Turning the therapeutic tables

December 2, 2008

On the way out the door, a client starts grilling me:

“Do you have kids? Are you married?”
“No, not yet. We’ll get there one day.”
“But you’re still young. How old are you?”
“I’m old already. I’m 38.”
“Oh well, you live your life the way you want,” she says, delivered with an airy flourish.
Oh great, I think. Another patient who thinks I’m gay.

Remembering this exchange today, I can’t help chuckling at my client’s curiosity. And it also gets me thinking about psychology and power. I often think that psychologists love being the ones asking the questions rather than receiving them. One psychologist I knew always answered a question with another one. [A handy tip: So what makes you think that?] It’s not so great when we’re on the receiving end of prying. Put another way, we like to be the ones wielding the power, putting the patient under the microscope and analysis. Analysis after all comes from the Greek work “analyein” which means “to break up”. The dictionary gives as one definition: “The abstract separation of a whole into its constituent parts in order to study the parts and their relations.”

She loves me then she loves me not.

He loves me then he loves me not.

So what do we (as therapists) do when it is the client who wants to break us up into little bits and to study our parts and relations? 😉 Well, we tend to become a bit defensive. We devise useful ways of deflecting the question such as: “We can talk about me if you like, but I’m wondering what that’s about for you. Are you wondering if you can trust me, if I will understand where you’re coming from?”

No, I was just curious.
What were you thinking?
No, I just wanted to know. You don’t have to answer the question if you don’t want to.

I envisage the conversation going round and round until the therapist answers or deflects the question successfully. In my own therapy, I have found it liberating to be able to discuss my reservations about the therapeutic relationship. Having inside knowledge about the process helps but also hinders here since I know it’s a bit of a game on my part. Trying to outsmart my therapist by making shrewd interpretations. I am quite restrained in telling my current shrink why it’s just not working for me and the poor man has to sit through at least another three sessions of this before I break up with him. He is at least getting a decent fee for it but it is also a bit disconcerting sitting there and talking about how he just doesn’t quite “get” me.

Most South African men I know are just not that sensitive, I tell him, so you’re starting from a difficult position. I also have a natural suspicion of doctors and therapists since I’ve been exploited in the past. (Litlove’s hospital experience also springs to mind as a good example of how medical practitioners can, perhaps unknowingly, be insensitive.) But part of me also wants to hang in there for a bit. If a lot of these feelings arise from my own projections (of previous insensitive males), then can I change the projections by working on them?

Lastly, if there are any clients out there who are wondering if they should confront their shrinks with their reservations, my advice is: Absolutely! Talking about the therapeutic relationship can be wonderfully liberating if it’s done in a helpful way.

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Living with the cracks

November 25, 2008

hole-in-the-wall

“… we all go to pieces with our patients at one time or another. We all go to pieces now and then even without a patient to help us along. Your grief makes you more fragile. You know I’ve always thought of wholeness and integration as necessary myths. We’re fragmented beings who cement ourselves together, but there are always cracks. Living with the cracks is part of being.” – The Sorrows of an American, Siri Hustvedt

The Sorrows of an American by Siri Hustvedt is, as Jane Smiley points out in the Guardian, “beautifully thought through, deeply serious and enormously intelligent”. It is a complex novel narrated by a New York psychoanalyst, Erik Davidsen, who is coming to terms with his beloved father’s death as well as the failure of his own marriage. It is two years after the tragedy of 9/11 and his sister Inga, a philosopher / writer is also mourning the death of her husband Max, a famous novelist. Erik is also preoccupied with his tenant, a beautiful Jamaican woman, while Inga is trying to discover the contents and meaning of seven letters which Max wrote to a former lover.

Perhaps what I enjoyed most about Sorrows were the carefully described observations Erik makes in reference to his patients, himself and his family. Erik’s style of therapy sits easily with me and I admired his ability to reflect on his own feelings with such clarity and detail. Hustvedt has this aspect of the novel down to a fine art. But there was also something quite anti-climactic about this novel. I found it dragged in the middle and it left me rather unsatisfied. Perhaps Erik Davidsen seems rather tame as a main character. Hustvedt does a good job of portraying him as a ‘wounded healer’. As one of the characters points out, it is the cracks that let the light in, and Erik’s own crackedness, while not fully explored, is what makes him interesting and likeable as a character. When he’s doing therapy he’s controlled, rational and reasonable but in his own time he’s wrestling with personal and familial troubles.

Reviewing Sorrows in the New York Times, Sylvia Brownrigg puts it well:

While (frustratingly) reticent about his ex-wife and the reason for their split, he [Erik] speaks at length about his ambiguous attachment to Miranda, his new downstairs tenant, a Jamaican woman with a lively 5-year-old daughter and a manipulative, sinister boyfriend. Observing himself with the same care he brings to his patients, Erik remarks on his uncharacteristically obsessive behaviour in relation to Miranda: “My solitude had gradually begun to alter me, to turn me into a man I had not expected. … I’ve often thought that none of us is what we imagine, that each of us normalizes the terrible strangeness of inner life with a variety of convenient fictions.”

For me, this is what makes psychology and literature so important to one another. We all have ‘convenient fictions’ and it is in telling our stories that we make meaning of our lives. On another level, Smiley comments that for all the novel’s considerable strengths, she finds it most interesting for the way in which it fails. “There is a reason why Freud and Kafka belong to one culture, and Ibsen and Sigrid Undset belong to another,” she argues. “It’s a rare Scandinavian writer who expects any sorrows at all, even those of an American, to be healed by mere memory.” This is an interesting argument, connecting the stoicism of Scandanavian storytelling with the healing work of sorting through memory that psychoanalysis offers.

*****

On a personal note, it’s been a rough few days here at the Couch Trip. I’m going to be trying to take things easy for a week or two but I’ll still hopefully be reading and commenting. Incidentally, the photo at the top is from the military base where I work. I liked the way it gives a glimpse into another world.


Catching your own therapeutic fish

September 25, 2008

Do you ever get a slight feeling of apprehension when you open your blog-reader and see what’s waiting to be read that morning? For me it’s a bit like going down to the post-box first thing in the morning, taking out the newspaper and scanning the headlines. I know that most of the world probably wakes up to either the radio or the TV but my first contact with the outside world beyond my street is the morning newspaper. After the political upheavals of the past week I am a bit apprehensive of further shocks.

But it’s also quite a relief to turn to the blog-world and read some well-observed and thoughtful descriptions. I’ve been thinking about that quote from C.S. Lewis that Dick Jones posted here and it reminds me of Buddhism and living in the moment. Just observing and describing first without rushing to judge and categorise and label what it is I’m observing. Easier said than done of course and then it makes me wonder about novelists and whether writing is a way of practising living in the moment. You need to describe in detail what your characters are seeing and thinking and feeling. I’m not sure that I could do that.

And then it makes me reflect about psychotherapy as well, and how difficult it is often to stay in the moment with my clients. They’re anxious and I’m anxious and both of us rush to fill in the gaps with solutions, with a neatly worked-out answer to the things that are troubling them. I’m not suggesting sitting back and letting them be overwhelmed but I think I should tolerate the uncertainty more. Not jump in with interpretations and observations. It’s difficult work and the client population here is very mixed. Very often what it most required and helpful is active intervention. They need someone to do their thinking for them and so I oblige. But then I kick myself afterwards. Wasn’t there a way that I could have got them to do the work instead of me? There’s a sense that I need to let them catch their own therapeutic fish.