It’s about not leaping into the material but bearing not knowing what to do; bearing not knowing how the situation will developby Anna Blundy / July 16, 2015 / Leave a comment
The patient, a beautiful woman with the bleakest of backgrounds mentions to me, by the by, that her husband occasionally beats her up. She shrugs.
Of course, it’s not uncommon for patients to relate disturbing material. The kind of patient seeking, and eventually getting, therapy within the NHS often has a grim history. It can be deeply upsetting to listen to the litany of neglect and abuse, but it’s familiar. It’s a question of listening to the patient and perhaps making links between these early experiences and their adult difficulties. Easy! (It isn’t). Where I get confused is when I start wanting to act instead of think. “Get out of there, quick!” I felt like saying. “There are refuges!” I think this is probably what she wanted me to say and do too.
I have begged my own analyst for advice, hated him for not giving it to me, spent years thinking, “If only he’d told me what to do!” Sometimes, exasperated, I construct a viewpoint for him from shreds of ambiguous interpretation.
But from the other side of the couch, I now see how difficult it is to maintain a therapeutic (instead of “someone’s forthright friend”) stance in the face of real life crisis. As a therapist, I should listen for the unconscious meaning in the communication, not suggest strategy (that’s the forthright friend’s job)—but it is HARD!
It’s also debatable. I’ve been in a supervision group with someone who is a psychiatrist (prescribing drugs) as well as a psychoanalyst (peering into the unconscious) and he is very dismissive of the strict therapist’s stance I’ve been taught. “Tell your suicidal patient you need to be sure she’s not going to do anything silly over the weekend,” he said to one trainee. This kind of intervention would get you practically turfed out of some training institutions. We’re meant to say, “I think you’re telling me this because you need me to worry about you”; not “Don’t do it!”
If someone is a danger to themselves or others they can be sectioned under the Mental Health Act, and a therapist would automatically report concerns to a supervisor. A patient in some other kind of danger would also be flagged up and you can always…