12. Changing Hands. One Patient. Two Therapists. Two Theories?
Presenters:
Lucy D. Freund, PhD
Dale K. Singer, MSWChair:
Patricia J. Rose, PhD
This presentation will describe a course of long term treatment with one patient and two therapists. The first treatment was largely guided by self psychological ideas; the second by a more interpersonal, relational approach, strongly influenced by Kleinian ideas.
Jack began treatment as a very depressed socially isolated and vulnerable young man, prone to fragmentation into near psychotic states. Intent on performing self object functions, the therapist provided a calm, solid maternal presence to shore up his depleted, inadequate sense of self. She contained his feelings of helplessness and hopelessness, thereby lessening his sense of aloneness and unbearable despair. She also provided limits to his self-loathing and rage. Jack was able to marry and left the area pursuing his career.
When Jack resumed treatment on the East Coast, the first few years looked similar to his previous treatment. Over time, however, the therapist became increasingly frustrated at Jack's impersonal use of her. The treatment was tense as the therapist using a more interpersonal paradigm sought to direct Jack's attention to her experience in the sessions with him; this mainly involved their mutual fear of his rage and his anxiety at acknowledging her separate presence. He left the area again, this time able to acknowledge the pain of his leavetaking.