A Touching Story Of Recognition And Disgust: A Case From Practice

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

Therapist K., a young woman of 29 years old, sought supervision on a case that caused her considerable concern. Being a talented novice therapist, K. found herself in a very difficult situation with her client L. L. turned for psychological help with complaints about difficult relationships with loved ones, in which she often felt unnecessary

In dire need of recognition, L. built her relationship in such a way that others rejected her. Awareness of her needs for acceptance and recognition frightened L., in such situations she became cold, rejecting and often irritable. After the reciprocal rejecting reactions of others, L. plunged into resentment, in which she remained for a long time. To complete the picture described, it is important to add that L. had a pronounced physical defect in her face, which, of course, was often the focus of her experiences. Supervision took place during the initial period of psychotherapy.

During the supervision, K expressed her difficulty, manifested in her disgust for L. Of course, it was an evil twist of fate to be disgusted with a client who was extremely sensitive to rejection and lacked recognition in life. In addition, in the process of supervision in the focus of the therapist's awareness after a fairly short time was the value of the woman's external attractiveness, elevated by K. to the rank of supervalue. K.'s life model suggested that "it is unbearable for an ugly woman to live." Of course, K. did not see any resources to support L. in the process of therapy. For some time, the therapeutic process has been completely blocked by aversion held out of the zone of experience. Unable to cope with the intense feeling that had arisen, K. was also unable to place him in contact with L. As a result, K. seemed to "hang" in the grip of the blocked experience process: it was already impossible to ignore the disgust that had arisen, but to deal with him in contact with L. environmentally friendly for the process of therapy seemed extremely difficult. K. thought about stopping the therapy and suggesting L. to transfer it to another therapist "under some plausible pretext."

Since the only conscious feeling of K. was disgust, in the process of supervision we focused on it in the experience. I asked K. to tell me about the disgust. Despite the fact that the fulfillment of this request caused shame in K., the placement of disgust in our contact allowed her to touch the experience of this uneasy feeling. Nevertheless, the figure of disgust still filled the entire space of possible therapy phenomena. I suggested to K. to imagine that L. was here and to try to place the blocking feeling on the border of contact with the client's image. Of course, my proposal aroused K.'s expressed protest, justifying which she referred to the idea that this method of treating L. was not environmentally friendly and unethical. However, in view of the fact that disgust was the only important phenomenon of contact with L. at the moment of therapy, K. agreed to the experiment. … The first attempts to experiment with placing disgust in contact with L. were unsuccessful - K.'s voice trembled, she lowered her eyes, experienced pronounced shame.

I said that no matter how difficult it was for K to admit his feelings in contact with L., it was still the truth of their relationship at this stage. In addition, the feelings held out of contact still tend to manifest, and, possibly, L. notices them. Moreover, in my deep ethical conviction, K. has a right to his feelings, even if they look repulsive and difficult to experience. Ethics, after all, is not a sorting of phenomena into "good" and "bad", but is a process of making difficult and responsible decisions. K. again turned towards "L." and spoke of her disgust. Tears appeared in K.'s eyes. I asked her not to stop the process of experiencing, but to accompany it, carefully observing what would happen. At the same moment K. became aware of the emerging pity, sympathy, tenderness for L. and a desire to take care of her. For the first time in therapy, warmth filled the therapeutic contact. K. was impressed by the dynamic of the experience that had taken place. To which I said that the ecology of the therapy process is regulated not by will, but by the own nature of the experience. You just need to trust the contacting process.

At the next session, K. and L. were able to talk about their feelings, which after the last supervision were somewhat transformed. Disgust was no longer the only phenomenon regulating therapeutic contact. Freedom emerged in the therapist-client relationship, the therapeutic impasse was resolved, and the process of experience that was the goal of therapy was restored. This session initiated the start of significant progress in therapy that continues to this day.

The described case, I believe, is a vivid illustration of the fact that the therapist cannot be divided into “human” and “professional” in him, if such a split, of course, is not of a theoretical artificial nature. It is the personal characteristics of the therapist and the client that create the specificity of the therapeutic dynamics. In the case described, the aversion that arose in the contact was a unique experience of precisely this therapeutic contact. What would have happened if L.'s therapist had been different, not with such a pronounced value of external attractiveness? Would the therapy be more productive or less effective? Is the emphasis on the phenomenon K. is experiencing a limitation or, conversely, a resource? These questions do not make much sense - the therapeutic process is always unique, and its uniqueness is determined by the uniqueness of the therapist and client. A therapy with a different therapist would perhaps actualize other phenomena. But this does not mean that it would be better or worse. It is only the respect and trust of the client and the therapist in their self-characteristics that are important.

So, any attempts by the participants in therapy to ignore themselves and block their process of experiencing do not support the process of psychotherapy, but rather deform or even destroy it. Therefore, I would consider the therapist and client's respect and trust in their experience as an important factor in determining the effectiveness of psychotherapy. Leaving the primacy of the process of experiencing in the methodology of the dialogue model of psychotherapy, I recall that it is a complex function of therapeutic contact, and, therefore, equally belongs to both participants in the therapeutic process. It should be borne in mind that the restoration of the experience process is determined to a large extent by the freedom in the choice of the intentions of the experience by the therapist and his sensitivity in this process.