- So I'm going to present a case of a man I'll call Bill.
And I'll give you some background
and then I'm going to present parts of two sessions.
So he's a man who is about 30, he's married,
father of three children.
At this point of this sessions have been
therapy with me for about five years.
He had a very very tough early life,
he was bullied and shamed a lot by various people,
quite severely by some cousins next door.
And things were pretty harsh in his family
with a couple of older brothers.
His father, who he had great respect for, still does,
but described him as very strict
and really was physically rough with him
in disciplining him and at times really beat him.
He describes his mother as very shaming and critical.
And he describes his role in the family,
I'll use his language here as a failure and a fuck up.
That's how he saw himself.
What he was like when initially walked into my office.
His whole persona was very gruff and tough,
he was prone to massive reactive anger.
He would be very blaming and shaming
of other people.
He could be very bullying.
He would get hyperactivated in rage,
which you'll see in one of the sessions.
And he would take up a stance
of very significant arrogance
even though he also struggled a lot
with feeling bad of himself but
and he was prone to depressions
but he had somewhat limited understanding
at that time about why what that was about.
He made huge progress in the years
in the therapy thus far to the point
where I'm presenting.
With increase capacity to reflect on himself
and own his own reactivity and his own tendency
to externalize everything onto other people
and increase capacity for empathy.
But he still tended to be cautious and distant
and he still could regress enormously
and be volatile.
In the week or two prior to the
sessions that I'm presenting,
he had a particular fight with his wife an argument
and he become, he gotten over the top
in how angry he was with her
and we've done some work on it
and he brought in a piece of writing that he did
when he got, he became reflective about his own role
in that conflict.
And in the piece of writing
he had written a note
and he brought it to share with me, it said,
"I am ..." A list of things,
"Quick tempered. Always on the defensive,
"and my defense is offense.
"I live emotionally alone.
"I insult and demean and it is wrong."
And it was a lot of progress for him
to be able to do that so quickly
after a conflict like that.
But since then prior to these sessions,
things have been heating up.
There was a crisis he had,
his son, a teenage son,
who was becoming more and more defiant
and himself explosive,
but especially defiant and very very difficult.
So the first of these sessions
you'll hear the focus is on his son
who I'll call Carl.
I'll preface though by saying
I selected this sessions not because
they're highly polished,
in fact it's choppy,
the process is choppy, it's difficult.
This first session was extremely difficult for me
and you'll hear that,
I mean you'll hear me struggling
and so just to know that.
But I chose them because I think
because they especially illustrate a particular style
of working a way of working relationally,
intensely in the relational way
that I am with Carl in the second session especially.
That's why I chose it
to illustrate some themes about this way of working.
Okay.
So, the first session.
He came in, Bill was very angry
and throughout the session
we're talking about Carl.
Carl had been acting out defiant,
despite a number of very positive efforts
by Bill and his wife.
Bill had tried to have conversations with Carl
recognizing that Carl had problems
and things going on inside himself
and that Bill recognize that
and that he and his wife wanted to continue
to try to help Carl.
But Carl continue to be defiant,
like typical he would refuse to get out
of bed to go to school
kind of for no reason.
And that had just happened.
And Bill, in this session, Bill has now,
he's not just angry now,
as he's telling this about Carl staying in bed,
he's starting to tell the story of it
and he's getting more and more pumped up
in the telling, very agitated,
red face, neck veins bulging.
And he says to me what he said to Carl,
"You are going to get out of that bed
"and fucking go to school."
And he said, Carl got quiet and then starts to comply.
And, I mean, and he described more,
he sort of go on in the ways that he talked to Carl
when he's in that kind of state
where he gets really, really demeaning towards Carl.
And he's not being physical with him,
but he verbally is being very very demeaning.
And he says to me, he says to me,
"Carl is behaving like a fucking asshole."
And Bill starts telling me,
his attitude is, that Carl is more or less a bad kid,
that he just not appreciate the efforts
that he and his wife make.
And that Carl seems to thrive on things going badly
on conflicts and stuff.
The one positive direction in this whole thing
is that Bill had made an appointment for Carl
at a particular treatment program
which sounded good.
But as this is going on and Bill is really pumped up
and telling me the ways that he talks to Carl.
I'm sitting there worried,
worried about Bill, worried about Carl,
worried about the whole situation
and where it's going.
And I was, Bill and I have a well-established
relationship at this point
and I was fairly confrontational
about his rageful hostility towards Carl.
And I'm trying to help him sort of contain himself.
I made a number of efforts throughout the session
to try to help him recognize that his own temper,
Bill's own temper and his anger
at one point as I put it directly
are not a solution to this problem
and are more of a contribution to the problem.
I confronted him several times that his way
of speaking to Carl is not appropriate
and ultimately will not be effective
even if he can get Carl to comply in the moment.
Bill mostly just disagreed with me
and argued his case.
There were several temporary shifts
during the session were he became calmer
and his emotions a bit more flexible very briefly.
He told me how he tried to, he tried to talk to Carl
about his own family of origin circumstances
were so different from Carl's.
He was telling Carl about how bad thing,
a little bit about how bad things
were in his own family.
And then Bill softened,
at one point into telling me this,
he became tearful at one point
when he was talking about his own
developmental circumstances.
How he did not have parents who recognize
that he did have problems inside,
but they just continually blamed him
and were extremely harsh and just rageful
in evaluating him in this negative way.
And he sat there sadly for just a bit
and then he smiled briefly
and he seemed to enjoy a kind of moment of calm.
And I was quite affirming about this
and tried to be attune to him in that state,
but it just didn't last long,
he very soon shifted back to a position
of disparaging anger towards his son.
And I kept at it, for better or worse I kept at it,
I continue to try to interpret and confront
his overly intense anger at Carl.
I spoke to him to try to help him
become more self aware,
that his anger at Carl reaches a degree of intensity
that is just beyond Carl,
it's just not all about Carl,
even though Carl can be very provocative.
And I talked about how Bill's own anger resonates
with the very history that he had just talked about,
that that's getting stirred up for him.
I also tried to help him look at his own personal hurt,
I thought maybe he is partly feeling rejected by Carl
because he's setting up treatment,
he's made all these these efforts to talk to his son
and yet his son is defying him.
So I thought maybe part of what his anger is
a kind of a personal feeling of either rejection
or failure because his efforts,
because of the efforts he made,
and that maybe that was part of why he was so angry.
But none of my attempts to help him,
I was trying to help him question or reflect
on his excessive anger and his devaluing stands
towards Carl and it didn't have an enduring impact,
he remained enraged and devaluing of Carl.
Then it was a piece of work in this session
on his recent, the recent fight with his wife.
And he kept referring to other people's bullshit.
His wife's, Carl's, other people,
and he says, "Why can't, people just can't be honest,
"you know all you get is their bullshit."
They can't be honest like me, like Bill.
And he told about a recent fight,
what happened, he hadn't put away his dishes
and he left it in the sink,
and his wife had been cooking and doing stuff,
got annoyed and asked him to complain about that.
And he started arguing with her
in a kind of bullying way,
complaining about her bullshit,
this idea that he should have to put the dishes away
when he had worked all day and et cetera.
So that was a recent fight,
he's bringing that up now
about other people's bullshit, Carl's, his wife.
And I challenge his view about his wife.
I tried to helped him look at how his own temper,
that his own temper was part
of his own defensive reactions,
kind of like everybody is human,
they are, he is.
I talked about his excessive anger at others
for, you know, well for their humanness
and I continue to talk with him about how
his temper is not only a defensive reaction on his part
but it also makes the problems worse
because it starts to over-activate other people.
Again, there were few moments when Bill showed
some brief softening of his attitude,
he listened to me a little bit,
but mostly he remained rigid and stuck with
his initial stance.
And this session was coming to an end,
for complicated reasons
we didn't have a session planned
for the following week,
so it was going to be two weeks til we met.
He agreed he would call me and let me know about
how things worked out with getting Carl
into this treatment program,
and that he call me if things heated up anymore.
I mean I was worried and I asked him
if he would do that,
and he sort of begrudgingly agreed,
and the session ended.
And after the session ended I felt very badly,
I felt very worried, but I also felt like
I have been so not with him
and I tried to help contain him,
but it hadn't worked.
And I felt like maybe I had contributed something
to the problem getting worse,
that I hadn't help.
And I felt confused about how to help him,
but I felt a sense of urgency.
So I called him that evening
expressing my concern about where we left things,
and I said, I felt that two weeks was too long to wait
to meet again.
I wanted him to come in sooner.
I was inviting him to come in sooner.
At first he expressed reluctance,
he wanted to wait two weeks,
and he wanted to take a break meeting with me.
And we went on to say that he felt angry with me,
and he feels angry and frustrated that therapist
cannot deal with his anger.
He felt like I was being like all the other therapist,
like Carl's therapist, there have been several
and they all end up tangling with Bill
about Bill's temper.
He felt no one can deal with his anger
or with anger in general.
And he asked me, "Aren't you people
"all trained to understand a person who's angry?"
He said, he could understand that someone
on the street might not be able to deal with him
if he express that kind of anger
or they wouldn't want to deal with him,
"But therapist are suppose to deal with people
"in their anger, aren't they?"
He complained that the whole focus
gets drawn onto him,
and he gets blamed for all of Carl's problems.
No one will agree, and these are his words,
"No one will agree that he, Carl
"is being a fucking asshole."
And he think he was talking you know about me
and about Carl's therapist too.
He reminded me, the way he put it, he said,
"You know my currency is anger."
And at the end of the call he told me his,
he wasn't as angry with me
as he was with other therapist,
and he begrudgingly,
somewhat begrudgingly agreed
to meet with me the next day.
He joked lightheartedly that he would not have agreed
to do this with anybody else but me.
So he comes in the next day,
and now here's the session.
Now, I was still struggling with what to do
and how to deal with the prior session
and how to try to help the situation.
And in musing about it,
I wrote a letter to him.
I wasn't sure what I was going to do with it,
but I wrote a letter to him.
I started to outline a letter to him, to Bill,
just to help me process.
And what I did was I brought the letter
into the session, the outlines of the letter,
and I began reading it out loud to him,
I told him that I've written this to him,
for him and to him and I brought it in.
It felt like a parallel,
you know he had brought in a piece of writing
after his, he'd lost it a few weeks before.
And I'll say now what I said to him roughly,
what I said to him.
I said, "Yesterday, I think I failed to hear you.
