My Journey through Psychotherapies: How I found PBBT

Blog post written by Lior Biran, MA, Supervising Clinical Psychologist, Shalvata Mental Health Center, Israel.

The best way for me to talk about this journey is by reflecting on my professional path. I started training as a clinical psychologist over 20 years ago in the Israeli field of psychology, which was heavily dominated by the psychodynamic approach. Klein, Freud, Winnicott, and others were the most prevalent theorists referred to in my psychology school, and my supervision as a clinical student was by supervisors holding similar views. CBT was perceived as superficial and often equated to plastic surgery, a view still dominant here today. Skinner was rarely thought of, and when some of my teachers mentioned him, it was usually only for the purposes of mocking him. Growing up as a psychologist in this atmosphere almost didn’t leave me a choice. My path was paved by my teachers and by what was considered “deep and intelligent” in the clinical field back then.

I went to an internship, which was very dynamic as well, and even took three years of studying in a psychotherapy program revolving around psychoanalytic theories.

I have to say it was beautiful and poetic. I enjoyed reading the analytic papers, listening to psychodynamic teachers, and participating in this community. But I must admit that things weren’t as poetic in the treatment room. I had a hard time translating the theories into clinical interventions, conceptualizing my clients in workable ways, planning therapy in a clear direction, etc. I did, however, become very skilled in working with the therapeutic alliance and noticing patterns in the interpersonal field in the room. I also became a good listener and learned to probe for deeper layers under the “front layer” given by the client. It was necessary, but more was needed. I wanted more from my work and searched for something else.

Around that time, I participated in an MBCT training, which was an eye-opening experience for me. I started meditating daily and felt the impact on my life and my relationships. I tried implementing meditation into my clinical work, but sadly, with minor success. Clients weren’t as interested in this as me.

So, I searched for a way to use this experience and found ACT. ACT has impacted my clinical work profoundly. I was in love with this approach and felt something I had never felt with the psychodynamic theories I learned. I felt its clarity, ease of clinical use, and significant impact on my life and the lives of my clients. I read a lot of ACT papers and books and learned massively. I felt like coming home into this “mindfulness-based” approach, as I perceived it back then. But, I gradually discovered that the basis was not in mindfulness but behaviorism. And I became even more fascinated with it. I read Skinnerian work and delved into RFT, trying to figure it out, still using mainly the Hexaflex model and the ACT Matrix in my clinical work. I still had questions, especially regarding my psychodynamic background. For example, what about the unconscious? And what about the therapeutic alliance? The things I feel in the room, things done to me, felt by me. A lot of information I had, but I did not know how to implement it with ACT clinical work.

I then ran into a recorded workshop that Perspectives Ireland gave in London, and it was mind-blowing for me. Meeting the ROE for the first time, even without fully understanding it, felt like fertile ground. This encounter answered many of my questions – suddenly, there was room for the unconscious, even in behavioral thinking, for the self, for the therapeutic relationship, and for the patterns of relationships enacted in the clients’ life.

I can now use my behavioral knowledge without tossing away the skills learned over my psychodynamic years. And I can replace the Hexaflex, which felt very fuzzy and raw, with a more complete and promising model. I am still learning, and trying to distinguish S+ functions from relating, me-me from me-others, and so on, but I have a more sophisticated and precise frame of thinking. PBBT has given me deep and accurate concepts that help me integrate the knowledge and experience I accumulated over the years.