What We’ve Said

What we’ve said about Psychotherapy technique

13 points from 4 episodes, newest first

Also searched as levels of intervention, psychodynamic technique

In short

Technique is central to psychiatry, which was never fundamentally about medications. We organize interventions in levels, with supportive work and empathic mirroring done most and interpretation least, and if you only ever do the first levels well, the patient may heal on their own. Follow the affect, do not take yes for an answer, and remember that therapy does not work by handing out answers.

Why it matters

  1. Psychiatry was fundamentally not about medications, which barely existed for psychiatry until the 1960s. It is about formulation and giving patients explanations that are adaptive.

    “Psychiatry was fundamentally not about medications, which did not really exist for psychiatry until about the 60s. Psychiatry is about formulation and being able to give explanations to the patient that are adaptive”
    2:13Psychodynamic Technique and Therapeutic Intervention: ContainmentApr 2026

The levels of intervention

  1. Picture the levels as a reverse pyramid, with what you do most at the top. That is level zero: the supportive elements, including frame, boundaries, psychoeducation, safety, the alliance and technical containment. Level one is empathic mirroring.

    “picture the levels in a descending pyramid, reverse pyramid, the one that you do the most. This is the top part of your food groups. This is level zero. That's the supportive elements, the alliance, and technical containment”
    0:59Psychodynamic Technique and Therapeutic Intervention: Mirroring, Clarification, Confrontation, InterpretationJun 2026
    Also said in 1 more episode
    “level zero is essentially the supportive aspects of treatment, including frame, boundaries, psychoeducation, safety and technical containment. Level one is empathic mirroring”
    22:25Psychodynamic Technique and Therapeutic Intervention: ContainmentApr 2026

  2. Clarification is any question or move that gets the patient to go into more depth or detail. Even if it redirects the narrative, it does not challenge it.

    “This is basically asking any kinds of questions or doing anything that gets the patient to go into more depth or detail about what they're talking about. But even if it redirects the narrative, it doesn't challenge the narrative”
    10:24Psychodynamic Technique and Therapeutic Intervention: Mirroring, Clarification, Confrontation, InterpretationJun 2026

  3. Interpretation is anything that explicitly links a pattern or a defense to an unconscious process: wishes, desires, conflicts, ways of relating.

    “it's basically anything that explicitly makes a link between a pattern or a defense towards some kind of an unconscious process for the patient. Wishes, desires, conflicts, ways of relating”
    34:09Psychodynamic Technique and Therapeutic Intervention: Mirroring, Clarification, Confrontation, InterpretationJun 2026

  4. In a Rogerian way, if you are just doing levels zero, one and two, your work is done. The patient will heal on their own.

    “I do believe in a Rogerian way that if you're just doing zero, one, two, your work is done. The patient will heal on their own”
    38:55Psychodynamic Technique and Therapeutic Intervention: Mirroring, Clarification, Confrontation, InterpretationJun 2026

How we use it

  1. Follow the affect. Be emotion focused in many ways, not just cognitively but interpersonally in your exam.

    “it's follow the affect. Essentially, you have to be emotion focused in a variety of different ways, not just cognitively, but in your exam interpersonally”
    7:22Psychodynamic Technique and Therapeutic Intervention: ContainmentApr 2026

  2. Technical containment starts with observing what the patient is saying and doing in front of you, what they are not saying and doing, and what an ordinary person might feel talking about the same thing.

    “So step one is you observe and hear what the patient is saying and doing in front of you, and also maybe what they're not saying and doing, or even what ordinary people might be experiencing if they're talking about or thinking about that”
    42:26Psychodynamic Technique and Therapeutic Intervention: ContainmentApr 2026

  3. Don't take yes for an answer. Go beyond the patient's conclusion or affirmation.

    “in the psychotherapy world, I refer to this principle as don't take yes for an answer. Don't take yes for an answer. You got to go beyond the conclusion or affirmation from the patient”
    52:35ADHD Is Not the Only Diagnosis: Differential and Diagnostic HierarchyNov 2025

  4. You can voice your countertransference tentatively. If a patient is conscious only of sadness and you find yourself angry at someone who hurt them: "I get that you're very sad. Is there any anger there? I'm feeling a certain kind of anger."

    “if your patient is conscious only of sadness, and you find yourself angry about somebody that's hurt them, you can say, I get that you're very sad. Is there any anger there? I'm feeling a certain kind of anger”
    1:29:32Nancy McWilliams on Psychoanalytic Diagnoses, Part 2: Depressive Personality, Histrionic Personality, OCPDNov 2024Guest episode

Talking to patients

  1. Teach patients explicitly that emotions, while unpleasant, are not in themselves dangerous.

    “we want to teach patients explicitly that emotions, while they're unpleasant, are not in themselves dangerous”
    8:45Psychodynamic Technique and Therapeutic Intervention: ContainmentApr 2026

Pitfalls

  1. Therapy does not work by giving answers. Hand a patient a diagnosis or formulation, even a 100% accurate one, and it might as well look like black magic to them.

    “a therapy does not work by giving the answers. You give answers to a patient. Right. diagnostically, formulation-wise, even if you're 100% accurate, it might as well look like black magic to the patient”
    26:43Psychodynamic Technique and Therapeutic Intervention: ContainmentApr 2026

Learning it

  1. Review moments in your own interviews. You may notice times you acted outside the treatment frame just because you were curious or afraid of a bad outcome.

    “you may notice times where you are actually acting outside of the treatment frame, that you're just doing something because you were personally curious or that you were afraid of a bad outcome”
    4:43Psychodynamic Technique and Therapeutic Intervention: ContainmentApr 2026

  2. The goal is for technique to become so ordinary to you that you can deploy it at will.

    “the technique should then be so ordinary to you that you can deploy it at will”
    21:47Psychodynamic Technique and Therapeutic Intervention: ContainmentApr 2026

It also comes up on

From these episodes

Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.

Educational content only. Everything here is what was said on the Psychofarm podcast, for clinicians. It is not medical advice and not a substitute for clinical judgment, current labeling or guidelines. An episode reflects what we thought when we recorded it, so check anything before you rely on it.