Monday, June 25, 2012

Learner therapist (12)……and misses

Learner therapist (12)……and misses

Torrey Orton

June 25, 2012


Stories of my therapeutic errors

I am somewhat obsessively tuned to my mistakes, a commitment moderated by a fairly balanced level of professional self-regard. However, it seems that mistakes continue to occur in sufficient numbers and powers to guarantee the balance falls slightly towards the obsessive side. From my point of view, my reputation is better than my performance.

It is of course also the case that some of these may not be mistakes but effects of unreadiness… a condition afflicting both patient and therapist in unequal and differing measures. The patient is often not ready for certain lines of self-development. I may be unaware of the unreadiness because it has not surfaced clearly…and often does not until the patient decides not to show up anymore (though often, again, to return a year or two later when readiness has re-emerged!). Timeliness is near to all in effectiveness.

What follows are some examples which set mistakes in the context of the commanding injury which was the central object of therapy. Where obvious, I note my unreadiness. Theirs can only be guessed, if it was a factor at all.

A lost childhood

She was sent to me because she had seen another therapist unsuccessfully, had a powerful, wholly justifiable anger about her upbringing, had an Asian background I know the historical context for closely. She wanted to get over the anger – tools and techniques, please, for keeping the feelings at bay. I lost her after one session. So, another therapist failed her. I imagine she needed not to be lost more than I needed not to lose her.

I knew it at the end of the session. She sprang a surprise demand on me: Show her how she would get rid of her bad feelings fast. I'd spent a lot of the session listening to her story of separations – first her parents from each other, then she from her mother; then she from her grandmother who had brought her up in father and mother's absences: all perceived by her as abandonments, some of which she railed energetically against at the time they occurred, most notable of them that from her grandmother, the only real parent she'd known. The story was laced with appropriate venom, sadness, outrage and insight.

She signed up for another session and did not reappear.

A lost hope

A convicted paedophile who was trying to recover a workable social self. I felt I wasn't getting anywhere after 8 sessions and raised that with him – that he might want to see someone else. He didn't say no, just disappeared. My sense of not getting anywhere was real, but there wasn't anywhere to get to other than acceptance and support in the struggle to be…a role I have trouble with out of my own passivity? I have to constantly pay attention to the quiet depressed.

A lost trust

The engineer who should, but did not think he could, lead; always second guessing himself in a contest with chronic I'mnotgoodenoughitis…couldn't bear anything like a judgement because he judged himself to distraction. I, after 15 sessions, needed to make a judgment about his progress and he disappeared. I couldn't frame it right, though I had repeatedly worked on distinguishing 'evidence-based' judgments from judgmental ones. No evidence-based judgment, no progress. But there had been progress of concrete sorts, it seemed.

He was at that point going backwards for reasons we couldn't get a grip on. The triggers were not clear. And the pattern reiterated events of a year earlier which led to medication and time off work. An incipient anxiety I had not seen clearly, acknowledge clearly enough?

A lost bet

28 year old, under-employed, anxious single child of divorced parents with an injustice chip on his socially phobic shoulder…who desperately wanted me to validate his interpretation of a speeding infraction which he saw as the reason for his alienated social life, to agree that the authorities had been wrong in taking his right to drive away for 12 months (a fairly large speeding infraction).

This went on for 6 months until I finally suggested we stop, since I was not going to validate the causal chain he was using to contain his troubles; they just couldn't fit under the rubric of a miscarriage of road safety justice. He agreed, and was a little further ahead in his struggle with loneliness, injustice, physical complaints and dangling between his parents.

A next step

With many of these I imagine I would not lose them now, having improved my sensitivities in some of the faulty areas. But, now I will have other insensitivities, newly minted on the back of those improvements as my attention is preoccupied with their potentials and not their risks!

To get better at recognising unreadiness – mine or a patient's – and acting on it when the occasion arises is no simple matter. Unreadiness may be a cover for unwillingness, which in turn is a surrogate, possibly, for rejection, for not liking or approving of the other (going both ways, of course). And what my patients are here to see me for is almost always some rejected part(s) of themselves. These rejected parts involve some sense of rejection by others for those parts and therapy is meant to be a rejection free zone. That's pretty much recognised as a precondition (though not a permanently applicable one) for recovery of self.

Join me next Learner Therapist exploring this implication – the interpersonal politics of relationships.

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