"And at least two way I missed the boat.
"I think there are ways that you too missed the boat,
"but I'm going to start with me."
And I said I'm going to talk about me,
"I'm going to talk about you,
"I'm going to talk about you and me,
"and I'm going to talk about Carl.
"But me first.
"With regard to your anger.
"I got so drawn in to focusing on your anger
"as the problem,
"that I distance myself from you
"and from your anger at Carl.
"I acted part of the time
"as if I don't know this kind of anger in myself,
"as if I'm somehow above that.
"And that's not true.
"I know this kind of anger in myself.
"I even know this kind of anger ..."
I told him this.
"I even know this kind of anger with my own kids
"when they were young, years ago."
He at this point, he knew I had kids,
he didn't know any of the details about
their ages or gender,
but he knew I had them.
I said "I remember what it was like
"when they were going through
"the earlier parts of their lives,
"of feeling angry like that,
"of wishing or urging or doing of yelling at them.
"Including, I know the wish
"you used the words like fuck
"when I would you know what to yell at them."
I said, "I also missed, another thing I missed
"was your fierce wish
"to protect your other two children.
"Your fear about the impact on the family from Carl.
"I heard that, but in my focus on your anger
"is the problem.
"I failed to fully appreciate and acknowledge that.
"But I do appreciate it."
I switched it around,
next I talked about Carl,
I said, "Now for Carl."
The quote unquote fucking asshole in your words.
I said, "I know he can behave,
"he can be selfish, inconsiderate, angry, mean,
"oppositional, superior to others, childish,
"very dramatic, I know he can behave that way."
Now I'm also implicitly,
I'm implicitly talking about Bill too,
but I'm not saying that,
I'm talking explicitly here only about Carl,
which he also can be.
So I said Carl can behave this ways.
"He may well act this way
much of the time nowadays,
"he comes across this way,
"I think because he losses connection
"to other parts of himself.
And I told Bill, "I'll come back to this theme,
"but I do not believe this is all
"of who Carl is or has been
"or all of who he can be.
"And now you Bill and the situation with Carl.
"And where you are in this
"feeling a threat to your family,
"feeling frightened, feeling angry.
"You too lose touch with parts of yourself
"when you get overactivated.
"When you get over-angered
"where is the guy ..."
This is a little complicated,
but what I said was,
"Where's the guy who wrote that piece
"that you brought in a few weeks ago and showed me.
"The guy who had been, the guy who,
"yes, he has been in a state of rage
"and denigration towards his wife
"in the fight about the dishes.
"But the guy who then recovered,
"who was then able to look openly at himself
"and at his wife
"and to reflect on how he had behaved,
"and be open and honest about it and write it down
"and bring it to me.
"That guy who wrote it."
And I reminded him,
"The guy who recognize in himself,
"I am quick-tempered, always on the defensive
"and my defense is offense,
"I live emotionally alone,
"I insult and demean and that is wrong.
"The guy who wrote that."
I said to him, to Bill,
"The problem it's not just anger,
"the problem is kind of inner hijacking,
"internal hijacking that it can take place
"when your anger is above a certain level.
"When anybody becomes angered that intensely,
"it hijacks them.
"Then the person temporarily losses access
"to major parts of who they are as a whole person.
"Why do therapist ..."
Outspokenly,
"Why do therapist shift the focus from Carl to you?"
I'm talking about child therapist but you know me too.
"When you are caught up in being only the guy
"you recognize, the guy you wrote about
"when you're hijack by your own nervous system,
"then you can't show the guy who is the writer,
"the guy who can reflect and who could
"write a journal entry like that.
"You're only able to show
"the guy who is out of control,
"the guy you wrote about.
"I know that you are not at your best self
"when you're hijack into one part of yourself.
"You need both parts,
"you need the strength and the capacity to be firm,
"but you also need the understanding
"and the emotional sensitivity
"that you've been developing.
"When you comment people from only the angry side,
"demeaning and enraged,
"it overactivates other people.
"And then there are two negative results,
"you don't get their best selves,
"even the therapist,
"and you don't get recognize for all of your strengths."
In the course of my,
that just sort of paraphrasing of what I've said
as I held a piece of paper and read and spoke
these things to Bill.
He was tearful periodically.
He was tearful.
And he was clearly touched
and he said that the fact that I took the time
to write this letter,
it meant a great deal to him.
And he was especially tearful
when I acknowledge the ways that I failed him
the day before.
And that was there,
but it also was complicated
after I finished speaking
he initially started to take us in another direction
to dispute and defend,
now he's talking about the child therapist,
complaining about, they're trained,
they should know that he has more to him
than just the angry guy,
he doesn't go in angry, he says
but he feels like they're avoiding stuff,
well then he gets into a mode
let's fucking deal with this.
And he's back in that way.
But then there's another shift,
and he ask me, he says,
"Are you ever afraid that I'll attack you?"
Which I thought was a great question,
and I paused, and then I spoke,
and again you're hearing a lot of self disclosure
for me in this session.
It's more than my ordinary mode,
but I chose it for this kind of reason.
So I'm using now more self disclosure here,
and I tell him,
"No, I don't fear that now,
"but only because we know each other so well."
I tell him, "If I didn't know you so well
"and you came across like you do
"when you're at your most angry,
"I would be afraid you'll attack me.
"People who get to that pitch
"sometimes do explode physically and in an instant
"and sometimes do attack people."
I also another piece of self disclosure,
I share with him that I say,
"I'm sure as you know,
"I'm not as comfortable as you are
"with the intensities of anger that you get to.
"Just personally in terms of my nervous system,
"my personal history,
"I'm not as comfortable as you are
"in that, at that pitch.
"That being said ..." Continuing to speak to him,
"That being said, I agree with you.
"I consider it my professional responsibility
"to go there with you.
"And generally, I feel that I can,
"though I do better in worse at dealing with you
"when you're in your most angry way,
"and I did not do so well yesterday."
And finally I said to him,
"You know I also grow from dealing with you."
And he's very tearful at that point.
And then we see another shift.
He talks about, but not, it's a different shift.
He talks about his frustration with other people
and their bullshit.
But he's calmer now,
and he's reflecting on himself,
he's not merely enacting it.
And then we elaborated together something that
he's very, we sort of developed this together
that he's very vigilant,
he's very weary and he's very observant
about other people,
and any signs of any discrepancy
between what they're saying and what they're feeling
or any defensiveness
and or steering away from any issue,
and he just grew up with so much of that
dysfunctional kind of communication in his family
that we've already, we discussed.
And he's so on the lookout for that,
and he says that when he see something
he trust that he probably,
he's probably picking up on something
that he generally when he sees a sign
of something like that going on in another person
it's, he's sensitive and he's picking up something.
But then he goes on in this moment to say
in a very insightful and self-reflective way
that he realizes that what he makes of it
can be way off base,
he can make it much worst in his mind
than what it is
and then he gets very reactive to people.
He revisits now the recent fight with his wife
about the dishes,
he repeats the story to me
which I won't repeat.
And that you know that he had blasted her
about how he does so much for the family
and argued her into the ground.
And eventually in their process,
now he's telling me a new part of the story,
eventually she shared more honestly and personally
how she felt undervalued and unappreciated
when she'd been cooking for all that time
and he just left his dishes in the sink.
She was more disclosing,
she was just shared that with him,
not part of the fight exactly,
but just saying what it made her feel,
and he told me now that when she said this to him,
rather than just that he should put his dishes away,
when she expressed how she felt,
he was moved by it at the time
and he put his dishes away,
he cleaned them and put them away.
He says to me now in this session though,
"Why did she have to go on and on
"with the bullshit first about how I should put
"my dishes away and everybody
"has to do their job or whatever.
He says, "Why did she go on with the bullshit first,
"how it's my responsibility.
"It's bullshit, why wasn't she just honest
"up front about how she felt?"
I said, "Well you know, I think it's human."
And I said you know, I took the risk now of saying,
"You know, you, Bill, you also led with
"if you want to call it bullshit or defense,
"you led with your offense,
"which is your defense.
"You know you did too,
"you know we all do sometimes."
There was no more arguing coming from Bill
at this point, he really took this in.
Eventually then, we get to the deepest layer,
he gets to the core of it.
How when she's not more open and honest initially,
like she just told him to put the dishes away
without sharing her feelings
that it made him feel hurt
and it made him feel unworthy.
And now he starts to really cry in this session,
not just be tearful but cry.
And he says, "I've been alone my whole life.
"I have to learn everything on my own.
"I have to soothe myself on my own.
"I have to do everything on my own."
And he said sort of existential statement,
"I feel like I dwell deep in the ocean
"and everybody else is at the surface."
It is a very tender moment,
I just reflected back my appreciation first.
I tried to convey a sense of empathy which I felt
for his feelings of aloneness and for his dilemma
about being so hyper vigilant with people and reactive
coming from his family of origin,
but then causing such ruptures in relationships.
He then reconsiders the child's,
Carl's therapist negative reactions to him
in a more reflective mode.
He can understand it more.
And he said,
"The thing is yeah, it's like I'm not the only one
"in the room with those therapist.
"You know when I get that upset and that angry
"there's a third person in the room,
"there's Carl in the room,
"and the therapist has to be concern
"about Carl, so I can see why
"they're not kind of so much with me."
This now, there's a light bulb that goes off
in my mind when he says this,
which I then I share this insight I say,
because I'm trying to also process the day before
the session that went badly.
And I said something like,
"Oh, that's what happened here yesterday.
"There was a third person in the room, here,
"metaphorically yesterday.
"It was Carl, a child, your child."
And I tell him, I go on to tell him
that my concern with Bill's intense anger yesterday
was because I was worried he would harm Carl.
The problem was not how angry he was in my office,
he wasn't throwing things around the office,
he was being intensely angry.
But the problem was that I had,
I was holding an image of him
being that way with Carl,
so there was a third person here too
and that's what made it so hard for me to be with you.
And he could really see this,
Bill could see this.
Near the end of the session I asked for his reflections
on this session.
He said again, he appreciated that I took the time
to write the letter that it obviously meant a lot
to me and it meant a lot to him.
And he could see all that I wrote about.
And he went on to discuss his armor,
kind of his armored stance versus his
openness to emotional connection.
And he acknowledge that his stance
still in the world is the armor
and he doesn't want to put it down.
And I convey my understanding about this
because we know a lot about where it came from.
But I also say that the irony is
when you put the armor down
and you're able to be more open
emotionally and sensitive
that's when you're generally when you're less alone.
