In these seven lessons for young therapists, a practising psychiatrist and psychotherapist with more than 40 years' experience surveys what therapy is about and how it works, from behaviour therapy and family therapy to psychodynamic psychotherapy. Ranging from what to read and how to begin therapy, the lessons cover therapeutic temperaments and technique, the myth of independence and individual psychology, the nature of change, the evolution of therapy, the search for meaning and relational ethics, and finally, when therapy is over. Overview: 1. People come into therapy in order not to change - When does therapy begin? 2. Therapeutic temperaments - Who conducts therapy and why? 3. The family as a unique culture - Relational psychology and relational therapy. 4. Changing the subject - How does therapy work? 5. One hundred years of invisibility - The evolution of therapy from the 19th-century discovery of the unconscious to the 21st-century values of diversity, decolonization and change. 6. Making meaning - Making sense, technique, and doing good: Relational ethics. 7. "And on the seventh day, the Lord rested" - When therapy is over: The myth of closure, flow, and slowness in therapy. This workshop integrates the author's model of working with families across cultures presented in "A Stranger in the Family: Families, Culture, and Therapy" (1997) and elaborated in his "Letters to a Young Therapist" (2011) with more recent work on trauma-informed therapy in "Trauma and Transcendence" (Capretto & Boynton, eds., 2018), and his "Slow thought manifesto" (2019).

1. Workshop
Lessons for Young Therapists:
Getting Started and Staying on Track
in Your Psychotherapy Practice
Vincenzo Di Nicola
73rd Annual Conference
Vancouver, British Columbia
October 21, 2023

2. Professor Vincenzo Di Nicola
MPhil, MD, DipPsych, FRCPC, PhD, FCAHS, DLFAPA, DFCPA
Professeur titulaire, Université de Montréal
President, World Association of Social Psychiatry
Email: vincenzodinicola@gmail.com

3. Conflicts of interest
•The presenter has no financial conflicts of interest to
declare

4. Learning Objectives
1. Discern the patterns in psychotherapeutic practice based on a
survey of the evolution and current practices of psychotherapy
2. Answer such basic questions as to what to read and how to begin
therapy and what motivates both the patient and therapist
3. Avoid theoretical riddles and practical traps and focus on the
therapeutic relationship and its ethical conduct

5. Introduction
• In these seven lessons for young therapists, based on
practising child psychiatry and psychotherapy for almost 40
years, I will survey what therapy is about and how it works,
from behaviour therapy and family therapy to
psychodynamic psychotherapy

6. Workshop: Questions
• What kind of psychotherapy practice do you have or plan?
• Do you have or plan ongoing supervision, advanced training, and access
to mentors and a peer group of therapists?
• What changes are you planning for your practice?
• What more resources do you need to accomplish your practice goals?
• Are you practising adequate self-care and work-life balance?

7. Workshop: Resources
• Kids: American Academy of Child& Adolescent Psychiatry (AACAP)
• Link: https://www.aacap.org/
• Trauma-informed care: Harvard Program in Refugee Trauma(HPRT)
• Link: https://hprt-cambridge.org/
• Psychodynamic Psychotherapy & Psychoanalysis: American Academy of PsychodynamicPsychotherapy&
Psychoanalysis(AAPDPP)
• Link: https://www.aapdp.org/
• Webinar: https://members.aapdp.org/upcoming-events?reload=timezone
• Culture & Families: World Associationof CulturalPsychiatry (WACP)
• Webinar: WACP Family & Culture Special Interest Group
• Link: https://waculturalpsy.org/wacp-news/family-culture-special-interest-group/

8. Introduction
These lessons integrate my work in psychiatry and psychotherapy:
• A Stranger in the Family: Families, Culture, and Therapy (1997)
• Letters to a Young Therapist (2011)
• “Two trauma communities” in Trauma and Transcendence (2018)
• “Slow Thought: A Manifesto” in Aeon Magazine (2019)
• Psychiatry in Crisis: At the Crossroads of Social Sciences, the
Humanities, and Neuroscience (2021)

10. First Lesson
People come into therapy in order not to change
What is the task of therapy?

11. Peoplecome into therapy not to change
Systems theory
the basis of Systemic family therapy
calls this homeostasis

12. What is the task of therapy?
Freud wrote that the task of psychoanalysis is
to make the unconscious conscious

13. What is the task of therapy?
To give structure and meaning to the predicament of
an individual, a couple or a family,
a group or a community

14. What is the task of therapy?
This exploration of predicaments is done in therapy
when it is not possible elsewhere
or otherwise

15. What to read, whereto start?
•Read Freud first, don’t read about Freud
•Start with The Interpretation of Dreams (1900)
•After Freud, read Winnicott’s Playing and Reality (1971)

17. Donald Winnicott (1896-1971)
Key ideas
• The “holding environment”
• The “good-enough mother”
• The “transitional object”

18. Second Lesson
Therapeutic temperaments
Who conducts therapy and why?

19. Who conducts therapy and why?
The therapist you are now, or will be - and that you
were meant to be – was determined long before you
started your professional training as a therapist

20. Who conducts therapy and why?
• Phenomenological temperament
Understanding – What? Why?
• Technocratic temperament
Intervention – How?

