Aug 16, 2015 | Clinical, Psychiatric Writings |
“I’m whining. I should just stop it. It’s an ugly sound. No one wants to hear it. It would be better if I were just gagged.” “All I do is complain. I don’t know why that is, but it gets tedious. I can tell by the look on your face that you hate it. You listen because I pay you. I know there are better things to do than complain.” It is possible, of course, to whine about whining and to complain about complaining. I have puzzled over the years about how to respond to these regressive sallies. I call them “regressive sallies” because they aim to close down psychic space, to preempt any investigation that aims to reach psychological depth. Instead of proposing to listen to themselves, the patients who propose these solutions through will power are trying to shut themselves up, to shut themselves down, to shut themselves in.. The Free Online Dictionary defines “whining” as “to utter a plaintive, high pitched protracted sound as in pain, fear, supplication or complaint.This is a reasonable place to start, although whining can be applied to sounds that are not so high-pitched, not so protracted. It can be applied to what would be described as normal speech were it not tinged with overtones of reproach and accusation. Whining has to do with frustration and rage. Whining has in common with itching that it has a direct route to the limbic system. When a person whines, we feel a distinctive kind of discomfort that reflects and propagates in the interpersonal field the acute discomfort of the whiner. Two important ingredients...
Nov 23, 2012 | Clinical, Psychiatric Writings |
There is no “talk” therapy without “listen” therapy. Patients are as likely to say that they want a therapist who talks as they are to say that they want a therapist who listens. Of course, there are patients who can talk but not listen and also patients who can listen but not talk. Or at least there are patients whose predilections are heavily skewed in favor either of talking or of listening. Ideally both therapist and patient are competent in both modes, both able to speak and to listen. This makes a reliable and rich back and forth possible. It supports the ecology of exploratory conversation. For the first ten years of my career as a psychotherapist I was tormented by a voice in my head that kept ranting at me during sessions that I talked too much. The voice was humiliating without having any particular corrective impact. It simply served to make me miserable as I continued to say what I had to say. The position advocated by this voice was one, I believe, that my mother would have endorsed when I was growing up. I had many questions, many more in my head than I expressed or could have expressed. But I had ways of expressing that I had doubts, that I was intrigued, that I needed to know more, that explanations presented to me did not seem to hang together, that I had seen moments that had become mysteries. I was in many ways a nuisance and a burden to my mother. She surely thought I asked too much in both senses of the word. But...
Nov 23, 2012 | Clinical, Psychiatric Writings |
T was a very disturbed, attractive, bright young woman, chronically suicidal, sometimes intensely suicidal. She was almost always in despair, perhaps always there. In the days when this was possible for someone whose family was not enormously wealthy, she spent long periods of time in the hospital. She was a management problem, cutting, burning, eloping from the hospital. In general she terrorized the nursing staff charged with taking care of her. Their terror followed her terror as her behavior transmitted terror very effectively. The nursing staff took its job seriously. In addition, many of them genuinely liked T, who could be charming and interesting as well as dangerously out of control. The nursing staff may have hated T because she regularly threatened to expose their powerlessness and incompetence. But they also loved her, so the conflict was heightened in them. Certainly there was a sadistic element in T’s behavior, a way in which she was so out of control that she needed to tyrannize over those who tried totake care of her. T had a horrendous history that was definitely operative in her predicaments of the moment. There really is no point in reciting it in any detail. She was actually a very sensitive person who had experienced both neglect and abuse. She actively resisted looking at her history and how it worked on the present and in the present. She was too beset “right now” for this other enterprise of internal self-observation. She could do a little, but recoiled even as she did so. A few of her most disturbing memories were externally corroborated during her time in...
Nov 22, 2012 | Clinical, Psychiatric Writings |
1.A woman in her mid-eighties brought me flowers from her garden for one of her early appointments. The flowers were lovely but I was a bit taken aback, so I asked her why she had brought them. “I brought them so you won’t forget me,” she answered unhesitatingly. On the one hand, this was poignant. She was deeply worried about being forgotten by others, this being tantamount to being wiped out of existence. On the other hand, this implied that I was one who was prone to forget. It was a criticism in floral form, reminding me of Freud’s noting that “gift” in German meant poison. “You don’t need to bring flowers for me not to forget you. I won’t forget you even if you don’t bring flowers,” I responded. This exchange had no effect on her behavior at all. Each week she came with a gift of another small vase with flowers from her garden in it. The flowers were lovely but I continued to be a bit taken aback. She gave me watering instructions. She brought a cactus on the verge of blooming. She brought a huge red hibiscus flower,cautioning me that I couldn’t expect it to last for more than a day, but it was so beautiful that it was worth bringing even if it would last just one day. She brought me many other kinds of flowers which had a special spot on the sill of a window in my office. Over the months that followed the initial gift, I learned more about the parade of flowers that came to my office. I accepted the...
Nov 22, 2012 | Clinical, Psychiatric Writings |
“Phoney” Therapy? “Phone therapy is phoney therapy” A very experienced and adept psychoanalyst made this acid remark, quoted approvingly to me by a psychiatrist who holds him in the highest esteem. More than a decade ago, I had a patient who had had a very hard time both inlife and in therapy. I was by no means her first therapist. I practice in Baltimore and she was offered a plum job out west. She wanted to take it. One of the major areas of work in our therapy was to help her see just how talented she was and to stop apologizing for it and colluding with the theft of her ideas by co-workers. While she he wanted to take the job, which represented real recognition for her and a real and useful boost in income, she did not want to stop her therapy, feeling that at last she had found something like an emotional home. She proposed that we continue once or twice each week on the telephone. She said she would fly back to the east coast from time to time to see me. I dithered. It was not something I had done before. Previously the therapy I had done had involved both participants breathing the same air alone together in the same room at the same time. I told her that I needed time to think about it. Why couldn’t she find a competent therapist where she was going? Probably she could, but she and that therapist would not share the years of accumulated context that she and I had together. She was very interested in...
Nov 5, 2012 | Clinical, Psychiatric Writings |
“Do you get what I’m talking about?” is one of the most difficult questions that a patient can ask a therapist. It is difficult because it goes right to the heart of the enterprise of therapy. It is also slippery. Just what is the import of the question? Does it mean something like, “Do you wholly and without reservation not only understand what I’m saying, but resonate with it and agree one hundred percent with me?” In thinking about the slipperiness of the question, it helps to keep in mind that so many of a child’s complaints that “it’s not fair” really are complaints that the child has not gotten his way. Of course, it is not simply children who reason this way. Also, what are the criteria for a therapist’s knowing that the therapist “gets” what the patient is saying? If the therapist feels that the therapist “gets” what the patient is saying, if the therapist is passionately of a mind that the therapist “gets” what the patient is saying, does that mean that the therapist “gets” it? Any experienced therapist knows that it is possible both to be convinced that he or she “gets” what the patient is saying and to be quite wrong. “I would never go out with a person like that. It’s a bad fit and it just wouldn’t work. I’ve explored it enough in my own mind. It’s all wrong. Do you get what I’m talking about.?” This young woman was very convincing and her therapist was not bothered by the fact that she was too adamant and so agreed that he “got”...
