lots of clinical wisdom in this one (as with all Dr. Coughlin's videos!). I especially liked the analogy "you can complain that people are walking all over you, but you might want to ask yourself why am I laying down...?" 😀👏
Those analogies are very effective. Another good one is, "A new neighbor moves in next door and you go over to greet them, only to be bitten by their dog. You go over the next day and the day after that, complaining that their dog bites. The questions is why you keep going into their yard??"
What Coughlin describes sounds like learned avoidance -- and it makes perfect sense. And, it doesn't square with the idea of a self-punitive super ego, a homunculus within hell bent on sabotaging someone's life. Telling patients that there's a part of them that >wants< to suffer often doesn't work because it simply isn't true. What they need is to relearn in a safe environment.
I would never suggest that a patient wants to suffer. Consciously we are all trying to get along and, as you say, avoid pain. However, these intrenched avoidant patterns, that were adaptive in early chlldhood, often wreak havoc in adult like. Acquainting patients with their defenses and the ways in which they create and perpetuate suffering is the first step in interrupting automaticity and creating choice.
Oh wow this was so illuminating! The point about how a "good baby" and how agreeableness is so wildly reinforced helped me understand these defenses so much more now, and in some way this was a personal blindspot for me! Thank you so much for responding to my request, Dr. Coughlin. I get so much out of your videos.
Patricia, would it be possible for you to make a video about panic disorder and how to understand it within the different ways in which anxiety manifests in ISTDP? I assume that they can manifest in the smooth muscles or with perceptual cognitive alterations, since at the level of striated muscles the physical manifestations would not be as intense as for a panic attack (DSM V) or am I wrong? For me, patients with continuous panic attacks are a challenge, as is the fear of speaking in public. These types of patients often require specific maneuvers to reduce anxiety in these contexts, so I would like to know which ones you would recommend? Thank you very much in advance!
Dr. Coughlin, could you please tell me when a person is projecting and when that kind of accusatory, resentful, disproportionate acting out is transference? Since both involve splitting and often accompany together so how to know what the person is exhibiting? Thank you for your videos.
It's projection when the patient is viewing an unacceptable aspect of themselves as living in you and transference when they see you as someone else from their early life.
@@patriciacoughlinphd1852 Dr. Coughlin when they exaggerate your harmless remark as harmful due to paranoia, when their repressed rage/resentments come out as they split the person as the "bad" object without hearing the other perspective should we consider it as transference? Aren't transference, projection signs of a weak ego?
Thanks again for the great video Patricia. I have a question: with some clients, I get them to see the (character) defense for what it is. They can spell out the costs, but sometimes they don't seem to turn against it. Or they start to wonder how to stop the defense from showing up, but more in a theoretical / intellectualizing way. My sense is that they haven't really felt the costs yet. Or that they still like to keep holding on to it on a subconscious level. I try to get specific examples (or take what happens in the T right now) to showcase the costs more. But sometimes I feel like I'm steering too much. Any thoughts or tips on how to proceed from there?
Goethe said, "The addiction to suffering is the hardest to break." Patients often have several lines of defense. When one is addressed, another appears. They are bricks in the wall of detachment between the patient and his own feelings and between you and the patient. This indicates higher levels of resistance and calls for an increase in challenge. Alternatively (or yes, and) you need to address the anxiety about dropping the defense and experiencing feelings directly.
Will do, although an active addiction is a counterindication to intensive treatment. In such cases, treatment aimed at sobriety must take place before the patient is available for psychotherapy.
Not sure I understand your question but if you are referring to an interpersonal interaction in which you not getting a response, DECIDING not to continue to pursue is self respecting. Why consider that "giving up" rather than a conscious and healthy choice?
@patriciacoughlinphd1852 I'm certain my question is vague, but you got the gist of it. You are saying there is a difference in being "aware" and not reacting. It doesn't change anything but neither does reacting. The difference is defining it for myself. It's wild being an adult and not having a framework for what makes people act normal. Thanks your videos show a genuine care in the field of psychology.
lots of clinical wisdom in this one (as with all Dr. Coughlin's videos!). I especially liked the analogy "you can complain that people are walking all over you, but you might want to ask yourself why am I laying down...?" 😀👏
Those analogies are very effective. Another good one is, "A new neighbor moves in next door and you go over to greet them, only to be bitten by their dog. You go over the next day and the day after that, complaining that their dog bites. The questions is why you keep going into their yard??"
