The Stages of Psychodynamic Psychotherapy: Summary
Psychodynamic psychotherapy was used to treat underachievement, self-destructive behavior, and a variety of psychological symptoms in exceptionally and profoundly gifted adolescents and adults. Each patient’s psychotherapy unfolded in a series of recognizable stages, and each stage addressed similar issues.
Crisis management requires a directive approach, accurate symptom diagnosis, and suggestions for stress management. As each patient’s crisis resolved, conveying an understanding of the inner experience of giftedness often prevented premature withdrawal from therapy.
A therapeutic alliance developed and treatment went beyond symptom relief. A more complete assessment process permitted the development of a psychodynamic formulation. This formulation invariably revealed that although conflicts with parents, peers, school, and work were always factors, the primary causes of underachievement, self-destructive behavior, and psychological symptoms in many of my patients were unresolved conflicts about their inner experience of giftedness. The formulation also helped focus and guide the therapy through the remaining stages.
In the second phase of therapy, the patients began to address their shame and embarrassment, as they clarified and elaborated a vision for their giftedness and attempted to find a setting for its expression. As the therapy unfolded, the most effective approach was a lively interactive one that combined psychologically informed mentoring, coaching, and advising with standard psychotherapy techniques.
The principles of psychodynamic psychology were integrated into the flow of the sessions in the third phase of psychotherapy. Understanding that the presence of anxiety and psychological conflict were not signs of mental weakness, attempts to completely eliminate anxiety and conflict would seriously restrict normal as well as gifted development. Psychological conflicts needed to be understood and anxieties needed to be experienced and expressed directly so that effective methods of resolving conflicts could be substituted for the less effective methods of underachievement and self-destructive behavior. This awareness helped prepare patients for this third phase of psychotherapy. Now each patient could discuss and examine several important central conflicts: the desire for autonomy vis-à-vis the need to depend on others, and feelings of pleasure and excitement when using one’s special endowment vis-à-vis guilt at having been given too much.
In the fourth phase of psychotherapy, patients worked to resolve conflicts and anxieties about the true essence of their giftedness. They explored how the different elements of their extracognitive endowment conflicted with one another; how the extracognitive conflicted with the intellectual; and how the fun of quick solutions that broke conventional rules conflicted with the possibilities for profound exploration. This final phase of psychotherapy helped my patients use their analytic as well as their intuitive skills to recognize and resolve the complex conflicts of exceptional and profound giftedness.
Conclusion
Psychodynamic psychotherapy revealed that a group of unresolved core conflicts about the inner experience of giftedness were the primary causes of underachievement, self-destructive behavior, and serious psychological symptoms in a group of exceptionally and profoundly gifted adolescents and adults. A lively, interactive combination of psychologically informed mentoring, coaching, advising, and more flexible psychotherapy techniques addressed guilty feelings about being given too much endowment, an insistence on autonomous functioning, confusion about integrating extra cognitive abilities with the intellect, and using gifted endowment to explore the profound aspects of important problems instead of finding speedy solutions to them. More mature methods of conflict resolution evolved as did a highly effective collaboration.
