Jung At Heart

Did you find it interesting that Paul was not  "successful "with all of his patients? This is one of the things I appreciate about In Treatment.  So I thought it might be worthwhile to talk a bit about what constitutes success or failure in therapy, because it is not so easily determined as one might think.

Take, for example, Jake and Amy. Several people have written in the comments that they feel the work here failed because they apparently end in divorce. But is this failure? Before looking at the outcome, we have to think about what we look for as success in treatment. Does it mean a marriage saved Or does it mean that the parties are able to arrive at a choice that they believe works best for them? And it also depends on who one thinks the patient is. If the patient is the marriage, then it can be argued that it is the task of the therapist to support and work for it, for the improvement and survival of the marriage. But if it is the two people, then a successful outcome might well be very different.

I come back again and again to Bion and his dictum that we approach sessions without memory or desire. I have to remember when I work with someone that it is not my life we are considering, nor are my choices or the choices I think I would make necessarily the best ones for the patient. This is a tough position to hold, to be as neutral about what the patient chooses as humanly possible in order that the choice be his or hers. 

Many times a patient will say to me, "I know you think I should do X", because that is what they want for me to think and want. And often they are initially unhappy when I remind them that what they decide will not change my life, but it may change theirs so it is what they want, what they choose that matters. Like Paul wants Gina to make him choose whether or not to pursue Laura, he wants it to matter to her even more than it does to him because then, no matter the outcome, the responsibility rests on her, not him.

So, in the case of Jake and Amy, it is important that Paul allow them to come to their own choice about what they do. Culturally, despite a 50% divorce rate, we tend to see saving the marriage as always the better choice. Therefore many people, probably most people believe that the purpose of couples therapy is saving the marriage. My own view is that therapy cannot save a marriage unless both members of the couple want it to be saved; thus when I do work with couples, I see discovering where each party stands as the crucial first part of the work. I work with them to help them determine what is the marriage they would like, how it differs from what they have and what would have to change in order for them to feel that they want to stay. Then comes the tough part -- are they willing to do that work?  And when they are not willing to do that work, when they are not willing to face into what would be required of them to have the relationship they want, then ending is the likely outcome. Then the task is to end with as little additional harm or injury done to the other as possible, which is what Jake and Amy seem willing to do when we see them at the end. To my way of thinking this is not a failure in therapy.

Tomorrow, I will look at the other patients and consider the issue of success.

There have been many comments and questions about the relationship between Paul and Laura in the comments to those episodes. So I want to write for a bit about transference/countertransference and look at this from a Jungian perspective. This will probably take a couple of days so get a cup of tea and let's see if we can unravel this knot a bit.

I think it helps to start with the understanding that in therapy, in the therapist's office, a special space is created. A space which resembles in some ways the space of friendship, or of intimate partners. It is quiet. Optimally there are no interruptions, no knocks on the door, no insistent ringing of the telephone. So that each session has the quality of time out of time to it. The ordinary rules of social interaction are not in play. The fundamental rule is to say whatever comes to mind, something we probably rarely if ever do in other relationships. The patient is free to speak whatever feelings or thoughts she has and the therapist has no expectation of reciprocity. It is time that belongs to the patient, is for and about her in a way that most of us simply do not experience elsewhere. That no subject is ruled out, no topic taboo, an unusual degree of intimacy develops. I can say anything, feel anything and all I have to do is put it into words.

Both the therapist and the patient are in this space, often referred to by Jungians as a temenos --  from the Greek meaning a sacred, protected space; psychologically, descriptive of both a personal container and the sense of privacy that surrounds an analytical relationship.

And into this unusual space, the patient brings all of her history, dreams, fears, desires, wishes, hopes, fantasies.

Let's look at what Jung says about transference --

Transference is a term  used to describe the unconscious, emotional bond that arises in the analysand toward the analyst. 

"Unconscious contents are invariably projected at first upon concrete persons and situations. Many projections can ultimately be integrated back into the individual once he has recognized their subjective origin; others resist integration, and although they may be detached from their original objects, they thereupon transfer themselves to the doctor. Among these contents the relation to the parent of opposite sex plays an important part, i.e., the relation of son to mother, daughter to father, and also that of brother to sister.["The Psychology of the Transference,"( CW 16, par. 357.)

Jung writes, "Careful analysis of the transference phenomenon yields an extremely complicated picture with such startlingly pronounced features that we are often tempted to pick out one of them as the most important and then exclaim by way of explanation, 'Of course, it's nothing but...' I'm referring chiefly to the erotic or sexual aspects of transference fantasies. The existence of this aspect is undesirable, but it is not always the only one and not only the essential one. Another is the will to power (described by Adler) which proves to be coexistent with sexuality and is often very difficult to make out which of the two predominates. These two aspects alone offer sufficient grounds for a paralyzing conflict". (C.G. Jung, CW 16, p.173)

Now think about Laura. Can you see an element, not only of erotic transference from her, but also power, her power to control men through sex? She brings this to her therapy as part of how she has come to experience relationships with men.

Consider an important piece of her history -- at a time when she needed her father's attention, comfort, care, he was depressed and withdrawn and unavailable to her and put her in a position of having to care for him. On the other hand, the family friend she stayed with noticed her, wanted her and she ended up in a sexual relationship with him. It seems likely that these two kinds of responses set the pattern for her relationships with men.

She comes into therapy with Paul. He listens to her, pays attention to her, notices her, helps her to make sense of her world. And activates her long frustrated father hunger which has become intertwined with sex. Life has taught her that men either fail to notice her at all or want her sexually. This man notices her and so she begins to feel as if she were in love with him. And she is, but the Paul that she is in love with is the Paul who exists in his office in that hour every week. That Paul would want her, pay attention to her and keep her in that place of feeling wanted and cared for always -- or so she fantasizes. And that fantasy is important because it holds valuable information for her about what she does want and how the way she has gone about her life has kept her from it.

Laura does exactly what the basic rule of therapy dictates -- she says what comes to mind and tells Paul she is in love with him, that she wants him. And this is the stuff of her therapy.

Tomorrow -- Paul and countertransference