Author Archives: John James

Self Esteem

Most everyone would agree that  self esteem is a major factor in feeling emotionally healthy.  Poor self-esteem often  makes it difficult to take care of yourself and negotiate the stresses of daily life.  It is hard to move forward when you are persistently unsure of yourself, have difficulty making decisions, let others take advantage of you, or when you just don’t have the inner sense that you deserve to have good things happen to you.  Therapy can guide you in learning about yourself and your negative self-view.  This can make a big difference in helping you to change old patterns and enabling you to live you life with deeper personal satisfaction.


Relationships are one of the greatest sources of both satisfaction and stress in our lives.    Relationships can be intimate, as with spouses, family,  friends and lovers.  Or they can also be more casual as is often the case with professional and social relationships.   No matter what the situation, all of our relationships are fertile ground for intense feelings.  Frequently  these feelings result in  misunderstandings, anger, hurt, disappointment, distress, helplessness and despair.   Our relationships  are a sensitive source of personal pain as well as great joy.

Working with a therapist either individually or with your partner, creates more understanding  and can improve your ability to resolve differences.   Therapy can help people develop better ways to form relationships and/or improve their existing relationship.


Depression is one of the most widespread afflictions of modern times and most people experience depression at some time in the course of their lives. However, some people experience persistent feeling of sadness, hopelessness, worthlessness and a sense that things are pointless and your life has no meaning. This is different from just having the occasional ‘blues’. Not everyone is a ‘glass half full’ person, but when you see things in shades of black, it is time to seek professional help to relieve the pain and emptiness that depression can bring.


Anxiety in some situations is not only normal, but quite needed. It is your mind and body’s signal for fear. But for many, anxiety is severe, pervasive and often debilitating. It can take the form of panic attacks, feelings of dread, persistent worry, fear of death, phobias, and social anxiety that makes it difficult to engage in interactions with others. There are also anxieties that are episodic or specific to certain situations. These are no less serious and can interfere with your life. Anxiety makes it difficult for you to relax and enjoy what you are doing.


Excerpted by New York Psychotherapy Group from:
Men’s Health, March, 1997. Title: Tomorrow and Tomorrow and Tomorrow, (different types of people who procrastinate) Author: Bill Heavy

There are many things you can do to change your life. There are just as many reasons why you are not doing them. Psychology professor Linda Sapadin has identified six types of procrastinators. She also has some helpful approaches for solutions.

If you are a procrastinator, you will recognize yourself. Procrastinators have great intentions they never quite act upon; procrastinators are masters at rationalization and are usually aware that they are sabotaging their own happiness; procrastinators castigate themselves for their inability to act, thereby further lowering their self esteem and perpetuating the self-defeating behavior. The psychological underpinnings of procrastination are rooted in fear. Most procrastinators think they are just lazy. This is rarely the case, but it is easier to think that than discover and deal with underlying fears. The fears can be anything – fear of failure, fear of change, fear of completion, fear of losing the fantasy, fear of not measuring up, fear of reprisals, fear of humiliation….and any other fear that fits the bill.

The following are the six types of procrastinators Dr. Sapadin identifies in her book ‘Its about Time! The 6 Styles of Procrastination and How to Overcome Them’. (Viking Press). She also suggests ‘solutions’, which are helpful as guidelines for thinking and action, but which like any ‘solutions’, are easier said than done. Procrastinators especially can have a field day with solutions.


These procrastinators desperately want life to be easy and free from pain. They retreat from the real world and live in their heads, where everything is vague, nonthreatening and cozy. They cherish the notion that they’re special, that they don’t have to play by the rules. This kind of “magical thinking” often leads to employment problems, spouses who tire of unkept promises and the assuming of disguises as they flee collection agencies from state to state.

Solution: If this sounds like you, you need to leave Peter Pan behind. Recognize the difference between “feeling good at the moment” (fantasizing, watching TV, buying stuff) and “feeling good about yourself” (the pleasure of accomplishment, mastery).

Learning a new software program for example, won’t be as much fun as watching basketball, but it yields greater self-respect and confidence. You also need to ground yourself in the here and now. Lists are good for this. Write down what can realistically be accomplished each day and the specific steps that must be take to do it. Develop a passion for the “middle stage of projects, that detail-rich area where you tend to check out.


