A supervisee, praised in her respective psychoanalytic training program for her “calmness and stability,” asked me recently how she could keep herself stable when faced with her very unstable patient whose instability, lamented the supervisee, she could feel inside herself as if her patient were “pushing” her. The therapist complained that she could feel herself “influenced” by her patient’s self states. Her patient was continually running away from the chaos of her own world and now the therapist-supervisee wanted to run away from this patient. A professional therapist, the supervisee claimed, can keep herself stable, work deeply and slowly, and could “stay there” in the room with her patient.
I was pleased to know that the therapist I supervised had the capacity to be influenced by her patient. Now we had to find a safe and comfortable enough way for the therapist to share with her patient that her patient was no longer alone in the chaos. And what a good job the patient was doing communicating her own internal states. [Is this what projective identification is?] If the therapist, too, could feel the chaos, and if the therapist could both survive the chaos and not be shamed by her lack of stability, what might these mean for the patient? That the patient was no longer alone? That it is okay to make mistakes? The supervisee further lamented that when she managed to feel calm and stable with this challenging patient, it was at the cost of feeling “dead” inside, feeling “serious: and unable to “interact” with her patient. The therapist found that paying attention to her own body sensations relieved her some of the deadness. The supervisee asked how she could be both alive and stable with this patient.
That is the big question, isn’t it? Bromberg, in On Knowing One’s Patient Inside Out (1991), wrote about how very difficult it is to be both participant and observer [Sullivan]. I have often wondered how one can hold the patient’s hand and jump into the abyss with the patient, and still hang on to the rim. It must take Herculean strength, and personal mettle. I know I failed gravely at least one patient.
Is the deadness the therapist feels inside not also, at least partially, a joining with a self state of the patient’s? Could the patient’s chaos be a way to protect herself from such deadness? Had the therapist stumbled upon something that the patient had dissociated in attempt for the patient to save herself from deadness? The supervisee asked why I, the supervisor, in multiple venues we had shared, was always so alive. That got me to thinking about from what deadness inside myself did I wish to run? Was avoidance of such deadness what made it impossible for me to truly leap into the abyss with my patient(s) and could it have simultaneously caused me to let go of my observer stance? The supervisee worried that, were she to enter the self states of her patients, they would either not make progress in therapy or they would leave treatment altogether for they would lose hope. I surmise that, should we make friends with our dissociated self states, neither destroyed not shamed, that might open a path for hope.