Sean Friedman

Psychodynamic and Behavioural Psychologist

Making sense and making changesSea Point Cape Town

I am of the view — from time in my own therapy, working as a psychologist, and of working with mental health professionals in a number of areas (in academia, centres, institutions, and trainings) — that there is no 'cure' for the human condition: life is going to be very painful and difficult at times, and that no one really has it all together.I have also been strongly convinced through my own personal process, the cumulative and available evidence, and the observed and described effects of psychotherapy, that beyond the treatment of acute issues, psychotherapy assists greater self-awareness/understanding/acceptance and importantly facilitates actual changes in behaviour and relationship. We will always have certain vulnerabilities and challenges, but knowing and being able to work with our flaws, and to keep showing up for what matters in life — all the same — is a kind of wonderful outcome.I also have a mischievous orange cat that may-or-may-not make an appearance in the therapy room (let me know if you have allergies); a love for theory and practice (martial arts and psychology); and an appreciation for the strange and curious.

Trauma Specific Work

Prior to my MA in Counselling Psychology, I worked with refugees, migrants, and people affected by extreme violence and torture via the Trauma Centre in Cape Town, as well as with individuals presenting in crisis with Lifeline from 2014-2016. Trauma, and repeated trauma's in particular, alters the sense of self and relationship to others and the world in particular ways, and working with processing difficult experience, reconnecting to self and other, and realigning to goals and values became a special area of interest.During my MA, I continued to focus on complex-trauma (C-PTSD) 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 in the South African context who faced extreme circumstance and violence, and how they were able to cope and later thrive.

Developmental and Educational Placements

From 2018, I began training in Acceptance and Commitment Therapy, an approach that emphasises identifying what is most important to a person, and developing specific skills to get on with doing what matters, even in the face of fear, anxiety, despondency, or pain.At the same time, I spent several years in education. Working with children, adolescents, and adults through both schooling and tertiary level systems. I worked with behavioural challenges, identity formation, and engaged in lecturing and mentorship. How we best learn, develop, and grow (when safe to make mistakes, in contexts of trust and support, and given appropriate challenge) has come to greatly influence my understandings of psychotherapy as one such learning context.

Masters Training and Supervisions

I chose the Community Counselling Masters 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. As such, I take care to differentiate between problems which are amenable to personal change, as well as those that are external from ourselves and require mitigating their effects. Sometimes other people/society/finances really are the problem.My clinical supervision during my masters was primarily psychodynamic, while during my internship I worked with short-term models with clear goals and outcomes.

Registrations

Independent Practice Counselling Psychologist | PS 0159018
Health Professionals Council of South Africa

Training & Membership Groups

Cape Town Psychoanalytic Society. 2024
Association for Contextual Behavioural Therapy. 2018 - 2024
ACT Peer Supervision. 2020 | 2024.

Placements

Acceptance and Commitment & Psychodynamic Psychotherapist. UWC. 2023.
Intern Psychologist. Phelopeppa Community Health Train. 2022.
Narrative, Brief, & Psychodynamic Psychotherapist. Health Sciences, WITS. 2022.
Person-centered Counsellor. Lifeline. 2015-2016.
Narrative & Solution-focussed Therapist. The Trauma Centre. 2014-2015.

Trainer Experiences

Advanced Training in ACT & Mindfulness-based Interventions. Facilitator. 2021 - 2022.
Counselling Skills Trainer. Lifeline. 2016.

Course Specialisations

ACT for OCD, Emotional Regulation, Anxiety, and Perfectionism. 2022.
Focussed Acceptance and Commitment Therapy, 2021.
Foundations in Acceptance and Commitment Therapy, 2021.

Academic Qualifications

Masters Community Counselling Psychology. WITS. Cum Laude
Honours Psychology. UNISA. Cum Laude
Postgraduate Certificate of Education. UNISA. Cum Laude
Psychology, Sociology, History, Classics. Undergraduate. UCT. Not at all Cum Laude

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 is my training was orientated to possibilities of thriving, and living with vitality with the range of human feelings and challenges that are inevitable.I work with adolescents and adults of all ages. With younger adults I work considerably in areas of identity, meaning, and purpose, and relationships with self and others. As older adults tend to know themselves well, and be established in their lives, I tend to work in more pragmatic approaches with acute issues of anxiety, depression, and loss.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, I am not experienced with working with disabling forms of schizophrenia, life-threatening eating disorders, or severe and dangerous addictions. These 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

I have trained, and continue to further my training in several approaches, most notably Psychodynamic Psychotherapy and Acceptance and Commitment Therapy. I use these in tandem to help people to better understand themselves, clarify what is most important in their lives, own their choices and space in the world, and develop skills and life strategies that enable and support the taking of action that aligns to their values and goals.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 (ADD/ADHD), and Behavioural Activation (for depression) as well as other behavioural 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

Attention Deficit Hyperactivity Disorder, Specific Learning Disabilities (ie Dyslexia, Dyscalculia), Neurocognitive (ie short/long term memory functioning)Cognitive, academic, and socio-emotional functioning are assessed to determine difficulties in work/study, determine eligibility for accommodations, and provide recommendations for assistance.

Career Assessments

Person-to-environment, contextual, and adaptive considerations. Constraints, opportunities, and the changing workplace informed. Strengths, areas of development, potential problems, and possible solutions outlined.Personality, interests, values, needs, purpose, capabilities, and skills are considered to provide guidance in career and work choices.

Diagnostic Assessments

Multiple forms and systems of diagnosis utilised and combined holistically for self understanding & recommendations. Psychodynamic, DSM/ICD, and ACT informed.Differential diagnosis, considerations of history, patterns, personality, strengths, and vulnerabilities. Skill identification and treatment recommendations.

Special Interests

Recurrent and Chronic Mood or Identity Disturbances
Overwhelm, Panic Attacks, Social Anxiety, and OCD
Complex Trauma and Healing the Relationship with the Self & Others
Gender and Relationship Issues of Young Men and Women
Assessment and Treatment of Adult ADD/ADHD

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.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.     Fees from 2023 — June 2024Individual Psychotherapy Session R1200
Online Psychotherapy Session (outside of established in-person therapy) R1450Adult ADHD/ADD Assessment with Psychologist Written Report R4000
Full Career Assessment with Psychologist Written Report R4000     Please note:Diagnostic assessment is always part of the process of psychotherapy.Certain reports are indicated and necessary when required for concessions or, in some cases, in order to acquire medication.Career assessment includes assessments of personality, interests, talents, values, needs, and culture and is interpreted in the context of opportunities, limitations, trade-offs, and possible trends and changes in technology and the work context.Both assessments above include two online or in-person assessment sessions, as well as a feedback session. A computer generated report in place of the psychologist written report is possible which reduces the total cost to R3500.

Do you accept Medical Insurance & PMB’s?

My fees are line with medical aid rates, though there may be a copayment depending on your provider and plan. Please contact your medical aid if uncertain of your coverage.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 personally have 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 good 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 feature of these 'third-wave' approaches is that there is a reduced emphasis on challenging irrational thinking, and a greater recognition in the utility of learning to care less about thoughts, tolerate difficult emotions, and focus on living in accordance with ones values with an emphasis on taking action towards what matters despite difficulty.

What is Psychodynamic Psychotherapy?

Psychodynamic or Psychoanalytic Psychotherapy involves an emphasis on the therapeutic relationship, along with developing greater 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.

+2776 7222 123
2 Rhine Road, Sea Point
Cape Town

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S Friedman
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Account Number: 18685487819
Branch Code: 679000
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Ramblings, Investigations, and Essays.

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