Sunday, November 1, 2015

notes from a previous patient

Here is a write-up from my session notes with a former patient from the East.

This is from his second session.

I thought I'd put it up for transparency and to commemorate that I've had 50 000 visitors to the blog. It's not much of an achievement considering that site has been around since 2011, but considering how my work goes against the fashions in both psychoanalysis and academia, it feels like an achievement.

...Transparency here means that many analysts have written about how their analysis with certain theoreticians didn't resemble their ideas.

I believe my thinking about, for example, phallic father-substitutes (bosses, mentors) informs the questions I ask. Also, my Reichian roots in the body are here in the reduced form they sometimes have to take.

I ask my patient, S., about his new job and he tells me about how his boss pays him more money than the average in his field and how he will let him buy the business for a very good price.

I ask S. why he would do that and he replies that his boss said that he has “always seen something in [him]”

I ask him if he has had a mentor before and how his previous bosses have treated him.

S. replies “Yeah a few bosses that promote me quickly, see me do well, and then I start drinking and not show up”

I ask how one boss that he goes into more detail about would describe him once he starts drinking. S. says “unreliable, disappointing, not responsible”

I ask him to put these into You-statements (i.e You are unreliable, you are disappointing, you aren’t responsible) and whether anyone he knows comes to mind.

He initially denies it, but I saw that something registered for him. I asked if there was anyone from his past and he said “Well, my dad”

S. begins to talk about how he wasn’t in our lives,”  “is not a good person”, “didn’t care about anything but alcohol.”

I ask him to turn the last expression into a self-statement (i.e. When I was drinking, I didn’t care about anything but alcohol”). He replies that it feels right, but he said he did it more for “the atmosphere” and to be able “to open up more” and get past his shyness. S. says he doesn’t know why his father did it. 

As he’s talking I notice more irritation in his voice and say “it seems like there’s some anger”. He agrees and says talking about his dad can still make him angry.

I ask him to take a breath and tell me where he feels the anger in his body. He says he can feel it in his stomach. I tell him to take a few more breaths and concentrate on the anger in his stomach and see if it wants to grow or go anywhere else. He is surprised and says he can feel his throat tighten. I ask him to focus on his throat and see if the tension wants to grow or go anywhere else. He takes a couple breaths and then said that it’s gone and he can’t feel it anymore.

I ask him to complete the statement “Another time I felt my throat tighten was when…”. He balks at this and says “Anytime I’m pissed at anybody who runs their mouth bout me, my mom, or my son”. I ask “What’s the first time that comes to mind?”

He says that it was the last time he was in court with his “baby momma”. She had taken pictures of him at a bar 6 months earlier and tried to say that she had taken them when he was on probation and therefore he was in violation of it. We go on to explore how else she tries to “manipulate” him and I mirror his indignation and try to help it grow. I then ask if his throat is tight because he holds back saying what he wants to say. He agrees to this but if an interpretation is correct I’m usually rewarded with a memory or some following thought that surprises the patient. I pause but nothing seems to want to follow the interpretation so I ask “What would you have said if you knew that there would be no repercussions?” He says “You dirty bitch… you manipulate, you point out other people’s problems to cover up your own…”

We go on to explore and the portrayal of his “baby momma” becomes less evil and more about someone who is unstable. He reports that she would start a fight say she hated him and then call him and beg him to come back and say she loved him. He goes further into how she took other pictures and made videos to blackmail him. He begins to add epithets: she is a “planner,” “a schemer,” she is “disgusting,” she “uses people,” and “whatever her goal, she does what she needs to to accomplish it…”.   

I ask S. if he says “My father is a planner, a schemer, etc… does it feel true?”
He says “yeah, pretty much” with his venom beginning to leave his tone.

S. details how his father returned to his life when he was 16 and had only been pretending to be sober, and that he ultimately had a plan to get him, his mother, and brother to move with him to ultimately ruin their lives.

I’m torn about where to go. His representation of his father seems a little fantastical and paranoid. However, it’s also strange to me that he’s not surprised that his ex girlfriend is based upon a prototype he has in his father. I chose the latter and ask him if he is surprised that his baby momma resembles his father.

S. replies that this is the reason he doesn’t date anybody and that all his girlfriends have been crazy. He doesn’t answer the question directly.

I explain to him that hate for someone can mean that they continue to exert a power in our lives, and ask him what he thinks it would take for him to let go of the hate for his father.

He again ignores the direct question and says that he will just wait for someone to find him and that if he stays out of bars that he might actually meet someone good.

I point out that without the alcohol he wouldn’t get over his shyness and approach anyone, so the point is moot anyway. He again replies with “yeah, pretty much”.

S. goes on to say that his brother has the same issue with girls and that all his girlfriends are crazy too.

We are out of time and I end the session.

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