22. Third Lesson
The family as a unique culture
Relational psychology and relational therapy

23. Family Sayings
There are five of us children.… When we meet, we can be indifferent and
aloof. But one word, one phrase is enough; one of those ancient phrases,
heard and repeated an infinite number of times in our childhood … would
make us recognize each other in the darkness of a cave or among a
million people. These phrases are our Latin, the vocabulary of our days
gone by …. They are the evidence of a vital nucleus which has ceased to
exist, but which survives in its texts salvaged from the fury of the waters
and the corrosion of time. These phrases are the foundation of our family
unity which will persist as long as we are in this world, and which is
recreated in the most diverse places on earth …
—Natalia Ginzburg, Family Sayings (1963, pp. 23-24)

24. The trigenerational
family
•Attachment
•Belonging
•Identity

25. Families
• Salvador Minuchin (1921-2017)
• Articulated a coherent approach with a
model of family functioning, a theory
of change, and techniques for therapy
• Psychoanalysis,he argued, sees
“Man out of context”

26. Systems theory
deconstructed Freud

27. Families
• Mara Selvini Palazzoli (1916-1999)
• The Milan Team: Systemic family
therapy
• “Family therapy is the starting point for
the study of ever wider social units.”
—Mara Selvini Palazzoli

28. Families
• Maurizio Andolfi (b. 1942)
• Relational psychology and therapy
• This represents nothing les than a
rethinking of psychology based on
relationships and therapies that
follow from such a psychology

29. Fourth Lesson
Changing the subject
How does therapy work?

31. How therapy works
Therapists do three simple things with information:
• Enhance uncertainty (that doesn’t seem to be working out
so well for you)
• Introduce novelty (there may be other ways to look at it)
• Encourage diversity (let’s try a different approach)
Reference: Di Nicola, V. A Stranger in the Family (1997)

32. How therapy works
• Freud’s psychoanalytic method uses introspection to arrive
at insight
• Yet Freud never used the word “insight”
• He wrote about “working through”

33. Donald Winnicott
(1896-1971)
•The “holding environment”
•Allows both child and parent,
patient and therapist to play
Reference: Winnicott, D.W. Playing and
Reality. London: Tavistock (1971)

34. Louise Glück
(1943-2023)
We look at the world once, in childhood.
The rest is memory.
– “Nostos” in Meadowlands (1996)
• American poet, Nobelist in Literature
(2020)

35. Fifth Lesson
One hundred years of invisibility
The evolution of therapy

36. One hundred years of invisibility
The evolution of therapy
19th century – symptoms
20th century – schools of therapy
21st century – change
And yet, people remain invisible – the most vulnerable –
children, other minorities

37. Making visible what was invisible
•Freud said that psychoanalysis aims to make the
unconscious conscious
•The story of therapy is the story of making visible
what was invisible

38. Isolation
vs.
connection

39. We are social animals
No more fiendish punishment could be devised …
than that one should be turned loose in society and
remain absolutely unnoticed by the members thereof….
We are gregarious animals with an innate propensity to
get ourselves noticed favorably by our own kind.
—William James (1890)

41. Sixth Lesson
Making meaning
Making sense and doing good:
Relational ethics

42. What is said and what is unsaid
• People will tell you or show you what you need to
know
• Anthropologist Gregory Bateson (1972) said that
sometimes people speak in “metaphors that are
meant”
• “I am a rug – my husband walks all over me”

43. What is said and what is unsaid
• Sylvia Plath (1932-1963) – American poet
• Patient at McLean Hospital – The Bell Jar (1963)
• Committed suicide in London
• In “Lady Lazarus” (1965) she wrote,
Dying
Is an art, like everything else.
I do it exceptionally well.

44. What is said and what is unsaid
•Haitian therapist to a Haitian mother in Montreal:
“I have understood everything that you have NOT said.”
“If you do not witness what cannot be said,
you will shatter what can be said.”
—al-Niffari (cited by Adonis, 2005)

46. The fox’s lesson
Les hommes ont oublié cette vérité, dit le renard. Mais tu ne dois pas l’oublier. Tu
deviens responsable pour toujours de ce que tu as apprivoisé.
—Antoine de St-Exupéry, Le Petit Prince (1943)
“Men have forgotten this truth,” said the fox. “But you must not
forget it. You become responsible, forever, for what you have tamed.”
—Antoine de St-Exupéry, The Little Prince (1943)

47. Face-to-face encounter
• Psychotherapy of all types is a face-to-face encounterwith
other human beings
• Response and responsibility begins with that
• Emmanuel Levinas asserted that “Philosophy is first ethics”
• Healing, holding, caring in psychotherapy must be founded
on the ethics of face-to-face

48. The gurū-chelā relationship
• Each society has the resources to construct
psychotherapy in accord with its values and traditions
• In India, JS Neki used the gurū-chelā (master-disciple)
relationship as a paradigm for Indian psychotherapy
Reference: Di Nicola, V. The Gurū-Chelā Relationship Revisited: The Contemporary
Relevance of the Work of Indian Psychiatrist Jaswant Singh Neki. World Soc Psychiatry
2022;4:182-6.

