Great conversation, great video. I have learned a lot from you, consistently, over the years, working on my personal growth as a person, from the other side of the world, for free, from the comfort of my personal quiet hours, watching these videos; and I thank you very much, deeply. Always waiting for more...
Part of my issues with the CSJT approach is that it calls for the therapist to be affirming. But being affirming may not always be what is most helpful to the patient, as that may threaten their ability to truly grapple with an issue and develop their own authentic understanding. Take for example a patient who is deeply uncomfortable with their sexuality and can not tolerate their own same sex attraction. If this attraction threatens their sense of self and safety and the therapist "affirms" this attraction as ok, they may fall into distrust of the therapist and feel pushed too far too fast. But if an opportunity is provided for the patient to reflect on how this self disgust came about and they are allowed to slowly approach the issue, it may be much easier to slowly explore and accept themselves as they are. Their ceartinly are cases where affirmation can be useful, but it's not a useful rule.
I basically agree, and it's important not to throw out the baby with the bathwater. Your example reminds me of the difficulties encountered by the character of William Lee in Burroughs' book and also the Cronenberg film of 'Naked Lunch'. An article you might find of interest is by Bjorn Killingmo, a Norwegian analyst, who discusses the implications for technique of whether issues of conflict or deficit predominate a given session. He speaks of a continuum between interpretation and affirmation, and emphasizes the importance of being attuned to the particular anxieties being expressed, including in the transference. Killingmo, B. (1989). Conflict and deficit: Implications for technique. The International journal of psycho-analysis, 70, 65.
Validation of the analysand's experience is occasionally appropriate but in a treatment underpinned by the unconscious, unconditional regard or affirmation must be tempered by a benign skepticism. Ella Sharpe considered it a therapeutic necessity in analysis.
I found the APA discussion very stimulating and I appreciate this second revision, very much. I find the DEI discourse (which is what we call it here) problematic in my work becasue as a Lacanian, I was trained to privilege the particularity of each analysand's experience. I have a colleague who is (miraculously!) completely off social media and has no online presence except her professional advertisement. She absolutely adheres to the 'blank screen' concept and it works for her. Sometimes I envy her, and at others I marvel at the fantasy that underpins my analysand's transference to me, making of me whatever they will ,despite very concrete evidence to the contrary (my qualifications/ publications, my wedding band, etc.).
Interesting conversation. If part of what psychoanalysis is about is holding the tension of too much vs too little disclosure, then integrating CSJT, depending on how it's done, could threaten that, possibly to the point of creating something else that's no longer "psychoanalysis". All unions are not necessarily an elevation. It could compromise one or both. The marriage of psychoanalysis and CSJT sounds like a big step closer to religion, at least for psychoanalysis. Lastly, acknowledging that there is an important and necessary place for political action does not mean it should be a focus in all aspects of life no more than all organs of the body should be involved in breaking down and digesting things. Certain functions should very importantly be contained to a certain area, as with organs which are both distinct from one another while being integrated within a single body.
No problem, I tried to link you the actual PDF which you should be able to find on google but it appears youtube won't allow me.@@dan-arebjrngrnvik3513
@@dan-arebjrngrnvik3513 The 2017 paper by those authors contains a case report with verbatim vignettes of session material: Stern, B. L., Diamond, D., & Yeomans, F. E. (2017). Transference-focused psychotherapy (TFP) for narcissistic personality: Engaging patients in the early treatment process. Psychoanalytic Psychology, 34(4), 381.
Excellent discussion. Very funny examples of some rigid analysts trying to be a perfect mirror and what that says about what psychoanalysis is for those practitioners. To my mind that striving for inhuman objectivity is the same instinct as what I sense is the goal in CSJT narratives. It belies an inability to contain essential conflict and paradox - splitting in short. I like some of Yalom's stories ("In Search of the Dreamer" for example), where he deliberately acknowledges his inner responses to the client. In that model, the therapist mines their own emotions for information about how the client's behaviour might determine their social outcomes in the outside world - the therapy relationship is a microcosm of the client's outer world. In that model, revealing their subjectivity to the client is seen as a vital aspect of genuine connection and a teaching tool. I don't think Yalom considers himself an 'analyst' as such... like you said, more of a psychodynamic psychotherapist. But maybe in that sense psychodynamic psychotherapy is more honest and real in its conception of the humanity of the therapist than the formal paradigm of psychoanalysis. And maybe that is more useful to the client in discovering their humanity? How is it genuine to pretend to be neutral when we simply cannot be? What do you think?
