Thursday, July 31, 2014

In-house #2 -- Two mini-vignettes

A client who left

Here I sit in my pity pond, steeping in bile and tears.  I don’t know the answer to a question: Why do some clients, steadfast in their neurotic alacrity and appreciation, suddenly become immaturely irresponsible: a downward parabolic curve to an ugly end?  Why did this woman attend a handful-and-a-half of sessions, mostly her intense soliloquys, then respectfully cancel and reschedule, then “too late cancel” (post-appointment hour) and reschedule, then just no-show no-call?  This may, of course, be her life out of control.  Though that generous theory seems belied by the fact that she recently won her Disability benefits and now sits on a small cushion of money.

This woman was truly self-enclosed, even though she had gushed to front desk staff that she “loved” me.  I had diagnosed her as Histrionic Personality: She was “very, very close” to every former boss (even those who’d fired her) and a bevy of others, including acquaintances and a pimp.  Self-enclosed meant a brand of solipsism,* not the execrable kind that starves one’s child, de-oxygenates his life by absolute blindness and neglect, but a cloying sort that clings to the child as a possession to decorate and fill up with goodies.  The kind that “loves” the counselor, even claims to be re-railed by some simplistic guidelines (a “My Goals”-type listing), but is still daddy’s abject girl and princess, sees and knows only herself.

So, and still, what happened in her inner life to pull her away, without a blink, from the therapy that seemed to matter to her?  I do not know what happens in a Histrionic, whose problems – her childhood life of cluster-crazy dynamics poking holes in her and filling them with sequins – by sheer force could fuel the drama I’d see in that chair.  The only other Histrionic I’ve known would show up two or three times a year with lite regret for the many missed months.  Remember that Narcissists can extinguish the therapist’s existence after leaving therapy; Borderlines may forget what their spouse looks like during a short separation.  Levenkron treated an Obsessive-Compulsive man who admitted the therapist wouldn’t exist in his mind for a long time.**  But I’m sure there’s more in a Histrionic’s hollow core – the convex mirrors to herself, the neglect by both parents – that made her so negligent.  Maybe we could say that such an individual is always tragically negligent, of her own life and therefore everything in it.

Identity and truth

There is a college student too dysthymic and intellectualized to do deep-feeling work, who nevertheless is intent upon grasping his identity problem.  He asked, How do I know my thoughts are mine?  This question is as heavy as the world, because I believe most adults have screen thoughts, ventriloquist-dummy thoughts that defend their pain rather than reflect their health, and are therefore deceptive and “wrong.”  A related question, my client wanted to know how one determines what is the “truth.”  We imagined this scenario: Two ten-year-old neighbor friends come from very different homes.  One, Gil, has parents who are human: grown up and secure in themselves, content, and therefore able to love and accept their child as a separate, individual self.  The other boy, Bill, has parents who are off-human: vessels of unmet needs, never grown up, unable to countenance a child different from and better than themselves.  The healthy boy values life as he is valued; the other the same, and opposite.  On a spring day, a beautiful green praying mantis is perched on a bush.  Bill rushes into his house and returns with a container of Elmer’s Glue, intent on covering the mantis with it.  Gil cries, in alarm, “Don’t do that!  Why would you want to hurt it?”  Bill stops, flustered.

The client and I considered their thoughts.  Gil thinks: The praying mantis deserves to live.  Bill thinks . . . nothing!  He is troubled, confused.  Gil’s question has struck him like unique therapy, in a place where nothing from his parents ever struck him – in his heart.  He is not too old and callused to feel his pain, and probably some memory of compassion.  Maybe if he could think now, it would be: It’s true.  Life is wonderful and deserves to live.  Why doesn’t anyone see mine?  And my client and I saw that if Gil had not intervened and Bill did suffocate the mantis, and was never touched in his heart through his childhood, he would indeed grow thoughts.  Bugs are ugly, they are nuisances.  They deserve to be eliminated.

Who nowadays has truthful thoughts, those that accord with the real self before injury?  Pain screams need and hides; health feels.  And feelings are the inner voice that thoughts find words for.  Question your bent clients who talk about love, their academic or career ambitions, their “guilt,” their assessments of their children, their “anger at life” and hatred for their wife, their politics which believe it’s right to deprive the poor or rob the rich, their moral system, their certainties.  They are stating their defenses, labyrinthine or straight.  You won’t know what real is underneath them, what identity, until you parse them away.

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** “He laughed quietly and responded, ‘Not really.  People don’t count in my pictures.  It’s only the other objects I have to think about.  Actually, it may take me months to remember what you look like.’”  Steven Levenkron, Obsessive-Compulsive Disorders, Warner Books, 1991, p. 76.

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Comments are welcome, but I'd suggest you first read "Feeling-centered therapy" and "Ocean and boat" for a basic introduction to my kind of theory and therapy.