He sees this but he says,
he says, "I lack the receptors."
It's an interesting way to put it.
"I lack the receptors for that other kind of relating."
The more intimate or connected relating.
He says "When people reach back to me that way,
"I don't know how to receive it."
I point out, I acknowledge that,
but I point out he has trouble with it.
But I point that he can receive it
sometimes from his wife, he agrees.
And I say,
"And you can receive it sometimes from me."
And he says to me,
"Yeah, but it took years."
And I say,
"Well, we're working on your receptor sides."
And that was the end of the session.
So, I'm going to use, holding that session
in the background.
And I'll make some explicit reference to it.
I'm going to come back now to talk about
relational theory now with a capital R,
the relational school.
And I'm going to come back to this
six dimensions or themes
where I traced out earlier
starting with subjectivity,
and the classical paradigm.
I'm going to trace out those six themes
or dimensions again,
and in your handout on page 17,
what you'll see is the tracing out
of those six dimensions,
on the left is the classical one
it's repeated from what I already went over,
but on the right will be corresponding
relational principles that form this kind of continuum.
And but you know one of the problems
with this kind of chart
is it can make things seem to simple
and of course they're not.
Even though this sound,
in most cases like their polar opposites,
it's really not either or.
Often when we do our work where
we're embodying some of each or blends of them.
So there are apparent polarities.
Sometimes we're embodying both sides
of the same one dimension.
Sometimes were navigating
and sustaining tensions between this.
So I just want to put that caveat out there
before going through them
and we'll bring that complexity back in as we go.
So the first of those six dimensions,
which you'll see on page 17 in the hand out.
Subjectivity was the on the left side
the classical sensibility.
And then on the right side intersubjectivity
the relational column.
Corresponding to free association on the left
psychoanalytic dialogue,
that's by the way you may know that
very intentionally chosen name
of one of the main relational journals.
On the left, the space to explore the interior.
On the right, explore the interior
while engaged with a relational partner.
And what's going on with the interior
is all intertwined with
what goes on in that engagement.
Like with Bill, working relationally.
The royal road to his inner world
was in the context of his relationship.
When I tried to confront his defenses,
it didn't worked so well
even or I tried to interpret what I thought
was going on underneath his anger
in the first session.
It didn't worked so well.
That may lots of reasons,
maybe that my timing was off,
or I wasn't attuned enough in the way
I expressed the interpretation.
But in any case that didn't work.
But what emerge in the relational working
in the second session,
we get at two underlying configurations
of his inner world
or several underlying configurations.
I mean we get the raging bully that's on the surface
punishing, dominating, shaming.
But we also get glimpses into his feeling inadequate
that the self as the "fuck up."
And in the intersubjective work
we get to open up to the painful,
the pained struggling vulnerable boy.
That part of the self,
that internal narrative part of the configurations
that he tends to keep out of his awareness,
and it was the relational work that helped bring that
into his awareness and into our dialogue.
So that's what I mean by the intersubjective work
is can be part of the royal road to the inner world.
Still under subjectivity,
transference as brought by the patient,
which of course it always is.
Just like we're always exploring the subjective world.
All these things on the left,
they're still enormously they're crucial.
So there's elements of the transference
that are brought.
You know Bill is in a fight with everybody,
everybody around him.
There's no coincidence then that he and I
are in this conflict.
So that's an aspect of the transference brought
but the screen is never blank.
We, therapist reveal all kinds of things
about ourselves even when we're silent.
And patient make use of different aspects
of what's already there inside us
through selective attention.
But they don't have to make things up
out of thin air to comprise the transferential
sense of us,
they can borrow sort of build on
aspects of ourselves that show up
even when we don't intend them to show up
and don't know they show up.
And the patient is not only selectively picking up
on aspects of us,
but they're also of course evoking and enlisting us,
provoking different aspects of us,
which was you know a huge part
of what happened with Bill.
But the story of my being alienated from him
and the way that I was distant from him
in the first session,
it's partly a story about him,
that my reaction to him.
But it also has elements of me,
you know that I'm not as comfortable with
levels of anger that he's as comfortable with.
That's part of my what happened in that first session
or a part of me that remembers feeling
overly criticized by my own father,
having that experience and so I'm siding with Carl,
that's part of my inner world.
So there's aspects of me, I didn't share that with him,
but there's aspects of me that are all part of
part of the transference, countertransference matrix.
So this is the sense that, yes the transference
is always brought by the patient,
but it also gets co-constructed
in terms of selective attention
and enlistment of aspects of things from the therapist.
And we'll come back to this around reenactment
in the second part of the day.
Okay. The talking cure on the left,
the second dimension.
And on by contrast, a cure by action or interaction.
Now of course it's still a talking cure,
but there's also relational is going to bring in
action and interaction.
On the left, there's interpretation and insight
that's what we say as therapist.
On the right, there's what we do in a relationship.
On the left, there's communication as informative.
On the right, there's communication as performative.
On the left, there's an archeological model
of unearthing the layers within the patients inner life.
On the right, there's a transformational model,
some kind of transformation that's,
that involves both people.
But these ideas like there's the talking
and then there's the doing,
of course it's so complex
and I want to, even I set up that dichotomy,
I want to deconstruct it at the same time.
Take an interpretation,
something that on its surface is just verbal.
As Mitchell said, "Every interpretation
"is also a relational event."
Every interpretation is both informative,
but it's always performative to some degree.
It always involved, because we're always selecting
what we say and what we don't say.
And there's always some implication about our
positioning vis-à-vis the patient
in what we choose to say and how we say it.
So talking is always also doing in that sense.
My interpretation in the first session with Mike.
You know it was done from a particular
relational position that was problematic.
I was distant from him,
I was kind of above him,
and that was part of what,
part of what made the interpretation not work.
But it also goes the other way.
If talking is always also doing.
Doing in a sense is also talking.
Thomas Ogden makes this point.
He talks about interpretive action.
The idea that action is also an interpretation,
every action conveys meaning.
My letter to Mike,
they were words
but it was an action,
I wrote this letter.
The act of doing that and bringing it on paper
had a lot, it communicated a lot.
My feelings about him as a worthy person,
my regret for how I've worked with him
the day before.
My implicit faith that he could work with emotions
more deeply and more personally.
All of that was implicitly communicated
by an action of that paper.
I mean as well as my words.
But doing is also communicating.
Talking is doing, and doing is talking.
The next dimension, and the third,
analytic restrain and discipline on the left,
expressive participation on the right.
We talked about neutrality, enmity,
abstinence on the left Freud.
On the right, authenticity,
saying it with feeling.
Spontaneity.
In contrast or in counterpoint to optimal frustration
on the left, Howard Bacal talks about
optimal responsiveness of the therapist on the right.
In contrast to enmity,
there's therapist disclosure.
I engage in a lot of disclosure,
an unusual amount for me of disclosure
with Mike in that second session.
There's a wonderful, this is just in the side.
Title of the paper which I love,
I think it's Spezzano,
it's poking fun at relational therapist and analyst
for disclosing a lot.
The title is something like Listening and Interpreting:
How relational analysts kill time
in between enactments and disclosures.
You know this idea, it's sort of like
the New Yorker cartoonish image of the
relational therapist as always disclosing things,
you know like always being authentic
and you know sharing with their feeling, stuff like that.
But the issue is,
these two ideas,
the idea of analytic therapeutic restrain or discipline
and the idea of expressive participation.
Just think about it for a minute,
I think Irwin Hoffman says this.
Think about of any therapist
of any school of thought who collapses
on one side or the other of that polarity.
If you collapse on the side of discipline or restraint,
letting go of anything about expressive participation,
then you become the stereotype
of the New Yorker cartoon.
If on the other hand you collapse on the side
of expressive participation
letting go of restraint and discipline,
then you become like a social friend,
it's no longer a therapist.
So that, this is exactly what I mean by
the need to sustain necessary tension
between these two, kind of a dialectic tension,
and that relational, relational theory needs
classical theory, just as classical theory
needs relational theory in that sense.
Some other sort of other ideas around self-disclosure.
And it's more, it's kind of brought into
therapeutic work in like the
interpersonal relational school.
Things like sharing musings.
It's not only relational or interpersonal who do this,
other therapist do too for sure when [caught in.]
But in any case, the idea of the intersubjectivity
the and the expressive participation.
The idea of sharing musings from the therapist
with some spontaneity sometimes.
One aspect of this,
I think it's, I can't remember if it's
Hoffman or Bolas,
but one of them calls it,
they both talked about it,
one of them calls it the dialectics of difference.
This is when the therapist has multiple reactions
or responses in their mind
and just shares them multiply with a patient.
Let me get an example of that.
This has come up from me a number of times
in a particular context.
I have this come up where a patient
at a certain point of therapy
starts to talk about feeling ready to stop therapy,
and they talked about ways they've grown
and they feel ready to stop.
And I'm sitting there, and sometimes
I'm resonating with that, but sometimes I'm not.
Sometimes I'm holding other thoughts and reactions
that where I think it might be better
for the person to continue where I think
there are some things we've been working on
that don't seemed resolve enough to me yet.
And then there's a real dilemma.
So one way to,
here's using the dialectics of difference
and sharing musings is a way to respond to that,
a therapeutic option.
Something like this.
Part of me, this is me as a therapist speaking
to that patient.
Part of me celebrates your growth,
your increased confidence,
your sense of readiness to be more
on your own with things.
But there is another part of me that feels concern,
that it might be too early
that it's best for you to leave the therapy now,
that staying longer might be better.
But then even as I say that,
there's another part of me that worries
that my saying that might be shaming,
might feel negative towards shame you
around your sense of growth.
So that's an example of sharing musings
around this dialectic of difference,
on the one hand I think this,
on the other hand I think that.
And it has a number of advantages.
You get to share some rich complex reactions.
You get to model, as a therapist model
openness and complexity and self-reflection,
being of more than one mind.
Okay, the next, the fourth theme or dimension.
asymmetry was what we talked about before
as a counterpoint to that mutuality.
The mutuality and the therapeutic relationship.
On the left hand side asymmetry
where the roles where that
the patient is free associates
and the therapist interprets or clarifies.
On the right, mutuality.
The therapist also shares associations,
free associations, there's a mutuality of process.
And the patient also interprets
because they do anyway,
but making that explicitly part of the work,
the patient interpreting not only themselves
but also interpreting the therapist.