I understand the rationale behind those methods, and I think there is something to it, but I wouldn’t want to work that way always. I wouldn’t want to work anyway always. General rules just don’t apply in all cases. I think we have to adjust our technique to each patient’s individuality. Overall, I prefer exploring the patient’s fantasy about my feelings rather than reveal them, but there are many exceptions to this rule.
@@nickcarvethi have a question. On one hand addiction is often portrayed as self-medicating to deal with trauma and on the other hand it is often portrayed as a disease. In the first case there is agency (it's a choice to use drugs as a coping mechanism) and in the second case, there is no agency, since disease is something that happens to you. I see this debate often between those who blame the addicts and those who feel compassion towards them. How do we reconcile it? Can it be both at the same time? Thanks
Such an important question. In short, I think it is both but we will likely have to take some time to reflect on your question and then attempt to give the depth view of it when we're able to make the next video in perhaps a week or so. I imagine we'll be trying to outline the dialectic once again. @@LoveAutopsy
I’d also be interested in this. I’ve been involved to some extent in the recovery community (largely unsuccessfully) for about fifteen years. I never found much direction in the whole 12-Step thing. Never felt like I was getting anywhere till working with a psychoanalytic therapist. I think it set me back for a long to be told what was going on with me was some directionless biochemical malfunction. I’m reading Wurmser’s The Hidden Dimension right now and am finding it largely spot on. I don’t have a good question rn (on account of being, ironically, quite drunk), but would love to see this happen.
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Great conversation, great video.
I have learned a lot from you, consistently, over the years, working on my personal growth as a person, from the other side of the world, for free, from the comfort of my personal quiet hours, watching these videos; and I thank you very much, deeply.
Always waiting for more...
Thank you, most welcome
Would love if you guys talked about ocd or just neurotic conflict more in general
Part of my issues with the CSJT approach is that it calls for the therapist to be affirming. But being affirming may not always be what is most helpful to the patient, as that may threaten their ability to truly grapple with an issue and develop their own authentic understanding.
Take for example a patient who is deeply uncomfortable with their sexuality and can not tolerate their own same sex attraction. If this attraction threatens their sense of self and safety and the therapist "affirms" this attraction as ok, they may fall into distrust of the therapist and feel pushed too far too fast.
But if an opportunity is provided for the patient to reflect on how this self disgust came about and they are allowed to slowly approach the issue, it may be much easier to slowly explore and accept themselves as they are.
Their ceartinly are cases where affirmation can be useful, but it's not a useful rule.
I basically agree, and it's important not to throw out the baby with the bathwater. Your example reminds me of the difficulties encountered by the character of William Lee in Burroughs' book and also the Cronenberg film of 'Naked Lunch'. An article you might find of interest is by Bjorn Killingmo, a Norwegian analyst, who discusses the implications for technique of whether issues of conflict or deficit predominate a given session. He speaks of a continuum between interpretation and affirmation, and emphasizes the importance of being attuned to the particular anxieties being expressed, including in the transference.
Killingmo, B. (1989). Conflict and deficit: Implications for technique. The International journal of psycho-analysis, 70, 65.
Validation of the analysand's experience is occasionally appropriate but in a treatment underpinned by the unconscious, unconditional regard or affirmation must be tempered by a benign skepticism. Ella Sharpe considered it a therapeutic necessity in analysis.
I found the APA discussion very stimulating and I appreciate this second revision, very much. I find the DEI discourse (which is what we call it here) problematic in my work becasue as a Lacanian, I was trained to privilege the particularity of each analysand's experience. I have a colleague who is (miraculously!) completely off social media and has no online presence except her professional advertisement. She absolutely adheres to the 'blank screen' concept and it works for her. Sometimes I envy her, and at others I marvel at the fantasy that underpins my analysand's transference to me, making of me whatever they will ,despite very concrete evidence to the contrary (my qualifications/ publications, my wedding band, etc.).
Yes, despite my website, my RUclips channel, etc., patience still develop the transferences they need.
