Sean Friedman

Psychodynamic and Behavioural Psychologist

Therapy and Assessment
Online | Sea Point Cape Town

I am a psychologist in private practice with special interests in the assessment and treatment of adult ADHD, anxiety disorders (OCD, Panic, Social), and complex trauma.In addition, I work considerably with health anxiety, depression (acute and chronic), and borderline states (especially dissociation, emotional dysregulation, overwhelm, shame states, and impacted self-esteem).I have been trained both psychodynamically and behaviourally, meaning that I draw on the rich and in-depth understanding of a person's internal dynamics along with utilising evidence-based, pragmatic, skill building approaches from DBT, ACT, and mindfulness orientated CBT as appropriate.My research focused on the effects of trauma, especially repeated childhood trauma, how it changes us, and how we can learn to live with and grow with these effects.I offer both longer-term dynamic work, and more outcome focussed shorter-term intervention.

I trained as a psychologist at the the University of the Witwatersrand in Johannesburg which is renowned for it's psychodynamic contributions in the field of trauma treatment, while my specific program had an integrative focus including supervised training in CBT, DBT, and the narrative therapeutic approach.

Trauma Specific Training

My internship in Trauma counselling consisted of a 720 hour supervised practice working with refugees, migrants, and those affected by extreme violence and torture via the Trauma Centre in Cape Town in 2014. Soon after, I joined Lifeline (Western Cape) and was invited to train new counsellors in counselling skills from 2014 - 2016.During my postgraduate training, I focussed on complex-trauma (cPTSD) and the effects that it tends to engender. For my research, I investigated factors that contribute to resilience and post-traumatic growth among migrant children who had faced extreme circumstance and violence, and yet were able to cope and later thrive.

Clinical Training and Supervision

I chose the postgraduate training program at the University of the Witwatersrand for its skeptical and critical approach to pathology: while training was comprehensive, it maintained a careful consideration of philosophical issues with diagnosis, and a recognition of the contextual and systemic factors that influence our lives. In addition, as an integrative program it included in-depth training and supervision in both long term psychodynamic and short term ('evidence-based') approaches including Solution Focused Brief Therapy (SFBT), Brief Dynamic Therapy, Dialectical Behavioural Therapy (DBT), Cognitive Behavioural Therapy (CBT), and Narrative Therapy.My clinical placements were varied. In my first year, I worked under supervision in in-depth psychodynamic psychotherapy. I was also trained at this time in a variety of intellectual, personality, and pathology assessments.In my second year, my internship consisted of at least 1600 hours in the assessment and treatment of patients with brief therapy for acute disorders (primarily anxiety, mood, and dissociative). I worked considerably with OCD, depression, and panic disorder, and in the area of psychoeducational assessment (particularly career assessment, ADHD and Dyslexia).

Qualifications | Registrations

Masters in Community & Counselling Psychology. WITS. Cum Laude
Psychology, Honours. UNISA. Cum Laude
Postgraduate Certificate of Education. UNISA. Cum Laude
Psychology & Sociology. UCT.Independent Practice Counselling Psychologist
Health Professionals Council of South Africa (HPCSA)Cape Town Society of Psychoanalytic Psychotherapy.
Association for Contextual Behavioural Therapy.

Competency and Scope of Practice

I am trained to diagnose, assess, and treat across the range of mental health disorders as well as difficulties and problems that are subclinical. My professional interest however extends beyond the treatment of pathology and my training was orientated to possibilities of living fully with the range of feelings and challenges that are inevitable aspects of life.I work across existential and pragmatic issues with both chronic and acute forms of anxiety, depression, and trauma sequela.Although I do work with transient psychotic and other states, I work best with people who are generally able to function without frequent periods of hospitalisation.Similarly, disabling forms of schizophrenia, life-threatening eating disorders, and severe and dangerous addictions are best addressed by professionals in collaboration who specialise in these areas.

Approach

Therapeutically, I work collaboratively and contextually, meaning I understanding the therapeutic relationship to be co-constructed between us, and together we will explore and consider issues of importance, as well as the contexts that support or worsen them.My training in critical, psychodynamic, and behavioural models has given me some useful 'maps' in understanding problems in context of their histories, as well as how to realistically affect change. While I will bring a number of theoretical understandings and evidence-based approaches that may be applied, the choices and directions to follow are ultimately at the discretion of the person with whom I am working.Difficulties often manifest differently according to developmental period, gender, and culture. I take care to diagnose carefully given these and other considerations.

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 time of 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 Disorders | Anxiety and Mood Disorders | SituationalDifferential 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 neurological condition with specific effects. How these effects are managed 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.

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 and sexual abuse, neglect, physical and sexual violence, and profound loss and change to reestablish trust with others, and primarily the self.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.Similarly existential concerns, neurological differences (ie ADHD, Autism Spectrum), physiologically dependant disorders (Major Depression, Anxiety and Panic Disorders), or contextual issues in career, relational, or difficult contexts will intertwine and influence one another. I am interested in these different areas and their interactions.

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 and solve these difficulties usually end up making them worse.For example, adrenal stimulation can be experienced negatively (as anxiety) and efforts can be made to reduce or eliminate it. When this happens we start to 'flag' it as dangerous or as a problem to be solved, become more alert to it, and in the process ironically increase it (as adrenaline is then increased in response to perceived danger). At the same time, positive experience of this stimulation (ie as excitement) decreases.In cases where the cycle begins to happen more quickly, it can rapidly increase the sense of danger and produce panic. Once this has happened it is difficulty 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 walking these tricky dynamics back to where 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 new 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. Locally, I invoice accordingly, at R1350.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 may 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 application 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 (among others). 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, positive etc, an increased emphasis on holding and tolerating difficult emotions, and a primary focus on valued and vital living through taking action towards what matters.

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 needed.

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 problems. Sometimes temporary and short-term use will be adequate, for other difficulties chronic medication may be needed.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: Currency Dependant

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S Friedman
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