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Supervision: Paying Attention to the Soul, Not the Technique

Although I’ve never been a psychoanalyst, I did spend a year in analysis and took classes at the Columbia Psychoanalytic Institute. I left at the end of a year because being in practice at that time I came to realize that my own style of work was much more realistic, confrontational and time conscious than my analytic experience was and so I left the program.

Yet after over fifty years of practice I am deeply appreciative of my analytic experience as short as it was! Being conscious of childhood history, being sensitive to dreams, unconscious thoughts and emotions as well as free associations has always made me sensitive to my patients in ways that today’s therapy seems to pay little attention to or ignores completely.

Picking up on those kind of comments when my patients utter them has always led me to ask more profound questions and pursue issues which have frequently led to important matters which could easily have remained hidden.

By contrast, today’s psychotherapy style is leading us to a much more rapid approach to treatment. DBT, CBT, mindfulness, psychopharmacology are all practical and offer realistic approaches to speeding up therapy. But I feel we have left the baby in the bath water—to use a very old fashion word, we have abandoned the soul of therapy.

Granted we may with current approaches ease the pain or depressive and anxiety symptoms effectively, but what about the person behind the symptoms.

My own emphasize in therapy stresses the nature of the relationship between the patient and the therapist. A patient who feels a profound connection to a therapist—who feels deeply understood—who feels the therapist “gets” him or her—who is feeling accepted and understood as a whole person, not as a diagnostic entity with symptoms, will invariably open up and reveal much more than a “patient” would.

Therefore, as a supervisor I always stress the need to know the patient’s history in detail, as opposed to focusing primarily on the symptoms. I inquire about the relationships, successes and failures, goals and frustrations, losses and traumas as well as a detailed history of upbringing. I want to be able to feel whatever the patient is feeling. Once this information is given, I will then focus on symptoms and diagnostic issues.

To start with, I strongly believe that the impact of early child experiences, whether positive or negative have a profound impact on a person’s life throughout their entire life. Subsequent life experiences, in my view, are always handled through the prism of the way we have all grown up. Let me offer an example. Obviously, I will present a case whose identity will be disguised but the basic issues presented will be accurate and real.

One of my longest lasting patients in weekly therapy for many years is a woman in her 60’s. Married with three adult children who was referred to me by her Internist who became alarmed with her wildly fluctuating, often hysterical behavior. He feared the danger of her accidently causing herself harm due to poor judgment, impulsivity, and out of control behavior.

In our early meetings, she insisted on getting pills to calm her down and was very reluctant to engage in any exploratory talk. At one point I told her to answer my questions, other-wise I would not write any prescriptions to calm her down. She reluctantly began to respond with deep resentment.

It turned out that she was born into a family of very damaging parents. Her mother was a massively controlling person. Her father was constantly furious, short-tempered, unreachable and critical. Her parents fought and argued constantly.

My patient Ruth, remembered closing the door to her room to shut out the screaming her parents did constantly, feeling frightened and crying.

Her college years were a bit more stable being away at school; however upon graduation she moved back with her parents and sank into depression. She was introduced to a man by her aunt and ended up marrying him, though admitting she got married not out of love but as a solution to leave her home.

At times of tension in her new home she quickly seemed to lose control in a manner very much like her mother—throwing things and breaking them, screaming, running out of the house, taking the car and driving away in an erratic way.

When they began having children, her outbursts decreased somewhat, but as the kids got older they became the target of her anger along with her husband.

Finally, her exasperated husband insisted that she get into therapy otherwise he would leave her and take the kids with him. That’s when she came to see me.

One approach could have been to use “anger management” techniques. In reviewing her history however, including the impact of her upbringing on her way of dealing with frustration, I felt it much wiser to go to a more classical route and focus on the impact of her early life on her present situation.

By being gentle, supportive and focusing on understandable anger, she felt that I accepted the legitimacy of her feelings. She slowly began opening up feeling safe in expressing her feelings and making the connections between the feelings stemming from her early life to the current difficulties. She slowly evolved into a much more calm, understanding and accepting person.