And both two major figures in the relational school
Aaron and Hoffman,
both write about this extensively,
about really inviting this and using this
as part of the work to deepen things.
What the patients perception
of the therapist subjectivity,
or the patients perception of the therapist
countertransference.
In the work with Bill that,
you know his perception of me as marginalizing him
of faulting him the way that the child therapist did,
you know his perception we worked with that,
and that was an important part of the work we did.
And I had to contend with that and work with that,
but that intersubjective aspect of,
and it was not only that he perceive that,
but it was then my needing to work with that
and deal with that about my own embodying
of what he was talking about,
the ways that I thought I could see it too
and else working on that.
It was very generative,
and it led to the letter.
Let me say a little bit more about this whole issue of
inquiring about what the patient thinks
about what's going on in the therapist
and how we work with that.
Say a patient, a patient who is feeling
like I was being critical towards them
in an exchange in a session,
and the patient asked if I was,
"Were you feeling critical?
"Was that what I was hearing?"
Let's think about how might
a therapist respond to that,
and it's not that one is right or wrong,
but I'm going to talk about
two different ways of responding.
One that's more within classical sensibilities
and the other that's more
within relational sensibilities.
Within a classical sensibility,
the patient asked,
"Were you angry with me or critical of me?"
The therapist might want to explore
what's going on inside the patient.
What do you imagine I might be thinking
in a critical way about you?
Or classically thinking,
the therapist might think,
"Oh, let's see the patient just asked me
"if I was critical.
"What were they talking about just before that?
"Because maybe something's going on
"in their inner world that were there's
"self-criticism or internalize criticism
"and now it's being projected in the transference,
"so they just got done talking about X,
"and now they think I'm critical of them.
"And how might I try to inquire about that?"
That's another sort of guided by
classical sensibilities.
But essentially, it's working with this
subjective world of the patient.
In that moment of the patient inquiring
about whether the therapist felt critical.
Let's talk about a relational sensibility.
Here's the therapist working with more
of a relational sensibility.
I would ask myself "Hmm, was I feeling critical?
"Perhaps I was in ways I wasn't aware of.
"Maybe the patient can help me become aware
"of something that I wasn't.
"Why might I have been feeling critical
"with this patient in this moment?"
Or I might ask the patient,
"What did you see or hear in my response
"that made you feel I might be critical?"
Part of what this is playing with is that,
it's also this idea of the therapist
doesn't necessarily know
even about their own reactions.
Sometimes a patient maybe picking up
on something the therapist isn't even aware of.
As Owen Renik talks about
there's just the irreducible subjectivity
for both therapist and patient.
So, and it's not that that those two approaches
are the classical or the relational
are mutually exclusive either
or right or wrong,
one can you know mix in elements of each.
But just conceptually they're really different.
Back to asymmetry and mutuality,
this fourth point, tracing out.
The therapist speaks with authority
on the left classical.
On the right, the therapist can speak with conviction.
On the left, the therapist speaks from a
position of knowledge, experience and
in the really early days of analytic theorizing
there was more sense of objectivity
though the field is evolved.
But and on the right, well the therapist
does have greater experience with therapy
and the therapeutic process perhaps.
But again irreducible subjectivity.
So there's this idea about that's part of the mutuality
both people are struggling along subjectively
though on the asymmetry side
for in any school of thought,
the therapist does have certain areas of
training and background that we bring asymmetrically,
the patient doesn't bring that to their own treatment,
and that's why they come to us.
Asymmetry, on the left, the therapist sets the frame
about time and money.
Many therapist really are more negotiate about that
and it's not a setting stone kind of thing,
including classically oriented people.
But from a relational perspective
people write specifically
Stuart Pizer writes specifically about negotiation,
that sometimes negotiations about the frame
are not only needed but can be something
quite meaningful and therapeutic
the negotiation itself.
Okay, the fifth and sixth dimension.
The fifth dimension.
The fifth and sixth dimensions here.
needed and repeated relationships.
The fifth, repeated relationships.
Yeah, we've already talked about this,
I'm just going to just touch on it.
This is where the patient's transference as brought.
The repetition is the patient's experience
how they experience the therapist,
it's an intrapsychic repetition,
it's an internal repetition.
Like Freud's wonderful paper,
Repeating, Remembering and Working Through,
but the repeating is really conceptualize
as an internal repeating
and the working through
is an internal working through with the help
of the analyst or therapist.
And as this session with Bill illustrated
a relational perspective
on the intersubjective repetition
that therapist participation and repetitions
and the therapist and patient navigating
their way through that,
working out different resolutions
as an important element of the working through,
not only working through intrapsychically
in the patient's mind.
Bill's capacity to work through his storm
and become open to the vulnerable
child self in the session clearly wasn't interpersonal,
intersubjective process.
And I say we'll come back to this under enactment.
Okay, the sixth theme or dimension
about needed relationship with the therapist
and on the left remember on the classical view
it's important but it's more of a background factor,
and on the right the needed relationship
is seen as a more of a central factor
and borrowing really incorporating
from the self-paradigm and [cohort and winacott.]
Okay, what I'm going to do next is
I'm going to present one or two more case vignettes.
And these case vignettes,
yeah, so we've concluded this theoretical portion,
you know this first part of the course today
and before shifting into the next section on enactment
focusing in on that.
I'm going to present two more pieces of
clinical process to just continue to illustrate
some of these main themes that I've been tracing out
about relational, about the relational school.
This person I'll call Ellen.
Ellen is in her early 40's,
give you just a bit of background,
I'm going to move right into the process.
In her early 40's, married, at home mother
with a son and a daughter.
She began therapy about four years ago.
Just to describe her briefly,
she wears very colorful clothing,
very textured, scarfs and jewelry and beret's.
She's very sweet, has a very sweet smile and laugh,
is also very nervous, very anxious,
eager to please other people.
And there's especially when she first arrived,
less so now, but a fragile quality to her
often looking on the edge
like she was about to flip into
an intensely upset state.
And all too often she did
particularly in those early years of therapy.
And what would happen,
and what happened outside of session
and what happen in sessions.
She would start to turn bright red
would sort of start in here and then it would rise up
into her neck and her face.
Her hands often, she will become ashamed
and just completely overactivated,
cover her eyes, closing her eyes tight,
doubling over,
wrapping her arms around her abdomen,
and she could stay like that for awhile,
sometimes crying, sometimes and often still
kind of frozen,
very slow to respond to me
what I would say when she was in that state,
kind of suffering without words,
she just wouldn't have words.
That was one state she was prone to.
She also other states that she would be in,
another state she was much stronger in her voice,
kind of feisty with a light humor,
much more present, stronger in her physicality
a sense of robustness.
She could also be kind of giggly and playful.
So she had different modes,
different states she was presenting.
But that overwhelm state was one.
And she was prone to enormous volatility
in her day to day life around that state.
And it was a mystery for the first
at least a year of therapy,
it was a mystery about why this was,
where did this come from.
Her initial telling of her early,
of her childhood history was generally benign
somewhat there was a bland depiction
it wasn't very detailed of textured.
She described one stress,
the family moved a lot frequently.
Her father was a sales manager,
they moved a lot.
But she said her mother was pretty loving and warm.
She said her mother would lose
her temper sometimes
but was a very nice lady.
Father could be harshly critical sometimes,
have conflicts with Ellen,
but he enjoyed her tomboy athleticism
and it was, it just, there wasn't stuff in the history
to account for this catastrophic state.
She had a brother who was four years younger,
who had significant problems functioning.
So there's something, something.
Now initially in the therapy
she also told about an early experience of
sexual assault by some older boys
when she about five.
And it turned out that the first telling
was a confused kind of merged memory
of several different instances.
There were two or three boys
and she talked about them,
and she had some detail about them
putting their hands inside her
and some other things.
But she didn't tell it with a lot detail,
she didn't really feel that it affected her that much.
She didn't feel a lot when she talked about it.
And we didn't explore it early.
But later therapy it comes back
and explored it extensively.
But that's not the focus of this particular vignette
now that I'm going to share.
In any case, she seemed to have, her early life,
so there was this telling of this
at this point of therapy of one incident,
it didn't, I couldn't tell if it had a major impact.
The family environment seems not so bad.
And she had done pretty well over many years,
she graduated high school, then college,
she worked on a crisis hotline,
she became a supervisor there,
found that very satisfying.
She formed a relationship with Ron,
she fell in love, they married.
They shared the love of nature, of music,
of very humanitarian ideals, very idealistic.
They moved from the city to a rustic place.
They shared a vision of starting a family
and kind of doing good works.
They had a son a daughter
and Ellen was a stay-at-home mom,
and she loved her husband, she loved her kids.
And there was some fragility she talked about,
but basically life had gone pretty well.
And then things really started to collapse
when the kids were young
and there was a lot of you know stress.
And her husband was traveling a lot,
he was a consultant and worked for a consulting firm
and he traveled a lot.
And she was left and managed the young children
in the household.
There were levels of anxiety and overwhelm
and disorganization and scatteredness
that were just profound for her.
She would lose things,
she would lose track of things.
States of panic.
She couldn't figure out,
like she'll be paralyzed about what to make for dinner.
Simple task became difficult
when she was in certain states.
Things would be scattered all over the home.
And her just anxiety and disorganization
and overwhelm were huge.
And then when Ron would return from being away,
she was prone of just flipping out
in this intense states that I'll describe
and reactions, catastrophic.
So he'd come back, she had been overwhelmed
some of the time by what was going on at home
and in herself,
and there were tend to be two triggers
for these really catastrophic states.
One was when her daughter
would get defiant with her
while she was in that stress out state.
But the main one was the return of Ron.
What would happen is, he'd been on the road,
he'd come back and he would sometimes
not be so attuned to her,
and sometimes he'd be a little critical
about the mess in the house but
he would tune in to the kids
but he wouldn't know how derailed
she had been feeling.
And he would arrive and settle in
and focus on the kids et cetera.
She would often be too ashamed to really tell him,
but she would feel like he knew her,
he should know and how upset she was
and how thrown off she was
and that he should attend more to her.
And then she would just plummet,
and she would become convinced that he didn't care
about her, Ron didn't care about her
or love her at all.
He didn't see her, he didn't even know her at all.
And it was just profound.
Talk about a narrative configuration of self and other.
She would just collapse into this and really feel it.
And there were one of two ways it would go.
One way was she would be just devastated
and she would be standing so poignant,
standing alone at the sink,
doing the dishes after dinner.
