Transcription
In this session, we're going to see what happened approximately 6 months after the session in which the patient expressed a lot of rage and anger and I as the therapist communicated that we could contain that, experience it, and reflect upon it in a way that was a surprise to the patient who assumed that he would be rejected and abandoned because of those negative feelings. So, we're about 18 months into the treatment now and after that crucial session that opened up the patient to have access to the deeper, more intense feelings that he had not permitted himself to have access to and certainly had not permitted other people to have access to. We've been working now in a way that was more positive than before, more genuine, more authentic, but it had that back and forth between feelings of trust, doubt about the trust since trust is a new and unfamiliar feeling, but there'd been a shift from a fundamentally negative transference with fears of abandonment and rejection to a more positive transference of acceptance and trust. So, this is going to be an example of an idealized transference that had erotic aspects to it. In other words, when the patient expresses feelings of love towards the therapist, which can be a very challenging moment for therapists, even though in the early phases of the treatment, they're usually not comfortable with feeling the opposite of anger and suspicion and aggression and sometimes hatred. Most therapists say they're even more uncomfortable if the patient talks about love and affection towards them. So, we're going to see how that might be dealt with.
>> So, uh I'm a little bit nervous about today. I think um I think it it's time to This is crazy. Given what happened 6 months ago that now I want to end it because um I don't think it's appropriate to continue therapy if I'm developing um like feelings.
>> Mhm.
>> Um for you, obviously. But, um so, I think you probably think it's a good idea to to end it, right? I mean I think we should end it cuz yeah, I don't know. Um yeah.
>> Uh-huh.
>> Uh feelings
>> Feelings.
>> Yeah. Strong feelings.
>> Nice feelings, sorry.
>> Yes, feelings. Well, um I I know that um there's been there has been a development of more positive feelings than were initially here.
>> You felt that as well?
>> Yeah, I think we both felt that, but I I it didn't seem to make you as nervous as you are right now. So, I wonder if this
>> Well,
>> I'm I'm surprised by it myself because it's I don't know. No one's Like I don't know. You You just have this incredible ability to absorb the anger.
>> Mhm.
>> And that's um I don't know. It's not a pro obviously this is not a problem this is never going to happen you you're married you're with somebody so I'm not expecting anything which is why I think we should end it but um
>> Oh.
>> When you say I'm married you're saying
>> I mean you have this this perfect life it's um and you you showed me that it's possible for me to have but I didn't I just didn't expect this turn that it would be
>> Uh I I'm trying to respect your feelings but also make us a little more clear about them uh
>> I mean I think it's pretty clear what I'm saying.
>> So I mean you're saying that your feelings are getting stronger. And
>> Yeah.
>> You don't think we can talk about that.
>> You think there's a point in talking about it should
>> Well
>> What is there What is there to talk about? I I've just learned that people can be in a relationship and you've been in a relationship for how long? It's very long it's healthy you know how to communicate um
>> Well wait there's something really troubling you right now right? Um the level of difficulty kind of opening up a little bit more it seems like it's gone from positive to
>> I mean it's it's positive but it's negative at the same time.
>> But positive in the in the sense
>> sense that I've never felt like I've never felt like this I mean you know how how since the first time I came to you I've struggled to even continue talking to someone on a dating app.
>> Yeah.
>> And you're someone I see all the time and you you just have this incredible way of listening. You you never take it personally when I attack. It's
>> But um this is the kind of
>> thinking that there's uh
>> Well, there's a couple of things. One is you think there's something unique about our relationship that couldn't be replicated.
>> Our relationship? Yeah. Yeah.
>> Oh.
>> Yeah.
>> You you picked up on my saying our relationship. Yeah.
>> I mean, it is there. I know it's not I I know you're you're married. I get it. But it's a relationship and it's made it's helped me it's helped me it's helped me.
>> But it seems like your idea of where the relationship could go has somehow
>> No, I already told you I think it's it has to end. Obviously, this is not professional, but I just thought I
>> What part is not professional?
>> Um me sharing how I feel. That I'm developing strong feelings and
>> Yeah. I'm sure that's difficult to feel.
>> Yeah.
>> Yeah. And um but
>> And just the way I've I mean, sorry, but I've been looking at your social media or This is pretty weird, but your husband's social media.
>> Yeah.
>> And I the way you guys are it just seems so I mean, what I keep wondering, will I ever have something like that, you know, and go on holidays. It's Do you even fight? I can't imagine like with your energy and the way you are like you probably don't even fight.
