If There Be None

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We are all breakable. Or maybe it is more accurate to say, we are all broken, each in our own way.

And our attachments to each other are no less fragile.

They can be broken outright and permanently.

Humpty Dumpty sat on a wall,

Humpty Dumpty had a great fall;

All the King’s horses, and all the King’s men

Cannot put Humpty Dumpty together again.

Therapeutic alliances can fail, collapse under their own weight. Sometimes the death of a clinical relationship happens so slowly that it is imperceptible – the poison, so diluted accumulates incrementally, so neither therapist nor client can detect it until the connection has withered away.  Hopeful attatchment  shriveled into something dry, thin, brittle.

Other times therapeutic relationships can erupt, explode – felled by a single, violent event.

A therapist can destroy relationship out of their own limitations, unprocessed injuries, or simply because they are knocked off their pins by events in their own lives.

Sometimes therapeutic relationships are completely devoured by a client’s insatiable hunger that no psychotherapist can ever (nor should they attempt to) fill. And sometimes it is because the therapist sat back and didn’t try and they should have at least tried and failed. Or because they tried too hard, foolishly, and frustratingly when they should have left well-enough alone.

I do not like thee, Doctor Fell;

The reason why I cannot tell;

But this I know, and know full well,

I do not like thee, Doctor Fell!

Sometimes you can make sense of it all later – and sometimes it will never ever make any fucking sense at all.

In Restoration of the Self Heinz Kohut asks: “Why does one layer become actively engaged in the therapeutic work, while the other sinks into darkness and remains out of sight?

When I first began this work, as a therapist on an outpatient day treatment unit for adults, most of whom were diagnosed with schizophrenia by psychiatrists, I had a dream, that still makes me hold my breath when I recall it.

A kind, twinkly, toothless older woman, who who I believed I had a warm, amiable alliance with knocked on my apartment door. I greeted her happily, and began following her down the apartment stairs. At the next floor landing she turned to face me – and I saw a look in her eye that terrified me: She had no idea who I was. No understanding or trust, or even memory of who I was at all. Her look was suspicious, paranoid, rage-full – I saw that I had somehow, without realizing it – become her enemy. My intentions, my labors on her behalf, the real and positive effects that had come from our work together – a new and supportive living situation, a lowered medication regimen, a romantic partnership that was stabilizing and growing sweeter –  all  lost  – entirely. Deleted. Erased.

Horrified, I realized within the dream, that not only was she unable to retain a consistent sense of who I was – but that she was also unrecognizable to me. Perhaps that she was even unrecognizable to herself. She was not at all who I had understood her to be, and our relationship had instantly dissolved because we could not now comprehend who the person was in front of us.

In waking life our relationship remained stable enough – but I’ve seen, over the course of my work on that unit, in this field, in my own therapy and in my life – this dream play out many times, as repressed, or minimized shadows suddenly race forward from the far horizon to the looming foreground.

The shadow relationship – the one that lives on the other side of the looking glass –  can reach through, can take over. And then the relationship you thought you were in seems to disappear entirely, and often over a trifle.

Molly, my sister and I fell out,

And what do you think it was all about?

She loved coffee and I loved tea,

And that was the reason we couldn’t agree.

The greater our hope that we will never be disappointed the more assuredly we will be. The more we yearn for someone to be All Things, Abundant, Unlimited, the more injured we will be by their inevitable failures.

Psychoanalytic theorists might talk at this juncture about lack of “object constancy” – as the child struggles to keep the  depth  and force of their hate from contaminating their  admiration and love of the parent.

Winnicot might talk about the “good enough” parent needing to engage in a commensurate process in order to metabolize and guard the child and themselves from their maternal hate. A primal hate  called forth by the depth of the infant’s  hate and frustration.

When the force of our hate has not been metabolized and modulated – we fear that our hate and sadism could:

– annihilate our loved ones

– destroy their love for us

– or ruin our own ability to love them anymore.

So often (but not always) a client’s attempts to destroy the therapeutic relationship are pre-emptive strikes – attempts to drive the therapist away  – rather than wait to be abandoned or injured when they are unprepared.

But that is not always the case.

Clients may be trapped within an obedient, compliant, pseudo-alliance. And then lashing out may be healthy: self-respecting emotional violence. Rage, aimed squarely at the therapist, may be the most authentic gesture they can muster.

And sometimes clients know, better than we do, exactly what they need to survive or heal –

and it is not us.

And the only way they can sever the weighty  attachment and the unrelenting  pressure of your good intention is to break it off,

to break you off, to break you into pieces.

There was a little girl who had a little curl

Right in the middle of her forehead;

When she was good, she was very, very good,

And when she was bad she was horrid.

In Kohut’s words: “While a rapport between patient and therapist may be established, the diseased, or potentially diseased sector of the self does not enter” into the therapeutic relationship.

Heinz Kohut, Restoration of Self

Sometimes hatred and sadism are unleashed upon the therapist because it is the first real relationship where it is safe to do so – rage and destructiveness cannot be calibrated or modulated without someone to be injured, to survive the injury, to forgive and to accept reparation.

