[ Forum Central | Contents | Search | Post | Reply | Next | Previous | Up ]
From: Howard S. Baker, M.D.
Date: 25 May 1997
Time: 06:17:42
I agree with Jean Fitzpatrick that we generally ought not to "attack the defensive structure" since it is usually the patient's best effort to sustain their vulnerable self. Whether one chooses to call them selfobject transferences or organizing principles, it seems to me that our patients organize their current experience on the basis of what they expect or "know" to be true. It is inevitable that this will lead them to organize their expeience of us according to archaic scripts or transferences. This leads to the recreation in the transference-countertransference of some of the most difficult problems that they face in daily living, to a recreation of early difficulties that cause pain and for which they have been unable to invent better solutions--i.e. solutions that work better, new understandings of what happened and how it is continuing to unnecessarily limit their understanding of their present situation. When we are caught in our own countertransference in ways that seem to validate the earlier perception/solution of the patient, we participate in an enactment of the earlier, usually traumatic event. This, of course, leads to affect in both of us. That affect further intensifies the reality of the present recreation of the past. If the affect is not excessive, and if we can "get a grip" on ouselves and our countertransference, then we can shift our responsiveness. The same old script, which the patient has repeated with variation after variation in their life, now can move to a new outcome. It seems to me that this near recapitulation of the old script with a new ending offers a unique opportunity for the patient to create new perceptions/responses. This happens because the old script came so close to recapitulation, very importantly including the affects. Whether this becomes useful or not depends on the nature and amount of the affect and whether the established selfobject transference can be used to help contain it. If it is some, but not excessive affect, learning is facilitated. If it is excessive, then learning is more difficult or even impossible. At that point, we have become replicas of traumatic others rather than people who can fall into patterns similar to the others, no difference is perceived, and the therapeutic relationship is ruptured. Never-the-less, it is the near repitition of the old script (model scene, archaic transference) that sets the condition for the best therapeutic interventions. As Fitzpatrick pointed out, we need do nothing special to have this happen. Our personal shortcomings and the patient's transferences guarantee that it will at some point. What is crucial to keep in mind is that this is an opportunity, not a "failure" on our part. Where real failure can occur is the second element--how effectively we decenter from our countertransference and redirect the enactment/script.