TAKE YOUR TIME: Seven Lessons for Young Therapists Vincenzo Di Nicola 1. In these seven lessons for young therapists, based on practising clinical psychology, child psychiatry and psychotherapy for almost 50 years, I will survey what therapy is about and how it works, from behaviour therapy and family therapy to psychodynamic psychotherapy 2. These lessons integrate my work in psychiatry and psychotherapy with my Slow Thought Manifesto and my call for Slow Therapy 3. With these seven lessons for young therapists in this technocratic time of pressure and speed, I commend young therapists – eager to embrace change and to make a difference – to “Take your time” 4. By opening a space for reflection by every party in the therapeutic encounter, the possibility of an event – something surprising, unpredictable and new – may emerge DOI: 10.13140/RG.2.2.32747.55841

1. Take Your Time:
Seven Lessons for Young Therapists
Professor Vincenzo Di Nicola
Northwest Ohio Psychological Association (NOPA)
Toledo, Ohio – March 15, 2024

2. Professor Vincenzo Di Nicola
MPhil, MD, DipPsych, FRCPC, PhD, FCAHS, DLFAPA, DFCPA
Tenured Full Professor of Psychiatry & Addiction Medicine, University of Montreal
Clinical Professor of Psychiatry & Behavioral Sciences, George Washington University
President, World Association of Social Psychiatry
Email: vincenzodinicola@gmail.com

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

6. Introduction: “Take your time”
• With these seven lessons for young therapists in this technocratic
time of pressure and speed
• I commend young therapists – eager to embrace change and to
make a difference – to “Take your time”
• By opening a space for reflection by every party in the
therapeutic encounter, the possibility of an event – something
surprising, unpredictable and new – may emerge

7. These lessons integrate
my work in psychiatry and
psychotherapy with my
Slow Thought Manifestoand
my call for Slow Therapy

8. Introduction
• A Stranger in the Family: Families, Culture, and Therapy (1997)
• Letters to a Young Therapist (2011)
• Two trauma communities (2018)
• Slow Thought: A Manifesto (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)

18. Donald Winnicott
(1896-1971)
Working with children, Winnicott
coined the terms:
• The “holding environment”
• The “good-enough mother”
• The “transitional object”

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

20. 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

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

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

24. 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 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)

25. The trigenerational
family
•Attachment
•Belonging
•Identity

26. Families
• Mara Selvini Palazzoli (1916-1999)
• Milan Team: Systemic Family Therapy
• “Family therapy is the starting point for
the study of ever wider social units.”
—Mara Selvini Palazzoli (1974)

27. 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”

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

29. Systems theory
deconstructed Freud

30. 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

31. 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

32. Pause

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

35. 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)

36. 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”

37. 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)

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

39. One hundred years of invisibility
The evolution of therapy
From the 19th c discovery of the unconscious
to the 21st c values of diversity, decolonization and
change
And yet, people remain invisible – especially the most
vulnerable – children, women, and minorities

40. Making visible what was invisible
• Freud said that psychoanalysisaims to make the unconscious
conscious
• The story of therapy is the story of making visible what was
invisible
“Poetry must drag further into the clear nakedness of light
even more of the hidden causes than Freud could realize.”
—Dylan Thomas

42. Freud deconstructed
The story of therapy is also the story of
revising and revisioning Freud
• from radical critiques (Behaviour therapy,
Cognitive therapy)
• to adaptations (Child therapy, Brief
therapy)
• to new applications (Trauma-informed
therapy – Di Nicola, 2018; Mollica, 2006)
• to expansions (Couple, family, group, and
community therapy – Barreto, et al., 2020)
• and revisions (Interpersonal and
Narrative “turns”)

43. Isolation
vs.
connection

44. 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)

45. Loneliness vs. belonging
• We not only want to be noticed in society,
but we suffer in isolation
• Loneliness is a major issue that contributes to mental
and relational suffering
• And we share a need for belonging

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

47. 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”
Reference: Bateson, G. Steps to an Ecology of Mind (1972)

48. 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.