You tolerate your client’s illogicality, unreliability, suspicion, muddle, fecklessness, meanness, etc. etc. and recognize all these unpleasantnesses as symptoms of distress (In private life these

same things would make you keep at a distance.)

D. W. Winnicott, The Maturational Processes and the Facilitating Environment: Studies in the Theory of Emotional Development

And lets face it. Sometimes we just deserve it. Certainly, we all know that psychotherapists can be totally fucking insufferable. But hopefully not always unforgivably so.

But still, there are many instances where you are damned if you do, damned if you don’t. Absorbing, deflecting, reflecting upon, and attempting to survive hurtful, destructive rage is unavoidable as a psychotherapist because unmodulated, rage is often, precisely what has brought the client into therapy to begin with – expressed as dysfunction in relationships, or internalized and disguised as nihilistic, suicidal despair.

A client’s rage can activate our own – just as maternal hate can be triggered by a child’s rage.

There were once two cats of Kilkenny.

Each thought there was one cat too many;

So they fought and they fit,

And they scratched and they bit,

Till, excepting their nails,

And the tips of their tails,

Instead of two cats, there weren’t any.

It is then that the psychotherapists job is to buckle up, hang on for dear life, try not to defend or retaliate – absorb the blow, protect ourselves against the sharp bite, become curious about the cutting contempt, or go home and have a good cry and try to put ourselves back together again so that we can return to session ready to connect again, to sort out abuse from necessary corrective experiences, sadism from developmental maturational process, angry breakthroughs from pointless, relationship destroying temper-tantrums.

You accept hate, and meet it with strength rather than revenge.

D. W. Winnicott, The Maturational Processes and the Facilitating Environment: Studies in the Theory of Emotional Development

It is not easily done. And often you rotate though a series of attempts at empathic guesses, hunches, theories and formulations before you find the one that might transform destructiveness into connection.

If you can find the one that fits. Before the relationship breaks.

Before the client breaks. Before you break.

Before your capacity for on going concern is broken. Before their faith in you is lost for good.

But none of this teaches therapists what it feels like:

Another dream:

I pull over into a roadside attraction. There is a large hand painted sign, of a wolf with a vicious mouth – dramatic “all the better to eat you with” teeth, and the words: SWIM WITH WOLVES. The doors open on to a large indoor pool, where a pack of wolves are swimming like a school of fish. There are “experienced guides” overseeing the experience but they do not actually get in the pool with you – and as I inch into the deep end I realize that they will be of little use if this actually starts to head south. I wonder what I am doing, and why the hell I am doing it. But the wolves are wild and gorgeous, and I am drawn into the waters by their fear, their vulnerability, (they are profoundly out of their element after all) by their beauty, and power and by their exhaustion as they swim and swim in circles. I am concerned for them, I want to help to keep the wolves afloat. I want to be near them, to be accepted by them, trusted. Do I want to tame them? Not necessarily, but I surely want be seen as their ally. I swim in deep. One, so exhausted it is near drowning, lets me hold it afloat while it gasps for breath and takes in oxygen. Yet, I must also be skillful enough to let go the split second that the wolf regains its full energies – because I am supporting it before it can possibly have any reason to actually trust me. I smell its hot breath, I feel a low growl gathering deep in its belly I feel its dog-paddling legs gather strength and I swim away before it can go for my jugular. I hear it SNAP just milliseconds after I have kicked toward the far side of the pool. I look at the old, white-haired, experienced guides – who are gathered drinking coffee and see that they are all scarred, and have survived many deep and tearing bites. It is part and parcel of the work.

I get out of the pool, exhilarated to have been of use, to have been close to such an extraordinary creature, grateful that the wolf, and I have both survived.

This time.

Therapists can be seduced by the client’s idealization – or by the therapists own inflation and narcissism in to enjoying their own prowess and brilliant interpretations – We can over identify, assume that we understand what we do not, we can wander, unwittingly into a minefield – believing the relationship is on solid ground when it is not.

A wise old owl sat in an oak,

The more he heard, the less he spoke;

The less he spoke, the more he heard;

Why aren’t we all like that wise old bird .

As clients we can come to believe that we need to find therapists who are perfect mirrors of ourselves, and therapists can also attempt to cull clients who are the very easiest for them to treat.

Birds of a feather flock together,

And so will pigs and swine;

Rats and mice will have their choice,

And so will I have mine.

But are psychotherapists really fulfilling our moral commitments. are we truly engaged in the work if we restrict ourselves to the most domesticated and shallow end of the pool?

It is the therapists job to pace themselves – to alternately invest and divest – step in and step-back – in order to preserve their empathy for their client over the long haul. To do all they can make sure that resentment never accumulates or toxifies in any way that could undermine their ability to continue to empathize with the client’s experience.

But not every relationship makes it that far, and some last for years and still end before they have begun.

In all these respects you are, in your limited professional area, a person deeply involved in feeling, yet at the same time detached, in that you know that you have no responsibility for the client’s illness, and you know the limits of your powers…..”

D. W. Winnicott, The Maturational Processes and the Facilitating Environment: Studies in the Theory of Emotional Development

For every evil under the sun

There is a remedy or there is none.

If there be one, seek till you find it;

If there be none, never mind it.

Source: whatashrinkthinks.com

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