by Jerald Grobman, M.D.

Psychotherapy

Psychotherapy is a term originally meant to describe a method, closely related to psychoanalysis, for the treatment of patients with various forms of psychological illness. Today, the term has evolved to describe any method used by specifically trained therapists who use the relationship with their patients (sometimes referred as clients) and various techniques of verbal and nonverbal communication. Its purpose is to eliminate, change, or suppress psychological processes that interfere with psychological and personality development. Techniques may involve a combination of confrontation, clarification, interpretation, insight, advice, support, encouragement, guidance, and reassurance, as well as strategies for cognitive and behavioral modification.

There are no research studies that suggest standardized procedures or uniform approaches for the psychological treatment of gifted individuals. Nevertheless, clinicians are often faced with the need to help gifted individuals in psychological distress. A review of the limited psychotherapy literature may provide some useful insights.

A range of approaches is described. Cognitive and behavioral methods address conscious aspects of psychological difficulties. Psychoanalytic and psychodynamic methods address unconscious factors. One eclectic approach describes how both approaches are combined.

The literature includes a case report of the psychoanalysis of a young, gifted girl; clinical excerpts from the psychoanalysis of adolescents; a case report of the psychotherapy of a young boy. Other authors give general descriptions of the issues for both patient (or client) and therapist as they arise in psychotherapy. A recent unpublished manuscript gives a detailed description for how a traditional psychodynamic psychotherapeutic approach can be modified when treating exceptionally gifted adolescents and adults. The report also describes how their psychotherapy unfolded in predictable stages.

The Psychoanalysis of Gifted Children

Kerry Kelly’s report is of the successful psychoanalytic treatment of a 4-1/2–year-old precocious child. Functioning at 2–3 years beyond her chronological age in many areas, she developed sleep difficulties, refused to read or write, and began to wet herself day and night. Her parents were psychologically deeply disturbed individuals unable to gratify each other in their marriage. Instead, focused on their daughter, they got great pleasure from her precocious accomplishments but were unable to nurture her more age-appropriate childish needs. The child’s own self-criticism and high expectations caused feelings of intense inadequacy and poor self-esteem.

The clinical material is divided into four phases: oral, anal, phallic, and terminal. It provides an excellent example of how psychodynamic/ psychoanalytic play psychotherapy works. In the sessions, the child acted out her unconsciously repressed wishes and conflicts and was allowed an opportunity to express her emotions freely. The patient used the therapist to act out different versions of important relationships while the therapist, at times, interpreted different levels of the unconscious meaning of these relationships as well as gratified some of the patient’s basic needs. In this process, the patient found healthier solutions to painful conflicts—no longer needing symptoms to express herself. Of particular interest is a discussion of how psychoanalysis helped this young patient express her childish needs while simultaneously retaining her precocious level of functioning.

Psychotherapy of Children

William Dahlberg’s case report is of the successful treatment of a profoundly gifted 9-year-old boy who entered psychotherapy because he had become suicidal and homicidal. Dahlberg’s approach is a flexible one: Both parents, the patient, and his sister were treated individually. The parents were also seen as a couple.

The issues addressed in the psychotherapy were as follows:

  • Parental misunderstanding of giftedness
  • The patient’s social isolation caused by

a. Peer rejection
b. An idiosyncratic, precocious intellect that permitted secretive, spiritual, and magical thinking
c. An inadequate educational setting
d. The parentification of the patient and his sister

The goals of the psychotherapy were to help the patient engage in age-appropriate social tasks and to find an appropriate setting for the full expression of his remarkable gifts.

The length of the psychotherapy, although not exactly specified, appears to have been relatively short term. Rather than terminate the psychotheapy, Dahlberg made himself available in an open-ended way so that all members of the family could and did request periodic consultations.

Psychoanalysis of Gifted Adolescents

Calvin Colarusso’s case report is of the successful psychoanalysis of a twice-exceptional (gifted/learning disabled) 13-year-old boy. Clinical vignettes of major themes and conflicts are provided: The identification with a defective uncle, an oedipal conflict with the father, and learning as a homosexual submission because of passive identification with the father.

The patient was helped to explore the different levels of meaning of each of these conflicts and helped to express unconsciously repressed affects that accompanied each of these conflicts. Special mention is made of how frequently his underachievement and learning disabilities were used as unconscious mechanisms to express aggression toward his parents.

