A Psychodynamic Psychotherapy Approach to the Emotional Problems of Exceptionally and Profoundly Gifted Adolescents and Adults: A Psychiatrist’s Experience

originally published in the Journal for the Education of the Gifted vol. 33 # 1,2009, pp.106-125

An eclectic form of psychodynamic psychotherapy is presented to address the emotional problems of exceptionally and profoundly gifted adolescents and adults. The approach includes cognitive/behavioral techniques as well as psychologically informed mentoring, coaching, and advising. Once a psychodynamic formulation was established, it was used to guide all subsequent therapeutic interventions. Three phases of psychotherapy can be recognized. In the first phase, patients addressed their guilt about being exceptionally endowed. They elaborated and organized a personal vision for their giftedness and found an appropriate venue for its expression. In the second phase, patients modulated their need for complete autonomy so they could collaborate more effectively with the therapist and others. In the third phase, patients were able to integrate their extracognitive abilities with their superior intellect. They learned more mature methods of conflict resolution and were able to employ all aspects of their gifted endowment more effectively.


This clinical report is the sequel to a previous one (Grobman, 2006) in which I described a group of exceptionally gifted adolescents and young adults who had become underachievers because of their inability to resolve certain conflicts that accompanied each stage of their development. In this report, I will describe and discuss the issues and the therapeutic tasks that arose in each stage of their psychotherapy. My hope is to add to clinical observations made in individual psychotherapy case reports (Colarusso, 1980; Dahlberg, 1992; Kelly, 1970; Oremland, 1975); to add to the general observations made by those who have counseled (Colangelo & Assouline, 2000; Kerr, 2007; Mendaglio & Peterson, 2007; Rocamora, 1992; Silverman, 2000) and treated gifted adolescents and adults with psychotherapy (Jacobsen, 1999; Lovecky, 1990); to add clinical guidelines for the evaluation and treatment of interpersonal and intrapsychic conflicts and anxieties that may be specific to exceptional and profoundly gifted individuals; and to add to our understanding of the psychology of exceptionally and profoundly gifted individuals.

All of my patients were middle class and ranged in age from 15 to 35. They came from stable, functional families and had parents, peers, and schools who recognized and supported their giftedness. These patients were exceptionally or profoundly gifted in music, art, theatre, literature, or science. Some were gifted in several of these areas. They all had an intense drive to explore and master their environment, special physical sensitivities, distinct aesthetic sensibilities, and a strong need to function autonomously. Despite their different cultural and ethnic backgrounds, different personalities, and unique ways of expressing their giftedness, they all came to psychotherapy in crisis; and their psychotherapy unfolded in predictable stages. Similar issues and therapeutic challenges arose in each phase of their psychotherapy.

My theoretical orientation has been and remains a psychiatric and psychodynamic one. But my therapeutic approach has become eclectic. More than 27 years of clinical work with gifted adolescents and adults has taught me some important lessons about the special conflicts and anxieties of exceptionally and profoundly gifted individuals and how to treat them in psychotherapy.


Special Conflicts and Anxieties

For these patients, conflicts and anxieties about their inner experience of giftedness were usually more important in causing underachievement and self-destructive behavior than conflicts and anxieties about parents, school or work, and peers. In normally endowed individuals, vulnerabilities and strengths often seem like separate parts of their personality. Weakness can sometimes be avoided because strengths compensate for them. In my patients, however, different parts of their remarkable endowment could simultaneously feel like strengths and weaknesses. It was this phenomenon that was at the heart of many of the conflicts within their inner experience of giftedness.


Methods of Conflict Resolution

Because of their extreme physical and aesthetic sensitivities, each of my patients experienced emotion and emotional conflict in very intense ways. Although their intellect was highly developed, they used surprisingly primitive methods of denial and avoidance to manage their conflicts and anxieties. These attempts to completely eliminate conflict and anxiety invariably led to underachievement, self-destructive behavior, and severe psychological symptoms.


The Nature of Psychotherapy

Psychotherapy with exceptionally and profoundly gifted individuals needs to be a vibrant endeavor. A traditional approach—the therapist as a thoughtful, but somewhat removed observer—does not work. For me, a lively, engaged, and interactive approach that also incorporates the ability to stand back, observe, understand, clarify, and interpret the content and process has proved more effective.

Although my approach with gifted patients is an eclectic one, this does not mean that I am continuously shifting my theoretical orientation or technique. It does mean I often use the techniques of coaching, mentoring, psychoeducation, case management, and cognitive/behavioral therapy to enhance my interventions. As long as I can maintain a clear understanding of how my patients’ normal developmental conflicts and anxieties intersect with conflicts and anxieties about their giftedness, the psychotherapy will have an anchored and consistent focus.

A firm grip on each patient’s psychodynamic formulation also allows me to be flexible and adaptive. I can be prepared to see their psychological problems in fresh ways, appreciate how their gifted endowment interacts with other parts of their personality, and be ready to invent individual “on the spot” therapeutic approaches worthy of each individual’s unique form of giftedness.