The Psychotherapy Process

Toward a View of Positive Resistance: One Perspective on Change in Psychoanalytic Psychotherapy

According to Dr. Tobin, psychoanalytic psychotherapy features patterns of relational engagement between therapist and patient in which each contacts, adjusts, and conforms to the other, often due to simultaneously prosocial and defensive motives. Yet, as the intersubjective process unfolds and rigidifie throughout the course of therapy, the dyadic system is inevitably altered as determined by new strivings on the part of one or both partners. At these junctures, it is erroneous to characterize the patient as “resistant,” especially in the context of the patient’s emerging realization that he or she cannot be fully and accurately conceptualized by the clinician’s mind. Rather, “positive resistance” more aptly captures an advancement in the patient’s psychological and interpersonal functioning marked by an acknowledgment of what the other distorts or fails to comprehend about the self.

The Anatomy of Discovery in Psychotherapy: “Something So Familiar, It is Strange”

In this talk, Dr. Tobin cautions that the current environment of empirically-based treatment may foreclose on the discovery process psychotherapy affords. According to Dr. Tobin, psychotherapy is most successful when the patient’s self-observing capacities are supported by the therapist. If the therapist can avoid narcissistic ambitions and instrumental fictions employed to understand the patient prematurely, the conditions may allow for the patient to connect with dissociated memories, cognitions, and affects. Dr. Tobin utilizes movie clips from the feature films “Ordinary People” and “9 1/2 Weeks” to illustrate his perspective.

The Utility of Regret in Psychodynamic Psychotherapy

Utilizing clips from the feature films “Ali” and “Magnolia,” Dr. Tobin emphasizes the importance of regret in adult development. When pursued in psychotherapy, regrets a patient experiences serve as a bridge into vital aspects of emotional development, mourning, and self-integration. Further, Dr. Tobin introduces the notions of “otherness” and “non-meaning” and characterizes their relevance for personal and existential experience.

Uncertainty, Being Uncertain, and Refusing Uncertainty: Can Therapists’ Ambition in the Era of Evidence-Based Practice Be Counterproductive?

This paper explores the important role of uncertainty in the clinical psychotherapy process. It argues that the field of clinical psychology is now prioritizing problem-solving, conviction, and analytic conclusions to the present generation of students in training at the expense of collaborative discovery between patient and clinician.

A Therapy Hour: Revisiting Winnicott’s Notion of “Object Usage”

In this talk, Dr. Tobin applies the fundamental constructs of D.W. Winnicott’s theorizing including “going on being” and the distinction between “object relatedness” and “object usage” to a clinical patient. The therapy hour selected features the therapist’s and patient’s complex negotiation of and resistance to aspects transitional junctures of the interpersonal space.

One Way Out of Enactment: The Patient’s Differentiation from the Therapist

In his important work “Partners in Thought: Working with Unformulated Experience, Dissociation, and Enactment” (2010), Donnel Stern posits, “All experience is subjective, the analyst’s as well as the patient’s… We must now understand that we all continuously, necessarily, and without awareness apply ourselves to the task of selecting one, or several, particular views of another person from among a much larger set of possibilities” (p. 8). For Stern, enactment gradually evolves as each participant in the clinical situation constructs the other more narrowly and rigidly, thus limiting the “freedom” of relatedness and mutual meaning-making. But in any attempt to interrupt, understand, and move beyond the current enactment circumstance, how does the therapist recognize the mistaken components of his subjective construction of the patient and alter that construction to one that is truer, more real? Dr. Tobin’s answer to this question involves an attunement to the patient’s necessary differentiation from the therapist’s own metapsychology, i.e., the therapist’s mind and relatedness. Differentiation relies on the therapist’s capacity to shift from a subjective to an objective stance which is, in essence, the capacity to apprehend disconfirmation in the clinical moment. It also requires that the therapist has done enough to enable the patient to disconfirm.

Finding the “Subversive” in the Persona of the Therapist

In this talk, Dr. Tobin’s presents a perspective on the psychotherapeutic process that involves a shift from the conventions of typical social reality into a therapeutic space oriented toward self-expression and self-experience. This shift is usually a significant challenge both for the patient and therapist, particularly therapists-in-training or those early in their careers. The therapeutic couple may collude in an avoidance of deeper levels of the patient’s experience and of the therapist’s capacity to articulate what he/she observes or feels about the patient. This presentation attempts to conceptualize how the identity of the therapist needs to be altered into a “therapeutic persona” that subverts conventional relational and attachment tendencies in order to liberate the patient’s recognition of oneself.

Promoting the Patient’s Capacity to Suffer: A Revision of Contemporary Notions of Psychotherapeutic Aim

In this presentation, Dr. Tobin argues that the era of evidence-based treatment has inadvertently placed too much pressure and responsibility on the part of the clinician to “heal” the patient. Symptom reduction and characterologoical transformation are perspectives on therapeutic transformation that oversimplify the clinical situation. According to Dr. Tobin, a principle focus of psychodynamic treatment is increasing the patient’s capacity to contact, tolerate, and represent his or her contributions to experience; learning by suffering denotes a psychological competency in which denial, minimization, and other defensive modes of distortion are replaced by more accurate appraisals of reality.