Ron was off with the kids and she would be sobbing
standing alone at the sink,
feeling totally alone in the world,
desolate, empty, unloved, desperate.
Another way it could go is she would become
enraged with him, pursue him in tears and anger,
accusing him of terrible insensitivity
of not caring about her, not knowing who she is,
demanding that he answer her.
Sometimes he would get angry,
sometimes he would just be bewildered
and he would withdraw from her.
And she would just escalate,
and in her words, with the way she put it she'd say,
"I just lose my shit."
And she would, she sometimes would grab at him,
throw things, swearing, yelling,
very much out of character for her
ordinary state of self.
And in the aftermath she would collapse,
she would curl in bed,
she would be under the cover sobbing alone
feeling mortified for how she had behave
and utterly confused about what happened to her.
She would come into sessions
and when she would often when she would try
to tell me about this,
and this is in the early phase of therapy.
When she would try to tell me,
she couldn't understand and often
she would get triggered,
she would start to get triggered into the state
when she was trying to tell me,
and she would get into the extreme state,
you know I described doubling over
disorganized, flooded,
and afterwards she would kind of
come out of this states in the office and at home,
and afterwards she realize she gotten
like lost in something,
she knew that Ron loved her and knew her
and loved her, and cared about her
and could be very supportive of her
and that he could be insensitive sometimes
and he's human and you know whatever.
But she could recover that,
but in this states she would be completely lost.
And when they got triggered in the sessions,
I mean it was the same you know that I've described,
we couldn't really work with it,
she was so flooded,
it's like she would lose her words and lose mine.
Eventually she kind of come out of it,
and we would try to talk about what had happened,
but we couldn't make any sense out of it.
This was early in therapy.
Now I've work with her in a variety of ways,
did some grounding practices and different things
but I'm selecting material here
that's specific to, very specific to this point,
some points I want to make about
relational dynamic work.
What would happen,
in this early phase,
she felt good about the therapy,
she felt an emphatic connection,
she felt there was a place
she could talk about her struggles.
But she still felt terribly vulnerable and fragile.
There was a med consult,
there was problem of mood disorder.
She started taking mood stabilizers,
they help some, but not so much,
and this rocky course continue.
Now as we moved in to the second year of therapy,
some memories emerged that are different
from the bland initial positive story about family life.
The family life was still positive in many ways,
but there were some,
some definitely problematic things
that now started to emerge.
They moved a lot.
I said, "What comes up now are memories of
"around the moves, moving very frequently
"being a new kid in school,
"sometimes midyear,
"and being so profoundly anxious."
I mean, I think she has an anxious constitution too
but so profoundly anxious.
There were periods when she would throw up
on the way to school everyday like walking to school,
throw up you know often to the bushes
because she was so anxious.
And I asked her about telling her mother
her parents and she never told her mother.
And I asked "Why not?"
And what emerged then was kind of glimpse
into life at home,
they were always packing up and unpacking.
This was one factor.
And one of the very common sort of etched in memory
is a mother being among cardboard boxes,
busy with packing and unpacking
and experiencing she and her brother
as being underfoot and in the way.
There was a story about Ellen falling and hitting
her head on a coffee table
and she started to bleed
and her brother was there
and her mother was right there in the room,
but it took awhile for her mother to notice
they were trying to get mother's attention
and she like didn't look up.
I mean once she looked up,
she was caring and attentive,
but it was sort of you know it symbolized something.
And there was an episode of being ill,
physically ill, abdominal pain
and this was another opening into family life,
she was ill for several days,
she crawled into her parents bedroom
and saying, "I'm so sick. We need to do something."
And the parents agreed they needed to take
her to a hospital,
but the parents then got into a fight
with each other about which hospital to take her to.
That becomes a permanent image,
a permanent part of the memory.
And the conflict of the parents in that story
opened up other stories about intense,
not only intense conflict,
but kind of silence seeding hostility
between the parents punctuated by intense fights.
There was one memory of the father throwing
a plate of food against the wall in anger.
There was a vague, sort of diffuse memory
of one of the parent's holding a knife
and that two parents in the kitchen
and Ellen just remembers being outside
and her brother too and no other memory,
it was never talked about.
So there's all this you know this sense of
both the hostility of the marriage
and also violence
which they're only this glimpses into memory.
And she felt totally alone with all these,
they never talked about it.
Okay, so there's that,
that's coming out in some of the sessions.
Now back into the process as the session
weeks are going by,
we're back now talking about the present,
her present life.
It's the aftermath of another scene,
Ron's come back.
She's ended up crying, standing at the sink
doing the dishes crying.
Continuing to not understand why she feels
so triggered and why it's so catastrophic.
This is introducing this dissociative state of the self
which will be the last part of our day today
we'll talk about.
But in any case, she's telling this,
and I'm feeling a bit tearful
like hearing about this and,
but I'm also thinking about the little girl now.
Now that we have this history,
the little girl who is so alone with her fears
and upsets and illnesses and the sexual abuse
and can't tell her parents.
And now I make an interpretation.
An interpretation linking past and present.
I say, "Now we understand what might be
"contributing to this state you get in.
"You spent your whole childhood crying alone
"at the sink."
And when I said that,
connecting her experience now
for crying alone at the sink
with her childhood situation.
She burst into tears,
there were waves of sobbing
which suggest you know something about
the connection in the statement.
But she was very present,
she didn't disappear,
and soon more will emerge about stuff
going on in the family that was really problematic.
Mother's temper, more stuff.
But, I want to emphasize in this, for this presentation
the interpretation.
So making an interpretation of past and present
to help make sense of the present
and help bring more of the past that's
sequestered away bringing into the light
so that it can be worked with to help work with
the present problem.
But now what I want to do is look at
that interpretation from two different perspectives.
I've been describing it already
from a classical perspective.
It's an archeological perspective.
The interpretation of bringing things
that are under the surface more to the surface
connecting them so that there is insight
within Ellen's mind about an emotional
reaction and state she gets in
that she can't make sense out of yet.
It's a quintessential interpretation.
You know therapist as interpreter.
But what I want to emphasize now
is looking at the same statement,
the same clinical moment of me saying that
from another, from a relational perspective.
And from a relational perspective
we're not only looking at the content
of the interpretation and how that helps her.
We're looking at the statement I made,
the interpretation as I made it as a relational event.
And thinking about it that way,
ironically or paradoxically
in the moment I say that statement,
Ellen is now no longer alone at the sink.
I'm talking about that experience of her feeling
totally alone in her distress and overwhelm
and no one who she feels see's it and knows it.
And there I am seeing it, speaking about it,
being with her metaphorically at the sink
or in her childhood situation.
And so in the moment that I'm saying it
I'm stepping in to the very state of aloneness
that I'm talking about,
and then paradoxically she's no longer alone.
So the interpretation itself is a relational positioning,
and the fact that I felt tearful before I said it,
and the fact that I'm was feeling as moved as I was
and as connected as I was with her
is also probably part of what made the interpretation
have as much effect as it had.
But that's all part of the relational positioning
that's in that same moment
as the content and the interpretation are there.
So of her feeling seen and cared about.
So that I wanted to share that as you know,
it's again this idea of it's not either or
the content was important.
Bringing that from what's in the darkness
into the light is important,
the therapist as interpreter,
and the therapist in this case
we might look at it as therapist as co-actor,
we might look at it as therapist as nurturer.
There are different ways to look at that,
but there's definitely a relational impact
that there in that clinical moment.
And I'm going to present one more briefer
clinical vignette still with Ellen.
Just to play with another aspect
of relational way of working.
And this has to do with spontaneity.
I'll read a brief quote from Wachtel, Paul Wachtel
about a relational way of working
and then I'll present this brief vignette.
Wachtel says, I think he's quoting someone else here.
It might be Mitchell.
Yes, it's Mitchell, actually this is Mitchell,
it's not Wachtel.
The therapeutic process.
The struggle to find a different kind of
emotional connection.
There is no general solution or technique,
because each resolution by its very nature
must be custom designed.
If the patient feels that the analyst or therapist
is applying a technique or displaying
a generic attitude or stance,
the therapy cannot possibly work.
Sometimes making an interpretation
works analytically, not simply because of the content
of the interpretation
but because the patient experiences
the interpreting analyst as alive, as caring
of providing fresh ways of thinking about things
as grappling deeply with was is bothering him or her.
That piece relates to what I just shared,
it's not the content of the interpretation,
it's not only, it's the relational impact.
But Mitchell goes on.
Sometimes, this is a counter point
to making an interpretation.
Sometimes refraining from
interpreting works analytically,
because the patient experiences the quiet
analyst or therapist as alive, as caring,
as providing fresh ways to be together
that don't demand what may have come to feel like
inescapable corruptions of language.
Sometimes patience for the therapist.
Sometimes patience seems called for.
A sustained involvement,
a sustained involvement overtime
that is evidence of a kind of relationship
different from past abandonment's.
But on the other hand,
sometimes impatience is required.
It's kind of an odd statement, but it's interesting.
Sometimes impatience is required and exasperation
that conveys a sense that the analyst or therapist
can envision something better than the patient's
perseverative patterns,
and that the therapist cares enough
not to take the easy way out and possibly go along.
Now that last idea about impatience
is what you'll hear in this vignette.
So here's the vignette
and it's with Ellen,
the same person I just talked about.
The preface to the vignette.
This is later, this is much later in the treatment now,
and there's been a lot of development
in the treatment,
more a better history,
and we've gone through that
fragile overwhelmed state many many times.
And we've done,
we've worked with it in many different ways.
Some, I've done some, helped her with some
self-regulation practices and techniques
included in this work.
We've work with it interpretively.
We've done a lot of different things.
But she's still anxious and fragile
and still sometimes prone to this states,
though less often at this point, but still.
And then we kind of plateau,
she's made some benefit,
but there's a sense of plateau,
and there's a phase now of therapy
where we're talking about the theme of abandonment,
how alone she felt with her suffering as a kid.
So here's the session.
There's a session, and I'm not going to give a lot
of context in the session,
because you have a sense of,
probably a sense of her in the process.
She has one of this states in the session
where she starts, she's just starting to turn
redness rising, she's starting to double over and stuff,
and I can see it happening
and her losing her visual gaze.
And I'm feeling frustrated.
And with a spontaneous outburst that
sort of surprised me,
I leaned a little forward and I said,
"You know what, maybe it would be better
"if you just don't go there right now."
