Welcome to Back from the Abyss. I'm Dr. Craig Hecock.

Today I'm doing a solo episode. This is called 10 Questions to Deepen Psychotherapy, Inviting the Here and Now.

There are basically four main things that can happen in a typical therapy session.

Number one, chit-chatting, which is reciprocal and superficial in placeholding and definitely not therapy.

Number two, there and then storytelling, where the patient opens up and shares affect-laden stories and fears and thoughts and beliefs.

Number three, psychoeducation, in which the therapist uses various techniques to help the patient better understand what ails them,

and thus move toward better coping or even healing.

And finally, number four, here and now work, where the therapist and patient explore what is happening in the room and what is

not happening, the transference and the countertransference, the hurts and the hopes, the acknowledged

wounds, and the ones that lie just below the surface.

In general, most therapists spend most of their time in the second mode,

there and then storytelling,

where the therapist's main role is to do what we call, quote-unquote,

hold the patient.

That is to provide a space where the patient can share their deepest fears,

wounds, and shame in a non-judgmental,

kind, compassionate, affirming, and even loving space. This holding stance and space can be incredibly healing, and for some patients holding, with maybe a little psychoeducation sprinkled in, it's really all that they need.

But for our patients with deep interpersonal wounding and trauma, the holding stance with their and then storytelling is just not enough.

These patients need the therapy office to become a relationship lab, a place where they can play out their old and tired and dysfunctional ways of being and relating, and then experience how poorly these play out with a therapist. And then, then they can begin to experiment with new ways of being in relationship,

which necessarily includes learning how to hear and then work through

the brave and honest and at times very painful interpersonal feedback from the therapist.

Patients who struggle with pathological caretaking or narcissistic indulgence or abandonment fears

...