Therapeutic space revisited

Yesterday I ran across an interesting blog post about the possibility of therapist and patient blogging together about the therapy -- you can read it here.  After reflecting on how blogging is of use for her in her therapy, she goes on to consider co-blogging and suggests:

"Idea # 2: Start a new Co-blog

This idea was inspired by an Irvin Yalom story about how, after each therapy session, he and a patient wrote a brief synopsis about each of their experiences, learnings, understandings etc. in that session. They then shared what they wrote at the beginning of the next session. It was intriguing how each picked different components of the session as meaningful. It seemed like a really interesting way for a patient to learn to fully understand their behaviours and experiences from a third part perspective.

I thought maybe Dr. X. and I could set-up a private blog; with the two of us as co-bloggers. Maybe we could shorten our sessions to 30 minutes and then each of us would be responsible for utilizing 20 minutes sometime during the week for each of us to blog about the experience. At the beginning of each session we would debrief what was blogged by each of us."

And this sets me to thinking again about therapeutic space, the therapeutic frame.

I read Yalom's book, Every Day Gets a Little Closer: A Twice-Told Therapy some years ago when I was deep in the throes of my own analysis. At the time it seemed such a bold and good idea, that the patient and the therapist would each write about the therapy. I was insatiably curious about what my analyst thought and what he might say and I already wrote voluminously after each session in my journal. I never followed through on asking about it though and I suppose never really seriously considered it as an option.

I did once in my analysis give my journal to my analyst to read. I had the notion that this would reveal to him what I found far more difficult to put into words in the sessions. He read it and there were no amazing revelations or changes that happened as a result. He told me then, and I came to understand that what was important was that I reach the place where I could and would put into words and speak what I until then would only dare write. Writing was safer. I could edit as I went along. I could stop and start. I could strip down my experiences, my self, to just the words that I wrote without the tone of my voice, or difficulty saying it or flush on my cheeks or any of the other embodied expressions that were part of sitting face to face and speaking the words. I was, without realizing, privileging the words over the embodied experience and expression of them, believing that the Word mattered most.

All of this reaches into the concept of Therapeutic Frame. In an excellent article on the frame, Robert Maxwell Young writes:

"the analytic frame is not confined to the room where the therapy is done. It is ideally tacitly in the minds of both therapist and patient all the time. It is there when you open the door or speak on the phone. It is carried with the patient (or not) between sessions: it is internalised. It is conveyed by the therapist’s demeanour, tone of voice, pauses, silences, grunts, the wording of any note or letter which it is appropriate to send to the patient. It is evident in pauses. It is all aspects of analytic space. To maintain the frame is to maintain the analytic relationship. Its essence is containment." (emphasis mine)

So the frame is more than just the physical setting. It is the larger notion of the therapeutic space, that space in which both therapist and patient relate to each other in support of the therapy. It includes sessions on the telephone, or in writing, or in other ways that the two engage in their work together. 

Young says:

Acting out is a substitute for verbal expression. It is expressive, symbolic communication, but it is not relfective. The patient is acting rather than reflecting. Where acting out is, thought cannot be.

One feature of acting out is that the therapist is usually put under pressure to do something he would not otherwise do — to go after the patient in some way, e.g., to write to the patient or phone, to reveal something, to move, to change a session, to press the patient, to relent about a decision or take a firm line, even to lose his temper."

There are purists who hold to a highly structured and idealized sense of the frame. Robert Langs is one and there are others as well. Frame becomes elevated to an almost absurd level so that ordinary human interaction becomes almost impossible -- like offering a tissue to a patient who is crying. But within the therapeutic community there are variations in how the frame is constructed and maintained. For the purists, a letter from a patient between sessions is an instance of acting out and they would not read it but rather place it on the table and wait for the patient to talk about it. And it is acting out, because it is an extra-therapeutic contact, a kind of effort to gain more time and attention from the therapist outside of the boundaries of their time together, and it is writing rather than putting the feelings into words and speaking them in the session. But that it is acting out does not mean it is useless, meaningless or bad; what it does is signal the presence of unresolved feelings or or need. 

The actual words of the letter may indeed impart thoughts or ideas not expressed in session but it is what drives the desire to write them rather than say them that is probably of greater importance. And dealing with the fear/resistance to expressing those feelings and thoughts directly is a big part of what depth psychotherapy is about.

So back to the idea of co-blogging --

I have to wonder if, like writing a letter or sharing a journal, this isn't at base a way to sidestep the heart of the matter -- that it takes time and effort to work through our defenses and resistances and to do so in the presence of another human being. If the entire therapy were in writing, and I know that such work does occur, then writing this way could have a place. I know of at least one Jungian therapist who works with some people via email exclusively. It is not a big step to go from that to co-blogging in a private blog. But when the heart of the therapy is the face to face encounter, this does seem a bit off the point. Whether the reading and writing takes place within the hour or outside of it, it is still not in keeping with the basic rule -- saying whatever comes to mind. In fact I have some reservations about blogging one's therapy in the first place.

Even when one can be certain of anonymity -- and is that ever possible? -- blogging for others to read session by session what one is experiencing in therapy may have some educative value for others, but it is also in a way inviting others into the space of the therapy -- via comments and even in the awareness of an audience when writing posts. It took me a long time as a patient to understand the importance on my end for maintaining the container of the analysis, to not talk about it and my experiences so freely to others. It took me a long time to understand that what I was doing when I did that was avoiding dealing with all of it, all of my feelings within the analysis. In this way, a publically accessible blog is quite a different thing from a private journal -- the journal is not open for others to read or comment on. A patient may write therein about her therapy, her therapist, but in the sense that the therapist, as she carries him or her inside, is internalized, then it is within the frame of therapy. It is when others enter that space, others who are not included in the therapy per se, that it violates the container.

The boundary conditions of therapy are more complex than they seem at first glance.

© Cheryl Fuller, 2018. All  rights reserved.