In a message dated 97-10-30 19:44:01 EST, Menachem Feder wrote:
<< Dear Jules,
...... When referring to "dialectic" I was taking issue with the the
struggle I perceived Dr Mittleman to be experiencing regarding the
object-relational stance, and ultimately the interpretative/action-oriented
stance he should adopt as therapist in
this initial encounter with his client.>>
I'm not sure that I view these as mutually exclusive, as you imply. My
intervention(s) was both an interpretive stance, a setting of limits, as well
as a comment about her conscious object-relations (her conflicting images of
self as "needing to please others" versus "needing to please her Self" and
her image of others as "expecting me to satisfy their needs" ).
<< It appears that, among the competing role-demands therapists
experience
with all patients at all stages in therapy, and which ultimately they seek to
identify, highlight, understand, and finally present back to the patient as a
focus of confronting the patient's own inner, split and polarized, role
demands/object relations, those presented at the initial therapeutic
encounter often revolve around issues of establishing a therapeutic alliance
(eg, intimacy, therapist role as protective
benevolent parent) on the one hand, while on the other hand having to
deal with "reality" issues of the therapist-patient relationship (eg,
some rules and expectations, setting limits, parental role of "neutral"
agent of reality).>>
Here too Menachem, I view the setting of the structure (the "reality") of the
therapy as part of the therapeutic alliance--although I could conceive of
situations (perhaps like this one!) where they could conflict with each
other, and perhaps that's your point here.
<< Thus, already at the outset the therapist is presented with an
opportunity to experience a significant dialectic struggle between two
opposite poles. However, the critical issue is the degree to which these
struggles resonate or at least touch upon dialectical pulls the patient is
experiencing, thus providing an opportunity to confront the inner dialectics
of the patient.>>
Yes, in a sense, I was experiencing her conflict as well--torn between
pleasing her by arranging therapy with her (which I feared would not be in
the best interests of my other patient--her friend--who referred her), and
pleasing my own Self (i.e. expecting her to make a shift to preserve my
interests with another patient, her friend).
<< In terms of ultimate action and intervention on the part of Dr
Mittleman in this case, he is thus presented with a complex set of
considerations:
Should he relate to/reflect upon/highlight the dialectical aspects
of his dilemma as a path linking to her dialectical dilemma? Should he
refrain from any interpretations completely at this early stage of encounter,
or at least from interpretations relating to dialectical phenomena and
experiences?>>
Good questions, which touch on areas that relate to the timing and depth of
interventions, as well as on the use of the therapist's internal experience
as a means of apprehending what's going on with the patient. No easy or
short answers here.
<< However, it was the ultimate choice of this therapist to de-amplify
the
dialectical aspects of the situation in favor of presenting boundaries (ie,
reality considerations) - ultimately favoring one side of a dialectic...>>
"De-amplify?" Please elaborate. How might it have gone had I chosen to
amplify
the "dialectic"--hypothetically?
<< Personally, it appears to me that assuming that dialectics are what
the
therapist was experiencing, and furthermore assuming that he was thus
empathically resonating with intense dialectics the patient was struggling
with, this kind of "interpretation" would have been more experience-close for
the patient, and, perhaps, also link-up with an important growth need within
the patient - perhaps allowing for fruitful work together.>>
That's an optimistic view! One that I hope was confirmed by her calling me
for a referral to a colleague. I shall never know.
David Mittelman
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