An interesting supervision (Continuing Clinical Case course)

A thirty year-old professional woman, married to her colleague, suffers from severe postpartum depression. “Help me! I want to get better!’ is her obsessive lament to the therapist. She cries and wails to her exhausted therapist about her inability to be there as a mother to her infant and about how she only wants to die. She has, in fact, recently attempted suicide by taking a full bottle of sleeping medication. The patient threatens repeatedly to quit treatment. While her patient, like a distressed and flailing infant, sobs and screams on the couch, the therapist, too, feels helpless and incompetent. The therapist recognizes she must first soothe (regulate) this patient but continual attempts leave the therapist tired, so tired. ‘The patient is “haunting” the therapist, appearing in the therapist’s dreams. Is all this projective identification?,’ the therapist wonders.

The supervisor suggests using a soothing tone like one would use with an infant. The therapist worries the patient would respond to that with anger. Sometimes the therapist cannot stand this patient but is mostly sad for the patient and the patient’s baby. A classmate suggests that the therapist let the patient know the therapist’s limits and frustration. Yes, let her know she has an impact on you. ‘Help me find a way to soothe you.’ The patient’s own mother was devoid of affect, cutting off all feeling after devastating childhood losses of her own. Only death can make the patient’s mother feel (cry). Perhaps the patient gifts her mother an invitation to feel again should the patient effect death once again in her mother’s life. Perhaps the patient’s screaming and wailing is the only way her mother might hear her.

Winnicott noted that the perinatal time of maternal preoccupation is very risky for the new mother, requiring the maternal grandmother, husband, and/or others to protect the mother’s bonding time with the baby from impingement by real world demands. Perhaps this patient is screaming for protection, screaming for her life. Screaming to be heard. But the baby is so demanding, a bottomless pit. There is no soothing the baby just as the therapist cannot soothe the patient. Perhaps the therapist could share with the patient that the therapist’s helplessness parallels the patient’s own helplessness vis a vis her own baby’s helplessness, and, moreover, how helpless the patient herself felt as an infant to soothe her own troubled mother. A classmate soothes the therapist, reassuring the therapist that the therapist has the right to be tired, to take a break, and to recognize that the therapist is actually good-enough.