The Therapist Needs The Patient: Is This So Bad?
Posted by Dr. Vollmer on January 30, 2014
Beginning psychotherapists, beginning psychoanalysts, depend on their patients to accumulate hours for a license or a certificate. Many times, the patient consciously or unconsciously is aware of this dynamic, giving some patients an opportunity to wield this power dynamic in ways which are further grist for the analytic mill. “Yes, I do need you to come to get my hours, but at the same time, I want you to do what is in your best interest and that is more important to me than getting my credit.” I propose that comment to my class, resulting in, what seemed like, a collective gasp. An active discussion ensued leading to a heated debate about honesty versus burden. “Is the ‘name it to tame it’ adage appropriate here?” I ask. Perhaps the honesty of saying yes, I do need the hours, but I also have integrity in my work, so that trumps my need for my hours, goes a long way towards diffusing the hidden issue in the room. Or, perhaps stating the need for the patient to come burdens the patient and thereby applies unnecessary guilt if the patient wants to discontinue treatment? My contention is that the therapist holds the anxiety that the patient’s termination compromises her training, then the analytic ear is sacrificed. One cannot listen when one is anxious, and so the ‘name it to tame it’ adage does apply. Putting the anxiety out there in a package which says there is a reality to my wanting you to continue, which is totally about me, and not about you, and that is a known limitation in our treatment, but having said that, let’s keep in mind the most important thing is that you do what is in your best interest, because, in reality, another year in training is something that I can deal with. This honesty takes away the potential for conscious or unconscious manipulation of the patient. My students proposed however, that the blunt statement of needing the patient, might, in fact be coercive. I countered by saying that the exposure of the reality creates an honest, although not ideal, relationship, which can then be discussed in an open manner. I was pleased to present a challenge to my bright and stimulating students. I was also knocked off-center by their startle response. I am thinking.