Interesting conversation. If part of what psychoanalysis is about is holding the tension of too much vs too little disclosure, then integrating CSJT, depending on how it's done, could threaten that, possibly to the point of creating something else that's no longer "psychoanalysis". All unions are not necessarily an elevation. It could compromise one or both. The marriage of psychoanalysis and CSJT sounds like a big step closer to religion, at least for psychoanalysis.
Lastly, acknowledging that there is an important and necessary place for political action does not mean it should be a focus in all aspects of life no more than all organs of the body should be involved in breaking down and digesting things. Certain functions should very importantly be contained to a certain area, as with organs which are both distinct from one another while being integrated within a single body.
Very sensible. Brings to mind a famous passage from Saint Paul, in which he develops the same metaphor of different bottle parts, and functions.
Agreed.
Is there any case studies of people who recovered from npd, or any successful treatments of npd?
Yes, please see:
Stern, B. L., Yeomans, F., Diamond, D., & Kernberg, O. F. (2013). Transference-focused psychotherapy for narcissistic personality.
@@nickcarveth thank you :)
No problem, I tried to link you the actual PDF which you should be able to find on google but it appears youtube won't allow me.@@dan-arebjrngrnvik3513
@@dan-arebjrngrnvik3513 The 2017 paper by those authors contains a case report with verbatim vignettes of session material:
Stern, B. L., Diamond, D., & Yeomans, F. E. (2017). Transference-focused psychotherapy (TFP) for narcissistic personality: Engaging patients in the early treatment process. Psychoanalytic Psychology, 34(4), 381.
Excellent discussion. Very funny examples of some rigid analysts trying to be a perfect mirror and what that says about what psychoanalysis is for those practitioners. To my mind that striving for inhuman objectivity is the same instinct as what I sense is the goal in CSJT narratives. It belies an inability to contain essential conflict and paradox - splitting in short. I like some of Yalom's stories ("In Search of the Dreamer" for example), where he deliberately acknowledges his inner responses to the client. In that model, the therapist mines their own emotions for information about how the client's behaviour might determine their social outcomes in the outside world - the therapy relationship is a microcosm of the client's outer world. In that model, revealing their subjectivity to the client is seen as a vital aspect of genuine connection and a teaching tool. I don't think Yalom considers himself an 'analyst' as such... like you said, more of a psychodynamic psychotherapist. But maybe in that sense psychodynamic psychotherapy is more honest and real in its conception of the humanity of the therapist than the formal paradigm of psychoanalysis. And maybe that is more useful to the client in discovering their humanity? How is it genuine to pretend to be neutral when we simply cannot be? What do you think?
I understand the rationale behind those methods, and I think there is something to it, but I wouldn’t want to work that way always. I wouldn’t want to work anyway always. General rules just don’t apply in all cases. I think we have to adjust our technique to each patient’s individuality. Overall, I prefer exploring the patient’s fantasy about my feelings rather than reveal them, but there are many exceptions to this rule.
I remember you mentioned that Nick was specialized in addiction, could you have a discussion about addictions at some point?
Yes, for sure. Maybe that will be our next one. Thank you.
It'd be my pleasure to do that. Do you have particular questions about addiction that you would like to be addressed by us?
@@nickcarvethi have a question. On one hand addiction is often portrayed as self-medicating to deal with trauma and on the other hand it is often portrayed as a disease. In the first case there is agency (it's a choice to use drugs as a coping mechanism) and in the second case, there is no agency, since disease is something that happens to you. I see this debate often between those who blame the addicts and those who feel compassion towards them. How do we reconcile it? Can it be both at the same time? Thanks
Such an important question. In short, I think it is both but we will likely have to take some time to reflect on your question and then attempt to give the depth view of it when we're able to make the next video in perhaps a week or so. I imagine we'll be trying to outline the dialectic once again. @@LoveAutopsy
I’d also be interested in this. I’ve been involved to some extent in the recovery community (largely unsuccessfully) for about fifteen years. I never found much direction in the whole 12-Step thing. Never felt like I was getting anywhere till working with a psychoanalytic therapist. I think it set me back for a long to be told what was going on with me was some directionless biochemical malfunction. I’m reading Wurmser’s The Hidden Dimension right now and am finding it largely spot on. I don’t have a good question rn (on account of being, ironically, quite drunk), but would love to see this happen.
20:11 Tronick. Those experiment videos are devastating to watch.
Yes
A patient who dives into conspiracy is my kind of patient.
Good luck.