Continuing on the theme of how important development is to the clinician, let’s review some developmental issues in adolescence, which can now be considered to go on until around age 25, when, as a parent wryly observed, "parental IQ begins to move back up to normal." First, let’s go through a cl...

Increasingly, I have been thinking of EMPs, entrenched maladaptive patterns, as having been invented by an “inner child” to solve a critical problem. I have always thought development was important, but experience has taken me further in that direction. At this point, for the majority of my thera...

A blog reader in her late 30s asked how attachment issues might be related to her recent symptoms of anorexia nervosa. As she has resolved painful memories of sexual trauma she has experienced more distress about relationships. She reports: “I just don’t think I matter to anyone. I realize thi...

In TIFT #14, I talked about my personal goal to see the psychotherapy integration movement turn from seemingly endless exploration to seeking consensus. At SEPI's 37th Annual Meeting in June, three of us surprised even ourselves in a Zoom session as we arrived at a core consensus on the common in...

This topic is coming into view for a reason. The Pilot group in the Howtherapyworks Training Program has just finished the first trimester on theory and, in our next term, will be working on therapy skills and technique. In this post, I want to use the concepts of Entrenched Maladaptive Patterns ...

Not everyone of adult chronological age feels or functions like a full adult. This TIFT is about those individuals. I suppose every therapist has a personal list of “syndromes” or patterns they recognize but don’t find in the literature. This is one I have found useful in many circumstances.

Th...

Words are amazingly precise

A patient in her 30s was defending her mother as she heavily blamed herself for her ongoing failure to function. She described how her motherwas sometimes very supportive, buthad been critical and harsh when told of the patient’s plan to attend her friend’s bacheloret...

The pathway starts by narrowing our view to precisely what psychotherapy aims to treat. As discussed in TIFT #11, this leads to identifying Entrenched Maladaptive Patterns (EMPs), as the basic units of pathology treatable in psychotherapy. From there,we bring in evolutionary biology, suggesting t...

In recent posts, I have talked a lot about general application of two change mechanisms, Extinction and Memory Reconsolidation, both implicated in research on how learned fear can be “unlearned” or suppressed. I have been a bit vague about a third foundational change mechanism, New Learning. In t...

The phenomenon of resistance turns out to be more central and more profoundly embedded in the work of psychotherapy than is sometimes recognized. Freud saw this when he said that psychoanalysis is the analysis of resistance. He also gave a clue as to why it has taken a long time to realize why. I...

What clinicians need from research

The psychotherapy research community has produced many good things, but complaints are common about a mismatch between what research produces and what clinical psychotherapy needs. In my view, the problems revolve around two words: Universal and Explanatory. So...

Why is age five so special? And what is it about fairytales that makes them so compelling at that age? Few therapists are aware (and if you are, I’d love to hear about it) of an important event in cognitive development that takes place at about age five. I have alluded to it before, but thought i...