Long-Term Psychodynamic Psychotherapy: A Basic Text – Mental Health Book Review

Key Insights from Gabbard’s Guide to Long-Term Psychotherapy

Gabbard’s Take on Holding the Frame of Therapy

The frame of therapy in its most basic sense includes therapists’ working hours, the time we allot for each session, where we hold sessions, our cancellation and rescheduling policies, the methods we use to contact clients, and our fees.

The author’s view on the frame of therapy, of course, holds its professional considerations in mind. However, from a psychodynamic standpoint, it also explores how bumping up against the therapy frame can give insight into the client’s (and therapist’s) struggles, unconscious hopes, or expectations of self and others.

Additionally, it can provide insight into the impact their independent relational histories have had on them, which can be important to reflect on – both for the therapist to remain safe and effective, and for clients who may benefit from exploring potential frame-related frustrations in sessions to deepen their understanding of self.

Attention Given to Resistance in Therapy

This book encourages clinicians to judiciously observe and eventually talk about possible resistances or roadblocks to therapy with their clients. It suggests resistance may arise in many forms such as frequent cancellations, lateness, no shows, or acting out behaviours within or beyond the therapy session.

What I found valuable was his invitation to attune to the way we as therapists may play into therapy interfering behaviour by remaining oblivious to them when they’re subtle, or by avoiding addressing them for fear of impact when it might be helpful to.

Transference and the Therapeutic Relationship

The psychodynamic model of practice emphasizes that the client-therapist relationship is a living, breathing, changing thing; it is impacted by ruptures and repairs within the therapy as well as relational experiences before and beyond the therapy.

Gabbard explores how reflecting on the client-therapist dynamic can offer important information about subconscious relational processes occurring underneath the talk of therapy. It further offers a chapter to clinicians to help them analyze and work through common feelings clients may bring up in them.

Therapy Termination

The process of therapy is often characterized by comings and goings, break and returns, however Gabbard also illustrates how healing it can be for clients to experience a positive goodbye when it may be their time to move on from their therapist.

He explores how to decipher when a client may be ready to terminate their therapy, and the delicate process of closing long-term work.