Promoting Psychological Flexibility by Practicing Flexibly: The Therapist as Model

In this discussion of Dr. Robert Cohen’s (2016) case study of his client Daniel, several integrative shifts over the course of the long-term, psychoanalytic treatment are noted. Initially, a shift from a traditional psychoanalytic model to a relational model was initiated in order to respond to Daniel's lack of responsiveness to a therapy focused on transference interpretation; and later a shift to employing strategies from Acceptance and Commitment Therapy (ACT;  Hayes, Strosahl, & Wilson, 2012) was implemented in order to address ruminative thought patterns and accompanying social inhibition. The therapist describes his own process of exploring options flexibly, allowing the reader a rare view into this clinical decision-making process. The treatment as a whole is conceptualized as fostering both mentalization and mindfulness skills in the context of the secure attachment that an intensive treatment tends to  foster. The possibility that a shift to ACT provided a bridge to a termination process is discussed.