Take Your Time : Seven Lessons for Young Therapists

Take Your Time : Seven Lessons for Young Therapists

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  Plenary Session Take YourTime: Seven Lessons for Young Therapists Professor Vincenzo Di Nicola International Federation for Psychotherapy 23rd World Congress of Psychotherapy Casablanca, Morocco 11 February 2023
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  Professor Vincenzo DiNicola MPhil, MD, DipPsych, FRCPC, PhD, FCAHS, DLFAPA, DFCPA Professeur titulaire, Université de Montréal President, World Association of Social Psychiatry Email: [email protected]
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  Introduction: “Take YourTime” • With these seven lessons for young therapists in this technocratic time of pressure and speed • I commend young therapists – eager to embrace change and to make a difference – to “Take your time” • By opening a space for reflection by every party in the therapeutic encounter, the possibility of an event – something surprising, unpredictable and new – may emerge
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  These lessons integratemy work in psychiatry and psychotherapy with my Slow Thought Manifesto and my call for Slow Therapy
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  1997 2011 2021
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  First Lesson People comeinto therapy in order not to change What is the task of therapy?
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  People come intotherapy not to change •Psychoanalysis calls this resistance •Systems theory – the basis of Systemic Family Therapy – calls this homeostasis
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  What is thetask of therapy? Freud wrote that the task of psychoanalysis is to make the unconscious conscious (working through resistance)
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  What is thetask of therapy? To give structure and meaning to the predicament of an individual, a couple or a family, a group or a community Reference: Di Nicola, V. A Stranger in the Family (1997)
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  What is thetask of therapy? This exploration of predicaments is done in therapy when it is not possible elsewhere or otherwise Reference: Di Nicola, V. A Stranger in the Family (1997)
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  What to read,where to start? • Read Freud first, don’t read about Freud • Start with The Interpretation of Dreams (1900) • After Freud, read Donald Winnicott’s Playing and Reality (1971)
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  Donald Winnicott (1896-1971) Workingwith young children, Winnicott coined the term: •The “holding environment”
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  Second Lesson Therapeutic temperaments Whoconducts therapy and why?
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  Who conducts therapyand why? The therapist you are now, will be, and that you were meant to be, was shaped long before you started your professional training as a therapist
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  Therapeutic Temperaments • Phenomenologicaltemperament Understanding – What? Why? • Technocratic temperament Intervention – How?
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  A bridge betweenunderstanding and intervention
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  Third Lesson The familyas a unique culture Relational psychology and relational therapy
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  Family Sayings There arefive of us children.… When we meet, we can be indifferent and aloof. But one word, one phrase is enough; one of those ancient phrases, heard and repeated an infinite number of times in our childhood … would make us recognize each other in the darkness of a cave or among a million people…. These phrases are the foundation of our family unity which will persist as long as we are in this world, and which is recreated in the most diverse places on earth … —Natalia Ginzburg, Family Sayings (1963, pp. 23-24)
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  Families • Mara SelviniPalazzoli (1916-1999) • Milan Team: Systemic Family Therapy • “Family therapy is the starting point for the study of ever wider social units.” —Mara Selvini Palazzoli (1974)
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  Families • Salvador Minuchin(1921-2017) • Articulated a coherent approach – Structural Family Therapy • Psychoanalysis, he argued, sees “Man out of context”
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  Families • Maurizio Andolfi(b. 1942) • Relational psychology and therapy • This represents nothing less than a rethinking of psychology based on relationships and therapies that follow from relational psychology
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  Fourth Lesson Changing thesubject How does therapy work?
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  How therapy works Therapistsdo three simple things with information: • Enhance uncertainty (That doesn’t seem to be working out so well for you) • Introduce novelty (There may be other ways to look at it) • Encourage diversity (Let’s try a different approach) Reference: Di Nicola, V. A Stranger in the Family (1997)
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  How therapy works •Freud’spsychoanalytic method uses introspection to arrive at insight •Yet Freud never used the word “insight” •Freud (1914) wrote about “working through” Reference: Freud, S. Remembering, repeating and working-through (1914). Standard Edition: 12. (1955).
