"Take Your Time: Seven Lessons for Young Psychiatrists" Vincenzo Di Nicola Inaugural Lecture 2023 Psychotherapy Special Interest Group Department of Psychiatry & Behavioral Medicine College of Medicine & Philippine General Hospital  University of the Philippines Manila 28 July 2023 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. 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 4. Therapy opens new vistas of life in a holding environment 5. Therapy makes visible the invisible – as social animals, we thrive in social contexts, suffer in isolation – Independence is a myth! 6. People seek meaningful lives 7. Slow Therapy respects the flow & rhythms of life, takes time to integrate change, and knows when to stop This address 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 his more recent work on trauma in Trauma and Transcendence (Capretto & Boynton, eds., 2018), and “Take Your Time,” his Slow thought manifesto (2019).

1. TAKE YOUR TIME
Seven Lessons for Young Psychiatrists
Professor Vincenzo Di Nicola
Department of Psychiatry & Behavioral Medicine
College of Medicine & Philippine General Hospital
University of the Philippines Manila

2. Professor Vincenzo Di Nicola
MPhil, MD, DipPsych, FRCPC, PhD, FCAHS, DLFAPA, DFCPA
Full Professor of Psychiatry, University of Montreal
President, World Association of Social Psychiatry
Email: vincenzodinicola@gmail.com

3. 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

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

5. 1997 2011 2021

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

7. People come into therapy not to change
•Psychoanalysis calls this resistance or a flight into health
•Systems theory – the basis of Systemic Family Therapy –
calls this homeostasis

8. What is the task of therapy?
Freud wrote that the task of psychoanalysis is
to make the unconscious conscious
(working through resistance)

9. 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
Reference: Di Nicola, V. A Stranger in the Family (1997)

10. What is the task of therapy?
This exploration of predicaments is done in therapy
when it is not possible elsewhere
or otherwise
Reference: Di Nicola, V. A Stranger in the Family (1997)

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

13. Donald Winnicott (1896-1971)
Working with young children,
Winnicott coined the term:
•The “holding environment”

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

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

16. Therapeutic Temperaments
• Phenomenological temperament
Understanding – What? Why?
• Technocratic temperament
Intervention – How?
References: Di Nicola, V. A Stranger in the Family (1997)
Barrett, W. The Illusion of Technique (1979)
Postman, N. Technopoly (1993)

17. Know all the theories.
Master all the techniques.
But as you touch a human
soul be just a human soul.
– Carl Jung

18. A bridge between understanding and
intervention

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

20. 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)

21. 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)

22. Families
• Salvador Minuchin (1921-2017)
• Articulated a coherent approach –
Structural Family Therapy
• Psychoanalysis, he argued, sees
“Man out of context”

23. 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

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

26. 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)

27. How therapy works
•Freud’s psychoanalytic method uses introspection to
arrive at insight
•Yet Freud never used the word “insight”
•Freud (1914) wrote about “working through”
Reference: Freud, S. Remembering, repeating and working-through
(1914). Standard Edition: 12. (1955).

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

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

30. 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

31. 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
“Poetry must drag further into the clear nakedness of light
even more of the hidden causes than Freud could realize.”
—Dylan Thomas

32. The myth of independence

33. 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”)

34. 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, Principles of Psychology (1890)

35. 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

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

37. 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)

38. 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)

39. The fox’s lesson: Relational ethics
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)

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

41. 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 Social
Psychiatry, 2022;4:182-6.

42. 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)

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

44. 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

45. 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, “The Ten Commandments” (1992)

46. “Take your time”
Question: “How does one philosopher address another?”
Answer: “Take your time.”
—Ludwig Wittgenstein, Culture and Value (1980)

47. 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)

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

49. 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

50. 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”

51. 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
4. Therapy opens new vistas of life in a holding environment
5. Therapy makes visible the invisible – as social animals, we thrive in
social contexts, suffer in isolation – Independence is a myth!
6. People seek meaningful lives
7. Slow Therapy respects the flow & rhythms of life, takes time to
integrate change, and knows when to stop

52. And
don’t
forget
to
play

53. Acknowledgements
I would like to express my gratitude to:
• Dept. of Psychiatry & Behavioral Medicine, College of Medicine,
University of The Philippines
• Prof. Evangelina B. dela Fuente, Chair
• Dr. Victoria Patricia C. de la Llana
• Dr. Constantine D. Della
• Dr. Justin Conrad Brana, Chief Resident
• Dr. Lia Palma, Resident
• John Farnsworth, PhD (New Zealand)
• World Federation for Psychotherapy

54. 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.
• Barrett, W. The Illusion of Technique: A Search for Meaning in a Technological
Civilization. Garden City, NY: Anchor Books, 1979.
• Bateson, G. Steps to an Ecology of the Mind. New York: Ballantine Books, 1972.

55. References
• 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.
• 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 psychiatrist Jaswant Singh Neki. World Social Psychiatry 2022;4:182-6.

56. References
• Frankl, V. Man’s Search for Meaning. An Introduction to Logotherapy (trans. I.
Lasch). Boston: Beacon Press, 1946/2006.
• Freud, S. The Interpretation of Dreams. 1900. Available at:
https://en.wikisource.org/wiki/The_Interpretation_of_Dreams
• 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.

57. References
• 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.
• Nussbaum, M.C. Philosophical Interventions: 1986-2011. Oxford:
Oxford University Press, 2011.
• Postman, N. Technopoly: The Surrender of Culture to Technology. New
York: Vintage Books, 1993.

58. References
• 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 Commandments of 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.