Sean Friedman

Psychodynamic and Behavioural Psychologist

Therapy and Assessment
Online | Sea Point Cape Town

I am a psychologist in private practice with a special interest in the assessment and treatment of adult ADHD, anxiety disorders (OCD, panic disorder, social anxiety), and complex trauma.In addition, I work extensively with health anxiety, depression (both acute and chronic), and borderline states—particularly dissociation, emotional dysregulation, overwhelm, shame states, and low self-esteem.I have been trained in both psychodynamic and behavioral approaches, as such I work to integrate an understanding of a person's internal dynamics along with evidence-based, pragmatic, skill-building techniques from DBT, ACT, and mindfulness-oriented CBT.My research has focused on the effects of trauma, especially repeated childhood trauma, its impact on psychological development, and how we can learn to live compassionately within sometimes fractured states of being.I offer both medium- and long-term dynamic psychotherapy, as well as more structured, outcome-oriented interventions.

Qualifications | Registrations

Masters in Community & Counselling Psychology. WITS. Cum Laude
Postgraduate Certificate of Education. UNISA. Cum LaudeIndependent Practice Counselling Psychologist
Health Professionals Council of South Africa (HPCSA)
Health Care and Professionals Council UK (HCPC) PendingCape Town Society of Psychoanalytic Psychotherapy.
Association for Contextual Behavioural Therapy.

Clinical Training and Supervision

I chose the postgraduate training program at the University of the Witwatersrand for its critical and skeptical approach to pathology. While the training was comprehensive, it maintained a thoughtful consideration of the philosophical complexities of diagnosis and a strong recognition of the contextual and systemic factors that shape our lives.As an integrative program, it provided in-depth training and supervision in both long-term psychodynamic therapy and short-term, evidence-based approaches, including Solution-Focused Brief Therapy (SFBT), Brief Dynamic Therapy, Dialectical Behaviour Therapy (DBT), Cognitive Behaviour Therapy (CBT), and Narrative Therapy. I specialised in two approaches, namely Acceptance and Commitment Therapy (ACT), a modern form of CBT strongly grounded in research, and Psychoanalytic Psychotherapy which is especially concerned with personality development, attachment, and unconscious processes.During my first year, I received supervised clinical training in psychodynamic psychotherapy, focusing particularly on identity disturbances, depression, and social phobia. I also gained experience in intellectual, personality, and pathology assessments.In my second year, I completed over 1,600 hours of assessment and treatment under supervision, primarily using brief therapy to help patients with acute disorders return to functioning. I worked considerably with OCD, major depression, and panic disorders, while also conducting psychoeducational assessments (e.g., ADHD, dyslexia) and career assessments.

Trauma Specific Training

Before my advanced clinical training, I worked as a counsellor and completed a 720-hour supervised internship in trauma-specific counselling. During this time, I provided therapy to individuals affected by extreme violence and torture at the Trauma Centre in Cape Town in 2014. Shortly after, I joined Lifeline (Western Cape), where I volunteered from 2014 to 2016 and where I was invited to train new counsellors in counselling skills.During my postgraduate training, I focused on complex trauma (cPTSD), its symptoms and effects, and took a special interest in differentiating it from other similar and overlapping difficulties (as seen in BPD, Autism, and ADD/ADHD). For my research, I explored the factors that contributed to resilience and post-traumatic growth in migrant children who had endured extreme circumstances and violence, yet were able to cope and eventually thrive.

Competency and Scope of Practice

I am trained to diagnose, assess, and treat a wide range of mental health disorders, as well as subclinical difficulties and challenges. However, my professional interest extends beyond treating pathology. My training is oriented towards helping individuals live more fully within the range of feelings and challenges that are inevitable aspects of life.I work with both chronic and acute forms of anxiety, depression, and trauma sequela, addressing both existential and pragmatic issues.While I do work with transient psychotic states and other similar conditions, I tend to work best with individuals who are generally able to function without frequent hospitalizations.Similarly, disabling forms of schizophrenia, life-threatening eating disorders, and severe, dangerous addictions are best addressed by professionals who specialize in these areas, often in collaboration with a team.

Approach

Therapeutically, I work in a collaborative and contextual manner, viewing the therapeutic relationship as something co-constructed between us. Together, we will explore and address issues of importance, while also considering the contexts that may support or exacerbate them.My training in critical, psychodynamic, and behavioral models has provided me with useful frameworks to understand problems in the context of their histories, as well as how to contribute to change when appropriate. While I bring a variety of theoretical understandings and evidence-based approaches, the choices and direction of our work ultimately rest with the person I am working with.I recognize that difficulties often manifest differently depending on developmental stage, gender, and culture, and I take care to diagnose carefully, considering these and other relevant factors.

