Addressing Challenging Moments in Psychotherapy

This practical and helpful volume details how clinicians can work through various common challenges in individual, couple, or group psychotherapy. Chapters draw upon clinical wisdom gleaned from the author's 48 years as a practicing psychiatrist to address topics such as using countertransference for therapeutic purposes; resistance, especially when it needs to be the focus of the therapy; and a prioritization of exploration over explanation. Along with theory and clinical observations, Dr. Gans offers a series of "Clinical Pearls," pithy comments that highlight different interventions to a wide range of clinical challenges. These include patient hostility, the abrupt and unilateral termination of therapy, the therapist's loss of compassionate neutrality when treating a couple, and many more. Many of the "Clinical Pearls" prioritize working in the here-and-now. In addition to offering advice and strategies for therapists, the book also addresses concerns like the matter of fees in private practice and the virtue of moral courage on the part of the therapist. Written with clarity, heart, and an abundance of clinical wisdom, Addressing Challenging Moments in Psychotherapy is essential reading for all clinicians, teachers, and supervisors of psychotherapy.

Jerome S. Gans, MD, is a Distinguished Life Fellow of the American Group Psychotherapy Association and the American Psychiatric Association. Now retired, he previously worked in private practice and as Associate Clinical Professor of Psychiatry, Harvard Medical School.

Part I: Introduction; Part II: Clinical Observations; 1. There Is No Completely Objective Data in Interpersonal Relations. The Way I Am with You Partly Determines the Way You Are with Me; 2. Many Natural Reactions Are Not Helpful and Many Helpful Reactions Do Not Come Naturally; 3. With Some Patients There Is No Risk of Ever Establishing the Truth; 4. In Most Cases, All Things Being Considered, People Are Doing the Best They Can. If You Don't Think So, You Probably Don't Have Enough Information, or You Do Not Fully Understand the Information You Do Have; 5. It Is at the Boundaries That Meaningful Psychotherapeutic Work Takes Place; 6. In Chronic Marital Discord, Each Is Contributing Approximately 50% of the Problem No Matter How Asymmetrically They Present or Seem During the Course of Therapy; 7. Internal Conflict Can Masquerade as Dialogue; 8. One of The Fringe Benefits of Being a Psychotherapist Is All That We Can Learn from Our Patients; 9. Seemingly Innocuous Patient Comments Often Yield Valuable Information About the Patient, the Patient-Therapist Relationship and the Phase of the Therapy; 10. Shame Is a Painful, Ubiquitous, Debilitating and Often Hidden Emotion; 11. Ideas Are One of The Most Powerful Medications; Part III: Clinical Pearls; 12. Shifting Focus from There-And-Then to Here-And-Now; 13. Employing Irony and Paradox for Therapeutic Purposes; 14. Using Countertransference for Therapeutic Purposes; 15. Responding Therapeutically to Patients' Questions; 16. Securing the Patient's Attention; 17. Dealing with the Group's Resistance; 18. Encouraging the use of imagination; 19. Welcoming and Deepening the Negative Side of Ambivalence; 20. Employing Methods of the Existential School of Psychiatry; 21. Miscellaneous; Notes.