The worrier prizes security above all else and pays a steep price for it. He has a narrow comfort zone and paralyzes himself with anxiety when faced by risk or change. He suffers what Sapadin calls “anticipatory anxiety” and endless stream of “what ifs” about hypothetical situations, all with negative consequences. What if the person I’m considering asking out says yes, we get together and then she dumps me and breaks my heart? What if I finally leave this job I hate and can’t find another one? Better to be safe, secure and bored than face that uncertainty. Worriers often had parent who took care of their every need and enjoyed (unconsciously of course) the feeling that their kid couldn’t get along without them. Worriers don’t have allot of fun and tend to suffer from burnout. But for them, it beats facing a task head on.

Solution: Deep inside most worriers lurks a more vibrant, courageous soul. If you are bored and sick of your life, that’s great. You ma y be ready to change. Avoid “catastrophizing” everything and see that making no decision is itself a decision. When you find yourself concentrating on the risk implicit in a new situation, stop and focus on what’s exciting about it. Interpreting the feeling makes the difference. Next time you have butterflies in your stomach, be glad. That’s the sound of life knocking at your door. Welcome it.


This class of procrastinators resents authority but expresses the rebellion covertly. Ask a defier to perform a task and he’s likely to say, “sure, I’ll do that”. Then he “forgets” what he promised, or delivers work that’s half-assed, late or both. I relationships defiers put off meeting their partners’ needs in much the same way. This withholding stratagem gives them a sense of power, but their co-workers and lovers feel manipulated, used and betrayed. When fired or stuck in dead-end jobs or relationships, the defier consoles himself that he’s lot is the inevitable fate of a true individual in a plastic world. He’s unhappy and proud of it.

Solution: Learn to act instead of react, to move from victim to active participant in live. The trick is to shift concern away from what other people are doing to you and see what you are doing to yourself. Realize that taking the initiative – not digging in your heels – is where the real power is.

Crisis Makers

Most of us do our best work under some kind of time constraint. A crisis-maker goes out of the way to create drama, going from one behavioral extreme or the other. He underreacts to a situation, ” I can’t get started until I feel the pressure”, then overreacts with a big shot of intense work to meet the deadline. That self- aggrandizing style of operating is a young man’s game. You can drive yourself to the edge with relative impunity in your 20’s and early 30’s, but after a while, your body doesn’t want to run of adrenaline anymore. A pot of coffee and a bag of Oreos don’t deliver quite the jolt it once did. And meeting deadlines in the real world isn’t heroic; it’s routine.

Solution: A lot of these guys are shocked when I tell them chaos is not mandatory. Sapadin says, ” it never crossed their minds that there is a different way to do things.” The crisis maker needs to increase his self-motivation to accomplish things and decrease the emotional investment in the death-defying, last minute performance. Recognize your need for an adrenaline rush, but find a safer avenue for it than your work or your relationships. Make a cold call to someone who’d never expect to hear from you. Set your sights on a five-minute mile or a 200-pound bench press.


Basically, perfectionists are nut cases, whose self-esteem is on the line every time they do anything. Often they are idealists who are unrealistic in their use of time and energy. Ask one to sharpen a pencil and he’ll either break out in a cold sweat and spend all day staring at it, or immediately plunge in and, at the end of the day, present you with a really sharp point attached to an eraser. “That’s because perfectionists see everything in all-or-nothing terms,” says Sapadin. “If the task they’re working on is a failure, it stands to reason that they’re failures too.” Deep down, the perfectionist fears nothing so much as not measuring up. I f you had the kind of parents who looked at the 95 you brought home on a test and said, “where are the other five points?” You’re a good candidate. Procrastination is a way of putting off judgement. I you don’t play, you can’t lose.

Solution: “I tell perfectionist to aim for accomplishment, not perfection,” says Sapadin. “Stop beating yourself up over what you should do and focus on what you can do – the realistic instead of the ideal”. Another strategy, Sapadin counsels for perfectionists is to make a deliberate mistake. Linger five minutes longer at home so you are deliberately late for an appointment, leave your normally spotless desk messy for half a day, let a grammatical error in an office memo go uncorrected. The experience of being imperfect- and seeing that the world doesn’t come to an end- is a great teacher.