Clinical Modalities

There are a number of therapy approaches, models, and intervention strategies. I am trained in both short and long term models. What is important — and what a psychologist is trained to do — is to carefully understand difficulties and goals in context, and to carefully select treatment approaches that will be likely to work in consideration of a person's history, personality, and situation.Psychodynamic psychotherapy is concerned with an in-depth understanding of the internal 'dynamics' at work in a person: all the conflicting feelings, thoughts, desires, past experiences, and importantly how these interact with one another. Whether using shorter or longer term approaches, this understanding is essential as the same tools or interventions will not work for different people, and in some cases can make things worse. This is recognised by both psychodynamic and behavioural research.Cognitive and behavioural approaches work with thoughts and behaviours directly, providing challenges and skills to teach emotional regulation, planning, solution finding, and other skills as needed to empower a person.Both in-depth and skill based approaches offer utility. The skill of the clinician is in making use of what is needed as is appropriate.I draw on best practices and the research literature in utilising techniques from Dialectical Behavioural Therapy (DBT for dysregulation), Exposure and Response Prevention (ERP for OCD), Behaviour Modification (for ADD/ADHD), and Behavioural Activation (for depression) as well as other evidence-based approaches when indicated for specific difficulties.

The Importance of Accurate Diagnosis

A difficulty (such as trouble concentrating on studies or work) could be due to stress, anxiety, or depression; neurological characteristics (ie ADD / ADHD, or dyslexia); or situational and environmental concerns.An accurate diagnosis can be immensely helpful, while inaccurate diagnosis can lead to misapplied and ineffective treatments.Comprehensive assessments include a thorough history taking of the issue, careful selection of specific tests, scoring, and finally holistic interpretation with practical recommendations. This process takes several weeks from intake to the final report.

Psycho-Educational Assessments

ADHD | Dyslexia | Learning DifficultiesCognitive, academic, and socio-emotional functioning are assessed to determine capacity specific functioning along with eligibility for accommodations, appropriate treatment options, and practical recommendations.

Career Assessments

Interests | Personality | Values | | Strengths | Challenges | Capabilities | NeedsAn holistic personal assessment attuned to opportunities and environment is undertaken to provide recommendations and pathways well suited to the individual.

Diagnostic Assessments

Complex Trauma | Personality | Anxiety & Mood | Situational ConcernsDifferential diagnosis that carefully considers history, symptoms, patterns, personality, and context to make sense of difficulties and recommend appropriate treatment or accommodations .

Assessment and Treatment of Adult ADD / ADHD

Adult ADD / ADHD is a neurodevelopment condition with specific effects. How these effects are managed and compensated for however is highly variable.Gender differences is one such mediator that tends to offset symptoms in predictable ways, and among women this often leads to deviation from 'typical' presentations. Similarly, personality, interests, contexts, supports, means, and prior experiences all influence the way that neurological sensitivities to stimulation manifest.Both over- and under-diagnosis is common, especially in regard to self-report and other checklist measures. Many symptoms are read inappropriately divorced from the context of other difficulties. Thorough assessment needs to take into account multiple sources of information, as well as utilising testing and carefully interpreting actual cognitive performance.I take an interest in the diagnosis of attentional and learning difficulties, and can provide reports when required. However, while the above kind of testing leads to more accurate and definitive diagnosis, it is also more time-consuming and expensive.When treatment timelines are more immediate and a report is not necessary, I can conduct a preliminary diagnosis that is treatment focussed: behavioural modification (learning to make and use effective systems, along with environmental changes) to facilitate focus and attention, along with working in tandem with a psychiatrist to trial medication if indicated.

Differentiating and Treating Complex Trauma (cPTSD)

I am especially interested in the effects of chronic and repeated traumas, and possibilities of growing and healing from these. I work with patients to integrate and make meaning of experiences of childhood abuse and neglect, and repeated physical and/or sexual violence. I work to facilitate the reestablishment of trust with self and others.The effects of chronic and repeated trauma shares and mimics aspects of personality disorders (ie Borderline Personality Disorder) but these are distinct and require different treatments. As such I take a special interest in untangling complex symptoms for accurate diagnosis, and in facilitating appropriate treatment.

Severe Anxiety, Panic, and Paradoxical Problems

Severe Anxiety and Panic are paradoxical problems in that many of the well-meaning, natural, and even apparently common-sense approaches that people take to try to solve these difficulties usually end up making them worse.For example, adrenal stimulation can be experienced negatively (as anxiety), leading to efforts to reduce or eliminate it. When this happens, we start to 'flag' it as dangerous or as a problem to be solved, becoming more alert to it and, ironically, increasing it (as adrenaline is then released in response to perceived danger). At the same time, positive experiences of this stimulation (i.e., as excitement) decrease.In cases where the cycle begins to accelerate, it can rapidly increase the sense of danger and produce panic. Once this has happened, it is difficult and 'sticky' to change, as a strong association between the sensations of stimulation and danger is created.I take an interest in psychoeducation around these and other similar dynamics, along with assisting in the process of reversing these tricky dynamics so that stimulation can be experienced differently and enjoyed as part of a sense of aliveness.

Chronic and Recurring Depression and Lack of Vitality

Chronic and recurring depressions likely have multiple intersecting pathways including genetic and environmental influences. When longstanding, these can greatly affect self-esteem and motivation. 'Good' periods are likely to be experienced with anxiety and anticipation for a coming 'bad' period, and moments of inspiration and excitement can come to be experienced with suspicion and distrust.I take a special interest in helping to cultivate capacities to hold painful experience, and look after oneself in difficult periods, while also clarifying the things that are most important to living a vital and alive life. I take a slower approach grounded in values and experience, to build security and trust in one's sense of self, choices, and capacities for enjoyment.

