Continuing Case Conference, continued

Power Games [TBIPS’ Continuing Case seminar] Part II

The patient accuses her therapist of playing “power games” [See post of Nov 1, 2018] in response to a connection the therapist tries to make between the patient’s acting out (destroying property) and feeling abandoned by her mother. The therapist also sees the behavior as an enactment for, when the patient was abandoned repeatedly by grievance misattunement on her mother’s part, the patient felt destructive violence had been done to her, her sense of self, her going on being. -- [When bad things happen to us, we feel ashamed, as if it were our fault.]

When the therapist makes a repair, and remains serious, the patient apologizes and looks ashamed. The therapist, reflecting later on the session, wonders if the shame had not been co-created, for the therapist had felt a need to regain control of the session. Perhaps the therapist had been too controlling, lending validity to the patient’s complaints about power games.

The therapist notes her and her patient’s strong tendency to have to be right. The therapist recalls that the patient had once said that her friends accused her (the patient) of playing power games. The patient is very articulate in being able to ‘put down’ the therapist when she feels the therapist is engaging in mind games. One classmate notes how the patient’s mother plays power games with the patient, but implicitly. This may have caused the patient to be more intolerant, or perhaps frightened by, covert power games. The patient prefers fighting outright.

When the therapist tries to ‘control’ the session, induce or prematurely introduce ideas, or has expectations that the patient should see things the therapist’s way, the patient may experience implicit violence. The patient’s behavior may bring this to the fore with her explicit action. Because the patient experiences herself to need the therapist more than the therapist needs the patient -- the therapist has many patients; the patient only one therapist-- the patient may not only feel shame but feel knuckled under to the therapist’s superior power play.

Attunement and Shame  [TBIPS’ Continuing Case] Part III

The patient relates a dramatic reaction to her rejection by her girlfriend. The therapist says, “It must have been so painful, I can’t imagine how painful.” The patient goes silent. The therapist inquires about how the patient experienced the comment, for the patient seemed to become defensive. [In the past, the patient had said when friends sympathized with her: “I can’t stand it. I want to be strong.”] The patient replies with derision, “You are professional; you do your job well.”

[Did the patient experience the therapist as disingenuous? Is sympathy too alien to the patient for her to assimilate it? Did it make the patient feel weak instead of ‘strong’ and serve to humiliate her further? What do we in class miss in tone and in other implicit communication when hearing case notes?]

The class discusses. Not only does failure to attune to one’s needs engender shame [I am not deserving of having my needs met. I am greedy. I am needy. I am not important. I am nothing.] but sympathy for the patient’s suffering may also inadvertently cause shame.  What if the patient experiences attunement as pity? Pity would devalue her, make her feel ‘less than.’ [Something happened to the patient but did not happen to the more fortunate and better-positioned therapist.]