Over the course of some years of weekly sessions her behavior at home turned around and she became secure and comfortable with herself. Her ability to go back to childhood, understanding what she went through, gave her a good understanding of the consequences influencing her adult life. It gave her insight into her behavior and with a strong wish to change her life; it enabled her to manage her emotions in a mature and sensible way.

A second example is that of an artist in his mid-fifties who decided to seek therapy because of the conflict between his own wishes and his mother’s continuing, amazing, incredible and total control over every decision he’s made in his life. Ben has a studio in which he paints and has his work shown in a number of galleries around the city. He is totally dependent financially on his parents having rarely succeeded in selling his work. Ben is also spending a lot of time with a very talented, independent-minded and self-sufficient woman who is a singer. She is reasonably successful, travels far and wide, singing in concerts and clubs in America as well as Europe. Ben’s mother constantly interferes in the relationship between Ben and Joan.

In the early stages of our therapy Ben spent a tremendous amount of time describing every single interference of his mother in all aspects of his life during early childhood. He rarely was allowed to play by himself. His mother chose all of his friends, criticizing any of them who demonstrated any inclination towards independence. Ben went to private schools chosen by his mother. She spent a lot of time meeting his teachers and expressing her wishes to them about Ben. There was almost no mention of his father. As Ben moved into high school, his mother became even more involved in his social life, resenting any move towards independence. Ben never rebelled, never contradicted her and was the “ideal good boy.” He rarely has any close relationships with boys or girls and ended up going to college near his home, therefore never spending any time away from his mother.

As Ben matured, he was able to convince his mother to give him permission to rent a studio while still living at home. He expressed himself in his art work in a very infantile fashion and was not very successful in getting his work shown.

At one point Ben was introduced to a woman who was very similar to his mother. She was intense, controlling, domineering and clearly approved of his mother’s style. They got married and had a baby girl who was totally controlled by Ben’s wife in the same way that he had been controlled by his mother.

Ben spoke a lot of his sadness at watching his daughter become part of his wife’s life and basically totally distant from him. As their life became relatively empty of emotions his wife decided to separate and Ben offered no objection. They got divorced and now a few years later, he rarely, if ever, sees his daughter.

In his early fifties Ben became aware of the profound emptiness with his life and entered into therapy. His longing for independence has been a constant theme in his expressions. The other side of the coin however is that anytime he spoke of his wishes to become independent, self-sufficient, and to separate from his mother, the level of guilt sweeping into his language was incredible. It was as though he was saying things that were totally sacrilegious and wrong. Spending a lot of time encouraging him to express precisely those thoughts and to recognize the level of guilt he felt in expressing them as an indication of pathology—not wrong doing, became a theme of therapy for a long time.

Luckily Ben was introduced to a subsequent woman, Jane, who appreciated his artistic work and was apparently very interested in Ben becoming very independent. Her influence in Ben’s life made my work with him speed up consistently. The level of guilt in speaking about his mother never quite left him but decreased a great deal. Making decisions without checking with his mother became more frequent and interestingly enough Ben’s relationship with his father, who was an extremely weak man, also under the control of his wife, helped the father speak up more openly about his own wishes. Between Jane and Ben’s father, the atmosphere in the family changed gradually but significantly. Ben began spending much more time away from his parent’s home. He traveled more with Jane, at times not even staying in contact with his parents when away and most recently ended up moving into an apartment with Jane, and letting his parents know that he had made that decision. There are still times when he feels that he is doing something wrong in making independent decisions, but he seems to be able to get over those feelings fairly quickly.

In both these examples both patients demonstrate the power and influence of a restricted upbringing on their adult life. The influence of their upbringing seeps into nearly every aspect of their adult lives and the amount of work it takes to become free of that early training is enormous and is essential to the patient’s growth and independence.

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