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  Donald Winnicott (1896-1971) •The “holdingenvironment” •Allows both child and parent, patient and therapist to play Reference: Winnicott, D.W. Playing and Reality (1971)
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  Fifth Lesson One hundredyears of invisibility The evolution of therapy
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  One hundred yearsof invisibility The evolution of therapy From the 19th c discovery of the unconscious to the 21st c values of diversity, decolonization and change And yet, people remain invisible – especially the most vulnerable – children and minorities
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  Making visible whatwas invisible • Freud said that psychoanalysis aims to make the unconscious conscious • The story of therapy is the story of making visible what was invisible “Poetry must drag further into the clear nakedness of light even more of the hidden causes than Freud could realize.” —Dylan Thomas
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  The myth ofindependence
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  Freud deconstructed The storyof therapy is also the story of revising and revisioning Freud • from radical critiques (Behaviour therapy, Cognitive therapy) • to adaptations (Child therapy, Brief therapy) • to new applications (Trauma-informed therapy – Di Nicola, 2018; Mollica, 2006) • to expansions (Couple, family, group, and community therapy – Barreto, et al., 2020) • and revisions (Interpersonal and Narrative “turns”)
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  We are socialanimals No more fiendish punishment could be devised … than that one should be turned loose in society and remain absolutely unnoticed by the members thereof…. We are gregarious animals with an innate propensity to get ourselves noticed favorably by our own kind. —William James, Principles of Psychology (1890)
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  Loneliness vs. belonging •We not only want to be noticed in society, but we suffer in isolation • Loneliness is a major issue that contributes to mental and relational suffering • And we share a need for belonging
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  Sixth Lesson Making meaning Makingsense and doing good: Relational ethics
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  What is saidand what is unsaid • People will tell you or show you what you need to know • Anthropologist Gregory Bateson (1972) said that sometimes people speak in “metaphors that are meant” • “I am a rug – my husband walks all over me” Reference: Bateson, G. Steps to an Ecology of Mind (1972)
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  What is saidand what is unsaid •Haitian therapist to a Haitian mother in Montreal: “I have understood everything that you have NOT said.” “If you do not witness what cannot be said, you will shatter what can be said.” —al-Niffari (cited by Adonis, 2005)
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  The fox’s lesson:Relational ethics Les hommes ont oublié cette vérité, dit le renard. Mais tu ne dois pas l’oublier. Tu deviens responsable pour toujours de ce que tu as apprivoisé. —Antoine de St-Exupéry, Le Petit Prince (1943) “Men have forgotten this truth,” said the fox. “But you must not forget it. You become responsible, forever, for what you have tamed.” —Antoine de St-Exupéry, The Little Prince (1943)
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  Face-to-face encounter: Relationalethics • Psychotherapy is a face-to-face encounter with others • Response and responsibility begins with that encounter • Emmanuel Levinas – “Philosophy is first ethics” • Holding – caring – healing in psychotherapy are founded on the ethics of face-to-face Reference: Levinas, E. Entre Nous: Thinking-of-the-Other (1998)
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  The gurū-chelā relationship •Each society has the resources to construct psychotherapy in accord with its values and traditions • In India, JS Neki used the gurū-chelā (master-disciple) relationship as a paradigm for Indian psychotherapy Reference: Di Nicola, V. The Gurū-Chelā Relationship Revisited: The Contemporary Relevance of the Work of Indian Psychiatrist Jaswant Singh Neki. World Social Psychiatry, 2022;4:182-6.
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  Rethinking Maslow’s hierarchyof needs The people need poetry like they need bread. —Osip Mandelstam (1891-1938) • Russian poet writing in the Soviet Gulag • Viktor Frankl survived the Holocaust, wrote about “Man’s search for meaning” Reference: Frankl, V. Man’s Search for Meaning (1946/2006)
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  Seventh Lesson “And onthe seventh day, the Lord rested …” When therapy is over: The myth of closure, flow, and slowness in therapy
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  The myth ofclosure •Freud said that therapy is over when the patient realizes that it could go on forever •There is no closure, just a choice to get on with it
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  Sabbatical Do your workfor six years; but in the seventh, go into solitude or among strangers so that the memory of your friends does not hinder you from being what you have become. —Leo Szilard, “The Ten Commandments” (1992)