This video came at a perfect time in my clinical practice. You’re making a real difference in people’s lives. Thank you!
Thanks so much - good to hear!
What Coughlin describes sounds like learned avoidance -- and it makes perfect sense. And, it doesn't square with the idea of a self-punitive super ego, a homunculus within hell bent on sabotaging someone's life. Telling patients that there's a part of them that >wants< to suffer often doesn't work because it simply isn't true. What they need is to relearn in a safe environment.
I would never suggest that a patient wants to suffer. Consciously we are all trying to get along and, as you say, avoid pain. However, these intrenched avoidant patterns, that were adaptive in early chlldhood, often wreak havoc in adult like. Acquainting patients with their defenses and the ways in which they create and perpetuate suffering is the first step in interrupting automaticity and creating choice.
Oh wow this was so illuminating! The point about how a "good baby" and how agreeableness is so wildly reinforced helped me understand these defenses so much more now, and in some way this was a personal blindspot for me! Thank you so much for responding to my request, Dr. Coughlin. I get so much out of your videos.
My pleasure.
Great video! Thanks!
Glad to do it.
Just yesterday we were discussing this with my students in a supervision group! Synchrodestiny some would say 👏👏
Thanks!
Patricia, would it be possible for you to make a video about panic disorder and how to understand it within the different ways in which anxiety manifests in ISTDP? I assume that they can manifest in the smooth muscles or with perceptual cognitive alterations, since at the level of striated muscles the physical manifestations would not be as intense as for a panic attack (DSM V) or am I wrong?
For me, patients with continuous panic attacks are a challenge, as is the fear of speaking in public. These types of patients often require specific maneuvers to reduce anxiety in these contexts, so I would like to know which ones you would recommend?
Thank you very much in advance!
Sure
Such an important topic. I'd be interested to read up on the research you mention (depression), could you point me in the right direction?
Dr. Coughlin, could you please tell me when a person is projecting and when that kind of accusatory, resentful, disproportionate acting out is transference? Since both involve splitting and often accompany together so how to know what the person is exhibiting?
Thank you for your videos.
It's projection when the patient is viewing an unacceptable aspect of themselves as living in you and transference when they see you as someone else from their early life.
@@patriciacoughlinphd1852 Dr. Coughlin when they exaggerate your harmless remark as harmful due to paranoia, when their repressed rage/resentments come out as they split the person as the "bad" object without hearing the other perspective should we consider it as transference? Aren't transference, projection signs of a weak ego?
Thanks again for the great video Patricia.
I have a question: with some clients, I get them to see the (character) defense for what it is. They can spell out the costs, but sometimes they don't seem to turn against it. Or they start to wonder how to stop the defense from showing up, but more in a theoretical / intellectualizing way. My sense is that they haven't really felt the costs yet. Or that they still like to keep holding on to it on a subconscious level. I try to get specific examples (or take what happens in the T right now) to showcase the costs more. But sometimes I feel like I'm steering too much. Any thoughts or tips on how to proceed from there?
Goethe said, "The addiction to suffering is the hardest to break." Patients often have several lines of defense. When one is addressed, another appears. They are bricks in the wall of detachment between the patient and his own feelings and between you and the patient. This indicates higher levels of resistance and calls for an increase in challenge. Alternatively (or yes, and) you need to address the anxiety about dropping the defense and experiencing feelings directly.
@@patriciacoughlinphd1852 Thank you for the clear answer! More resistance to tackle and anxiety to address. Thanks.
Could you do a video on ISTDP for substance use disorder ? T
Will do, although an active addiction is a counterindication to intensive treatment. In such cases, treatment aimed at sobriety must take place before the patient is available for psychotherapy.
When a person strategically ignores repeated requests and the other gives up trying. How is that passive, and not realistic?
Not sure I understand your question but if you are referring to an interpersonal interaction in which you not getting a response, DECIDING not to continue to pursue is self respecting. Why consider that "giving up" rather than a conscious and healthy choice?
@patriciacoughlinphd1852 I'm certain my question is vague, but you got the gist of it. You are saying there is a difference in being "aware" and not reacting. It doesn't change anything but neither does reacting. The difference is defining it for myself. It's wild being an adult and not having a framework for what makes people act normal. Thanks your videos show a genuine care in the field of psychology.