Continuing Case Continues? and disruptions, and continuity of sense of self

There was today in class a lot of confusion on the instructor’s part. Even if we get past the limitations imposed by differing accents, by the teleconferencing connection, and by this instructor’s hearing impairments, there remains that the instructor could not sort out when the presenter was talking about what occurred in the session explicitly between patient and therapist and what was being related from the presenter’s mind as hypotheses and as background information about the patient and the treatment for the class to know. [To this instructor’s relief, the instructor was not the only one confused about ‘what is going on around here’ in the class.]  So we decided to discuss together what was going on. [Unfortunately, the presenter was not able to get through the session she had looked forward to presenting; a melancholy choice: choose one, lose the other.]

By addressing in class the process instead of content, we were able to glean some useful ideas.

Quoting one classmate, we could ask: What belongs to whom? Whose ‘language’ is spoken? (whose desire? [a topic of the earlier course]) and Who am I?, all of which might relate to the patient, the patient vis a vis her parents, the therapeutic dyad, and to the class. This same classmate noted that the disruptions might be related to the session (as well as to the presentation), specifically to the possible dissociated self states of the patient coming into the session, threatening continuity of self and of session. Another classmate noted a possible dilemma between fusion and individuality for the patient, that is, the patient experiences an attachment as having to lose the self or part of the self if she is to maintain a connection. (The presenter confirmed this with an example from the session). There is also the Adult Attachment Interview research which found an incoherent narrative is indicative of insecure attachment, which the patient here certainly experienced with her intrusive mother. Lastly, the instructor’s repeated attempts to clarify what the presenter was saying caused not only too many  interruptions (discontinuity) but also had the presenter feeling scrutinized just as the patient had felt so micromanaged by her mother.

All this by way of saying what the reader already knows: process is as important, maybe more so, as content; class process may reveal valuable information about the patient’s inner life; parallel process exists; instructors need to be more mindful of how her desire affects the presenter’s; and much more.