel stupid, therefore I am.” or “I feel fearful of flying in planes therefore they must be dangerous,” or “I feel ugly therefore I am ugly despite what others tell me.”  

  • Shoulding: a thing that you believe you should or should not do, often created to try to maintain an image of yourself which is more in line with social pressures. For example, “I should be perfect,” “I should never cry,” “I should always win,” “I should be able to do this on the first try.”

  • Personalization: blaming oneself for a bad event without looking at external factors that contributed to the bad event. Attributing personal responsibility to things that you have no control over, or when you do not see all the things that caused something. For example, a friend is upset so you think it is something you caused or are responsible for.  

  • Error Messages: thoughts that are like obsessive compulsive disorder due to having thoughts that are repetitive, intrusive and not meaningful.

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