http://blog.longreads.com/2016/02/02/this-better-and-truer-history/
This Better and Truer History
On memory, therapy, and cats in the dryer: A discussion with J.M. Coetzee
Arabella Kurtz – It seems to me that we are talking about two very different kinds of truth. You write about an objective or a transcendent truth, a truth outside or above the realm of human understanding. I am working on the basis of a subjective and an intersubjective truth, a truth to experience, which is what I believe to be at issue when one is trying to help a patient who is suffering. People come for psychotherapy because they feel dreadful and are in subjective distress, not because they do not know if God exists or how to read the weather.
This is not to say that reality – whatever we mean by reality – goes out the window. But in psychotherapy one is not trying to establish objective truth. Instead it is the way the patient represents reality, the way in which the external world exists in the mind of the patient, with its distortions, its inconsistencies, its lapses, which one explores in order to understand the way their mind works and to help deepen their sense of subjective truth.
I would like to present a brief clinical vignette in order to think through this issue in the context of the therapeutic work I am engaged in with patients at the moment.
A male patient started psychoanalytic psychotherapy with me a year and a half ago. He comes three times weekly. This material is drawn from the first session after a long holiday break.
The patient talked about collapsing in the last few days of the break. He also spoke of missing his sessions very much, particularly at a time when he was fighting with his partner.This patient has always found weekends and holiday breaks difficult. Early on in the therapy he dealt with this by forgetting about what happened in sessions and not thinking about me or the therapy when he was not in the consulting room. I understood this as a defensive manoeuvre, whereby he would do to me what he felt I was doing to him – that is, dropping him from my mind.This made sense to the patient and he called his strategy 'turning the tables'.
At the present point in therapy, things have changed. The patient is more accepting of anxiety he feels about being dependent, which has had a positive impact on relationships in his life, most particularly with his son.
Today he complains bitterly to me about his partner. He has been horrible to her, he says. He does not know why he gets overcome by such rage towards her. The problem on the face of it is a strange one because his partner seems to be very concerned to do all she can to help him, but this only seems to enrage him. At one point he says to me: 'Her love and concern are the problem.'
After a while I talk with him about how he feels vulnerable and needs my help, he needs the help of both his partner and me, but he hates feeling this way. It makes him feel small. He feels this particularly when he can't come to see me in the break, and therefore feels shut out and rejected. I think when he is horrible to his partner he is getting rid of the feelings of being small and shut out by making his partner feel that way – he is making her feel how he feels. This makes sense to the patient. It draws on many conversations we have had in recent weeks, and has the effect of calming him.
Here I am trying to help the patient develop his tolerance of particular feelings – of needing help and being vulnerable, of feeling anxious about being hurt and rejected – so he does not have to get rid of them by making someone close to him feel them on his behalf.
The vignette describes a fairly standard piece of psychoanalytic work, one in which there is an exploration of feelings that a patient is struggling with inside of himself and the defensive ways he has developed of dealing with them. I hope it also shows the emotional nature of the therapeutic relationship, its significance for the patient, and the way in which one learns about the patient's mind through the direct, lived experience of a relationship with them. It is difficult to get this across when one talks in abstract terms about the transference. The patient's story is not something that takes place outside the consulting room and is reported back; it is enacted in a very real way in the relationship with the therapist. The therapist comes to adopt the curious position of being both inside the patient's story and commenting upon it as it unfolds.
In narrative terms we could say that the story changes in the course of the session from something like – 'I feel rage towards my partner who patronises me' – to something like – 'I hate feeling reliant on my partner and my therapist, it makes me feel small and wretched, and when it gets too much I can end up dealing with it by taking it out on them.'
One could characterise what is going on as a swap of one fiction (the patient's) for another (the patient's and mine). But this does not ring true for me. I believe that, like most patients, this one brought his lived experience to me in good faith. It did not have an 'as if' quality about it. It was the truth as he experienced it, although he had enough insight to know that there were aspects to what was going on in his life which he did not under- stand and which made him and those around him suffer. For my part, I believed in my experience of the relationship with the patient and in what I said to him regarding my understanding of what was going on in his mind.
The aim in psychotherapy is to help the patient fill in parts of a puzzle, which is their puzzle – the puzzle that is their mind. As the situation is considered more fully and one develops, through a shared, lived experience with the patient, an under- standing of the impact of the patient's unconscious mind on their conscious experience, one's view of the situation changes – as inevitably as one's view of a small part of a scene alters, sometimes dramatically, when a larger vista is revealed.
I would like to think that, on a good day, the trajectory of a therapeutic session is from a partial subjective truth to a greater subjective truth. I do not think the complete truth can ever be reached. " --Anabella Kurtz
http://blog.longreads.com/2016/02/02/this-better-and-truer-history/
Funmi Tofowomo Okelola
-In the absence of greatness, mediocrity thrives.
No comments:
Post a Comment