Friday, August 21, 2015

a new variation on the use of I statements.

Having to do short-term therapy I don't have the luxury to wait for the "transference neurosis." I also don't have the temperament for that style in some ways.

Anyway, to follow certain words back to important moments of the past that have affect seems like it should be the epitome of the psychoanalytic process.

So, a patient begins to get into her disgust with the world and how people are rude, riddled with guilt for their obligations to help others, and how the air and trees would soon be used up so that people would starve. She outlined the mad max ontology of the part-ego (formerly the auto-erotic) in which everyone would suffer but a class of super-elite rich. As much as I wanted to question her so she would develop the phantasy and give me more insight, I knew I had to make use of the bridge.

I ask her to complete the sentence. "A time I felt obligated to help someone was..." She repeated the beginning and then added "... was when I stayed in Montana and didn't come back for my sister". Her younger sister was sexually abused while she was trying to reconnect with her father and she was really emotional as she recounted her "selfishness".

There are so many pieces of ourselves and others in all the idiosyncratic ideas and imaginative productions of people.

Once one starts to get the ears to hear it, there are so many places to leave the ego narrative and enter into something vital and pulsing.

Also, I realized that "I statements is already a term that exists for couples therapy. So maybe something like 'self statements' is better for this...        

Tuesday, August 11, 2015

passive-aggressiveness and thrill-seeking

I've written before about how jouissance, getting off, the libidinization of anxiety, etc. often shows up in a variety of ways in patients.

I've been trying to figure out ways to work with it and have found one that is relatively simple that ends with the getting off ultimately pointing to passive aggression.

1. You have a patient who describes reckless behavior.

2. You talk about what they think can happen as a consequence of this behavior.

3. You as the patient if it feels true or not when the say "I don't care if I live or die"

4. They say it and say it feels partly true. If you aren't practiced at using this method, you sometimes have to remind them that this is only for a part of themselves and everyone has different parts that feel in different ways.

5. You ask them to talk from the place (the part of them) for which it feels true.

6. If this doesn't go somewhere, or after it does, you ask them what their family or "loved ones" would feel if they died.

7. It's usually good to ask about the mother for borderline patients and the father for neurotics, if it doesn't go anywhere.

8. When they talk about how someone would be devastated or sad, then ask if he or she might also feel responsible, feel guilt, or feel like he or she failed the patient.

9. Then ask the patient if it feels true to say "You failed me mom" or whatever word the patient might have used to get this across.

10. This will usually be accompanied by some anger and bringing up stories about how the parent or person failed them.

This will usually provide some relief but has to be followed up with discussion about the relationship with the person. Does the patient want to have a closer relationship with them (if they are alive)? Often there are feelings that the parent (if this is the person in question) doesn't let the patient know what is going on with him or her and the patient stubbornly keeps his thoughts private.

The patient often doesn't feel like the parent wants to take him or her seriously (as an adult).

The patient is scared to ask the parent to do so because that could end up with a rejection or dismissal.

To try to set up a straight forward goal to talk to the parents will often not end well because it's too frighting for him or her.

One approach here is for the patient to tell the parent something along the lines of "I feel like there's things you never tell me about (such as x) and I know that I don't tell you a lot about what's going on with me. If you'd like me to tell you what's been making me unhappy and what's been going on with you then let me know".

Tuesday, August 4, 2015

growing up too fast.

I've wondered for a while about what it would take to not form the latency superego and post-ambivalent ties to culture (by this I mean that the person might regress from passionate love or personal success but not fall into criminality, neurosis, and shrink from work or family)

For many of my patients who have become addicts or criminals there is often a common childhood experience of growing up too fast and having to parent one's brothers or sisters.

The problem with becoming a parent too early is that when hardships are faced later in life, one's economy of libido is such that one only personal success, devotion, and love are important and there's not enough social narcissism from group identities. When ego ideal tensions are too high, the person might be able to consciously admit that he has "become a kid" and no longer cares about trying to pretend to be an adult. Often this requires drugs or alcohol to sustain.