Fine-Thomas Psychotherapy

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Fine-Thomas Psychotherapy

Fine-Thomas Psychotherapy has as its core values privacy, understanding, and relationship. Our page is devoted to exploring topics related to our practice.

08/14/2023

Albert Einstein is thought to have said, "The intuitive mind is a sacred gift and the rational mind is a faithful servant. We have created a society that honors the servant and has forgotten the gift." He seems to have captured the spirit of the therapeutic attitude to remind us that we would do well to honor our intuition.

08/11/2023

Another way to think of the therapeutic attitude is that it involves intuition. Merriam-Webster defines it: the power or faculty of attaining to direct knowledge or cognition without evident rational thought and inference. Dictionary.com defines it as: direct perception of truth, fact, etc., independent of any reasoning process; immediate apprehension. Common definitions of the word “intuition” imply that something is occurring below the surface of awareness that allows one to ascertain meaning, knowledge, context, truth, etc. quickly and without conscious reflection. We have all had experiences of someone being intuitive. Perhaps they finished our sentences for us or said something that we never put words to but immediately seemed accurate or true.

08/10/2023

There is yet more to this second layer of the therapeutic attitude. Psychoanalysis points to a particular process that occurs between therapist and patient that neither is exactly aware of.
I liken the ability to have access to the phenomena of unconscious process to being aware of one’s heart rate. We all understand that every day our heart beats about 100,000 times. It is always working. For most people, most of the time, we give little thought to this fact. It occurs in the background while we go about our day. And, often when we do notice our heart rate, it is because something seems to be wrong: it is either beating unusually fast, arhythmically, or too slow. Otherwise, we don’t really think of it. However, it is possible to change your heart rate by paying close attention to it. By slowing your breathing or taking your pulse, you can make yourself aware of your heart rate and thus work toward slowing it. But, you can only do this for a limited amount of time before the realities of life call your attention back to other things. Those who cultivate this skill through activities like meditation can lengthen the amount of time they become aware of their heart rate. Focusing your attention in this way is akin to being aware of unconscious processes happening inside and between our patients and us. The therapeutic attitude is analogous to meditation in that it requires a kind of focus on something that is normally not in our awareness and that would naturally not be something we pay attention to. It takes a special kind of effort to stay focused on this attitude.

08/09/2023

The field of psychotherapy in general calls this instrument attunement. And, psychoanalysis has a whole host of concepts related to this skill. Generally, though, to be attuned to the patient means that we are listening carefully to the words they use and the meanings they make of those words (not our meanings). It also means we pay attention to the tone, rhythm/cadence/timing, speed, and cultural/familial/relational contexts of those words. As well, we look where the patient’s gaze goes, paying attention to how much eye contact they make with us. We notice if they blink or look away, stare off into the distance or to the right, left, down or up. We notice the movements of their mouth, brow, cheeks. We discern the energy with which they move, how their hands or legs are in synchrony with their words, whether they are fidgeting, tapping, cross legged, shoulders raised to their neck or lowered, head tilted down or to the side, etc. We listen for sighs, and even rate of breathing. All these behavioral cues offer information about what might be going on inside the patient. In everyday life, we tend not to pay much attention to these behaviors. But, when we sit with patients, these are vital clues.

08/08/2023

We often first learn about this part of the therapeutic attitude with a good supervisor. When we are new to the field, a good supervisor can seem to do Jedi mind tricks. They seem almost psychic or as if they have information about us that we are only just barely aware of. Of course, there is no magic involved. Instead, a good supervisor has cultivated an instrument they use to pick up on the nuances of communication.

08/07/2023

This process of one person detecting what the other is thinking is not unidirectional. The therapist is also working to discern what the patient is trying to disclose or hide. This second layer of the therapeutic attitude is where we cultivate a kind of dual awareness -- of what might be going on in the mind of our patient as well as of what is going on between the patient and us.

08/04/2023

The second layer of the analytic attitude is more nuanced and complex. From the beginning, psychoanalysis has made efforts to describe how people know when we feign openness, curiosity, or anything else. One clinician might ask the same questions of a patient as another but receive different answers partly because the patient is trying to perceive the intentions and attitude of the therapist. In a well known vignette, Greenson (The Technique and Practice of Psychoanalysis, 1967) describes an encounter with a patient who discerned that Greenson was a Democrat despite Greenson never commenting on his political affiliation. The patient, over time, realized that when he commented on the Republican candidate, Greenson would ask for associations but not when he commented on the Democrat. Likewise, when he criticized the Democrat, Greenson would ask who the Democrat reminded him of. Greenson had no awareness of treating the patient differently based on what he said related to the political affiliation. He was surprised to learn that his patient knew something true about him that he had never consciously disclosed.

08/03/2023

Perhaps the most important part of the analytic attitude is the idea of curiosity. If one is temperamentally predisposed with a touch of nerdiness about the social sciences, then being curious about why people do what they do probably feels natural. Otherwise, curiosity is something that requires practice. Anyone who has had to do a structured interview (where questions are given to the clinician to ask the patient) knows that if they express genuine curiosity in asking questions, the patient has a different level of responsiveness than if they merely read off or recite the questions. Patients know when we are not invested in understanding them.

08/02/2023

The analytic attitude builds on the idea of cultivating an attitude of openness. I think of this attitude as having two layers. The first is the kind mentioned yesterday in which the therapist learns by “faking it till they make it.” They practice and get feedback from peers and supervisors to learn what it means to express openness, warmth, and empathy in the presence of patients. This is a conscious and intentional process that the new clinician commits themselves to during training. They learn reflective listening and mirroring, how to word basic interventions, how to ask questions that are open ended and not leading, how to focus on feelings and explore subjects patients hint at, among other things.

08/01/2023

Most students of psychology learn early in their training that it is helpful for a clinician to have an open, warm, empathic attitude. They learn through practice that it is not sufficient to feign these behaviors because patients eventually can tell that feigned empathy is not the same as real empathy. Thus, they learn to cultivate an attitude of openness.

07/31/2023

While the idea of the working alliance has been defined in many ways in psychoanalysis, I find it most useful to think of it as the delicate time at the beginning of treatment in which the establishment of a meaningful connection must be carefully tended (of course, it must be nurtured throughout the relationship as well). It involves warmth, empathy, candid comments, and above all, curiosity on the part of the therapist. It may also require the therapist to find ways to support the patient’s intrinsic motivation to stay engaged before the therapist knows much about the patient’s relational patterns and styles.

07/28/2023

Often, patients start therapy at a moment in their life when they just cannot tolerate the problems they are experiencing anymore. They are sometimes at their wits end with the issues they face. Their meeting you often happens at a moment when their capacity to tolerate their feelings is low and their expression of those feelings is experienced as both painful and sometimes a relief. For people in this situation, saying out loud what they are feeling can result in a set of rebound feelings such as shame, guilt, fear, embarrassment, or humiliation, amongst others. How we handle the expression of these feelings in the first few sessions has a large impact on whether the working alliance will hold until we can form a more lasting connection.

Address

916 NW 139th Street Parkway
Edmond, OK
73013

Telephone

+14053230923

Website

http://www.fine-thomas.com/

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