“My wife, to whom I’ve devoted the last fifteen years of my life but who is acting really weird these days, has been saying I have a tin ear and work all the time, which I don’t. She now tells me that she wants a separation, and that her therapist thinks this is important for her growth as a person. We have two kids, tuitions, and a mortgage, plus I love her! I know I’m not supposed to, but can I call her doctor? The shrink is kind of old, and I have the sneaking suspicion that he doesn’t really know what’s going on. Besides, I myself never signed on for this…”
So is Mrs. B at a loss for what to do:
“My son graduated from college three years ago, and he’s still living at home and unemployed. He spends hours in his room with the shades drawn with music blaring and looks ‘out of it’ most evenings. I don’t smell any pot, but I can’t help wondering about one drug or another. I’ve tried to contact the doctor whom he’s been seeing, but she just sent voice mails saying Rick is an adult, and so she can’t violate any confidences. ‘And, besides,’ she added, ‘this is all part of a process—two steps back, one step forward.’ Yada, yada, yada. But, damn it, he wasn’t like this five years ago, and I’m at my wits end. Aren’t people supposed to get better in psychotherapy, especially when it costs so much money? What can I do? I’m his mother, not this shrink.”
At its best, dynamic psychotherapy provides people with their only chance to heal themselves by telling their whole life story, most often for the very first time. The results of this mutual and passionate hard work on the part of doctor and patient can be amazing, the changes it produces life changing.
However, as with any powerful treatment modality, the talking cure also has its risks. Like drugs that alter a person’s physiology and biochemistry, the profound emotional experiences occurring in psychoanalytic therapy, which are initially experienced in the relationship between client and mental health provider and thereby provide an entry into the forgotten past, can also make such treatment what one writer called “a most dangerous method.”
Most often, again like many medicines, the side effects are transitory or relatively insignificant as a patient acclimates to a new situation. And yes, as I said in earlier blogs, regression is necessary to effect change. However, like a potentially lethal Stevens-Johnson reaction to certain drugs or the c. diff bacteria that can proliferate in response to antibiotics that kill other bacteria, when mishandled the talking cure can cause permanent harm both to the patient and to significant others in that person’s life.
One difference here is that with psychological treatment, unlike medicines, typically the dangers are not clearly enumerated at the outset much less on any insert before the “therapy pill” is ingested. So the individual usually has little idea of either the hard road ahead or potentially treacherous detours. There are many reasons, legitimate and otherwise, why this is so; but in general only the positive outcomes are stressed.
There is another important distinction. For reasons of confidentiality, other people in the adult client’s life—spouses, children, parents—with whom that person is both intimate and inter-dependent, are not privy to the therapeutic contract. Excluded from the initial deliberations and assessment as well as the ongoing process, they may nonetheless suffer the untoward side effects of a treatment gone awry and stagnant because of the patients’ irrational reactions and unchecked actions—or what mental health professionals call “acting out.”
There is, of course, the huge “human factor” that differentiates psychotherapies from more purely physical interventions, namely, the emotional health, composure and strength of the mental practitioner. The integrity of the therapy is contingent on the doctor’s stability and courage under fire—an unwavering ability to maintain an empathic but utterly professional and relatively objective stance in the face of the most powerful passions that a patient directs toward her or him.
At the very worst, the therapist may succumb to temptation and truly cross the line. In a series of recent presentations to colleagues and professional articles, I have been exploring instances in which even the most prominent psychoanalysts have had sex with the patient, exercised “undue influence” in obtaining funds beyond their professional fees for themselves and their relatives or “adopted” another person’s child as their own. The shock waves and collateral damage done to family members, other patients and colleagues, reverberating through the generations, are dramatic and devastating.
However, these sexual, financial and other unmistakable boundary violations represent but the most extreme and crudest manifestation of an all-too-common distortion of the therapeutic process: the over-idealization of the analyst and with this, what analysts call “split-off negative transferences” redirected toward a partner or spouse. It is a resistance with which the practitioner, by virtue of naïveté, narcissism or “counter-transference” distortions, can collude—creating the folie à deux of a mutual admiration society and dodging the bullet by deflecting the aggression away from the dyad to a significant other. This “other” is then diagnosed and interpreted in absentia, and, as many couples therapists know all too well, may be significantly misrepresented in an individual treatment.
Even the best of therapists all too often doesn’t get the whole story. Not only flagrant liars but also the most honest patients are selective reporters, leaving out important details about themselves—drug use, internet and pornography addiction, etc.—and distorting or simplifying at times their pictures of significant others. And so, as one of those significant others, don’t let yourself be daunted by sanctimonious pronouncements and dissuaded from making that phone call and making yourself heard when someone you care for is in trouble.
I know that I always take those phone calls even as I try to respect my clients' privacy. More often than not, the information that comes my way about uncomfortable realities is invaluable in reorienting my thinking and on occasion changing or augmenting the individual treatment with other modalities: couples and family therapy, medications, substance abuse interventions and more.
So, yes, make that call and follow through with it! You deserve thoughtful and nondefensive answers.