>> But you're kind of wishing you were in his place.
>> I mean, that's normal, right? Feel that?
>> Um if it I Yes and no. I mean you might say it's normal, but then if it's normal, why would you want to leave and not continue to talk about it.
>> I guess I'm doing what I did 6 months ago. I'm assuming, but you're obviously like, yeah, you're better at this than me figuring out what it is that I need, which is exactly why I'm developed those feelings in the first place.
>> Um
>> No, I get more nervous when you're looking at me like that, but What do you What do you think should we should do if I'm if I have those feelings?
>> Well, I think like with every other feeling you bring in here, we have to reflect on it together. And the um unique thing about psychotherapy is that we can talk about any feeling under the sun knowing that it's safe to talk about it because we're not going to act on it. And it seems like you're afraid to
>> to talk Can I tell you what I want to talk about? I want to talk about your relationship, the one you're in, cuz I'm Yeah, maybe you can call it stalking, but it's just What is it like for you to be in a relationship? I mean
>> I'm more interested in what you're feeling now because it's leading you to want to get out of here. You're saying you want to leave.
>> Cuz it's I mean it's humiliating to stay and feel something for someone who's never going to feel anything for you in return.
>> But I would never feel anything.
>> Yeah, yeah. You don't. So
>> Nothing.
>> What What do you feel then?
>> Well first of all, I think it's important to reflect on the idea that to paraphrase you, I'm not sure it's a quote. You feel like couldn't ever have any feelings for you.
>> Yeah.
>> You feel that way. What is it about you or about me or about both of us that I could not have feelings about you?
>> Because I I couldn't be in the relationship the way you are in a relationship.
>> You feel you're kind of a
>> No, I mean, it's just we already went over how I how I how I am when I get angry and I imagine your partner is not like that, so
>> So, there are two things. One is the more you're talking it seems as though you've got an idea I have a pretty ideal life.
>> Yeah. It looks It sure looks that way.
>> Uh-huh. Well, and yet I'm questioning where that comes from because to tell you the truth, I'm not sure exactly what's out there. I tend as far as I know to keep a pretty low online profile.
>> I'm pretty resourceful, but I mean
>> You're resourceful.
>> I found pictures that your your partner was tagged in.
>> Okay. But on the other hand based on the nature of this therapy I don't say a lot about myself. So, a lot of what you think comes from you rather than being a
>> It's that
>> determined by objective information about me.
>> So, I'm I'm projecting again.
>> Well, you you you It's funny, the way you say that I'm projecting again is sort of like a devaluing of yourself. Because that is kind of what I'm suggesting. And that I could and I could find that an interesting challenge to think about what you're projecting, but you say that in a dismissive way. So, I'm projecting again. I guess I'm just this inferior being. Instead of saying, well, I'm projecting again. Let me learn about it. Let's look at it together. Let's see what
>> But this is this is what I mean. Like you always manage to see what's going on with me. This is I think the danger of what this is why those feelings developed. So,
>> You don't think anybody on the planet besides me could have an understanding of you at this
>> when you put it that way, yeah. I mean, I'm sure but I haven't met them.
>> [gasps]
>> Well, you've been struggling for a long time, for 35 years or so, with what you called your projections and with most people, I guess, or what we've learned is that you do what you've been doing with me, it seems. Seeing them as so ideal that you can only feel inferior in relation to them and then, of course, the tables turn in a way to protect yourself.
>> Yeah. So, you don't have a perfect relationship. It's what I'm hearing.
>> Did I say that? Did I Did I say I do? Is what I mean.
>> No.
>> Am I No, but you feel I do.
>> No, I think no. I mean, when you say it that way, no.
>> Yeah, you think I don't, but you feel I do.
>> Yeah.
>> Yeah, that's the problem right now. I think you've made enough progress to realize that that image you have of somebody could have a perfect life, be a perfect being. I think you've thought about it enough that you realize it doesn't quite hold water as we say. But, in your gut you haven't got beyond the feeling that that could exist. And you haven't got beyond the feeling that that's what you desire.
>> Yeah.
>> And when you desire that, which I understand I think we've gone over this before. You're condemned to being disappointed.
>> So, I shouldn't desire it.
>> Well, not if what you desire is what you were just talking about in terms of your image of me. I mean, frankly if you have that image of me it would be quite a revelation for you, perhaps to get beyond that image.