Like the perfectionist, the overdoer doesn’t seem like a procrastinator because he’s always busy. He’s a people pleaser, the guy who never says no to taking on more work. As companies downsize and combine jobs, the overdoer appears to be the guy poised for success. Except he isn’t. In his struggle to do it all and feel self-reliant, he has no balance of work and downtime, drudgery and fun. The personal and the professional. He also disappoints the people he wants so desperately to please because he has taken on more than he can deliver.

Solution: “Overdoers need to learn to say no,” says Sapadin. “It blows them away when I tell them it’s not a nasty word. In their minds, it’s hurtful to the other person”. She tells them to say “, but thanks for asking me”. Or ” I can’t right now, but ask me again in a week” as ways to reinforce the idea that they’re not slamming the door.

Give up the Superman myth. Accomplish what you can, and leave the rest to all those other Superheroes whose work you’ve been doing.

Long, Happy Marriages Take Work

Excerpted by New York Psychotherapy Group
from The New York Times, Personal Health by Jane E. Brody – 7/29/92

Long, happy marriages take work, work, work.
Asking long-married couples why their marriages have endured while nearly half those around them have been torn asunder is like asking 10 blind men to describe an elephant. The answers vary widely, but nearly always reflect mutual commitment, concern, love and respect.

For most long-married couples, “happily ever after” does not just happen. Couples in long, happy marriages reflected this fact of life when asked what has made their relationships a success.

“We work to keep the romance, alive,” one partner said. “We enjoy our differences and learn from them,” said another. Still a third said, “We voice our discontents freely and deal with them right away instead of letting them build into thunderclouds.”

But in a way, the thing all the couples have in common was reflected in this observation: “Even when things were really bad, we were both too stubborn to quit.” None of the 10 couples interviewed married with the idea that if things did not work out they could always split.

For many the road to marital longevity was not a smooth one. The bumps included a very disappointing inability to have children, the death of a child, alcoholism, extramarital affairs, a child with a serious chronic health problem, a difficult economic crisis and highly stressful career changes. But like a stockholder who invests for the long run, the couples did not consider selling out when the price was down. And their ability to stick with the marriage through thick and thin paid off, making their relationships stronger and richer.

Although none said so specifically, it was obvious that two other factors were important to their marital success. First, even though some couples faced considerable differences in personality and sometimes heavy emotional baggage, they maintained respect for one another and refrained from trying to remake their partners. And second, none of the marriages was marred by psychological disturbances too severe to preclude a true partnership.

Although one or the other may have faltered at times, there were no prolonged periods when either partner was unwilling or unable to contribute to a committed relationship.

Many couples with children are determined to stay together at least until their children are grown. But couples typically live 20 or 30 years longer, and with just a little effort these years can be among the most fulfilling times in a marriage.

What Therapists Say

Perhaps the best people to ask about the secrets of a successful marriage are the professionals who deal with troubled marriages all the time. Too often, these therapists find, couples wait until at least one has really decided to call it quits before seeking help, actually looking for confirmation that the marriage cannot work.

These therapists say couples should isolate the trouble spots and make improvements before moving irrevocably toward separation and divorce. Here are some of their recommendations:

