Te patient is middle-aged woman, and the therapist is a man similar in age. �: Tere are different levels o things and one o the things which I think is
still really important is to do with you try ing hard, I think you try terribly hard, genuinely …
�� : Yes, ’cos you gave me a, sorry to interrupt, but you gave me a look last time when I lef. As I looked back, you gave me this kind o a look and you prob- ably can’t remember it, but it was kind o, it made me eel like a naughty
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girl, you know like, like, it’s almost like I’ve orgotten to hand in my home- work or I’d neglected to do something and you, you know you gave me this slightly quizzical, concerned, almost despairing look as I lef. It made me almost go on to giggle, but then I … then there was a big gap and I thought, Oh gosh she’s, thought I didn’t, you know … I, I, it was almost like there was an omission o some kind in that last session.
�: In the look there’s a kind o … already in the look rom me and t he way you portray it looks as i it’s, well, distanced. And I’m looking at you as a per- son who’s either transgressed, done something wrong, or something, but with me slightly distanced rom you, as you leave. And then what you do in thinking about it is: “Oh, gosh, oh gosh, he thinks this, he thinks that,” and in both sets o experiences, you have the experience and you think I’m actually kind o disapproving … or, what else did you say?
��: Quizzical.
�: You see, quizzical is already a bit once removed rom you going off out o the door. And then you have your thoughts about “Oh, gosh,” but something again quite personal, actually i one takes the description you give o my ace, a lot o those things are very disconcerting. And here we are struggling in a way that is important or you. On your leaving it’s as i I’m doing some- thing to you which distances you rom me and rom all the more personal things that are going on. And then you think about them, “Oh, gosh is he disapproving?”, and you come back afer a long break and you try hard. You try hard to present something interesting and to get things going again. ��: Yes, yes.
�: All I’m trying to say is this: Tere are times when I think you do eel more personally involved.
��: Yes.
�: But things can interere with that, where you, as it were, hal step back … you have your ways, like you came today, almost as i I was unamiliar, you were trying to present yoursel again …
GAP
�: … Actually, you have these anxieties in a variety o circumstances, and they express something deep about you. And what I’m saying is in describ- ing things in the way you did [at the beginning o the session], you were indeed managing them in a certain way, even as you told the story. Te story was as it were keeping certain things …
��: But I’ve always managed it that way. Tose plates in the air have always been there, since I was at an age when I shouldn’t have had to be spinning plates.
EXCERPT FROM FIFTH PSYCHOTHERAPY 123
�: I think you are very attached to doing that.
��: Yes, yeah, well I’m not surprised though, really.
�: Now what you do also say which I think is much more personal, is that you don’t know how, you don’t know how to come back afer a long break and what that means, and get personal with me. You don’t know how to do it. You do your best efforts and then you eel I find ault, saying that is not good enough, and you think, “Whatever I do is never any good.”
Now when that alls away, when you stop spinning these things and I can see you’ve stopped, when you get over the act you eel I’ve put you down, and particularly when I say that something is serious … it alarms you, you pull aces, because you eel I’m pushing something at you rather than tak- ing something seriously, with you. Ten it becomes possible or something different to happen and partly you eel relieved that at least you don’t have to organize our getting in contact. And then one can begin to think about you as a whole person, including somebody as extremely sensitive to other people’s reactions to you … whatever was on my ace, you know you’re very alert to these things. And you also hear me differently when you shif, you eel more with me.
��: Yes, I do understand.
�: Yes, it’s visible, I can actually see it. Yes, I can see when you shif.
Discussion
It seems unnecessary to labour how, in a more extended manner than in the first transcript o this chapter, this excerpt illustrates many o the principles o Brie Psychoanalytic Terapy. Perhaps in the oreront are the therapist’s efforts to explore how the patient experiences him in the transerence, but he also tracks shifs in the patient’s relations with himsel, he highlights the contrast between deeper and less intimate contact between them, he acknowl- edges how the patient is trying hard as well as evading things, he dwells on her emotional states and her responsibility or choosing to “spin plates,” and he is serious in his commitment to pursuing, with the patient hersel, what is emo- tionally true about her. Tese themes characterize almost all the therapeutic work presented in this book.
I conclude this chapter by noting that in the final transcript, as to some degree in all the vignettes, we see exemplified what appears as Item 17 o the Adherence Manual, which states, “’s manner conveys that everything mat- ters. ’s predominant attitude is o taking things seriously, especially things the patient is inclined to shrug off.” More specifically, under the subhead- ing “Overarching eatures o therapist stance,” Item 13 reads: “Overall, ’s
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primary concern is to explore the nature of the patient’s state of mind and patterns of relatedness towards , and reveal the significance for the patient’s everyday life (rather than to make interpretations about links with the past, although these may occur).” Perhaps this is a suitably straightforward way to articulate not only the overriding concern of the therapists represented here, but also the psychoanalytic core of Brief Psychoanalytic Terapy.