Not my usual way of talking.
I spoke firmly.
And I went on to suggest,
"Maybe you should just focus on the present
"right here, right now.
"Maybe that's what you should do."
She sat back up,
she calms, she reorients, she looks at me.
The crying begins to subside.
And I then asked her to,
if we can talk about all that just happened.
And but if she can now see it
from another part of her mind
while she's able to be compose
and sitting here with me.
And we talked about both transformations of state.
The beginning of the catastrophic
and the pulling out of it.
And we were both amazed that she shifted out of it.
And I asked her what's her sense of
what happened there, the shifting out.
And she said, something like, she said,
it sounded like, it was like you,
it was like you extended a rope to me,
it was like you held out a rope
and you help pull me out or helped me climbed out.
But she emphasized what was so important
was that I really noticed that she was in the state.
I must have really understood it,
I really got it that she was disappearing into the state
and that I had handed a rope to help her.
It's very meaningful in terms of
standing alone at the sink
being alone in childhood with
throwing up in the bushes,
all these thing of the image, the sense of me
throwing a rope to her.
And in the weeks that followed
she ended up buying a bracelet,
that was a braided silver bracelet
and started to wear it all the time,
and thought of it as like the rope,
and it became a kind of transitional object
that was something that she would kind of
literally touch and kind of be aware of to help her.
And there was definitely this,
there's this sense of an internalizing of my presence
through that moment that was crystallized
around that particular moment and that way
where I was impatient, spontaneous
and impatient in, in kind of an action way.
And it's another, sort of another illustration.
Again it's not, it's not my ordinary mode of relating
but it comes from a kind of relational sensibility
or connects with a relational sensibility.
So that concludes this theory part.
We've gone through the three paradigms,
the classical, the object, the self.
Developed some of the ways that the flow of ideas
connects with the relational school
that started to evolve in the 1980's.
We've traced out this six themes or dimensions,
counterpointing relational and classical
around them.
And we've talked about three different aspects
of being therapeutic,
the therapist as interpreter,
the therapist as nurturer,
and therapist as co-actor.
In the next section, it's therapist as co-actor
in enactment, in psychotherapy,
that's where we're headed next.
To introduce enactment,
the theme of enactment.
Let's just say, patients come to us
asking us to help them change,
but we know the tendency to repeat things
is so strong.
There's a scene from a Charlie Chaplin movie
that was cited in an article on repetition.
I think it's the Gold Rush,
and in the scene, what happens is
Charlie Chaplin comes into his home
and he's out in the hall, his apartment or whatever,
he opens the door, he steps in, he closes the door
and there's a board in the kitchen ceiling whatever
that comes down and smacks him on the head.
And you see it happen over and over and over
and you just come to expect it.
And then later in the movie,
he shows up, he opens the door,
he steps in, he closes the door,
nothing happens.
And he looks around, he looks up,
and he's totally bewildered.
So what does he do?
He opens the door, he steps back out,
he closes the door,
he opens the door, he comes back in,
he closes the door,
the board falls and smacks him on the head,
and he goes, ump, like that.
And on with his day.
Repetition.
As Bromberg says,
"Every patient enter psychoanalysis or therapy
"with the same illogical wish.
"The wish to stay the same while changing.
"And as we know, patient's bring
"the same old dynamics into the relationship with us."
There's a story that was attributed
to Martin Cooperman, who was a long time analyst
and supervisor and mentor of Austen Riggs.
And the story goes is as follows that Cooperman
would tell the story, that he would say something like,
"I was looking through the window of my office,
"and there was a man outside yelling angrily
"and swearing and gesticulating.
"I thought he must be crazy.
"Then I moved over and I looked
"from a different angle,
"and I could see the other person
"who he was fighting with.
"So he's not so crazy.
"Then he came into my office,
"and we sat down,
"and pretty soon he was fighting with me."
Now I like that story for a lot of reasons.
Just that whole, the beauty of,
the metaphorical way of talking about
seeing the invisible forces in somebody's life
they're fighting with.
But in any case, the fight comes into the office.
And we all know when patients come in,
fighting, fleeing, flirting, whatever,
that these things they exert powerful pushes
and pulls on us,
and the patients also not the only one entering
with his or her own complex history
and rich inner world.
So I would add to Cooperman's story the following.
"Pretty soon, not only was he fighting with me.
"Pretty soon, I was fighting with him
"or I was silent with him,
"or I was contemptuous towards to him,
"or I was overly solidus towards him,
"et cetera, et cetera, whatever form it takes.
"And then I and we have to work with that
"enactment in the therapy relationship."
As David Weiland put it,
"What cannot be express in words
"is conveyed in other one of three other ways.
"It's embodied, it's evoked in the therapist
"or it's enacted and these overlap."
He also talks about two very broadly speaking
two different types of enactments,
enactments of collusion and enactments of collision.
Collusion, when a patient and therapist
unconsciously collude to stay away
from issues and aspects
within the patient's inner world
or within the therapy relationship
that would be aversive or threatening
to one or both of them.
Well to both for collusion.
How it feels in this collusion mode,
there can be a sense of tranquility
but with a staleness.
It's too safe, it's not dangerous enough.
And the subjects that should generate
stronger feeling failed too.
The therapist needs to be on the lookout
for ignoring subtle expressions
for example of negative transference,
that would be a typical thing that both people
might stay away from.
But that's talking about enactments of collusion,
which are tend to be less noisy
if you think about it that way.
Enactments of collision,
and that's mostly what's written about,
frictions, tensions, conflicts, upheaval,
entrapment in relational quagmires.
Paul Russell calls it "The Crunch."
Impasses and often both people feel done to
by the other, it's Jessica Benjamin's phrase.
In contemporary or post-Freudian perspectives,
we work with enactments, we worked in enactments,
and we worked through enactments.
Where was Freud himself on this matter?
Freud well knew about the
power of countertransference from experience.
And he considered countertransference
essentially as an obstacle.
He and the early analyst knew that in the,
the intensities of the analytic relationship,
they had a tiger by the tail,
it's a phrase used in the paper by Chris and Cooper.
They knew they had the tiger by the tail
and they could only try to tame one side of it
which was the countertransference.
So they try to,
so the prescriptions of neutrality,
objectivity, the therapist mostly staying
out of the fray.
If we get pulled in, we try to extricate ourselves,
we need some more analysis for therapy.
Thinking about the therapist neurotic issues
that need more work in order to not be,
not be intensely triggered.
And that the idea that this was really
the counter transference is essentially
the therapist transference to the patient.
And yes, it has something to do with the patient.
But Freud's approach to it
was more within a subjective or one person model.
The patient brought the transference
and that if there was intense countertransference
it need to be looked at
as what the therapist was bringing
that was getting stirred up.
And so counter transference remained an obstacle.
He did not do the parallel
of what he did with transference,
of transference, negative transference
from obstacle to vehicle.
That was left to post-Freudian theorist.
And not only the relational school,
but all the schools have found different ways
to work with counter transference
and moving from obstacle to vehicle.
And that includes contemporary Freudians.
An irony of the term enactment
I believe was introduced by a Freudian theorist
Ted Jacobs in 1986, counter transference enactment.
But the idea of enactment has been most central
to the interpersonal and relational schools.
But every school has some version
of dealing with this.
The contemporary classical thinkers
talk about countertransference enactment
and how to work with that.
There's a parallel in the contemporary [clinian] school
about, for those of you familiar with it
about projective identification
and containment by the therapist,
which I'm not going to elaborate on today.
Winnicottian's, we'll talk about countertransference
hate as part of the work,
working with intense feelings that gets stirred up
for the therapist.
And as I say, the interpersonal and relational schools
are so much about working with enactment.
The more conservative shifts
about countertransference
are that it's at least a rich source of information.
The more radical shifts and emphasize more
in the interpersonal and relational schools
are that therapeutic work can be done
within the very grips of enactment
and that's central for therapeutic action.
When we are open and allow ourselves
to be drawn in.
What do we drawn in to?
And it's the Cooperman story.
We're drawn into the problematic aspects
of the patient's internal world.
Again, multiple configurations of self and other,
and the most problematic aspects
the charge ones, the ways were that we are drawn in
are internal narratives that are overly defeating
or self-defeating.
Sometimes when the patient has irresoluble conflicts
among configurations.
For example, the patient wants the therapist
to be attentive,
but when the therapist tries to be attentive
the patient feels the therapist is being intrusive.
These are different configurations within the patient,
wanting and feeling different things.
How else do we get drawn in?
We get drawn into overly malevolent
or traumatic dangers within the patient's inner world.
Or overly dissociated and disavowed
internal narratives.
But we become involved, enactment.
Mitchell wrote beautifully about this,
Steven Mitchell.
"We inevitably get drawn in.
"We can't stay out of the fray."
Even if try to hold a separate,
whether it's an interpretive stance
or whether it's a nurturing stance.
That interpretations, as he wrote about,
like interpretations alone can't resolve it all.
And he had two different metaphors
to talk about that.
Why narrowly speaking,
just an interpretive stance can't resolve the issues
and that there's some form in which
enactment comes in.
One of his metaphors was
bootstraps and the missing platform.
Here's what he said.
"If interpretations are what we bring
"to try to help the patient
"lift out of their internal representational world."
Lift out of the defeating themes
of their internal representational world.
"With our attempts at interpretive clarification.
"It's like trying to pull ourselves and the patient
"and the treatment up by our own bootstraps
"which is impossible."
I'll read a bit from one of his books
Influence and Autonomy.
Here's what he says about it.
He says analyst, therapist analyst.
"The analyst arrives at way of
"understanding the patient,
"through which the patient organizes
"her subjective world and perpetuates
"her central dynamic conflicts.
"The analyst delivers this understanding
"in the form of interpretation.
"But the patient can hear the interpretation
"only as something else.
"It is slotted in to the very category
"the analyst is trying to get the patient to think about
"and understand.
"The analyst makes an interpretation
"about the way in which the patient
"eroticizes interactions.
"And the patient experiences the interpretation itself
"as a seduction.
"Or the analyst makes an interpretation
"about the way in which the patient transforms
"every interaction into a battle.
"And the patient experiences the interpretation itself
"as a power operation.
"Or in this case the analyst makes an interpretation
"about the patient's masochism.
"And the patient experiences the interpretation
"as a put down to be agreed to
"and to feel humiliated by.
