Meadow's "Treatment Beginnings"

An elegant, little paper from 1990 by Phyllis W Meadow, simply titled “Treatment Beginnings,” shows the author’s perspicacity about contemporary psychoanalytic ideas. She encourages the therapist to consider “[w]hat quantity of stimulation will help the patient to be in the room with me and to talk.” [‘Quantity of stimulation’ is what is noted in infant research re: regulation: up or down, to engage or sooth, respectively, the  infant.] She writes, “the initial phase of treatment is… creating an environment in which the patient can give up his resistances to talking in the presence of the analyst.” Contemporary analysts might substitute for “give up his resistances...” the words ‘feel safe and participate in building a relationship,’  but the author’s meaning is clear: “Creating the relationship that will be therapeutic is the primary task of the analyst…”  It is the analyst who bears the lionshare to create the safe space and to keep the process alive. (Winnicott described the good-enough mother who adapts the environment to the infant’s needs.) Meadow’s ideas about awareness of the patient’s “patterns for making contact” speak to a utilization by the analyst of relational paradigms. In fact, she states explicitly, “change takes place within the doctor-patient relationship.”

I am particularly fond of her stating that “The projector does not need a contradictory perception…” because I think it speaks to the idea that the patient first needs us to join with him, to welcome his perspective [and only later, when intersubjectivity is accessible to the patient, introduce our otherness.]  Recently a patient accused me of being “vindictive and treacherous” which I could not initially wrap my head around until the patient added that she believed I was plotting with another patient to kill her. Owning that all of us have murderous impulses, I then could understand my treachery. Wearing her attributions, instead of contradicting them [Note: if I had contradicted them even silently, with right-brain to right-brain knowing she would have felt my opposition] had the effect of calming her fright. She was calmed somewhat perhaps because I was not contradicting her, not challenging her beliefs, not murdering her agency, if you will. Later, much later, in moments of mentalization (a necessary component of intersubjectivity), we were able to consider her ‘assumptions’ as thoughts, without a psychic equivalence.

Another lovely pearl was Meadow’s “Even the simplest mode of interpretation, confrontation, pointing out a patient’s behavior or explaining its effects, even this leaves the patient feeling criticized or attacked…” [and shamed, like a specimen under a microscope, less than fully human;

All interpretations in the classical sense, ‘you did this ---  because of that ---’ may serve to humiliate and criticize.] Meadow notes that such confrontations “may intensify self-doubts.” Don’t many of our patients already come to us with a history of having their hard-wired capacity for reading the intentions of others vitiated by parents who scolded, ‘You don’t mean that!’ or ‘You don’t feel that way.’? When analysts want patients to question assumptions and erroneous beliefs, we hope to find a way for the exploration to be a collaborated effort which includes the patient’s curiosity and not just our own ambitions. Meadow wrote, "More important than progress is the ability to resonate with a patient..."

Meadow, PW (1990)Treatment Beginnings. Mod. Psa. 15: 3-10.