“When an inner situation is not made conscious, it happens outside, as fate.”
For many people who experience things like depressed mood or intense bouts of anxiety, there are also deep and painful patterns in the way that we relate to others and ourselves. For many of us, those patterns go back to the very beginning. Strategies that protected us when we were young — keeping quiet, keeping others at arm’s distance, behaving a certain way to be approved of, or maybe needing to make a scene to get any attention at all — cause nothing but problems as an adult. It’s easy to start believing “this is just who I am,” especially if others see you that way too.
Especially since mental health topics have become filtered through social media algorithms, these kinds of relational and attachment problems are often labeled as “narcissistic” or “borderline personality.” While the label may fit and provide value for some people, they are often misapplied and misunderstood, and carry a lot of stigma. While diagnosable personality disorders are relatively uncommon and a diagnosis should never be made lightly, problems related to our patterns of relating to others stemming from childhood experiences are almost universal.
What is often more helpful than labeling is developing a deeper understanding of where the patterns we act out in our intimate relationships come from, and what needs they serve. Sam can work with you to gently bring those patterns from your unconscious into your awareness, and to discover healthier ways to keep yourself emotionally safe while meeting your needs.
If you come to therapy to resolve these sorts of relational and attachment problems, you can expect to work with Sam to draw out a clear picture of your current and past relationship patterns, and to be presented with options about how to move forwards. Treatment can focus on resolving specific painful thoughts and behaviors in the present through a cognitive behavioral approach, exploring the patterns and beliefs you’ve carried since childhood to understand their core meaning, or take an explicitly trauma-focused approach to addressing the most damaging experiences that changed how you relate to yourself and others.
Cognitive Behavioral Approaches
A cognitive behavioral approach to relational and attachment problems focuses on the thoughts and behaviors that cause the most suffering right now. Instead of focusing on where patterns came from, CBT asks what you are telling yourself in the moments when things go wrong — when you find yourself reacting in ways you don’t want to or a familiar cycle plays out again. The work involves identifying those thoughts, examining whether they are accurate, and exploring new ways of responding. It is often more present-focused and structured than psychodynamic work, and can also be a useful starting point for people who want concrete tools before going deeper.
Psychodynamic Therapy
Psychodynamic therapy is a relatively unstructured and relationship-based approach based on developing insight into unresolved inner conflicts and developing an authentic relationship between therapist and client within the frame of therapy. Psychodynamic treatment sees the therapist-client relationship as the primary mechanism of change, and tends to focus on childhood experiences, relationships, dreams, attachment with caregivers and other forms of meaning-making rather than present-day symptoms.
Therapy will often address transference and countertransference, or the tendency for a client’s longstanding relational patterns to show up in the therapeutic relationship itself and provide both insight and an opportunity to try something new. The therapist-client relationship can be an opportunity for a corrective emotional experience — an opportunity to positively experience things like vulnerability and connection that went terribly wrong in the past. Psychodynamic therapy is often especially helpful for people whose relational difficulties are rooted in early or complex experiences with caregivers, when we are developing our most basic models for attachment and our deepest feelings about ourselves and others.
Treatment is not time-bound and does not stick to any set pace or agenda. It is common for psychodynamic treatment to stretch over a period of months or years, not weeks.