The Forward Edge (and a co-created opening of the therapeutic space)

Marian Tolpin encouraged us to consider the forward edge, that is, the striving for growth, which is often obfuscated by what appears to be only ill-conceived and regressive behavior on the part of our patients. An illustration of a forward edge, which only became evident one year later, was discussed in this week’s continuing case seminar. About three years into treatment, a patient and a therapist were having a difficult time understanding one another at the beginning of a session. Silence punctuated this difficulty and the patient abruptly left the session.

In the subsequent session, and another session later, the therapist wished to explore what had happened. However, the patient would not elaborate on what had happened. A year later, after the patient had missed the previous session, the therapist brought that abrupt leaving of the session again up to the patient. The patient wondered aloud if treatment were even helping and, then, this time addressing her abrupt departure from that session a year earlier, the patient shared how significant that leaving had been to her: after that event, the patient had become able to tell her intrusive mother ‘no.’

The class surmised that the patient, able to exercise her own agency, leave the therapist and have the therapist survive, had been a new experience for the patient which allowed her to ‘leave’ her mother’s point of view without fear that her mother would die. (The mother had often said that the patient’s words, object choice, and actions might kill her father or her mother.) Interestingly, the therapist’s own mother had died previous to that session of misunderstanding, something the therapist shared in a subsequent session. The patient’s ability to leave that session had not been merely an inability to tolerate a different, temporarily less attuned therapist, but had been the forward edge toward autonomy and independent agency, scaffolded by the therapist’s ability to survive the leaving.

Why was the patient now, a year later, willing to discuss with the therapist about that day? The class had some ideas. This patient had refrained from telling her mother any new ideas or events in her life until these were firmly established in her own experience lest the mother usurp, destroy, or self aggrandize what the patient brought to the mother. The patient had now firmly established the ability to say ‘no’ to her mother as well as had increased trust that the therapist would not usurp this new power.

What was the therapist’s contribution to facilitating this long awaited discussion? It turns out that the therapist had also brought up -- prior to the patient having shared the positive impact of that year ago session -- empathy or attunement to the patient’s little girl ‘lost’ self, and the therapist had brought up the idea of power games (patient puts down her girlfriend, patient’s mother puts down patient) between the therapist and patient: did patient feel put down by therapist’s power games [see post of 11-1-18] in the previous session, to which the patient replied that she now felt more equality between herself and her therapist. It was after making explicit this equality that the patient was about to share with the therapist how the therapy has been helpful.