Inside/Outside

Thursday, January 31, 2013

Unconscious Communication

I’m not quite sure what brought Amy to mind, a patient I saw many years ago, but there she was, clear as day, a tall, depressed, almost shabby looking woman. She’d been referred to me by a male colleague she’d seen for years. They’d decided it might be good for her to see a woman. It’s our first session I remember most clearly, when she told me she was having thoughts of drowning her three year old child and jumping out of a window. She seemed quite serious and although I did get her assurance that she wouldn’t hurt her son or herself before our next session, I was quite concerned about letting her leave my office.

I immediately called my male colleague and asked him why he hadn’t told me he referred such a disturbed patient to me. He was amazed. In the five years he had worked with her she never expressed suicidal or homicidal thoughts and he experienced her as a fairly ordinary, depressed patient. I didn’t know whether to be reassured or more concerned.

As it turned out, Amy never harmed herself or her child, but I would never have described her as an ordinary, depressed patient. She was prone to fits of rage, despair, and wild accusations directed especially at myself and her husband. She also wasn’t the only patient I had who seemed regress to a more seriously disturbed place when they began treatment with me. I think it was because they felt it was safe to do so, that I would be supportive and understanding and not afraid of “the craziness.”

And they were correct. At that time in my life I was a relatively new therapist who had worked at a VA Hospital, a community mental health center and a forensic center. Psychosis and other severe psychological disorders were fascinating to me. I loved working with primitive thought processes, delving into a world that seemed to be incomprehensible, but often was not. My interest in such work continued for many years. And then it stopped. After a particularly disturbed patient who disrupted my home life with more phone calls than I care to remember, I decided that enough was enough. I’d paid my dues in terms of really disturbed patients.

And, not surprisingly, fewer patients began immediately regressing. No one walked into my office for an initial consultation and told me they wanted to kill themselves and their child. This is not to say that patients don’t express suicidal feelings, that they don’t have crises and traumas and need significant help. In fact, I often encourage patients to regress, to go further into their feelings and their unconscious.  But I now must emit a different message from my own unconscious, one that is definitely open to regression but doesn’t actively encourage it. I have no idea how I accomplish that for, by definitition, the unconscious is always unconscious. But I do believe that my unspoken wish is communicated to patients who also receive it unconsciously and respond accordingly.   

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