Jung At Heart Archive February 2010

Psyche Goes to the Movies -- Nobody's Child

Time for our next film Nobody’s Child. This made-for-TV film stars Marlo Thomas in a superb dramatization of the real life story of Marie Balter. At age 16, she first attempted suicide and spent the next 20 years in and out of the institutions. At last, a caring doctor started treating her for extreme depression and panic disorder. Balter rose from chronically institutionalized mental patient to become a noteworthy champion of the mentally ill and founder of the Balter Institute in Ipswich, Massachusetts, a well regarded psychiatric rehabilitation center north of Boston, near Danvers, site of the Danvers State Hospital where she was hospitalized for many years.

Miss Thomas gives a excellent performance as the woman who was written off for years as an incurable schizophrenic, a serious misdiagnosis as it turned out, an all too typical fate for many persons warehoused in state institutions of the era without the benefit of proper diagnostic or therapeutic interventions.

Go home again?

A reader emailed me this week to ask about "patients returning to therapy with the same therapist following termination. What concerns might the psychoanalytically oriented therapist have, both for and against the idea?"

At first I wasn't sure how to answer because patients returning is so commonplace in my life. In fact I worked with an analyst for a number of years, left for 6 years and then returned to work again with him. 

Many patients leave when they have reached a place that leaving seems right for them or their circumstances improve and come back even years later to do more work. The work then is actually all of a piece spread out over a number of years, rather like chapters in a book. It is pretty routine when a patient leaves in these circumstances to let them know the door is open should they wish to return.

If the leave-taking is due to conflict, returning is still not out of the question. Both therapist and patient need to be willing to explore why the conflict occurred and how it might remain an issue in ongoing work. But much is available to be learned from working through these kinds of issues so that they exist is not necessarily a barrier. In my experience though, these patients are not likely to decide to return though.

As with most things in therapy, it is important to be willing to look at the meaning of returning and what the patient hopes for.

Interesting question

In the discussion after the film yesterday, someone asked an interesting question -- does accepting insurance alter the therapy? The person asking wanted to believe it does not. But as I have thought about it, I believe it does, though subtly.

One way that comes to mind for me is how diagnosis is made and assigned. Insurance companies require a diagnosis before they will pay and not all diagnostic categories are reimbursable. We might protest that it is mere formality to select a diagnosis and does  not impact the therapy itself, I suspect that is not completely true. Because in doing this, there is already a third party involved in the treatment, a third party who can significantly effect the duration of the therapy. 

Then comes the issue of missed sessions. Which cannot be billed to insurance. Therapists may hesitate to charge the patient for these sessions, fearing the patient's reaction. Or that the patient cannot afford the fee charged to insurance. 

Another way concerns notes. Insurance companies can audit records and ask for case notes. So the therapist has to think about how detailed to make the notes and what can and cannot be written.

None of these things seems to be present in the room in the hour with the patient but they are part of the background of the work and it must be considered that they exert influence, however subtle. Because a therapy contract which involves insurance involves 3 parties, not just the therapist and patient.

This is not to say that therapists who accept third party payment are unethical but I do believe the full range of implications of this practice really does need to be carefully considered and made as conscious as possible by therapists. 

Psyche Goes to the Movies -- Now, Voyager

After a delay, today I will be showing the Bette Davis classic, Now, Voyager. In this 1942 film Bette Davis stars as Charlotte Vale, a dowdy, repressed woman who, overwhelmed by her domineering mother, is on the verge of a nervous breakdown. She finds help at a sanitarium from a kind psychiatrist (Claude Rains), who turns her into a beautiful, confident woman. As a new person, she takes a pleasure cruise, where she meets Jerry (Paul Henreid), an architect trapped in an unhappy marriage, saddled with a troubled daughter. The two fall in love, but, of course, the romance is doomed. Yet their paths cross on occasion, and, despite their feelings, Charlotte finds satisfaction in helping Jerry's depressed child. 

In the 1940s and 50s, some severe mental problems were held to be the result of bad mothering. This view was so fervently held by some mental health professionals that, for them, the very existence of the disorder was proof of faulty parenting. Today, of course, we believe that severe mental problems result from a far more complex interaction of factors, including genetic influences as well as a variety of childhood and adolescent experiences and life events in addition to quality of parenting. 


Private vs. Secret -- what is the difference?

Several people in comments raised the issue of secret vs. private wondering about the difference and how that plays out in therapy.

While the dictionary does not make a clear distinction between the two, in practice they are different. We might start with this:

Privacy is the state of being unobserved; changing clothes for example -- that which I keep private, I am merely withholding from public view. Private matters are those traits, truths, beliefs, and ideas about ourselves that we keep to ourselves. They might include our fantasies and daydreams, feelings about the way the world works, and spiritual beliefs. Private matters, when revealed either accidentally or purposefully, give another person some insight into the revealer.

Secrecy is the act of keeping things hidden -- that which is secret goes beyond merely private into hidden. While secrecy spills  into privacy, not all privacy is secrecy. Secrecy stems from deliberately keeping something from others out of a fear. Secrets consist of information that has potentially negative impact on someone else-emotionally, physically, or financially. The keeper of secrets believes that if they are revealed either accidentally or purposefully,  the revelation may cause  harm to the secret-keeper and those around him or her.

So that which is secret often contains an element of shame that private does not. We may keep something private for all kinds of reasons, but most of the time, we keep something secret out of fear and shame of what others would think if they knew. We keep something secret because we believe the cost of telling is so high that it's virtually not a choice at all. Privacy is voluntary; secrecy is not.

Private: I got terrible grades in high school.

Secret: I forged my degree.

Keeping something private is an act of choosing boundaries and staying comfortably within them.

Keeping something secret is an act of hiding from the pain of disclosing something shameful.

This difference centering around the feelings about the information which is withheld is the principle factor in the difference between what is held private and that which is secret. It is this element of shame or fear attached to the secret that makes it different from something private.

When Jung writes:

The possession of secrets acts like a psychic poison that alienates their possessor from the community.

All personal secrets ... have the effect of sin or guilt, whether or not they are, from the standpoint of popular morality, wrongful secrets.

he underlines the corrosive effect they have because there is no way, so long as the secret is held, for its bearer to know that she is not worse than everyone else, that the secret does not make him unlovable. The revelation of the secret within the container of a secure psychotherapy relationship begins the  cleansing effect of exposing it.

Those things which a person decides to hold private, even in therapy, may in fact be secrets rather than merely private matters. Because if there is no shame attached, then why the need for keeping such a thing outside of the secure container of therapy? 

© Cheryl Fuller, 2007. All  rights reserved.