Friday, April 17, 2015

counter-transference as re-enactment vs. using intellectual constructions

Shedler recently had an article about the psychoanalytic relationship being the true therapeutic relationship, while the CBT practitioner would just be friendly and warm like your dentist might be. He gives the example of a patient who has had problems with her therapists before and how he'd explore with her the feeling that he'd like to have her approval as past therapists did.

What he's bringing our attention to here is either a deutero adaptation in which the person takes some of the transference the father imago would get and has that extra confidence or wholeness that people find attractive, inviting, or connected to that isn't based upon their achievements, what they've done, (etc.). The other option, is that through projective identification that the patient has totally assumed the parental imago. As I've posted before, this has been the case for a lot of depression (i.e. not melancholic self-reproaches, but feeling empty or no motivation) and often has repetitions in the person's romantic life (i.e. he or she is "the nothing" and the other is "the everything").

Anyway, based upon our economies of libido there will be times in which we are induced to take on certain roles with patients because we share similar fixations, adaptations, and are on opposite sides of a defense. There was a patient I had the other day who had an egoistic 'I don't care attitude' because he felt like he should have got a raise by now and he hadn't, so he wasn't going to "make those assholes any money". I mocked him about being too good for the world because he hadn't talked to his boss about a raise and expected him to see his work and give it accordingly as if the boss should be giving him special attention like a parent and pat him on his head. Afterwards, I had the feeling that I might have acted on an inducement (that would could only have found purchase because it worked in my libidinal economy). At the time, I thought that his narcissistic bubble needed to be pierced, but afterwards I came to think that the bigger ingredient was his echoism and fear of asking his boss for a raise that was central.

Counter-transference that is caught in the act is important. I've written before that I had several patients who have messy lives with no structure and that when I feel like I want to give advice and organize them, I instead ask them 'Should I be feeling like I should leave with you and talk to x and y, be a life coach with you, etc.?'  However, we won't have a lot of counter-transference inducements when we don't have the relevant libidinal positions (horizontal, bisexuality) or levels of being (vertical, superego) functioning. In these situations, one needs intellectual constructions.

Kurtz's Hakomi has 'probes' in which you listen to what a missing experience was with the patient and then, try to offer it. If you have a patient who brings up that she was neglected and other sisters got more attention from father and, in her present situation, she has similar themes comes up, then you might ask her how it feels if you tell her "you are loveable" or "I want you to be my daughter". Kurtz says to stay away from probes that might commit the analyst to much (i.e. choose you are loveable, rather than I love you). So, when one begins to hear a theme in a patient it becomes possible to deepen it by asking questions in that area and bringing it to the past if it's in the present or vice versa. At the point where it feels weighty enough, it's possible to try a probe or to use a counter-transference construction in which you think about what the person needs in the moment and putting yourself in that place.

What Shedler has written about has been around for a while in the work of Spotnitz and others in psychoanalysis. It's nice to see that it might gain a wider appreciation. However, coming through a relational framework in which the unconscious is constructed in the moment between the analyst and patient, and the loss of the economics of libido, my worry is that they will neglect the importance of intellectual constructions. (Of course intellectual here is a reference to EQ and not IQ, but as Wittgenstein showed, judgment in these areas is based upon a logical operation and not just mimetic sympathy).

No comments:

Post a Comment