• Work from a position of commitment. Too many couples believe the secret of a happy marriage is in finding the right mate. When problems arise, they assume that they made a bad choice and start looking again. But the real secret is not in finding the right mate but in being the right mate, a mate who is willing to weather the hard times and make the adjustments that come with children, job changes, financial difficulties or simply learning more about the person you married.
• Learn to accept each other’s shortcomings. Even happy, well-matched couples can experience conflict, hurt, disappointment and anger. They may recognize shortcomings in such areas as showing appreciation of each other, willingness to converse and expressing emotions clearly. But as Dr. Stuart A. Copans, a psychiatrist associated with Dartmouth Medical School, put it, in spite of such difficulties, studies showed that happy couples were able to “maintain a positive attitude toward each other and continue their ability to cooperate, compromise and appreciate each other.” In an article in the professional magazine Medical Aspects of Human Sexuality, Dr. Copans concluded: “Complaints by themselves don’t mean that a marriage is unhappy. It is when those complaints keep the couple from being positive and supportive of each other that the marriage is in trouble.”
• Don’t shy away from conflict. Disagreements can lead to marital growth, not distance. “Conflict is actually a sign of ongoing problem-solving, much as a fever is a symptom of the body’s battle to overcome illness,” said Marcia Lasswell, a Los Angeles therapist. But try to appreciate your partner’s perspective and arrive at a compromise or agree to maintain your differences but respect them.
• When you find yourselves arguing over trivial matters, try to zero in on the real reasons – for example, the feelings of hurt, fear and neglect that underly the anger.
• Do not take understanding for granted. Too often couples assume that if they really love one another, they will intuitively know what the other wants and needs, inevitably resulting in disappointment. Problems not dealt with do not go away with time, they simply go underground or loom increasingly larger until a bomb explodes.
• Maintain a balance of power. Each partner needs to have a sense personal authority, power, significance and equality.

Be willing to work at your marriage. Do not assume that since the first 10 or 20 years were good, the next 10 or 20 will also be good. Love needs to be fed with shared experiences, joys and sorrows. This requires time, attention and emotional energy.

Hope Emerges as Key to Success in Life

Excerpted by New York Psychotherapy Group
from The New York Times, by Daniel Goleman

From college grades to depression, new tests show optimism’s power.

Psychologists are finding that hope plays a surprisingly potent role in giving people a measurable advantage in realms as diverse as academic achievement, bearing up in onerous jobs and coping with tragic illness. And, by contrast, the loss of hope is turning out to be a stronger sign that a person may commit suicide than other factors long thought to be more likely risks.

“Hope has proven a powerful predictor of outcome in every study we’ve done so far,” said Dr. Charles R. Snyder, a psychologist at the University of Kansas who has devised a scale to assess how much hope a person has.

For example, in research with 3,920 college students, Dr. Snyder and his colleagues found that the level of hope among freshmen at the beginning of their first semester was a more accurate predictor of their college grades than were their SAT scores or their grade point averages in high school, the two measures most commonly used to predict college performance. The study was reported in part in the November issue of The Journal of Personality and Social Psychology.

“Students with high hope set themselves higher goals and know how to work to attain them,” Dr. Snyder said, “When you compare students of equivalent intellectual aptitude and past academic achievements, what sets them apart is hope.”

People who score high on the hope scale are understandably better able to bear up in dire circumstances, other researchers are finding. In a study of 57 people with paralysis from spinal cord injury, those who reported more hope, compared with those having little hope, had less depression, greater mobility (despite similar levels of injury), more social contacts and more sexual intimacy.

“Those with high hope were more adaptive in all realms regardless of how long they had been injured whether just a month or 4 years,” said Dr. Timothy Elliott, a psychologist at Virginia Commonwealth University in Richmond, who reported the study in the October issue of The Journal of Personality and Social Psychology.

“This kind of paralysis usually hits people in the prime of life,” Dr. Elliott said. “About half of cases involve men under 30 who are victims of accidents and end up paralyzed for the rest of their lives,”

Dr. Robert Steer, a psychologist at the University of Medicine and Dentistry in New Jersey who has done research on hopelessness, said, “Most patients with severe diseases don’t become hopeless if they are well adapted to life before their illness.

Other studies of patients with serious diseases like congestive heart failure have found that those who are more hopeful tend to maintain their involvement with life regardless of physical limitations.

Dr. Elliott also studied levels of hope in 82 rehabilitation nurses who care for paralysis patients. ‘”These can be terribly difficult cases to work with because they often take out their anger and disappointment on nursing staff” Dr Elliot said.

“Nurses on rehab units have a very high rate of burnout and turnover.”

Among the nurses, those who had higher levels of hope also reported fewer symptoms of burnout like mental exhaustion and emotional withdrawal from patients, Dr. Elliott said. His study will be reported in The Journal of Social and Clinical Psychology next year.

