informal eval enhances PSA

Enhancing productive self-awareness can also be done in the therapeutic hour. Patients often divulge distressing circumstances in the first few sessions, such as feelings of loss, regrettable behavior, or betrayal. In the telling of these stories, emotions will rise to the surface, sometimes causing visible distress, such as crying, physical tension, or dissociative behavior. The psychotherapist will observe this and ask the patient, “What do you notice about what you’re feeling right now?”, helping the patient reflect and reconnect with the physiological experience. Moreover, it’s important to note what thoughts and images surface along with the emotion. The therapist may ask, “What else can you say about this tightness in your chest?”

This is the very beginning of the therapeutic process, and it’s recommended that the therapist refrain from interpreting or analyzing the patient’s presentation. Instead, the patient is encouraged to continue monitoring their subjective experience in this fashion with the therapist’s guidance and eventually without.

The therapist is also taking copious notes about what the patient presents during this stage of the process, and it will be of tremendous value later for reference and verification as patterns emerge. For instance, Cain’s minimal eye contact, constricted affect, and limited range in dialogue are patterns that may change naturally over the course of therapy, or in direct response to the therapist pointing them out. Sometimes the therapist will intentionally share an observation to bolster the patient’s productive self-awareness.  

Productive self-awareness is the capacity to notice and reflect upon one’s internal states and behavior, consider the perspectives of others and the consequences of possible responses, and use that awareness to guide intentional behavior. When it is fully developed, Cain becomes self-reflectively objective as his perceptions rise to the surface in dialogue. This will give him more freedom and control of self-expression. In short, a more flexible personality will allow him to adapt to an ever-changing and tragic world while maintaining the emotional stability required to navigate life’s challenges and transitions successfully.

This phase of psychological development, the flowering of productive self-awareness, will occur much later in the process, the maintenance of which will take a lifetime. The work is never done, and now for Cain, given that he’s been effectively oriented to the therapeutic process, the work has just begun.