49. 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)

51. 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)

52. Face-to-face encounter
• Psychotherapy is a face-to-face encounter with others
• Response and responsibility begin with that encounter
• Emmanuel Levinas – “Philosophy is first ethics”
• Healing – caring - holding in psychotherapy are founded on
the ethics of face-to-face
Reference: Levinas, E. Entre Nous: Thinking-of-the-Other (1998)

53. 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.

54. Rethinking Maslow’s hierarchy of needs
The people need poetry like they need bread.
—Osip Mandelstam (1891-1938)
• Russian poet writing in the Soviet Gulag
• Viktor Frankl survived the Holocaust, wrote
about “Man’s search for meaning”
Reference: Frankl, V. Man’s Search for Meaning (1946/2006)

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

56. 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

57. 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)

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

59. 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)

60. Pause

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

62. 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

63. 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”

64. Seven Lessons: Summary
1. People don’t want to change (resistance, homeostasis)
2. Different therapeutic temperaments see different tasks,
seek different ways of doing therapy
3. Families are unique cultures that require a relational
approach – 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

65. Questions
&
Comments

66. And don’t
forget
to
play

67. Acknowledgements
I would like to express my gratitude to:
•The Northwest Ohio Psychological Association
•Audrey Smith Ellenwood, PhD (Sylvania, Ohio)
•John Farnsworth, PhD (New Zealand)

68. References
• Adonis. Sufism and Surrealism (trans. J. Cumberbatch). 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.
• Barreto, A.P., Filha, M.O., Silva, M.Z., & Di Nicola, V. Integrative Community
Therapy in the time of the new coronavirus pandemic in Brazil and Latin America.
World Social Psychiatry, 2020, 2(2): 103-5.
• 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.

69. 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: P.T. 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 psychiatristJaswantSingh Neki. World Social Psychiatry 2022;4:182-6.
• Frankl, V. Man’s Search for Meaning. An Introduction to Logotherapy (trans. I. Lasch). Boston:
Beacon Press, 1946/2006.
• Freud, S. The Interpretationof Dreams. 1900. Available at:
https://en.wikisource.org/wiki/The_Interpretation_of_Dreams

70. References
• Freud, S. Remembering, repeating and working-through (1914). Standard Edition:
12 (trans. J. Strachey). London: The Hogarth Press, 1955, pp. 147-156.
• Ginzburg, N. Family Sayings (trans. DM Low). New York: Arcade Publishing, 1963.
• James, W. Principles of Psychology. New York: Henry Holt, 1890.
• Levinas, E. Entre Nous: Thinking-of-the-Other (trans. M.B. Smith, B. Harshav).
Chicago: University of Chicago Press, 1998.
• Minuchin, S. Families and Family Therapy. Cambridge, MA: Harvard University
Press, 1974.
• Mollica, R.F. Healing Invisible Wounds: Paths to Hope and Recovery in a Violent
World. New York: Harcourt International, 2006.

71. References
• Nussbaum, M.C. Philosophical Interventions: 1986-2011. Oxford: Oxford
University Press, 2011.
• Selvini Palazzoli, M. Self-Starvation–From the Intrapsychic to the Transpersonal
Approach to Anorexia Nervsoa (trans. A. Pomerans). London: Chaucer, 1974.
• Selvini Palazzoli, M., Boscolo, L., Cecchin, G., & Prata, G. Paradox and
Counterparadox: A New Model in the Therapy of the Family in Schizophrenic
Transaction (trans. E.V. Burt). New York: Jason Aronson, 1978.
• Szilard, L. The Ten Commandmentsof Leo Szilard. In: The Voice of the Dolphins &
Other Stories. Stanford, CA: Stanford University Press, 1992.
• Winnicott, D.W. Playing and Reality. London: Tavistock, 1971.
• Wittgenstein, L. Culture and Value (trans. P. Winch). Oxford: Basil Blackwell, 1980.