Change precedes insight [example from TBIPS Continuing Case Conference/Course] Part I

A therapist makes an ‘interpretation’ which is summarily rejected by the patient.

The patient’s girlfriend has broken up with the patient and the patient takes a baseball bat to her girlfriend’s living room. (Some history: In high school the patient’s parents had disapproved of her homosexuality and immediately sent the patient to a different school upon learning the patient had a girlfriend. In college, the patient had belonged to an anarchist group which occasionally destroyed the property of capitalist institutions. The patient experienced her mother as abandoning and misattuned.)

Upon learning of this patient’s rageful breaking up of the girlfriend’s property as a result of their breakup, the therapist tries to explicitly link the patient’s violent reaction to the patient’s college interest in the anarchy group and to her mother’s abandonment. This ‘interpretation’ enrages the patient, “Stop playing power games with me with your irrelevant pseudo-interpretations!”

 

[What is an interpretation, different from clarification, confrontation, musing aloud? One participant in class notes it is a way to find meaning, to explicate meaning; it is a hypothesis. Another participant, recalling the traditional idea of ‘making the unconscious conscious’ says it is a way to bestow insight, to bring the intention into awareness. Some contemporary theorists say change in experience and behavior precedes insight. See example below.]

The therapist recognizes her misstep and ‘back pedals’ [Mitchell] saying that maybe she misstated or gave her idea too much weight or maybe was wrong entirely. The patient calms [an example of mutual regulation, see Part II in next post] and becomes her usual, joking self, but the therapist remains serious. The patient then looked ashamed and apologized [for being frivolous or cavalier]. However, the patient subsequently expresses a wish that her own mother would take her seriously, for her mother is always blithe and one cannot have a serious conversation with the mother.

How did the therapist ‘decide’ not to join the patient in her more jocular tone? It was not a conscious decision but the therapist did have previous knowledge that the mother could not take the patient seriously. The therapist’s ‘failure’ to join in with the patient’s jocular state of mind turned out to be a fortuitous, intuitive response because, in providing a different experience-- a different way of being-- with the patient, the patient recognized the longing to be ‘seriously’ connected to [recognized by] her mother.

One class participant wonders if perhaps looking ashamed had really been looking surprised, taken off guard by this peculiar/alien experience, or even looking relieved to be finally taken seriously. The felicitous outcome was that the patient was now aware of something hitherto unformualted; now she knew what it was she wanted. [Here is the example of a change in experience being followed by the insight.]