Another patient missed his previous session and had missed a session before. Instead of just treating this as transference, I tried to determine if this was a way of Being for him. Usually it's not difficult to tell if the patient is regressed, and living day to day— hour to hour is usually more precise— because he doesn't have a job, and usually strikes one as manic or depressed. This client had a job, was in a long-term relationship, and was more functional. However, he did admit to part of him feeling like he lives day to day and was just “going through the motions” in his life. He reported that he often misses appointments or plans and simply forgets and doesn't have any apparatus in place for scheduling things out of the normal daily routine. I began to build a metaphor with him. I told the patient that he has an interesting relationship to Time and that outside of the daily routine, it was like he expected Time to take care of him, and remind him of any special occasions that he might forget. I compared it to how I let my mother wake me up for school without setting an alarm for myself. He accepted the metaphor and I asked him to tell me his thoughts about how Time sometimes fails him and doesn't remind him of special events. He said that it's like Time "dropped the ball," “was forgetful herself," and that he can feel "disappointed" when she "fails" him. I took up the words that he affirmed in the co-construction and asked him to put them together as object-statements: "you dropped the ball, you are forgetful, you disappointed me, you failed me." He said them and said his mother came to mind. He said his grandmother was more of a mom than his mother was. His mother "hadn't been a mother" and "didn’t do her job". He got into particular moments of her selling drugs and using them. We analyzed them and he got in touch with strong disappointment with her but and feelings "that she's better than how she was acting." After he processed the feelings, he got in touch with new feelings of being "more proud of her now" and that "she's back to what she should be." He even expressed, spontaneously, that if he would share these thoughts with her "she'd probably cry". I investigated any resistance for client to act on this impulse but he didn't feel any and declared that he was going to say something to her.
I've discussed sleep before as something important or missing that can be gone, and also as something being interfered with. I've also seen sleep work like the above example. The patient is working through difficult material and feels sleepy, sometimes to the point of "not being able to keep their eyes open." In this moment you can similarly build the relation that sleep wants to take care of them and help them to deal with the psychic tension and pain involved but at the same time, sleep is failing them because they can't do the work they need to get better or improve. I don't have my notes with me to give a clinical example here, but I think my point gets across.
It's important for the patient to build co-construct this and use his or her language.
Of course you shouldn't force this too soon either. Wait for a pattern, and don't jump on the first time!