Posted by Dr. Vollmer on June 19, 2012
Getting stuck in treatment presents the question of who is stuck. Clearly, both the patient and the therapist are in a box, as all of the treatment is dependent on this dyadic interchange. The valence around this stalemate is often frustration, but it can be boredom or despair. Frank, a fifty-three year old patient, started each session by saying “I don’t know what to say.” The therapist, Fred, reacted differently each time. Sometimes he would wait. Other times he would bring something up that came to his mind. Still, other times, he would say “that is interesting.” Each comment was met with silence. In a psychoanalytic sense, this reluctance to engage, and yet still show up for psychotherapy, is the classical approach/avoidance in which someone has mixed feelings about entering into a psychologically vulnerable state. Fred’s job is to try to understand both the need to approach and avoid the psychotherapy at the same time. In this endeavor, both Fred and Frank are going to develop feelings about the process. A “stuck” feeling is a challenge to move the understanding of the conflicting forces of engagement to a deeper level. Eventually, Fred decided to say “you know, I am really stuck. I don’t know how to go further in our relationship.” Frank, relieved at Fred’s willingness to be so honest said, “yea, I know I am a lot to deal with, and I have been waiting for you to fire me.” This disclosure of Fred’s painful belief that he is “a lot to deal with,” opened their relationship to explore Fred’s deeply rooted negativity about himself. The glue was dissolved, such that Fred now feels the relationship is more fluid. Frank feels better too.