Leo S. Loomie, Victor H. Rosen, and Martin H. Stein’s report on the Adolescent Gifted Project is perhaps the first report of a group examination of the creative process using full psychoanalytic clinical material. In what was described as a “clinical research project,” a group of experienced analysts, led by Ernst Kris, met monthly to discuss the psychoanalytic treatment of “young people with creative gifts.” Strict adherence to psychoanalytic principles was maintained for treatment parameters. Although labeled as “adolescent” gifted, the ages of patients ranged from 9 years to 36 years. They included a gifted sculptor, a writer, a painter, a composer, two mathematicians, a choreographer, and a dancer. The child had many musical, graphic, and literary talents.

The techniques of psychoanalysis were not described. The substance of the report concerns general observations that evolved from each patient’s treatment:

  • The nature of their unconscious conflicts;
  • The special difficulties facing the analyst in attempting to understand highly specialized subjects;
  • The process of sublimation in each of these patients did not involve complete repression of their instinctual material. At times, these gifted patients had easy access to it and this duality of partial repression and ready availability infused their creative work with remarkable vitality.

Psychotherapy of Gifted Adolescents and Adults

Diedra Lovecky describes five traits of giftedness that she encountered in her psychotherapy practice with gifted adults: divergent thinking, excitability, sensitivity, perceptiveness, and entelechy (the need for self-determination).

Her therapeutic work takes place in the cognitive, behavioral, and experiential realms. Cognitively, she helps clients learn strategies for working with these traits so they can be used more effectively. She helps them determine if and how to compromise in order to be effective in work and social situations.

Awareness of one’s own limits and the limits of others is the key to higher levels of social connectedness and thus higher levels of self-esteem because isolation can be avoided.

Lovecky also describes certain difficulties that arise in the therapeutic process: Clients often have difficulty trusting the therapist and present ongoing challenges to therapeutic authority, expertise, and the basic premises of psychotherapy. Struggles also occur with the therapist when his or her empathy is perceived to have failed. She suggests setting short-term goals with clients when appropriate to avoid impatience with the therapy process.

Experientially, she suggests the use of shared intuition in the therapeutic process to help clients feel deeply appreciated for their special gifted traits.

Last, she describes psychotherapeutic work with gifted clients as an opportunity for the therapists to grow professionally as they develop new therapeutic techniques in working with these clients.

Jerome Oremland describes the successful psychoanalysis of a 20-year-old trombonist and composer. Only passing mention is made of Oremland’s analytic techniques. Details are provided about how this man’s talent as an instrumentalist and composer became enmeshed in conflicts about his biologically delayed adolescence and his deeply dysfunctional parents. Oremland discusses the specific conflicts that emerged in the different phases of this young man’s treatment:

  • His guilt when he discovered that he was more powerful than his alcoholic father.
  • His disappointment when he realized that his mother cared more about his talent than about nurturing him.
  • His continual struggle to limit his abilities so as to control his anger at his parents.
  • His self-punishing behavior: He would permit his talent to gain him only admiration, but not intimacy.

As his delayed adolescence finally unfolded, he discovered that his talent also included an exceptional ability to compose. As a result, his self- esteem improved, which allowed him to develop intimate relationships.

Mary Elaine Jacobsen discusses how gifted adults can achieve what she describes as a “corrected personal history” by identifying as gifted, personality traits that were thought to be liabilities. She offers two case illustrations: A middle-aged man who achieved enormous success but felt increasingly empty and a professional woman whose extreme sensitivity and empathy for others’ pain left her feeling depleted.

For Jacobsen, the psychotherapy process begins when the therapist examines patients’ histories for gifted traits and unusual areas of interest and curiosity. In this early stage, the therapist may need to be intuitive, as adults rarely identify themselves as gifted. She also urges caution in this identification process so that client’s chief complaints can be addressed first and to give clients an opportunity to work through negative connotations of giftedness. In addition, the client must be allowed to not explore giftedness even though it has been identified.

The working-through process requires a respect for the client’s defenses. Appropriate but camouflaged stories of other clients can facilitate this process. Inquiring about unfulfilled purposes or dreams may enhance the therapeutic relationship. Jacobsen suggests a number of other psychotherapeutic tasks:

Follow a client’s interests even though they may be complex or abstract.

  • Be active.
  • Avoid competing with the client.
  • Be transparent about your own giftedness.
  • Respect idiosyncrasies.
  • Do not represent social norms.
  • Confront self-destructive behavior.
  • Give advice about enhancing energy, creativity, and self-realization.