Hope, Dr. Elliott found, was strongly associated with the nurses’ sense of personal accomplishment, which may insulate them from burnout. Although they got little recognition for their work, the nurses derived satisfaction from even trivial chores. “Hope lends a sense of existential meaning to what you do,” Dr. Elliot said.

In devising a way to assess hope scientifically, Dr. Snyder went beyond the simple notion that hope is merely the sense that everything will turn out all right. “That notion is not concrete enough, and it blurs two key components of hope,” Dr. Snyder said. “Having hope means believing you have both the will and the way to accomplish your goals whatever they may be.”

Getting Out of a Jam

The scale assesses people’s sense of having the essential means by asking. for instance, whether they typically find they can think of many ways to get out of a jam, or find ways to solve problems that discourage others. It measures will through such questions as whether people feel they have been fairly successful in life or usually pursue goals with great energy.

Despite the folk wisdom where there’s a will there’s a way,” Dr. Snyder has found that the two are not necessarily connected. In a study of more than 7,000 men and women from 18 to 70 years old, Dr. Snyder discovered that only about 40 percent of people are hopeful in the technical sense of believing they typically have the energy and means to accomplish their goals, whatever those might be.

The study found that about 20 percent of the people believed in their ability to find the means to attain their goals, but said they had little will to do so. Another 20 percent have the opposite pattern, saying they had the energy to motivate themselves but little confidence that they would find the means.

The rest had little hope at all, reporting that they typically had neither the will nor the way.

“It’s not enough just to have the wish for something”, said Dr. Snyder. “You need the means too. On the other hand, all the skills to solve a problem won’t help if you don’t have the willpower to do it.

Traits Among the Hopeful

Dr. Snyder found that people with high levels of hope share several attributes:

Unlike people who are low in hope, they turn to friends for advice on how to achieve their goals.

They tell themselves they can succeed at what they need to do.

Even in a tight spot, they tell themselves things will get better as time goes on.

They are flexible enough to find different ways to get to their goals.

If. hope for one goal fades, they aim for another. “Those low in hope tend to become fixated on one goal, and persist even when they find themselves blocked,” Dr. Snyder said. “They just stay at it and get frustrated” They show an ability to break a formidable task into specific, achievable chunks. “People low in hope see only the large goal, and not the small steps to it along the way,” Dr. Snyder said.

Scales Measuring Lack of Hope

Many researchers use a scale that measures not hope but the lack of it. The scale, developed by Dr. Aaron Beck and colleagues at the University of Pennsylvania, asks people how much they agree, for example, that there is no use trying to do anything in the future, or, that everything they try ends in failure.

Researchers who use the scale to study depression have found that hopelessness plays an especially important mental role; unlike other, more prominent symptoms like listlessness or sadness.

Research has even found that feelings of hopelessness are good predictors or how well people will fare in psychotherapy. Perhaps it is no surprise that researchers have also found that hopelessness is the best predictor of who will commit suicide

In a 10-year study of 206 patients who reported thoughts of suicide but had not yet made an attempt, the patients’ scores on the hopelessness scale was the single best predictor of whether they would go on to attempt suicide, Dr. Beck reported in a 1997 article in The American Journal of Psychiatry.

People who get a high score on the hope scale “have had as many hard times as ” those with low scores, but have learned to think about it in a hopeful way, seeing a setback as a challenge, not a failure,” Dr. Snyder said

He and his colleagues are trying to design programs to help children develop the ways of thinking found in hopeful people. “They’ve often learned their mental habit of hopefulness from a specific person, like a friend or teacher,” Dr. Snyder said.

“Hope can be nurtured,” he said. Dr. Snyder has made a videotape for that purpose showing interviews with students who are high on hope, to help freshmen better handle the stress of their first year.

In a study by Dr. Lori Irving, a psychologist at the Palo Alto Veterans Affairs Hospital in California, women who viewed a videotape about cancer that had a hopeful script did more to change their health habits in a positive way, like getting Pap smears and quitting smoking, than did women who saw another one with the same information but without the positive wording.