Masculinities, Gender Dynamics, Identity

Culturally, many changes have produced new possibilities and ways of being, along with uncertainties, confused expectations, and sometimes harshly punishing and unforgiving contexts. While some constrictive double binds have been challenged, others have emerged in new and unacknowledged ways.I take a special interest in helping to acknowledge, voice, and facilitate self-acceptance and understanding, as well as communication — in identity, relationship, sexuality, and subjectivity. I see value in both traditional and newly constructed ways of being and take a non-prescriptive approach to these developments and challenges.

Frequently Asked Questions

What are the Fees & Billing Structure?

My fee is charged per 50 minute session. Typically we would meet once per week for either a contracted period, or on an ongoing basis depending on the presentation, history, and goals. In some cases, we may initially meet more than once per week.Individual Psychotherapy Sessions are charged in line with medical aids rates, usually with a small copayment.I do see a limited number of in-need patients at a reduced rate. If affordability is an issue, for acute difficulties, we can work out an appropriate treatment and payment plan.

Do you accept Medical Insurance & PMB’s?

Yes. There will likely be a copayment depending on your plan. Please check with your provider as to your benefits.Importantly, a number of conditions are recognised as Prescribed Minimum Benefits, or PMB's. These by law, are covered by medical aids including hospital plans. Dependent on the diagnosis, a number of sessions may be covered in full. I will assist with diagnosis and activation for PMB's when indicated.

What are Cognitive and Behavioural Therapies?

There are a number of cognitive and behavioural therapies and models. These approaches work primarily with thoughts and behaviours directly.I have personally resonated with Acceptance and Commitment Therapy which falls under the umbrella of what is often referred to as 'Third Wave CBT', along with Dialectical Behavioural Therapy (DBT), and Mindfulness-Based CBT. There is a strong evidence base for this approach, and as a framework it allows me to flexibly draw on a variety of other CBT techniques as appropriate.The distinguishing features of these 'third-wave' approaches are a reduced emphasis of caring about whether thoughts are rational, logical, positive etc., —and instead an increased emphasis on compassionately holding and tolerating difficult emotions while focussing on and taking action towards what is important.

What is Psychodynamic Psychotherapy?

Psychodynamic or Psychoanalytic Psychotherapy involves an emphasis on the therapeutic relationship, along with developing insight into oneself, self-awareness, self-acceptance, and flexibility in making and owning choices.There is good evidence that the effects from psychodynamic therapy are longer-lasting than short-term interventions or the effects of medication.

What is the Length of Therapy?

This does depend on the presenting concern and your goals.In our initial session, we will determine the appropriateness of therapy for your concern, the treatment options, and their possible lengths before contracting to work together.For acute issues and clear goals, such as depressive episodes, panic attacks, phobic symptoms, adjustment difficulties, or relational concerns, brief therapy (anywhere from 4 to 12 sessions) may be adequate.When difficulties have been long-standing and recurring, when shorter-term therapy has been attempted before (but was unsuccessful), or when there are multiple and complex issues and histories, longer-term supportive psychotherapy is likely to be indicated.When a therapeutic process is chosen for sub-clinical dissatisfactions and 'ordinary' difficulties, is orientated towards self and relational growth, and is aimed at greater resilience and vitality, it may be continued for as long as it is beneficial, and returned to periodically as relevant.

Do you prescribe Medication?

As a psychologist, I do not prescribe medication. However, I do work collaboratively with other professionals that I trust.Medication has been shown to be effective for a number of difficulties. Sometimes temporary and short-term use will be adequate, at other times ongoing use may be helpful.For some conditions, a combination of medication and therapy together may be most effective. Medication may work faster in the alleviation of symptoms, while psychotherapy is more effective at longer-term outcomes and preventing remission.If indicated, this is something that we will discuss as one treatment possibility. I work holistically, and recognise this as one of many changes that can be made including exercise, diet, meaningful work, hobbies, and good functioning relationships. I understand medication to be effective when it enhances these areas.

Contact

Please check my about, services, and FAQ first to get an idea of my approach and the kinds of work that I do.If interested in booking a psychotherapeutic session or assessment, please feel free to WhatsApp me directly and I will get back to you within business hours.

Alternatively, use the below form to make an email enquiry.

WhatsApp Only: +2776 7222 123
Sea Point | Cape Town

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Current Rates: June 2024 - December 2024

Local Patients
Individual Psychotherapy Session: R1350.
Assessments Please EnquireInternational Patients
Online Psychotherapy Session: Location Dependant
UK £85 Until HCPC Registration Confirmed. (The wheels move slow, expect increase from May 2025).

Please make use of the following EFT details, with your Full Name as Reference.

S Friedman
Discovery Bank
Savings Acc.
Account Number: 18685487819
Branch Code: 679000
BIC/SWIFT: DISCZAJJXXX

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