Jacobsen also alerts therapists to expect a wide range of positive and negative feelings of their own, such as exhilaration, hurt, rejection, envy, and intimacy.

The most recent articles are by Jerald Grobman. His first report is about the psychodynamic psychotherapy of 15 adolescents—exceptionally gifted in arts, music, dance, writing, and science—who became underachievers primarily because of unresolved conflicts about their “inner experience of giftedness” rather than because of conflicts about school, work, peers, and family.

In each of his cases the psychotherapy unfolded in predictable ways. Once their presenting crisis was resolved and more practical concerns about school, peers, work, and family were successfully addressed, these patients began to accept that emotional conflict was a universal aspect of all growth and development. They also realized that having ambivalent feelings did not mean that they were weak or defective. These insights prepared them for deeper explorations about all the unconsciously conflicted aspects of their gifted endowment: their special sensitivities, sensibilities, the power of their curiosity and inner drive for mastery; their conviction about a grand vision and personal destiny to make valuable contributions as well as a feeling that they had become charismatic.

As these conflicts became conscious, open and frank discussion about them helped his gifted patients find more mature methods of conflict resolution, minimize underachievement, and integrate their giftedness with the other parts of their personality.

In an unpublished manuscript, Grobman presents an eclectic form of psychotherapy for exceptionally gifted individuals. His approach modifies traditional psychodynamic psychotherapy to include cognitive/behavioral techniques as well as “psychologically informed” mentoring, coaching, and advising. He discusses the issues that arise for patients in each stage of their psychotherapy and the corresponding challenges for therapists.

Crisis Intervention

In this stage an active, take-charge approach is required, and accurate symptom diagnosis ensures that medication will be used appropriately. Concrete stress management techniques are suggested. Taking an extensive history from all family members can establish a central dynamic formulation that will be used to guide the therapy.

Psychotherapy Proper

Beginning Phase

As patients settled into the early stages of psychotherapy, they began to resolve their guilt for being “given” more endowment than others. Later in this phase, psychologically informed mentoring, coaching, and advising helped each patient clarify a vision for his or her giftedness. A judicious use of therapeutic transparency was useful in this phase.

Middle Phase

In this phase, patients began to relinquish their exclusive need for autonomy and slowly came to accept the importance of relying on others for inspiration and guidance.

Late Phase

In this phase, patients identified their extracognitive capacities—inspiration, imagination, intuition, clairvoyance, curiosity, and special physical and aesthetic sensitivities and sensibilities— as the core of their exceptional giftedness. Experiencing the success of the therapist’s intuitive interventions gave these patients permission to use their own extracognitive abilities in their therapy as well as in the outside world. They began to experience less conflict, less anxiety, and less need to deny, disavow, their exceptional giftedness or undermine it with underachievement and self-destruction.

Jerald Grobman

See also Adolescent, Gifted; Adult, Gifted; Career Counseling; Coaching; Precocity; Supporting Emotional Needs of Gifted; Underachievement

Further Reading

Colarusso, C. A. (1980). Psychoanalysis of a severe neurotic learning disturbance in a gifted adolescent boy.Bulletin of the Menninger Clinic, 44(6), 585–602.

Dahlberg, W. (1992). Brilliance—The childhood dilemma of unusual intellect. Roeper Review, 15, 7–10.

Grobman, J. (2006). Underachievement in exceptionally gifted adolescents and younger adults: A psychiatrist’s view. Journal of Secondary Gifted Education, 17(4), 199–210.

Grobman, J. (2008). A psychodynamic psychotherapy approach to treating underachievement in exceptionally and profoundly gifted adolescents and adults: A psychiatrist’s experience (unpublished manuscript). Retrieved January 20, 2009, from http://www.psychotherapyservicesforthegifted.com

Jacobsen, M. (1999). Arousing the sleeping giant: Giftedness in psychotherapy. Roeper Review, 22(1), 36–42.

Kelly, K. (1970). A precocious child in analysis. Psychoanalytic Study of the Child, 25, 122–145.

Lovecky, D. (1990). Warts and rainbows: Issues in psychotherapy of the gifted. Advanced Development Journal, 2,107–125.

Oremland, J. D. (1975). An unexpected result of the analysis of a talented musician. Psychoanalytic Study of the Child, 30, 375–404.

Copyright © 2009 by SAGE Publications, Inc. All rights reserved. No part of this work may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher. SAGE Publications, Inc., 2455 Teller Road, Thousand Oaks, CA 91320, USA.

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