>> Yeah.
>> And I'm talking now with a concern about the pain of giving up the desire.
>> I
>> I mean
>> I don't want to
>> Well, I know. You suffer a lot because you can't find the right person to be with. But, you'd suffer in a different way. But, I think in a healthier way if you gave up the desire for that image of perfection.
>> Maybe I should be with a therapist. Not you, obviously, but maybe I should be with a therapist.
>> There are plenty of therapists out there looking for partners, and if you wanted to date a therapist, that might make sense. But, on the other hand it seems like you're still feeling inferior. Like quote, "I could never understand things as well as a therapist could, so I need a therapist to provide the understanding to allow me to have a decent life rather than looking for that from within yourself.
>> Yeah.
>> It's painful. It's like a fight to give up a long-standing wish. And a lot of people, I think probably everybody has a vestige of that wish for some kind of perfection. But the more you act on that wish, the more you pursue that, the more you're going to be a victim of the impossibility of that wish.
>> And did you ever feel that and then come out of it? Did you ever feel desire something and were able to get over it?
>> What do you imagine?
>> Yes.
>> Well, uh as you know, I don't usually direct directly answer questions, but I think from the direction this conversation we're having is going, you might conclude that.
>> Oh, so we won't end the therapy, but I think today I feel a little bit embarrassed from what I confessed, so maybe we
>> Well, I'll be happy to continue to talk about it, but yes, unless you want, we won't end the therapy. What we saw in this vignette represented what can be the most difficult kind of situation for a therapist to find him or herself in. It's what we call the development of the erotic transference, where feelings of love develop between the patient and the therapist. It doesn't happen in every therapy, but the overall evolution we hope to achieve with our patients is from the predominance of a paranoid transference in which the patient projects their aggressive feelings, their angry feelings onto others and therefore expects others to reject them, to turn away from them, to criticize or judge them. So, that's the classic initial transference of suspicion and mistrust. We try to help people over time get to know their own feelings of anger and aggression. We try to help people gain a conscious awareness of what they used to deny in themselves. And as I explained in our summary of objects relations, very this is a difficult process. There's some guilt involved. This ownership of the capacity sometimes to hurt others or harm others. But if the patient accepts that they have that within them, but they also have a lot of good and loving and caring feelings, then they begin to have that balance we call integration of the whole spectrum of emotions. However, sometimes as the paranoid transference is getting resolved an idealized transference of the therapist begins to emerge in which the loving feelings can develop. Now, we have to distinguish between an idealized form of love and a more mature form of love. Uh writings about love, especially Dr. Kernberg's writings about love, show how complex it is. A mature loving uh relationship includes a whole range of emotions. It's not just a Hollywood romantic kind of love. But some of our patients think that one can achieve that idealized purely romantic form of love. And as we have helped them resolve their doubts about us, their suspicions of us, their paranoid fears of us, they go into the kind of idealization we just saw in this vignette in which they imagine we're perfect, everything in our life is perfect. Our emotional life, our psychological life, everything is ideal. And in instances like that, the patient sometimes begins to have loving feelings for, they think, the therapist, but it's really loving feelings for that image they project onto the therapist. So, it's a very awkward and uncomfortable moment if the patient comes in saying, you know, I can't come here anymore. Uh as I've worked with you, I've got to understand that you accept me for who I am. You see my potential. That's such a wonderful experience. But now I have these strong loving feelings for you, and it's hopeless. You could never love me the way I love you. So, I've got to leave here to get away from the awkwardness and the frustration of this impossible love. So, what we have to do is remind ourselves as therapists that the person is in love with an image. They don't know us well enough to really love us. And we have to tactfully say, "Tell me about this person you're in love with. Tell me how you see me. Tell me your image of me as that loved object." And usually, when they begin, when you remind them that any feelings can be expressed and communicated. Nothing will happen in this safe context. As they begin to talk about the person with whom they feel they're in love, the idealization emerges. They can begin to reflect on the idealization. They begin to become aware on the likelihood that it's not possible in reality. And this is an important step towards integrating those two extremes of the initially polarized internal world, the ideal segment and the aggressive or persecutory segment. And it's really important for the therapist to empathize with the pain of mourning the ideal object, the pain of relinquishing this wish, that's a very understandable human wish to find some perfect caretaker in the world. So, it's with great empathy that we join the person in this journey towards accepting both the limitations, but also the richness and complexity of the real world and real others.
>> [snorts]