Reflective practice UKCP
In initial consultation I offer to the patient a slot that will be its own if I undertake a therapy with him or her, or a couple in case of a child. The second week of consultation I offer two slots, one is the same of the previous week, and the other one another possible space for the patient.
After the consultation process I set up a restitution to the the patient in one of the two slots, where at the end of the session I make the offer for therapy if needed or a referrals to another service .
I divided my practice between psychoanalytic psychotherapy, once or twice per week session, and psychoanalysis, three, four or five times per week.
In psychotherapy mode I am more flexible about cancellations and rearrangement of the sessions, in psychoanalysis I am strict on that.
If I take a child in psychotherapy or in psychoanalysis normally I see the couple once per month or twice.
When the process starts there is a beginning phase where I am not making interpretation and my main concern is to establish an alliance with the patient.
A middle phase occupies the central part of the therapy and in this period my main intervention are interpretations required to the patient to move to another way of functioning, for example if the child is symbiotic to detach him/her from the mother. If the child is autistic to re-establish the relationship with the carer.
An ending phase starts with the set up of and ending date and last for at list six months.
In my orientation I do not think that there are for example a schizo-paranoid stage and a depressive one, for me these two way of functioning of the mind operates at the same time, at the beginning the baby works with the aggression, and after the weaning process with the libido.
I track all the time these two elements of the mind in order to help the patient to move to a more adaptive way of functioning.
All my patient in psychoanalysis are in supervision because I am not yet qualified, the psychotherapy cases not.
After each session I take some notes on the session and for this reason I have normally 25 minutes between each patients.
Both cases are allowed to use the couch if they want.
The arrangement for the children are different, for them I set up a box for each of them, and they can use other material in the room, for example box of lego, but at the end of each session everything go back to the boxes.
If we take the box as an analogy of the mind, the objects inside them represents the internal object of the patients, and in the session I allow the appearance of them, and at the end of the session we put them back.
What I monitor mainly in the session are my feelings and what are my reactions to the patients, for example if I feel tired this is a sign of a severe patient.
I consider these points described above essential in every therapy.
Now we can move to some modification of the setting.
The main modification is to offer the possibility to patients that move to other cities to connect to my office from their homes, in order to do that I use peer browser connection to protect the confidentiality of the session.
I made also another modification of the setting, for people that were not able to recreate the setting in their houses I started to see one of my patient from another office and since I moved back to Italy I offer the possibility to some of my patients to go physically to my office in London and to connect from there.
I understand that this sound strange to some of you, but I consider this modality something in between the in person and the online session (from their houses) and I called this modality virtual-reality, becasue, some times, I commute to the other office to see them in person.
Talking about that I am thinking at the moment to develop a possible use of a virtual reality google for me and the patient and to create a virtual environment where to meet.
This modality could be helpful, I think, to work with adolescent and maybe children.
Now I would like to present more my understanding of the development of the mind, at the beginning of life with the physical birth there is no mind and this state is the same for the first two months. In a way with the help of the mother the baby has the illusion to be still in the womb. Slowly the mother is able to receive the aggression of the baby and to give some frustration to him7her, in order to reach the psychological birth at around six months. It is only at that point that the libido takes over the aggression in the way of functioning of the mind and the child able to feel separated from the mother.
This process ends with the recognition of the father as another person and the primal scene.
What happens between the second month and the second year of life is the set up for the rest of the life of the individual and the modification of these experiences needed a therapy in order to re-establish a more functional configuration.
Of course working in psychoanalysis is more easy compare to psychotherapy because I can see the patient almost every day and I can use the transference and countertransference phenomena.
The aim of the therapy is to transform the internal configuration of the patient from an aggression preponderant way of functioning to a libidinal one. In this sense the patient will be able to invest the internal energy, that was infused into him from the caring of the mother, to the external world and to contribute to it (creativity).
My practice is informed by the fact that I started to be trained as child psychotherapist and I use the play with my adult patients. I even developed further my tecniche with the training that I undergo as psychoanalyst and child analyst.