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  “Take your time” Question:“How does one philosopher address another?” Answer: “Take your time.” —Ludwig Wittgenstein, Culture and Value (1980)
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  Slowness in therapy,flow We need a philosophy of Slow Thought to ease thinking into a more playful and porous dialogue about what it means to live —Di Nicola, “Slow thought manifesto” (2018)
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  Conclusion – Keywords •Holding – psychotherapy • Attachment – child psychiatry • Belonging – social psychiatry holding attachment belonging
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  Belonging Belonging is tosocial psychiatry what attachment is to child psychiatry Belonging is the glue that holds together the Social Determinants of Health and Mental Health and gives them structure and meaning
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  Holding Holding is theglue that binds introspection to insight in a relational act of empathy and witnessing (Mollica, 2006) or, as philosopher Martha Nussbaum (2011) put it, “the highly particular transactions that constitute love between two imperfect people”
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  Seven Lessons: Summary 1.People don’t want to change (resistance, homeostasis) 2. Different therapeutic temperaments see different tasks, seek different ways of doing therapy 3. Families are unique cultures that require a relational approach 4. Therapy opens new vistas of life in a holding environment 5. Therapy makes visible the invisible – as social animals, we thrive in social contexts, suffer in isolation – Independence is a myth! 6. People seek meaningful lives 7. Slow Therapy respects the flow & rhythms of life, takes time to integrate change, and knows when to stop
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  And don’t forget to play
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  Acknowledgements I would liketo express my gratitude to: •Prof. Driss Moussaoui, MD (Morocco) •Prof. César Alfonso, MD (USA) •International Federation for Psychotherapy •John Farnsworth, PhD (New Zealand)
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  References • Adonis. Sufismand Surrealism (trans. J. Cumberbatch). London: SAQI, 2005. • Andolfi, M., Angelo, C., de Nichilo, M. & Di Nicola, V. The Myth of Atlas: Families & the Therapeutic Story. New York: Brunner/Routledge, 1989. • Barreto, A.P., Filha, M.O., Silva, M.Z., & Di Nicola, V. Integrative Community Therapy in the time of the new coronavirus pandemic in Brazil and Latin America. World Social Psychiatry, 2020, 2(2): 103-5. • Bateson, G. Steps to an Ecology of the Mind. New York: Ballantine Books, 1972. • Di Nicola, V. A Stranger in the Family: Culture, Families and Therapy. New York & London: W.W. Norton & Co., 1997. • Di Nicola, V. Letters to a Young Therapist: Relational Practices for the Coming Community. New York & Dresden: Atropos Press, 2011.
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  References • Di Nicola,V. “Take your time: Seven pillars of a slow thought manifesto.” Aeon (online magazine). February 27, 2018. https://aeon.co/essays/take-your-time-the-seven-pillars-of-a-slow-thought- manifesto. • Di Nicola, V. Two trauma communities: A philosophical archaeology of cultural and clinical trauma theories. In: P.T. Capretto & E. Boynton (Eds), Trauma and Transcendence: Limits in Theory and Prospects in Thinking. New York: Fordham University Press, 2018, pp. 17-52. • Di Nicola, V. The gurū-chelā relationship revisited: The contemporary relevance of the work of Indian psychiatrist Jaswant Singh Neki. World Social Psychiatry 2022;4:182-6. • Frankl, V. Man’s Search for Meaning. An Introduction to Logotherapy (trans. I. Lasch). Boston: Beacon Press, 1946/2006. • Freud, S. The Interpretation of Dreams. 1900. Available at: https://en.wikisource.org/wiki/The_Interpretation_of_Dreams
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  References • Freud, S.Remembering, repeating and working-through (1914). Standard Edition: 12 (trans. J. Strachey). London: The Hogarth Press, 1955, pp. 147-156. • Ginzburg, N. Family Sayings (trans. DM Low). New York: Arcade Publishing, 1963. • James, W. Principles of Psychology. New York: Henry Holt, 1890. • Levinas, E. Entre Nous: Thinking-of-the-Other (trans. M.B. Smith, B. Harshav). Chicago: University of Chicago Press, 1998. • Minuchin, S. Families and Family Therapy. Cambridge, MA: Harvard University Press, 1974. • Mollica, R.F. Healing Invisible Wounds: Paths to Hope and Recovery in a Violent World. New York: Harcourt International, 2006.
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  References • Nussbaum, M.C.Philosophical Interventions: 1986-2011. Oxford: Oxford University Press, 2011. • Selvini Palazzoli, M. Self-Starvation–From the Intrapsychic to the Transpersonal Approach to Anorexia Nervsoa (trans. A. Pomerans). London: Chaucer, 1974. • Selvini Palazzoli, M., Boscolo, L., Cecchin, G., & Prata, G. Paradox and Counterparadox: A New Model in the Therapy of the Family in Schizophrenic Transaction (trans. E.V. Burt). New York: Jason Aronson, 1978. • Szilard, L. The Ten Commandments of Leo Szilard. In: The Voice of the Dolphins & Other Stories. Stanford, CA: Stanford University Press, 1992. • Winnicott, D.W. Playing and Reality. London: Tavistock, 1971. • Wittgenstein, L. Culture and Value (trans. P. Winch). Oxford: Basil Blackwell, 1980.