What Therapy Takes

Wednesday, February 9th, 2011, Written by jackrosenberger

To engage the process of analytic psychotherapy, the patient has to bring many strengths to the table. There are too many to mention here, but one I wish to highlight is the capacity to attach positively to the clinician. Exactly how this happens varies greatly among patients. It has been my experience that the deeper and darker the symptom picture the patient brings to the encounter, the greater the need for the positive attachment, indeed to the point where it can described as an idealized transference. This attachment is necessary as it allows the patient the strength and insight to make other necessary adjustments in what I like to call their “attachment field.” Without these other adjustments to previous images of relationships, only superficial progress will be made. Thus, analysis, when done well, affords the patient the ability not only to do different things in relationships but to relate differently. There should come to be a greatly enhanced ability for honesty, self disclosure, and ultimately, the ability to love both wisely and well. All of these goals rest, however, on the patient being able to make the primary attachment to the therapist. If that transference becomes idealized, so be it; it would then appear that precisely THIS kind of relationship is what the patient needs in order to come to healing. My task as a clinician is to live up to the obligations of that relationship and even transference as much as possible. At the very least, I cannot sabotage it, or even countenance the possibility of having that transference sabotaged. I do not believe that being a “blank slate” as so many clinicians do enhances the patient’s ability to connect. Indeed, if anything, I find such intentional distancing a hostile act. A relationship, by definition, takes two. This is not to say that there are no boundaries. Indeed, the whole relationship exists for the sake of the patient’s healing. But my “being in the room” I believe allows the patient to feel less like they are going through the layers of the Inferno by themselves. This way of practicing does at times force the patient to deal with the sometimes quirky and even at times all too human aspects of my own personality structure. In that sense, one cannot be all things to all people. But I believe that this realization would occur to the patient in time anyway. I am simply more upfront about the flaws and warts (as well as strengths) that make up the personality that I am bringing to the therapeutic encounter, both with the patient, and often with the important people in his/her life. As one writer said, “Jews are just like everybody else, only more so.” In this sense, the fullness of my humanity is in the therapeutic encounter, for good or for ill. I simply try to be honest about my own continuing process with my patients. If I cannot bring at least honesty to the encounter, then I am not sure what psychotherapy is about. Some clinicians will discuss how they are less who they are in the treatment room. In my case, I am more myself in the treatment room. More than once it has occurred that my patients and those that love them come to healing by coming to be able to tolerate and perhaps even embrace those flaws that make me who I am, in all my broken humanity. This does not make for a therapeutic process that would be a one size fits all kind of experience. But at least it’s real. I owe my patients at least that much. This kind of encounter is not for everyone, I know. There are days when I’m not sure I want to sit with me. But for those people who are most serious about healing and human growth, I have found it the only way to go. Or as we would say in Pittsburgh, go real or go home. I’m not going home! As Martin Luther, the 16th century reformer would say, “Here I stand, I can do no other. God help me.”

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