2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43
Reflecting on the toxicity of our profession in general and public contact in particular, I recall an instructive incident. He describes a not quite typical professional problem, which corresponds to the same atypical solution. Both the problem described and its solution in this case are not in the field of theory and methodology of psychotherapy, but in the field of professional and personal ethics. Since each ethical choice, as opposed to moral prescriptions, is unique, I leave it to the reader in a similar situation to make his own. The described case quite vividly illustrates the situations of psychotherapy, being present in which the therapist can be destroyed after the client.
The events took place at the beginning of my professional psychotherapy practice in the supervision group where I was a participant. The leader of the group is James, an elderly man who has devoted his whole life to psychotherapeutic practice. Participants are practicing gestalt therapists with little work experience. In one of the sessions, Valentina, a 33-year-old woman, asked for supervision. At that time, for 6 months she had been working with Vlada, a woman with extremely destructive behavior and many psychosomatic symptoms. The client was never married, but was in alternating relationships with a fairly large number of men. However, relations were not built with any of them. Men either ran away from her or, more often, died prematurely due to various tragic circumstances - traffic accidents, sudden acute dangerous illnesses, suicide, etc. The number of "relationship victims" was approaching ten. In addition to this, Vlada quite often became pregnant from her men, but invariably had abortions. Since pregnancies were not uncommon, there were many abortions. By the time the therapy was started, they numbered more than 10. Outwardly, according to Valentina, Vlada looked very cold, in her face "there was something gloomy and ominous." Sometimes it seemed to Valentina that "death itself is talking to her."
It is important to note that in the course of Valentina's story about the state of affairs in psychotherapy and Vlada's life, no distinct emotion was reflected on her face. She spoke as if she were retelling boring news she had heard from someone. Meanwhile, the band members were terrified of the story being told. Suddenly James asked Valentina: "How are you feeling lately?" The therapist replied that she was not feeling well. An ulcer recently opened and she is currently in the hospital. She really wanted to get to the group. And so she ran away from the hospital. In addition, she feels exhausted and has insomnia. And all thoughts revolve around "how you can help Vlada." Valentina's passion and paranoid determination surprised James. The conversation continued for several minutes, when he, looking straight into the eyes of Valentina, said: “You must leave her! There is nothing you can do to help her! " Valentina seemed surprised and tried to confront James. The supervisor said, “It is very clear that you are collapsing in the course of therapy. This woman, Vlada, destroys everything in her path, including herself and the people who approach her. You are testimony to that. " Valentina looked puzzled. The supervision stopped there. I remember that at that moment I was filled with horror at Valentina's story and at the same time anger and indignation at the words of James. Having shared my horror with Valentina, I unleashed my anger on James: “How can you say that !? The poor woman is innocent! What does it mean to leave her! She asked for help! Are you completely insensitive ?! " Throughout my monologue, James was looking at me. Suddenly his eyes filled with tears, and he said in response: “It is not at all easy to refuse a person to help. But it's pretty clear that working with some clients is killing us. Valentina destroys herself with this day by day. " And after a while, he continued: “I remember by the names and in the face of all the clients whom I could not help and refused therapy. It hurts me a lot. But I had to do this. " I remember that both the content of what James said, and the form in which it was done, I was very impressed. The other members seem to have been impressed as well. During the break, we only talked about similar situations in our practice or about the possibility of such situations. For the first time then I thought about the limitations, both my own and psychotherapy in general.
This case was quite a long time ago. I still do not have an answer to the question of what was the reliable reason for Valentina's professional difficulties and personal danger. It is possible that such a destructive dynamic for Valentina in psychotherapy was not a derivative of excessive presence in contact with Vlada, but rather, on the contrary, of the inability to be present. Maybe, risking being in contact with the client, Valentina would have more freedom. Since at that time of my professional path I still did not think in terms of presence and experience at all, this question remains open for me to this day. However, I am convinced that in some situations of therapeutic contact, it is worth giving up presence. Moreover, this depends not only on the toxicity of the client's story or his way of building contact, but also on the therapist's own willingness to be with him. You should not deceive yourself and take risks that you are not ready for.
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