Psychotherapy Of The Disorders Of The Self by James F. Masterson M.D. & Ralph Klein M.D

Author:James F. Masterson, M.D. & Ralph Klein, M.D.
Language: eng
Format: epub
Publisher: Brunner-Routledge

THE CASE OF A.P.

The following example will demonstrate in greater detail the use of confrontation during a four-year course of intensive therapy.

The patient was a 22-year-old woman who was first referred by her therapist of several months, who conveyed two quite different impressions of the patient when making the referral. While he stated that the patient needed “analysis” and this was the primary reason for the referral, he also stated that the patient was being referred because she had repeatedly damaged his office by throwing things and “the landlord insisted that I get rid of the patient or that I leave.”

As soon as she entered my office for her first appointment, the patient stood by the door and stated that she had three needs that had to be met for her to be able to enter into treatment with me: (1) she needed to know that I would still see her even if she broke something in my office, because at times she could not control herself; (2) she needed to know that she could call me anytime day or night and that sessions would not be strictly limited to 50 minutes (in fact, she later told me that her previous therapist had always arranged for her to be his last patient of the day so that she might stay in the waiting room as long as she felt she needed to and then would lock up when she left); and (3) she needed to know that she could walk around my office and did not have to stay seated; she insisted that when seated she became too anxious to talk.

It is important to understand the true meaning of these questions or demands. Put into action, these feelings would be a simple expression of the patient's false, defensive self. Put into words, these questions are at one and the same time arising from both the false, defensive self and the impaired real self. Both are asking, “Will you give me what I want and need?” Only one will be satisfied with the answer. If it is the false self, then the treatment will most likely fail. If it is the impaired real self, then treatment will be possible and the first link in the chain of the therapeutic alliance will have been forged.

A.P.’s questions were her way of asking if I could set limits, unlike her former therapist (and her parents before that). Could she rely on me to be any different? Also, was I willing to hold her responsible for acting in an appropriate and adaptive manner? Would I respond to her false, defensive self—a helpless, impulsive child who needed to be excused and tolerated because she was basically unable to care for herself? Her stated need to walk around my office, and her refusal to stay seated, can be viewed as an assertion that acting out was her principal means of expressing her feelings. She rationalized this by stating that it enabled her to think better. In general

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