The effect of the hopeful videotape was strongest on the women who had gotten a low score on the hopefulness scale. Dr. Snyder said similar approaches might work to raise hopefulness among children in impoverished neighbor hoods.

Will I Become Dependent On My Therapist?

by Joyce Prince, CSW

This is an often asked and good question and can be answered as follows. Just as an apprentice becomes temporarily dependent on a mentor, or a student on a teacher, in a well conducted therapy the patient may become temporarily dependent on the therapist. As the therapy progresses, the patient will learn from the therapist and the therapeutic process which will gradually become a part of him or her; a set of ” psychological tools”, a way of looking at oneself which will increasingly reside within the patient rather than with the therapist. The patient becomes progressively more empowered to effectively manage his or her own life. Good therapy is a collaborative process, with an important goal being the transfer of the “psychological tools” from the therapist to the patient, so that ultimately the individual can discontinue therapy with fortified emotional and mental “muscle”.

Direct advice is given relatively infrequently in therapy because constant advice would turn over to the therapist the patient’s responsibility for his/her life. This would not be a collaboration, and the “muscle” would continue to reside in the therapist. The dependence in this case would be permanent, not temporary. Each new life situation would have to be brought to “the master”, which would not be helpful in building up the patient “muscle”.

Instead, the individual in therapy goes through a process of self-inventory and exploration of feelings, of memories, of behavior, of assumptions, of relationships, of fears, of new and different ways of handling life encounters, guided by the therapist/mentor. Gradually the patient becomes able to handle situations on his/her own, without the therapist’s presence. As the individual absorbs and accepts both the information gleaned from this process and becomes more able to explore and self-reflect on his/her own, the capacity to manage the psychological world is increased. This also broadens the behavioral response repertoire to the situations which occur in life, making it less likely that one will respond in an inappropriate or ineffectual manner. As the psychological “muscle” of the individual develops, the collaborative guide (therapist) ultimately is not needed.

In summary, the potential “consumer” of psychotherapy should be assured that in a well conducted therapy, while there indeed may be a phase of emotional dependence on the therapist, the collaborative alliance works toward transferring the “muscle” from the therapist to the patient, thereby solidifying and consolidating autonomy.

Psychotropic Medication In Psychotherapy

For New York Psychotherapy Group
By Claude Miller, MD

Ideally the function of medication in psychiatry is to help the patient be able to participate in psychotherapy. This may involve antidepressant and /or antianxiety preparations. The decision to inaugurate, change or terminate a given medication is made by the prescribing psychiatrist.

There have been many improvements in psychotropic medications in recent years so that many of the side effects that made patient compliance problematic have been decreased.

In addition to the preparations noted above, there are also antipsychotic medications to treat the major mental disorders or psychoses, primarily schizophrenia and manic-depression. These also act to render the patient accessible to psychotherapy but their use is far more critical than in the neuroses.

The dosage of a medication requires careful monitoring because too low a dose is ineffective and too high a dose can precipitate unpleasant side effects. The use of other systemic medications concomitantly with psychotropics must also be noted and controlled for.

The traditional antipsychotics for schizophrenia and manic-depression are often used and well studied. They act primarily by blocking postsynaptic receptors, and can effect a reduction in non-psychotic symptoms such as excitement, tension, aggression, hostility, uncooperativeness, restlessness, anxiety, irritability. There have been modest effects with the antipsychotics and low doses usually work. No antipsychotic has been found to be more effective than another. A physician should use a side effect profile as a guideline for selection.

There are certain families of medications that are extremely popular at the present time. One of these is the SRI’s (Serotonin Reuptake Inhibitors) which are used as antidepressants. The antidepressant, antiobsessive-compulsive, and antibulemic actions of fluoxetine are presumed to be linked to its inhibition of central nervous system neuronal reuptake of serotonin. Studies at clinically relevant doses in man have demonstrated that fluoxetine blocks the uptake of serotonin into human platelets. Studies in animals also suggest that fluoxetine is a much more potent uptake inhibitor of serotonin than of norpinephrine. These medications include Prozac. Another family that continues to be used comprises the tricyclics. An example of this is Elavil.

