The document summarizes a presentation given by James Tobin, Ph.D at the Western Psychological Association Annual Convention on April 25, 2014. The presentation discussed the concept of discovery in psychotherapy and argued that true discovery occurs when patients recognize something familiar about themselves that was previously unintegrated or unformulated. The therapist's role is to create an environment that allows patients to self-observe and explore their experiences to promote this recognition, rather than imposing their own interpretations.

1. The Western Psychological Association Annual Convention
April 25, 2014
The Anatomy of Discovery
in Psychotherapy:
“Something So Familiar, It Is Strange”
James Tobin, Ph.D.
Assistant Professor of Clinical Psychology

2. The Film “Ordinary People”
• https://www.youtube.com/watch?v=F7SA5xL
OoWo [minute 7:30 to end of clip]
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3. Can Anything Surprising or
Unexpected Still Occur in Therapy?
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4. Evidence-based Practice
• An unfortunate consequence of APA’s
endorsement of empirically-based treatment
approaches (APA, 2006) has been the
undeniable “medicalization” of the
psychotherapy.
4

5. Evidence-based Practice
• The therapist’s consulting room has been
transformed into a rather sterile forum in
which the clinician unfurls a series of
evidence-based, health-producing
interventions targeting the patient’s problems.
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6. Evidence-based Practice
• Clinical psychology training curricula are
structured around evidence-based practice
(EBP), which may lead to a regimented, one-
size-fits-all approach to clinical practice.
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7. The Relational/Interpersonal
Movement
• Postmodern constructivism gone awry? I
would argue that an almost radical focus on
CT and enactment has resulted in therapists’
“use of self” leading them to be dogmatic and
self-preoccupied (not focused on the patient).
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8. The Clinician’s Need to Know
• In Between Conviction and Uncertainty:
Philosophical Guidelines for Practicing
Psychotherapists, Downing (2000) argues that the
clinician is guided by a personal epistemology, an
organizing schema that serves as a heuristic for
understanding patients.
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9. The Clinician’s Need to Know
• In his review of Downing’s book, Kose (2003)
called these heuristics “instrumental fictions,”
[which are] “motivated by the conviction or
desire to know the truth and provide useful
illusions that allow us to work toward the
fulfillment of that desire” (my italics, p. 214).
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10. The Narcissism of the Clinician
• There is also a narcissistic need on the part of
the therapist to be helpful, knowledgeable, and
capable.
• Therapists-in-training are burdened with
enormous expectations, many of which are
misguided (see Misch’s 2000 paper “Great
Expectations: Mistaken Beliefs of Beginning
Psychodynamic Psychotherapists”), and many of
which come from unresolved historical issues re:
treating/healing a pathological caregiving
figure (Miller, 1997).
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11. The Static Nature of the Consulting
Room
• So the therapist is oriented toward symptom
reduction, being helpful/smart/capable, and
personal knowledge schemas; the patient is
also oriented toward a rigidity that obstructs
something new being discovered.
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12. The Patient’s Rigid Narrative
• Research and anecdotal evidence suggest that
patients typically enter therapy with firm
beliefs about themselves, others, and
themselves in relation to others (preferred
ways of thinking/acting/feeling that are
often quite rigid).
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13. The Patient’s Rigid Narrative
Schema
Narrative
The common occurrence of a new patient in a first
session who says, “My upbringing and family
were totally normal.”
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14. Narrative Therapy
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15. Therapy as Arm-Wrestling
• Given these circumstances, it is not surprising
that entire therapies can be characterized by
the patient and therapist arm-wrestling about
whose certainty is more accurate, or, instead,
a lack of engagement on the part of the
patient.
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16. The Patient’s Compliance
• These issues often result in the patient merely
complying or accommodating (either
consciously or unconsciously) to the
therapist’s preferences.
• This is often defensive on the part of the
patient, particularly if there has been
significant impingements in the patient’s
developmental history.
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17. The Alternative: A View of
Psychotherapy as Promoting Discovery
• In my view, psychotherapy is a medium that
makes it possible for the patient to self-
observe, explore his/her life experience, and
potentially DISCOVER something.
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18. Promoting Discovery
• Discovery involves the patient’s recognizing
something about him- or herself not seen
before through the preparation of the
patient’s own mind.
• The relational aspects of the therapeutic
situation prepare the patient for this work, but
the therapist’s efforts/brilliance does not
constitute the patient’s discovery.
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19. Stern
• Donnel B. Stern (1997) has broached the issue
of discovery in psychotherapy from a
relational perspective, illuminating how the
therapeutic dyad may arrive at the shore of
“unformulated experience.”
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20. Stern
• In his two important works ,“Unformulated
Experience: From Dissociation to Imagination
in Psychoanalysis” (1997) and “Partners in
Thought: Working with Unformulated
Experience, Dissociation, and Enactment”
(2009), Stern describes his view of the
mutually co-created discovery process in
psychotherapy and psychoanalysis.
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21. Stern
• I don’t view the discovery process as being
mutually co-created but, rather, as an occurrence
within the patient that the therapist is largely a
spectator to – the discovery is a product of the
patient’s mind and the setting the therapist has
created.
• It has very little to do with constructs like
countertransference, enactment, use of the self,
etc. that dominate the current environment.
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22. Discovery Not as Aha!, but as
Recognition
• I emphasize recognition, not learning or
understanding, in my conceptualization of
discovery.
• Discovery is visceral, not intellectual or
academic.
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23. Discovery as Recognition
• The therapeutic process is a slowly evolving,
gradual endeavor in which the patient’s
characteristic ways of thinking/acting/feeling
emerge, are contacted, and are examined.
• As close examination proceeds in sessions,
there naturally arises an integration of
elements of the patient’s personal identity
that was not available before (something is
recognized – it is a kind of binding together
of disconnected parts).
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24. Integration as the Key to Mental Life
• What is recognized is not something new, but
what has always been (“dissociation”); what
has always been finally becomes integrated
(moved into conscious awareness).
• In this perspective, there is no interpretation,
idea, etc. offered by the therapist to the
patient that hastens the discovery process; if
anything, the therapist’s ideas get in the way
of discovery.
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25. Depiction of the Integration of What
Has Always Been
The Film “9 ½ Weeks”
• https://www.youtube.com/watch?v=e9zctBOL
K_E
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26. Creating a Therapeutic Space for
Discovery
• How, and under what conditions, does
discovery occur in psychotherapy?
• “Therapeutic space” is seldom considered.
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27. Discovery as Awareness of What Is
• The main assumption is that the patient is
thinking/acting/feeling in ways that are out of
his/her own awareness, and, as such, the
patient is not liberated.
• Therapeutic cure, in this
context, is liberation
via awareness of what
is (integration).
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28. The Clinician’s Therapeutic Function
• The therapeutic function has more to do with
setting the stage/promoting the patient’s
capacity to “connect” with what the patient
has not seen or recognized about him- or
herself.
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29. Ambiance
• It is not a battle of certainties or agendas, but
establishing a therapeutic ambiance which
allows the patient to ultimately self-observe
what has always been known, but never
recognized (the “something so familiar, it is
strange”).
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30. The Patient’s Capacity to Self-Observe
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I propose that the main
therapeutic task is to
activate the patient’s self-
observing capacities, in
order to set the stage
for recognition.