49. Forget Maslow’s hierarchy of needs
The people need poetry like
they need bread.
—Osip Mandelstam (1891-1938)
Russian poet

50. Seventh Lesson
“And on the seventh day, the Lord rested …”
When therapy is over:
The myth of closure, flow, and slowness in therapy

51. The myth of closure
•Freud said that therapy is over when the patient
realizes that it could go on forever
•There is no closure, just a choice to get on with it
•Asymptote: the point of diminishing returns

52. Sabbatical
Do your work for six years; but in the seventh, go into
solitude or among strangers so that the memory of
your friends does not hinder you from being what you
have become.
—Leo Szilard (1992)

53. Take your time
Question: “How does one philosopher address another?”
Answer: “Take your time.”
—Ludwig Wittgenstein (1980)

54. Slowness in therapy, flow
We need a philosophy of Slow Thought to ease thinking
into a more playful and porous dialogue
about what it means to live
—Di Nicola, “Slow thought manifesto” (2018)

55. Conclusion- Keywords
• Holding – psychotherapy
• Attachment – child psychiatry
• Belonging – social psychiatry
holding
attachment
belonging

56. Belonging
Belonging is to social psychiatry
what attachment is to child psychiatry
Belonging is the glue that holds together
the social determinants of health and mental health
and gives them structure and meaning

57. Holding
Holding is the glue that binds introspection to insight in a
relational act of empathy and witnessing (Mollica, 2006)
or, as philosopher Martha Nussbaum (2011) put it,
“the highly particular transactions that constitute love
between two imperfect people”

58. Seven Lessons: Summary
1. People don’t want to change (homeostasis)
2. Different therapeutic temperaments see different tasks,
seek different ways of doing therapy
3. People live in social contexts, not isolated worlds
4. Therapy creates new views of life through a holding
environment
5. Therapy makes visible the invisible
6. People need and want to have meaningful lives
7. Therapy respects the flow & rhythms of life, taking time
to integrate change, knowing when to stop

59. And don’t
forget
to
play

60. Acknowledgements
I would like to express my gratitude to:
• Accademia di Psicoterapia della Famiglia (Rome)
• American Academy of Psychodynamic & Psychoanalysis
• World Federation for Psychotherapy
• John Farnsworth, PhD (New Zealand)

61. References
• Adonis. Sufism and Surrealism. London: SAQI, 2005.
• Andolfi, M., Angelo, C., de Nichilo, M. & Di Nicola, V. The Myth of Atlas: Families &
the Therapeutic Story. New York: Brunner/Routledge, 1989.
• Bateson, G. Steps to an Ecology of the Mind. New York: Ballantine Books, 1972.
• Di Nicola, V. A Stranger in the Family: Culture, Families and Therapy. New York &
London: W.W. Norton & Co., 1997.
• Di Nicola, V. Letters to a Young Therapist: Relational Practices for the Coming
Community. New York & Dresden: Atropos Press, 2011.

62. References
• Di Nicola, V. “Take your time: Seven pillars of a slow thought manifesto.” Aeon
(online magazine). February 27, 2018. https://aeon.co/essays/take-your-time-
the-seven-pillars-of-a-slow-thought-manifesto.
• Di Nicola, V. Two trauma communities: A philosophical archaeology of cultural
and clinical trauma theories. In: PT Capretto & E Boynton (Eds), Trauma and
Transcendence: Limits in Theory and Prospects in Thinking. New York: Fordham
University Press, 2018, pp. 17-52.
• Di Nicola, V. The gurū-chelā relationship revisited: The contemporary relevance of
the work of Indian psychiatrist Jaswant Singh Neki. World Social Psychiatry
2022;4:182-6.

63. References
• Freud, S. The Interpretation of Dreams. 1900. Available at:
https://en.wikisource.org/wiki/The_Interpretation_of_Dreams
• Ginzburg, N. Family Sayings. New York: Arcade Publishing. 1963.
• Glück, L. Meadowlands. New York: The Ecco Press, 1996.
• James, W. Principles of Psychology. New York: Henry Holt, 1890.
• Minuchin, S. Families and Family Therapy. Cambridge, MA: Harvard U Press, 1974.
• Mollica, R.F. Healing Invisible Wounds: Paths to Hope and Recovery in a Violent
World. New York: Harcourt International, 2006.

64. References
• Nussbaum, M.C. PhilosophicalInterventions: 1986-2011.Oxford: Oxford
University Press, 2011.
• Selvini Palazzoli, M., Boscolo, L., Cecchin, G. & Prata, G. Paradox and
Counterparadox:A New Model in the Therapy of the Family in
Schizophrenic Transaction. New York: Jason Aronson, 1978.
• Szilard, L. The Voiceof the Dolphins & Other Stories. Stanford, CA: Stanford
University Press, 1992.
• Winnicott, D.W. Playing and Reality. London: Tavistock,1971.
• Wittgenstein,L. Culture and Value. Oxford: Basil Blackwell, 1980.