There are other medications formerly used to treat anxiety such as Valium and Quaalude which have fallen into disrepute because they are now classified as “Drugs of Abuse” which means they are habit forming. The family including Valium is called the Benzodiazapines.

As noted at the outset, the decision to begin psychotropic medication, at what dosage, and for how long, is a decision make jointly by the patient, the treating therapist and the consulting psychiatrist. In the right hands they can prove miraculous (as Lithium for Manic-Depressive Psychosis); conversely, in the wrong hands they can prove disastrous (as prolonged use of Valium for chronic anxiety.

Psychoanalytic Psychotherapy

by Joyce Prince, CSW

When someone is considering beginning psychotherapy, there is awareness of needing some relief and/or clarity regarding personal concerns. At the same time, the prospective client may wonder what actually will go on in the treatment, the format that assistance will take, etc. Thus, prior to actually arranging for the very first appointment, there may be a variety of questions, hopes, and fears about beginning.

This informational piece will briefly address these questions by looking at the ‘what’, ‘when’, ‘who’, ‘why’ and ‘how’ of psychotherapy; namely, psychoanalytic psychotherapy.


Various precipitants prompt someone to seek psychotherapy. Some precipitants are external in nature, for example, a life situation change, such as a geographic move, or a misfortune such as the loss of a loved one ( a death, divorce, etc.). Sometimes, even a positive event such as a salary increase, or winning an award can be a precipitant. In this instance, even though the event is ‘good news’, it is experienced as somehow unsettling or disruptive and difficult for the person to psychologically metabolize.

At times the precipitant is internal, for example, persistent depression or sense of unfullfillment and malaise. With an internal precipitant, there may not be a specific event that is the trigger. In this instance, someone may have been considering therapy for some time and simply reaches a point where he/she feels ready to begin. Thus, no actual definable event is causative, or the event is minor – ‘the straw that broke the camel’s back’.


Psychoanalytic psychotherapy is premised on the belief that the current adaptation and functioning of an individual is in a large part acquired through interpersonal learning and development. Development includes biological maturation as well as psychological maturation. For just as an individual gradually evolves and grows biologically, the same occurs psychologically. Stages exist both biologically and psychologically.

Thus, the individual’s temperament and biological givens, converge with the interpersonal learning (relationships with other people) to shape how that person relates to himself/herself and others, deals with life’s promises and disappointment, and so forth.

Metaphorically, it is as though psychological blueprints are laid down within the mind. These blueprints stored most often outside one’s awareness nonetheless inform how the individual manages his/her life. Optimally, the blueprints aid in dealing with self and others. Less than optimally, the blueprints are inadvertently experienced as ossified mental straitjackets obviating against a person’s ability to adapt well and comfortably within his/her own life. Subjectively, this results in feeling unhappy and uncomfortable but stuck: stuck without options — stuck without a way to overcome the discomfort and unhappiness; thus, stuck in blueprints that do not allow for creating and building a satisfying life.

The goal in psychoanalytic psychotherapy is to investigate these blueprints by exploring the client’s current concerns. There is the further premise that not all the information contained in the blueprints is accessible to awareness. Some, probably a significant proportion of the information, for protective purposes, has been warehoused in an unconscious mind.

As therapy progresses, there is a gradual unfolding of personal information. The information includes the more readily available conscious memories, thoughts and feelings. The warehoused information also becomes overt. A sense of liberty and relief results as the therapy client becomes unstuck. Greater personal comfort occurs because the client is not guided (perhaps misguided) by ineffectual blueprints. Thus, the client has more options regarding his/her life.

Because these outdated blueprints tend to remain fixed and used automatically, it is necessary to allow sufficient time in therapy to familiarize oneself with them and how they effected the construction of the client’s psychological self. This then, prepares the client to undertake the work of strengthening the blueprints that serve well and remodeling and renovating the ineffectual ones that cause pain.


Therapists are drawn from the disciplines of psychology, psychiatry, social work, nursing, counseling and vocational rehabilitation. To practice psychoanalytic psychotherapy, the mental health provider should have been trained at the post graduate level. It is the specialized training in psychoanalytic procedure gained from the post graduate work that qualifies the therapist to accompany the client in the investigative journey described.