"It is also, it's very difficult for the analyst
"to pick up and hear the patient's hints
"in this directions,
"because the analyst wants so much to feel
"that the analysis is going well,
"and that interpretations are truly analytic events
"rather than reenactments of chronic disasters.
"But it is often more complicated still.
"Generally speaking, the analyst, the therapist,
"despite his best intentions
"is likely to become entangled in the very same web
"he is trying to get the patient to explore.
"So the analyst making an interpretation
"of the patient's tendency to eroticize interactions
"is likely to be speaking from an eroticize
"countertransferential position in his own experience.
"The analyst is parallel.
"The analyst making interpretation
"of the patient's tendency to transform
"all encounters into battles
"is likely to feel embattled himself.
"And trying to use interpretations
"as a potent weapon in his arsenal.
"And the analyst making interpretation
"about the patient's masochism
"is likely himself to have felt victimized
"by the patient's long suffering misery
"and is speaking in a voice laced with exasperation.
"Thus, the analyst experiences likely
to be infused with the very same affix,
"dynamics and conflicts he is trying to help
"the patient understand.
"Because analyst make their living as helpers,
"there's a built in chronic counter resistance
"to becoming aware of themselves
"of precisely what they mean
"to help their patients locate
"and understand in themselves.
"Because they try so hard to be part of the solution.
"It is very difficult to grasp the subtle
"but profound ways in which they have in fact
"become part of the problem."
The last part of this quote.
"This seems to be precisely the problem
"that we have been tracing
"with the traditional model of therapeutic action.
"Interpretation are credited with pulling patients
"out of their psychopathology.
"Yet interpretations are deeply mired
"in the very pathology we use them to cure.
"There must be something else on which the analyst
"can rest his weight
"while he is tugging on his interpretive bootstraps.
"There is a missing platform somewhere."
And that's what this theorizing about enactment
is partly about.
He also use, he uses a metaphor of weeds
in a parallel way.
He says, "When the therapy begins to uncover
"an inner issue or conflict
"and we try to work with it interpretively,
"and work on its various layering
"of this issue or conflict.
"It's like trying to get at a complex
"inner weed system.
"So the therapist interprets it
"as it emerges in various forms."
But what if, you know again,
the patient experiences the interpretation
as something else?
"The therapist interprets the patient's tendency
"to feel overly criticize,
"and the patient feels criticized et cetera. "
Freud's idea was that the therapist
can stand out, this is Mitchell's critique still.
"That the therapist can stand outside the web
"of sticky transference,
"transference, countertransference configurations
"interpreting.
"But the patient may not experience us
"as doing this at all.
"Transference and the ways we are
"drawn in with that,
"the patient can experience us as problematic aspects
"of the same stuff we're working on.
"And sometimes we start to behave that way.
"So if you think of the patient's problematic
"inner representational world,
"internal configurations
"as like a system of weeds,
"we try to pull them out with interpretations.
"But our very attempts to do so,
"because of all these forces we're talking about,
"can merely scatter seeds of the same weed."
That's how Mitchell puts it.
So the bootstraps and the weed metaphors
relational theories trying to address that.
Whether we're being interpreters
from outside the fray
or nurturers from outside the fray,
because the patient can experience thus as
inside the fray and we can get drawn in there.
Now for a case, I'm going to present a case
and then we'll talk some more about enactment.
This, I chose this case,
there's an early enactment in this case
of something absolutely central to the miseries
of this woman's early development
and her ongoing miseries
and central to her sense of self
and sense of others in the world.
And it almost ended the treatment.
And the story of this treatment is very much
a relational story.
Processing and renegotiating that enactment.
Interpretations were part of this relational process,
but the therapeutic action is broader than that.
A bit of background about Mary.
She was in her late 20's when she came to see me.
She was in a relationship,
a long term relationship with a boyfriend.
She worked as an editor.
When she first met with me,
she came across as constricted, formal,
distant, very guarded, not spontaneous, generally,
harsh towards herself, harsh toward others,
and quick to assume that
others think very badly of her.
She did not show a lot of warmth
or humor in the beginning.
There were some brief moments of tearfulness,
but they were quickly truncated
and she did have some sort of
kind of clever cynical sense of humor that was there.
In talking about her history,
she said that she felt that her parents always
regarded her as ugly and unappealing,
and they discounted her wishes and concerns.
They regarded her feelings as either trivial
or lacking in validity.
and they regarded her request for support
as burdensome.
She noted that her father was especially
demanding of precision in whatever she said,
and that her mother was excessively demanding
of absolute propriety
in whatever she did and how she behaved.
And she recalled as a young girl being told
to be quiet a lot
when she spoke or played exuberantly.
Not surprisingly these themes
these kind of grim light motifs
permeated Jane's story into her adult life.
Her stories of relationships of her past
were replete with themes of her wishes for love
and closeness, repeatedly rejected,
sometimes after an initial build up of false hopes
which were always destined to be dashed.
This left her feeling bitter and futile about herself
and about others in the world.
By the time at the beginning of therapy
she had learned to approach people
in a weary guarded way
even in some cases her boyfriend.
When he put his arms around her for example
on one occasion she told me about.
And he talked about wanting to go out
for a nice dinner together.
She was convinced that he was just feeling lazy
and wanted to go out,
he was enamored with the food
and didn't really take it in
as a personal nice moment.
In the beginning of therapy,
from the moment that Mary entered my office,
she was cautious and tense.
In an articulate manner
though hidden behind chilly formality,
she began to tell me of her profoundly unhappy life.
For her life was a grim and serious business,
not much joy, plenty of harsh critical attitudes
coming and going in all directions.
From the get go,
she experienced me as repeating
her same old story with her
rather than his one who provided what she needed.
My moments of feeling most in touch with her,
my best efforts at conveying my empathy
generally fell flat.
She discounted my responsiveness,
chalking it up merely to my professionalism,
just doing my job.
She was convinced that beneath this thin veneer
of apparent interest and understanding,
I must find her just as boring
and unappealing as everyone did
as she experienced it.
And whenever there was any kind of lapse
in my responsiveness,
for which she was quite vigilant,
she took this as proof positive
or should I say proof negative
that I have been utterly bored
and disgusted with her all along.
These moments merely confirmed
not only her bleak view of the world
but also her harsh self-image
as a terribly unintelligent, ugly, miserable bore,
which is such a negative self-image.
She could really be harsh at both of us
at such moments.
Then a few months into the treatment,
the crunch moment.
She came in one day and she demanded
that I answer point blank,
"Do you like me?"
And she waited for me to answer.
She made it clear that if we were gonna go on
working together she needed to know.
I felt a knot in my stomach.
"Do I like her?
"Could I simply answer yes that I like her?"
No. In the conventional meaning of liking,
I could not at that time honestly just say yes.
Mary was so so off putting in many ways
that of course she was partly right in her assessment
that in the early stages of treatment
I was not so wild about her.
What could I say?
I was determined to be honest.
I was not going to say something that was untrue.
But I began to feel desperate
to think of something I could say
that would prevent the treatment
from ending right then
and my mind raced.
I mean, there's a whole series of thoughts
flew through my mind.
She had been relating to me.
This is me thinking.
She'd been relating to me in unlikable ways,
she needed to that.
She had to bring the most troubled and unlikable
parts of herself right into our relationship,
otherwise her therapy would be a sham.
She needed this space to be unlikable.
But she was sitting there asking me if I like her
and I had to say something.
"Could I answer this question with a question?
"Such as, what makes you ask this right now?
"Or what do you imagine about how I feel about you?
"Could I try to respond emphatically?"
Saying something like,
"Having felt so disliked and unloved
"by your family and by others
"throughout your whole life,
"of course this feels urgent here with me,
"especially if you're going to let yourself
"be open and vulnerable.
"How painful it is to feel that I don't like you."
Those kinds, and there were others
that flew through my mind.
Those kinds of statements.
Any of them could have,
Any of them in of themselves just look at
are okay things to consider to say,
for a therapist to say.
But in that moment,
and in what was happening between us
and in how I was feeling,
those statements felt like,
for me in that moment
they would have felt like a dodge,
like I was avoiding something and hiding,
and that she would know that.
And she would see it as code for
"No, I don't like you, but I can't say that
"because of my professional responsibility."
I mean that's how she would see it.
So I kept working at it,
about what I could say to her in this moment.
I felt she needed something more
than a statement that felt false.
The irony is as you'll hear in a minute,
what I ended up saying to her while true
certainly did not feel like something better,
it didn't feel good at all.
In any case, I'm getting there.
As I began to fear that the treatment might be over
before we really got going
and I have to answer her in some form.
And it's not that I should or even could in that moment
try to dispel all of her conviction that I disliked her.
This conviction and the ways that it was true
were clearly going to be at the heart of our work
for quite sometime.
We were at the heart in the transference
of what she repeats in all of her relationships.
However, I was struggling to find some way
at this initial and fragile stage of her treatment
to provide some needed response
at this critical juncture.
I think here Freud statement that I referred to earlier
that when we're in the thick of it
we cannot just "Sit back and practice
"explanatory arts."
Well here is where I went.
Sitting there with Mary
as various possible responses flew through my mind
they all seemed abysmal.
I had a sinking feeling
that our relationship was doomed.
A feeling by the way that she knew all too well.
"Did I like her?"
I reflected on things I could appreciate about her.
Not only was she intelligent and articulate,
but she had this kind of irreverent sensibility,
you know the cynical sense of humor.
And I enjoyed that.
She had a way of looking beneath the veneer
of what people present when they try to obscure
their unspoken agendas.
And there had been some brief moments
when she had shared some tears with me
which I found to be quite poignant
even though she had almost immediately
slammed the door shut as soon as I started
to show signs of being moved.
She was just too frightened
by that kind of closeness at that point.
But I thought to myself,
though my feelings are mixed,
I honestly do have some feelings of liking for her,
that's literally the words in my mind.
All of these trains of thought
took place in seconds that felt to me like hours
and undoubtedly to her as well.
More over I knew that the longer I took,
the longer I delayed,
the more she would be convinced
that I was constructing some untruth
and then underneath it all
it must be that I simply couldn't stand her.
So lacking anything better to say,
I stumbled along out loud and said,
"I can find in myself feelings of liking for you."
Well, damned with such faint praise
that clearly took me some doing to generate.
Mary felt enormously hurt which I understood.
There was no hiding from either one of us,
my role on the analytic stage
as the unloving parent
and her role as the unlovable child
and we both felt pretty terrible about it.
I'll read a quote here from Mitchell
about repetition in therapy or analysis.
