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Gaining a Second Impression in Psychotherapy: Pivoting Toward a More Accurate Understanding of the Patient
James P. Gustafson
Routledge / Softcover / Feb 2020
9780367281250 (ISBN-10: 0367281252)
reg price: $54.95 our price: $ 52.20 (may be subject to change)
184 pages
Not in Stock, usually ships in 7-10 business days

Integrating psychotherapy with psychoanalysis and philosophy, this text offers therapists a way to reframe a client’s understanding of their mental health issues through a holistic, dynamic lens.

Drawing from theory, research and over fifty years of clinical practice, Dr. Gustafson analyzes a unique range of case stories from diverse clients with varying problems including trauma, anxiety, depression, stress and relationship conflict. This book pictures five different domains that make huge differences in the quality of psychotherapy. Part I offers a snapshot of what is possible for the patient during the initial patient study. Part II shows how the patient’s expectations can be subverted. Part III draws upon subconscious elements, mainly dreams, that can provide the patient with unique perspectives that the conscious mind is not capable of. In Part IV, the author looks at how the evolution of human emotions and relationships can have a negative impact on the individual patient. Part V examines the impact that large-scale issues such as religion and faith can have upon our daily lives.

The author weaves together philosophical theory, psychoanalytic techniques and psychodynamic psychotherapeutic strategies, to provide clinicians and therapists with an innovative approach to healing their clients.


"Ranging across fields, one of a kind, Gustafson seems to have invented himself. Intuitive, lightning quick, swimming in the flow of the unconscious, he drops an interpretation into a supersaturated brew, and what will crystalize awaits us. Collaborative, humane, he listens – pivots – and self-corrects his canny/uncanny flashes by literally sleeping on it, dreaming his way into recrystallizing awareness. This dreamy book is terse and telegraphic, perhaps edgy, but always creative and evocative."

Alfred Margulies, MD, author of The Empathic Imagination; Harvard Medical School

"In a style that is both erudite and conversational Gustafson illuminates the power of the unconscious and its manifestation through dreams. Interweaving brief narratives of his patients with their dreams and his own, the depth of his wisdom and professional experience as well as breath of scholarship and candid self-disclosure result in a rich read. It is a very impressive contribution to our understanding of the unconscious and the role of dreams to guide our patients and to inspire us with its dimensions of beauty, creativity and ultimately the sacred."

Jonathan D. Smith, LLb, CQSW, UKCP registered. Clinical Service Lead for Staff Counselling & Well-being, South London & Maudsley NHS Trust

"Gustafson shows us how each patient arrives at the office, stuck in a critical dilemma, i.e. , to stay with a controlling husband or not, then what? He describes frequently brief treatments, in which he often follows the patient's dreams, and his own dreams, in reaction, to develop a 'second impression' of the issue, deeper than the manifest content of the initial request. This new information is often in a pictorial dream form and not in a verbal linear one, direct communications from the unconscious. Dr Gustafson shows how the treatments framed by W. Reich, H.S Sullivan and D.W. Winnicott pivot on a similar construction of the 'second impression.' Gustafson is a brilliant scholar of psychotherapy's historical sweep. This volume represents a true second impression of the world we thought we knew so well and is a crucial addition to any therapists outlook."

Jim Donovan PhD., Associate Professor of Population Medicine (Part Time), Harvard Medical School

"I love reading Gustafson! He is highly intelligent, literary, and I always come away with new perspectives and interesting ideas. The Importance of Second Impressions in Psychotherapy offers the advantage of ways to anticipate and handle conflicts and dilemmas. As carpenters say, 'measure twice, cut once.' Highly recommended!"

--Michael F. Hoyt, Ph.D., author/editor of Brief Therapy and Beyond: Therapist Stories of Inspiration, Passion, and Renewal; Single-Session Therapy by Walk-In or Appointment; and Creative Therapy in Challenging Situations: Unusual Interventions to Help Clients

Table of Contents

Part 1. Focus; 1. What Is Possible And What Is Not Possible; 2. Forces In Shadow; 3. Dilemmas; Part 2. Reversals; 4. Life Lies; 5. Will Trying To Do The Work Of The Imagination; 6. Double Takes; Part 3. Dreams and Myths As Second Impression; 7. The Pivot Of The Night Painting As Second Impression; 8. A Step From Walking Off A Cliff; 9. Imagining What Has Not Been Imagined; Part 4. The Evolution Of The Species In Everyday Life; 10. How Our Species Came To Love Acceleration In Jumps; 11. Dangerous Intersections Of Evolution In Everyday Life; 12. Brakes Are Necessary If You Are To See The Whole Situation; Part 5. The Great World In Everyday Life; 13. The Immense Realm Of The False; 14. Noble Playing Fields; 15. Religious Deliverance: Light And Dark

About the Author

James Gustafson is a Professor of Psychiatry at the University of Wisconsin and the author of thirteen books on psychotherapy, including Very Brief Psychotherapy, The Complex Secret of Brief Psychotherapy and The Dilemmas of Brief Psychotherapy. He is a graduate of Harvard College with AB and of Harvard Medical School with MD.

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