Psychodynamic: the pattern arrives in the room
A focal theme, a defense operating in real time, and a transference moment you can either use or step over. The session where the work stops being about his week.
What you are practising
- 1Hold a focus rather than following the material
- 2Confront a defense without confronting the person
- 3Work the triangle of conflict from defense toward feeling
- 4Recognise a transference moment and judge whether to use it
- 5Notice the countertransference before acting on it
Briefing
The frame
Twenty sessions, agreed at the outset, ending in nine. The focal theme, stated aloud in session three and accepted by him: "You learned that you are only tolerable when you are producing, so you produce — and then you are exhausted and quietly furious, and nobody knows."
Where you are
Sessions 4–10 established the theme in his work life and in his marriage. He has not brought his father since session six, and the sessions have become slightly comfortable. His PHQ-9 has moved 17 → 11 and stalled.
The case
Daniel Okonkwo
41, he/him, structural engineer, married, two children
Longstanding low mood, exhaustion and loss of interest, framed by him as "burnout".
Read the full case firstThe phases
- 1
The opening
Notice what he does with the first two minutes.
- 2
Working the defense
From defense, through anxiety, toward the warded-off feeling.
- 3
The transference moment
Recognise it, and decide.
- 4
The ending, nine sessions out
Use the termination date as the technique it is.