31. A Focus on Preparing the Patient’s
Mind
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• This involves a different type of activity than
what most therapists have been trained to
execute: it involves potentiating the patient’s
mind, not acting on the patient.
• The therapist mainly focuses on observing
what he/she recognizes about the patient, in
order to stimulate the patient’s self-
observing capacities. AND THAT’S ALL!

32. The Abandonment of Meaning-Making
• The therapist consistently attempts to
examine the patient’s beliefs and convictions,
yet does not arm wrestle the patient with
his/her own or throw the patient into a
position of defensive compliance.
• In fact, all meaning-making is distracting
from a focus on the patient’s capacity to self-
observe.
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33. Foregoing the Clinician’s Narcissism
• What is satisfying narcissistically
for the majority of therapists
must be relinquished; instead,
the therapist needs to focus on
setting up the conditions in
which the patient can most effectively work
and helping the patient do the work.
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34. Conclusion
• The therapist’s attention:
(1) observing what one notices about the
patient;
(2) catching when and how the therapist
obstructs the conditions of the therapeutic
space.
These two activities should be the focus of
supervision.
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35. Conclusion
• I rely on the capacity of the space itself to
engender the patient with an ability to use it,
and, consequently, his/her own mind long
after therapy has ended.
• To me, this seems more to the core of what
actually happens in “successful” treatments.
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36. Questions
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37. References
• APA Presidential Task Force on Evidence-Based Practice (2006).
Evidence-based practice in psychology. America Psychologist, 61,
271-285.
• Downing, J. N. (2000). Beyond conviction and uncertainty:
Philosophical guidelines for practicing psychotherapists. Albany:
State University of New York.
• Duncan, B.L. (2010). On becoming a better therapist. Washington,
D.C.: American Psychological Association.
• Fisher, J.E., & O’Donohue, W. (2010). The practitioner’s guide to
evidence-based psychotherapy. New York, NY: Springer
Science+Business Media, LLC.
• Goodheart, C.D., Kazdin, A.E., & Sternberg, R.J. (2006). Evidence-
based psychotherapy: Where practice and research meet.
Washington, D.C.: American Psychological Association.
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38. References
• Kose, G. (2003). Book review [Review of the book Between
conviction and uncertainty: Philosophical guidelines for practicing
psychotherapists, by J. N. Downing]. Journal of Psychotherapy
Integration, 13, 211-215.
• Miller, A. (1997). The drama of the gifted child. The search for the
true self. New York: Basic Books.
• Misch, D.A. (2000). Great expectations: Mistaken beliefs of
beginning psychodynamic psychotherapists. American Journal of
Psychotherapy, 54, 172-203.
• Stern, D. (1997). Unformulated experience: From dissociation to
imagination in psychoanalysis. Hillsdale, N.J.: Analytic Press.
• Stern, D. (2009). Partners in thought: Working with unformulated
experience, dissociation, and enactment. New York: Routledge.
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39. James Tobin, Ph.D.
Licensed Psychologist PSY 22074
220 Newport Center Drive, Suite 1
Newport Beach, CA 92660
Assistant Professor of Clinical Psychology
The American School of Professional Psychology
at Argosy University | Southern California
Orange, CA 92868
Email: jt@jamestobinphd.com
Website: www.jamestobinphd.com
Phone: 949-338-4388