Reading Sofia's comment has me want to make a clarification about the importance of being disturbed by one's patient's disturbance. So, yes, it would indeed be a clear disaster if one were to be freaked out in the consulting room! After all, clinical consultation is supposed to have what psychotherapists call a 'containing function' - th…
Reading Sofia's comment has me want to make a clarification about the importance of being disturbed by one's patient's disturbance. So, yes, it would indeed be a clear disaster if one were to be freaked out in the consulting room! After all, clinical consultation is supposed to have what psychotherapists call a 'containing function' - that is, the mental health professional is supposed to be able to keep on thinking, and help to start make tolerable, thinkable, dreamable, such experience as the patient finds intolerable. I confess I took for granted, in what I said, that this would be our baseline. BUT there are I think 2 ways in which a clinician can keep somewhat calm in the face of dread etc. One involves not getting in touch with the patient's disturbance, staying in a de-haut-en-bas position in which the patient is an object of clinical curiosity, a paternalistic role perhaps in which the human commonality of patient and doctor is ignored, an I-It stance perhaps, a remote and uninvolved stance. The other involves human connection, inevitably being troubled by the patient's troubles, an I-Thou mode of relating. Here, especially, it's important that the clinician can be in touch with the shame and hurt and wretchedness from which a patient may be on the run in their psychosis. And not just 'in touch with it' as an objective fact 'over there', but as a truly troubling, mind-breaking, dimension of life. ONCE that disturbance has been truly registered in subjective space, then the task of bearing it, of being a useful container, can proceed. But a container which copes by simply keeping its lid on - that's no use to anyone.
Reading Sofia's comment has me want to make a clarification about the importance of being disturbed by one's patient's disturbance. So, yes, it would indeed be a clear disaster if one were to be freaked out in the consulting room! After all, clinical consultation is supposed to have what psychotherapists call a 'containing function' - that is, the mental health professional is supposed to be able to keep on thinking, and help to start make tolerable, thinkable, dreamable, such experience as the patient finds intolerable. I confess I took for granted, in what I said, that this would be our baseline. BUT there are I think 2 ways in which a clinician can keep somewhat calm in the face of dread etc. One involves not getting in touch with the patient's disturbance, staying in a de-haut-en-bas position in which the patient is an object of clinical curiosity, a paternalistic role perhaps in which the human commonality of patient and doctor is ignored, an I-It stance perhaps, a remote and uninvolved stance. The other involves human connection, inevitably being troubled by the patient's troubles, an I-Thou mode of relating. Here, especially, it's important that the clinician can be in touch with the shame and hurt and wretchedness from which a patient may be on the run in their psychosis. And not just 'in touch with it' as an objective fact 'over there', but as a truly troubling, mind-breaking, dimension of life. ONCE that disturbance has been truly registered in subjective space, then the task of bearing it, of being a useful container, can proceed. But a container which copes by simply keeping its lid on - that's no use to anyone.