“I got a great idea after our last session,” 30 year old Melinda says enthusiastically.
I remain silent.
“You know how we’re always arguing about whether or not you care about me? Well, I figured out how you can prove it to me.”
Oh my, I think to myself. Whatever’s coming can’t be good.
“You can stop charging me for some period of time we agree on. That way I’d believe you cared about me and weren’t just in it for the money.”
I feel as though I’m going to be walking through a field full of land mines. Other than agreeing to Melinda’s request which I know I’m not going to do, whatever I say has the very likely potential of a large explosion. I’m also aware of feeling angry and put upon. Hmm, I think to myself, I bet at some level Melinda could have anticipated that would be my reaction.
“When you came up with this idea, Melinda, how did you think I’d respond?”
“I don’t know. How should I know how you’d respond?”
“Well, we’ve worked together for about three years, you might have some thoughts about what I would or would not say or would or would not do.”
“You’re not going to do it, are you? You’re just stalling, playing games,” she says, her anger building.
“Is that what you would have expected?” I ask.
Melinda crosses her arms over her chest and glares at me. “I’m not saying another work until you answer me directly.”
I sigh inwardly. Melinda and I have frequently found ourselves in these kinds of power struggles. I can refuse to say anything, at which point she will indeed not say another word until she storms out at the end of the session. Or I can submit to her demand that I answer her, which feels to me like an uncomfortable submission. Or perhaps, just perhaps, I can try and interpret what’s happening between us. Melinda’s mother died when she was nine, leaving her to be raised by her distant, authoritarian father, who she rebelled against while desperately wanting his love and approval. In her interaction with me, Melinda can take the role of her authoritarian father who tries to force me to be as she wants me to be. Or she can be the needy, demanding child who wants both to win her father’s love, while insuring that her mother will not abandon her.
“So I’m going to run a few assumptions by you and you can tell me what you think. First, I think you knew – if only unconsciously – that I would not agree to your request, that it would stretch the boundary of our relationship in a way that would not be acceptable to me. Second, the reason you find it so difficult to believe – and accept, I might add – my caring is that you felt abandoned by your mother and rejected and criticized by your father. It’s also easy for you to become your father in this room with me and just as you refused to bow to your father’s demands, at some level you know that I will not bow to your demands either.”
“It wasn’t a demand, it was a compromise, a negotiation.”
“I’m not sure about that Melinda. I think you came prepared to fight with me. And that’s probably the most interesting question. Why is it that you want to fight with me?”
“I don’t want to fight with you. I fight with you because you won’t give me what I want.”
“Which was exactly your relationship with your father.”
“I guess,” Melinda says reluctantly.
“But I think that as much as you say you want my caring, you often do things that prevents your getting exactly what you say you want, which leads me to wonder if you need to reject my caring.”
“That doesn’t make sense. Why would I do that? I think you’re just playing therapist tricks, trying to get away from your not caring about me.”
I choose to ignore Melinda’s last provocation. “Melinda, if you accepted my caring you would be saying that you were a person who deserved caring about. And if you allow that in, then you’re left with the realization that you are indeed loveable and that no matter what you did – or do – you couldn’t keep your mother from dying and you can’t keep your father from being a cold, critical person. And that leaves you feeling powerless and helpless and we know how awful those feelings are for you.”
“Is there any way you’d consider my suggestion?”
So much for interpretations, I think to myself. What I say is, “Now I know you know the answer to that question, so I guess you’re saying you’re mad at me.”
“Yeah. I think you should have to do something to prove your caring.”
“I guess we’ll continue talking about this next time.”
Interesting dialogue... reminiscent of the child being the parent, and the parent being the child syndrome
My reaction would have been that I am not there to 'care' for her, but to advise and help her sort out her own emotions about being 'cared of' as a child. And the fact that she is paying me is connected to my role as advisor and guide through that process, than her paying me to care for her.
By allowing the factor 'care' to be a negotiating factor in your relationship with a client, it can lead to such power struggles of 'you care', 'you care not'. That is why I remove that factor and tell my clients that they are hiring me to help and guide them on their way to discover their own caring ability and how that was shaped and formed by how their parents (or other significant adults in their life) initially taught them about 'care' and love. So they pay for my knowledge and expertise not my caring or not caring. The fact that I care for them is an extra bonus, a gift they receive totally for free, so it can't be manipulated.
100% analysis, 0% warmth. Said in clinical terms: No affective content. This is one the kinds of exchanges that gives tx a bad name. If I were Melinda I'd change therapists. I suggest that the therapist look into AEDP and the work of Diana Fosha et al.
Thanks for your comment, Anonymous, although I would take issue with some of what you say.
First, I don't see myself as an advisor or a guide so I could never present myself in that manner. Second, despite what any therapist says the question of "do you care about me?" is always present. There's no way to remove it from the treatment. I tell patients that they pay me for my time, not my caring, but that doesn't erase the issue. I do agree that patients pay us for our knowledge and expertise, but since so much of the work of treatment resides in the interactive process between the two parties in the room, I find it unhelpful to present myself as the one in authority. Patients usually teach us quite a bit.
We obviously see treatment differently, Ellen, but I appreciate your taking the time to comment.
Clients pay for the room and the set up of the therapy like the skills of the therapists or the expenditures which are needed to open and run this business. They don't pay for the attention and the kindness of the therapist. This is given into the therapeutic process without payment. And, on the other side, in addition to payment, the client has to bring in herself or himself into the therapy. Bearing this in mind, both, client and therapist act on the same level as human beings who bring themselves into the process without any payment. Therefore, the interaction is a caring one.
Therefore, unwillingness to pay is an agressive act; and I would prefer to ask my client what she/he wants to achieve with this and to say clearly "No" to this idea.
Thanks for your comment "Dieter."
The patient wasn't refusing to pay, she was asking that I not charge her for some specified period of time to "prove" my caring which is clearly impossible to do.
Was the patient being aggressive? Absolutely. But for me the more interesting question is why she needed to provoke me and that was what I was trying - not all that successfully - to get at with my interventions.
Post a Comment