Transcription
The worst kind of therapy in my mind is the therapy that never challenges. We all as therapists have seen cases that have gone on for 10 and more years where the therapist only reflects the patient's unrealistic narrative and it seems to be an ineffective -- to put it mildly -- use of therapy.
Isn't that considered 'supportive therapy' versus-- Yeah, you're using terms that are more complex than one would think. Because there's actually a good form of supportive therapy. So I wouldn't dismiss all supportive therapy as not challenging the patient's current belief system, but just to generalize, you're right.
I say it from my own experience, which is going to garden-variety therapists, where my life would be like collapsing all around me, relationships would just be decimating, and I was 'right.' Yeah, you know, let me put it this way. I think this angle might help understand it.
As a therapist, perhaps the most central part of our job is to empathize with the patient's mind. Now, I think those therapies we're calling for lack of a better term 'supportive' tend to offer sympathy rather than empathy, because sympathy doesn't go beyond what the patient is aware of. Empathy, the way we understand it in the group I work with, is to be in touch with both what the patient is aware of in him- or herself, and also to be in touch with parts of them that they can't think about yet, because it's too scary: the empty parts, the aggressive parts, the parts that are provoked in us through our countertransference.
That lady who made me feel like a horrible, sadistic monster, my empathy for her was to help her realize she had her own aggression and that didn't make her a bad person. Unfortunately, narcissists think that you can only be a decent person if you're a perfect person, any negative element would destroy the whole thing. So I had to gradually help her see, 'yes, you're well-intentioned, you want to love your family, you want to be the best mother you can, but sometimes other stuff is there too, and we'd be better off acknowledging it than denying it and having it burst out and cause all these conflicts with other people. It's very dramatic.
One morning, I got to my office and a patient had left a message that would have made a sailor blush. She was just insulting me with the most vulgar stuff because I couldn't change a session and she couldn't come and asked if I could reschedule and I couldn't, so anyway it was quite dramatic. So when she came to the next session, she didn't mention at all this really hostile-- I'm smiling because it was almost creative in how insulting and vulgar it got but anyway, so I said to her, 'you know, you're telling me about what happened since the last session, but you didn't mention the phone message you left that's kind of intense.' She said 'what phone message?' So I said 'Well the one where you called me all those insulting terms because I couldn't reschedule a session.' She said, 'I didn't leave a phone message.' So I said, 'Well it's still on my machine.' I played it back for her. She said, 'Well that sounds like me but that wasn't me.' It's really hard to get people to see things in themselves that are horrifying for them to see and we have to try to make it as palatable as possible with empathy and without judgment.
How would you put the concept of fake news in this framework? I mean whether it's fake news or not depends on the person who's using the term. I guess the act of trying-- well the act of trying to discredit news as fake news. Yeah. Maybe that's more-- Well that's what happened in that session. The news was 'you left this really insulting, vulgar message.' The response was, 'That's fake news. It didn't happen. It sounded like me but it wasn't me.'
I think the concept of fake news is what we simply say in psychiatry and psychology, denial. You don't agree with it you, know don't want to hear it, you say it's not real. The question is - and I don't have the answer - to what degree does the person claiming 'this is fake news' believe their claim. Sometimes they do, sometimes they know it's not fake news but it's convenient or it serves a purpose to say it's fake news. It's more scary if they believe their claim of fake news because that's denial of reality.