Sunday, April 29, 2012

With and Without You

Carolyn Costin, in The Eating Disorder Sourcebook, talks about how eating disordered clients must "learn how to develop healthy attachments" (of course this is true for all of us), and how "the therapist's task is to help uncover what developmental arrests or deficits exist for each client and help 'reparent' the client so he or she gains the ability to rely on self or others rather than the eating disorder behaviors."  

The therapist's job is always to foster a healthy attachment.  The therapeutic relationship, we are taught, is supposed to offer the patient a "corrective emotional experience" (Franz Alexander). Yet, ironically, as Costin also points out in her book, the therapist must remain unattached to the results of therapy and not become invested in changing the person.  Nonattachment being, she reminds us, one of the main spiritual principles of Buddhism.

Similarly, the psychoanalyst Wilfred Bion exhorted analysts to enter the therapy room each session without "memory" or "desire."  In short, without an agenda.  In practicums, therapists-in-training are taught to follow the client's lead, to track the client, to not distract, or avoid, or force an agenda.  But then we do have an agenda, aka the treatment plan, whether it's for the client to begin relying on herself and so stop starving herself, or to function through depression, or to be better able to tolerate anxiety.  If we're trained in Evidence-Based Practices, we're in most cases required to be more agenda-focused in the sense of utilizing techniques in a highly structured, time-bound manner.  But we still cannot become personally invested in the outcome.  Yet how can we not?  (Therapists deal with this, and with their emotional responses to patients, by examining their countertransference.)

This is the psychotherapist's unique dilemma--to foster attachment, and to be attached and not attached at the same time.  In some ways, though, this may be the key to any healthy/good/successful relationship.  As David Schnarch points out in Passionate Marriage, a relationship requires two differentiated individuals--otherwise all you have is fusion.  Differentiation (a term Schnarch borrowed from Murray Bowen) refers to the ability to maintain your unique self in relationships, and it involves balancing two basic forces or needs--the drive for togetherness and the drive for individuality.  We're all wired for autonomy and attachment.  Keeping these balanced is the trick.  Schnarch's elegant premise is that, in order to have any kind of truly intimate relationship, you must be differentiated enough to tolerate the anxiety of constantly revealing yourself to the other without any assurance that the other will continue to love you.

Jack White, in his brilliant new song "Love Interruption," sings, "I won't let love disrupt, corrupt, or interrupt me anymore." One can't help but smile at the slight pause before "anymore": 

That's the chorus.  But the rest of the song is about the craving.  We crave the intensity of love, or falling in love, but, alas, it is a "falling."  An all-consuming, sometimes destructive, distraction.  At some point we may lose ourselves.  That fusion blights our souls and corrupts us.  "You gave it all but I want more," U2 sang 25 years earlier..."I can't live with or without you."

I once had a patient who was so emotionally fused with his mother that he couldn't imagine how he could continue to live if his mother died.  (And he would say "if," not "when.")  Once, he had tried to individuate by fleeing from her to another country--you can run but you can't hide, as the saying goes.  And then there are those who try to escape fusion by making non-attachment a way of life.

Starting in 1994, Leonard Cohen spent five years in a monastery (the Mt. Baldy Zen Center).  He was ordained as a Buddhist monk and took the name Jikan, meaning "silence."  Ha!  Some wiser part of Cohen knew that he was not ultimately suited to this path.  In fact, Cohen reported that his teacher Roshi told him that he knew how to work but not how to play, and so sent Cohen down the mountain to take tennis lessons.

Which brings me to my favorite conception of/metaphor for therapy, introduced by pediatrician and psychoanalyst D.W. Winnicott in Playing and Reality.  Winnicott believed that psychotherapy needed to be a mode of play, for it is in play that we are our authentic selves.  The therapist's role is to create a "potential space," a safe interpersonal field where one can both play and be connected.  

As Cohen sang, "There ain't no cure for love." So we might as well let it roll us over slowly...and then learn to play with our beloved.

To comment on this post, click the comments link below.

No comments:

Post a Comment