"Unless the analyst affectively
"emotionally enters the patient's relational matrix.
"I.E. their cast of characters and scripts
"or rather, unless the analyst discovers
himself within it.
"Unless the analyst isn't some sense
"charmed by the patient's entreaties,
"shaped by the patient's projections,
"antagonize and frustrated by the patient's defenses.
"The treatment is never fully engaged
"and a certain depth within the
"analytic experience is lost.
"The analyst discovers himself a co-actor
"in a passionate drama.
"The analyst becomes the various figures
"in the analyst and
"or patient's relational matrix.
"Taking on their attributes and assuming their voices.
"The analyst and analyst
gradually rewrite the narrative,
"transforming those characters in a direction
"which will allow greater intimacy
"and more possibilities
"for varied experience and relatedness.
"One never stands completely outside
"the transference, countertransference configurations.
"Instead one struggles continually
"to emerge from them."
A quote from his chapter called Penelope's Moon.
After the session, Mary called me
and left a message that she was quitting treatment.
I called back and invited, convinced her to come back
so we could try to continue and she did fortunately.
And I'm now going to talk about some of the
present some vignettes of the process
that continued from that.
I'm going to present first though some
one vignette that involves
my working more interpretively.
And it didn't work so well for her.
Here's what happened,
this was one particular session.
The session began,
I call this the phone ring session.
The session began with her thinking out loud with me
about a particular decision she was making
and she was letting herself use me
to explore this decision and the issues involved.
It was a personal decision,
and I felt the sense that she was,
she was entrusting me and sharing this decision
and things were fine in this session,
things were going along fine.
Then my phone rang,
I've forgotten to turn off the ringer.
I got up and turned it off
and when I came back to my chair
there was a dramatic switch for her
from openness to complete shutdown.
First, she was just silent.
But she was certain that I was bored
and that she was boring.
And she kind of clamped down on herself
for being so foolish as to let herself feel
like someone could be truly interested,
and like she could be truly interesting.
It was sort of vague but minimized anger at me
but it was more directed on the surface at herself.
Now I tried to talk to her about what I thought
was a defense in operation
to emphatically interpret that.
I talked about her, her kind of fine attunement
to whether the other person in this case me,
is with her or not with her,
and she has like finally attuned radar,
looking for enemy planes,
where the enemy plane is somebody who
doesn't want to be with her,
doesn't like her, is bored with her whatever.
But I said to her,
but maybe sometimes it's just a bird flying
into the space, it's not an enemy plane,
and how can you know?
Now, first she agrees with me
about what I'm commenting about her reaction
to the phone ring.
So, the first thing is she agrees with the
"Wisdom of what I'm saying."
But then what emerges in her association
is completely contrary,
because all of her associations were stories
a series of relational vignette stories
from different parts of her life
where other people,
it turned out really didn't like her,
there was one particular story,
there was one character who pretended initially to be
neutral but interested in her point of view
and ended up using her words against her,
siding against her.
And then she said to me after telling stories like that
she says to me,
"Your implication with the radar thing is
"that I should drop my guard,
"not set my radar off so easily,
"that I should be more open.
"But my experience tell me, when I do,
"I just get hurt over and over.
"So when there's an indication on the radar screen,
"I take it very seriously."
So in that session, you can hear my attempt
to help her reflect upon something of her
internal system, it didn't go, it didn't take.
It was more like scattering weeds.
More like the bootstrap.
I'm trying to help her look at something,
but she's very weary about me
and that I'm telling her this.
That she's saying, "People duped me,
"they make me think that I'm likeable,
"they're going to like me and then it all falls apart."
So I am that person to her now,
even while I'm trying to talk to her about that
internal configuration.
But the way things started to really open up gradually,
but open up in this treatment.
Amidst her chilliness, guardedness,
and rejection sensitivity,
there were tentative forays by her
into being more open, more tender,
more vulnerable, more expressive,
sharing certain longings.
At first closing over quickly.
I felt quite moved whenever she did open up
in this ways.
I was very expressive, and would try to
really celebrate and reflect back
on this forays into her expressiveness.
And this is my expressive participation
in this process.
In one particular session
there was a moment of lightheartedness
and humor in her that really stood out
and it became an important moment.
There's one time, what happened,
she was on one of her familiar jags,
kind of berating herself about for being stupid
and really harsh about incapable and stupid,
it involved a piece of writing that she done,
that she was working on. But in the midst of this
familiar attack upon herself.
There was one very surprising moment
that captured my attention.
She shifted from this scathing attitude
towards herself,
to something more soothing and light.
And she laughed with a gentle tone
and became momentarily more forgiving
towards herself,
for her own imperfections in writing.
And in this spirit
she even was able to laugh with herself not at,
but laugh with herself in a kinder way,
over making understandable mistakes in her writing.
It was more like chuckling.
And then chuckling about how over the top she goes
in getting so down on herself about it.
There's this real lighting up.
However, then within some seconds,
the soothing starts to morph back into scathing
with this acerbic laughter at herself
and accusation towards herself.
And she said, "There you."
Meaning herself.
"There you go again, trying to get out
"of your old miserable self."
The truce was over and the barrage was resuming.
But my response to this,
as soon as I heard her start to shift back
into the self-approach,
I doggedly brought us back to her surprising moment
of truce with herself,
and I picked up on this evanescent emergence
of her part of herself that she generally hides
even from herself.
I told her I was moved by her being able
if even only for a moment to laugh with herself
in a benign and understanding tone.
I told her this was a moment of emergence
of her vital and enriching sense of humor
and playfulness.
Hearing me celebrate her enlivening sense of humor,
Mary's demeanor shifted dramatically
from the bitter self-approach
back to the calm and relief.
And she said to me,
"In this moments of solidarity with me."
Meaning with me.
"Her old familiar self-loathing softens.
"She's able."
This is still her talking.
"That she's able to see her shortcomings
"as mere indications of sharing
"in the human condition rather than confirmation
"of some terrible and humiliating inferiority."
She went on to speak with pride
and then a mischievous gleam in her eye
of her own keen and wicked sense of humor.
Now everything shifted,
suddenly we were co-conspirators.
I proclaimed,
"You're not just some efficiency machine."
This was an illusion to sort of how she felt
that her parents regarded her,
you know around her mischievous gleam
and sense of humor and keen wicked sense of humor.
I said, "You're not just some efficiency machine."
And she nodded vigorously in agreement.
And then I told her again, I repeated myself
how her sense of humor is a wonderfully
vitalizing part of her.
Now this is, I'm talking now,
this is not just informative,
this is performative,
I'm intentionally repeating something
I've already said.
But I really want, I want to give voice to this
in this interaction.
She became tearful and was touch
and said poignantly,
"You know sometimes I think the idea
"of psychoanalysis, is that I'm suppose to be
"wholly self-creating and self-constructing.
"If that's the ideal, I'm going to have to be content
"with the idea that I don't experience it that way.
"I need at least at moments to hear
"that you recognize in my sense of humor
"a vitalizing part of me,
"so I can say, yes that's uniquely me."
Speaking about the need for recognition.
And as the treatment continued,
what emerged was more and more of a kind of poetic
play in our dialogue.
Mary, and it's there.
She's speaking beautifully
about the needed relationship
that theme, as an essential aspect of therapy.
Even as she said it, I revisited in my own mind
a prior comment she made,
it brought back for me a prior comment she made
about her experience of her parents.
She once said, "There is no me for them."
And I thought about the need in childhood
and in therapy for mirroring and recognition.
So I said,
"It helps to have a better sense of you in you
"by hearing that there is a sense of you in me."
You know, my holding, a sense of her
vitalizing sense of humor.
It helps to have a better sense of you in you
by hearing that there is a sense of you in me.
She became tearful as she agreed,
and she remained calm and quiet for a minute or two
with a smile in her face
and with tears streaming down her cheeks.
It's so touched her that even amidst her self-loathing
as she was going back into that.
I could hold a positive image of her
that I could notice and celebrate
the emergence of her playfulness,
humor and positive self-regard
vitalizing parts of her
that had been buried so deeply
since early in her life.
And as the treatment continued
there was the emergence more
of sensuality and playfulness.
She talked about her experiences of swimming
of being in the water,
of bright colors of flowers.
She opened up more and more
allowing herself to be increasingly playful and poetic,
in reminiscing about her childhood,
she recalled how much,
yeah, I've said this,
how much she loved to swim,
basking in the memory of the sensual feelings
of the water on her body.
And we commune together in this emotionally
rich revisiting of childhood pleasures
in colors, sensuality, flowers, and the natural world.
A kind of nostalgia suffused with pleasure and lost.
We even got to a place in our relationship
where I could even, I could tease her a bit, playfully.
There was a session where she'd been talking about
her boyfriend and how they,
he had agreed to come out and help her in
I think it was gardening,
yeah, to help her in the garden.
What happened was, he didn't come out,
she was out there weeding,
and in a bitter resigned way,
she described herself to me,
toiling away alone, even for an extra hour
kind of silently angry with him.
So I decided to take the risk of telling her that,
I said in this playful way,
"If she really wanted to get even with him,
"she should have stayed out there
"for three or four hours yanking at the weeds."
And she laughed with recognition.
You know I was talking about
a kind of passive aggressive defense way
not so helpful way of dealing with anger.
But I was doing it in a playful
and a bit of a teasing way,
and she was able to take it in a positive spirit.
But I'm not emphasizing so much the insight,
the content of my talking about
the passive aggressive defense,
as much as an evolving playfulness between us.
Here's another quote from Mitchell.
It's about why interpretations fail
or why they work.
And there's the phone ring session
where my interpretation failed.
And there's say this weeding interpretation
or my interpretation worked.
"Interpretations fail because the patient
"experiences them as old and familiar modes
"of interaction.
"The reason interpretation worked when they do
"is that the patient experiences them
"as something new and different,
"something not encountered before.
"The effective interpretation is the expression of
"and sometimes the vehicle for
"something deeper and more significant.
"The central locust of analytic change
"is in the analyst struggle to find a new way
"to participate."
This is strong relational statement
about therapeutic action.
I'll read it again.
"The central locust of analytic change
"is in the analyst struggle to find a new way
"to participate
"both within his own experience
"and then with the patient.
"There is an enormous difference between
"false empathy, facile and postured,
"and authentic empathy
"struggled toward through [miscues,]
"misunderstanding and deeply personal work
"on the part of both analyst and patient."