Psychotherapy Teaching Sample: On working in the initial phase
Date : September, 2025
These “Psychotherapy Teaching Samples” are designed for psychotherapy students who are beginning their clinical practice. That is, trainees who are not attempting to do psychoanalysis as such, but who seek to do competent psychotherapy that might later eventuate into the workplay of psychoanalysis. In this context, much is missing about the inner reactions of the practitioner and their significance…material that is essential to the conduct of psychoanalysis as such.
IMPORTANTLY: The strong distinction between psychotherapy and psychoanalysis — that is made again and again in the “Rediscovering Psychoanalysis” literature — must be kept in mind when studying these “Samples.”
Your male patient, 35 years in the third month of x4 weekly psychoanalytic treatment, walks into his session handing you the payment for the month’s sessions (as is the best practice for the mode of fee payment). The payment is several sessions early, because the agreement is that he will pay on or before the last session of the month.
He starts talking about how he driven his 9-year-old son to school that morning. It was cute because the boy had talked about how he is best in his math class and also about his excitement at the prospect of soccer practice. The patient adds “it was sweet, when we stopped at the school, even though his friends were there, he kissed me on the cheek and said ‘thanks for dropping me off, Dad, see you tonight.’
The patient continues: “Then driving here to see you I suddenly had a memory of what was probably the one and only time my father ever took me to school. It turned out that he didn’t know that I didn’t attend the local government school a few blocks away, but a parochial school that was further toward town. He was impatient and when he drove up to the local school, he told me to get out, and was angry when I tried to explain that it wasn’t the right place … He yelled and insisted that I hurry up and get out of the car. So I did. And I had to walk the rest of the way to my school.” And the patient falls silent.
What are you going to do? In the first place, you are going to attend to the affect with which the story is told, and you definitely should say something empathic. Is it told with sadness? … prompting you to say something like “you must feel so bitterly disappointed at the way your father was.” Is it told with anger? … prompting you to say something like “it must feel infuriating that your father could be that way with you.” Is it told with smug pleasure? … that would make it feel right to say something like “you must feel pleased that you are doing better as a father than your father was with you.”
Empathizing is important. To be empathically treated promotes the patient’s positive feelings about himself and it promotes the development of the relationship, including facilitating the patient’s ability to reflect more deeply. It is good therapy, but it is not enough to facilitate the patient’s movement toward psychoanalysis.
There is obviously a link between what happened with his son and the surfacing of the childhood memory. But it is probably fatuous to point it out by saying “What a contrast between your fathering and his!” … although such a compliment might feel empathically good to the patient, it is not enough and risks you developing a relationship in which the patient becomes overly tied to receiving your compliments.
There is very probably a link between the early payment and the surfacing of the childhood memory. [And in any event, you will very likely find, during the middle phase of the analysis that the memory screens other matters that the patient has still forgotten … to give one speculative example, that the patient knew his father was on his way to visit his homosexual lover for whom he will later divorce the patient’s mother.]
But in thinking about the simplest links we you can, even at this stage be way too clever, and should not be!
For example: “You pay me early today because you want to ward off the possibility that I could become like an irascible and uncaring father toward you.”
This might be correct, probably is. But it is probably not appropriate for the initial phase of a psychoanalysis. Why? Some possibilities as to its prematurity would include…
(1) Because it makes a link for the patient in advance of helping the patient to make links for himself.
(2) Because it excludes another transferential possibilities that might be linked, namely that the early payment is rendered because the patient regrets he cannot give you a kiss at the end of the month.
And (3) It can too easily be heard as telling the patient he has done something he shouldn’t have done.
In the initial ― psychotherapeutic ― phase of a psychoanalytic treatment, we want: To be empathic, not just to make the patient feel understood or even better about himself, and not just to make the patient attached to us, but additionally to facilitate the patient’s capacity to listen to himself…
So, after we have been empathic, we are going to say … What?
What do you think is coming up here?
Why do you think you suddenly recalled this story about your father?
[not What does it mean to you?]
Has it occurred to you that there is a connection between remembering this story and paying me early?
[which is better than “there is a link between remembering this story and paying me early”]
You want to:
(1) Build a working alliance around listening together, with making links between meanings and with attending to the phenomena of anxiety, affect and bodily sensations.
(2) Facilitate the patient’s understanding that every meaning is also a metaphor or metonym of some other meaning.
(3) And this means tactfully but directly pointing out defense mechanisms…but always doing so “on the side of the ego.”
(4) Facilitate the patient’s understanding that the three spatiotemporal arenas (the experiences of present outside the psychoanalytic relationship, the experiences of the present inside the psychoanalytic relationship, and the experiences of the past from childhood) always complexly reflect and refract each other.
(5) Build a relationship in which the patient experiences the way you treat everything—including and especially resistances—as being the ‘best and most adaptive thing’ the patient could do, in the context of his or her psychic reality.