Saturday, 26 November 2016

trust and the transference

Here is just about the key question for the patient in psychotherapy: How can you tell if your apparently unhelpful therapist is truly unhelpful or is a victim of your negative transference? (If you're not asking this question then maybe you're avoiding it, taking refuge in a positive transference?)

There he sits, all self-satisfied, telling you what he thinks of you, infringing your agential sovereignty, failing to offer meaningful recognition, smug and far too comfortable in his therapist's chair, intrusive with his interpretations.

Or: There he sits, trying to understand you, doing his best, occasionally clumsy but on the whole well-meaning, respectful, interested, in this for you not for him, willing to take back and own his errors, with useful things to say, things which might go against one's first thought as to one's motives or feelings or thoughts but which might be all the more valuable for that.

The thing is, from within the transference - and where else can you reside? - we can never test the issue. Matters feel the way they feel: here one sits, and one can do no other.

But here is the juncture for an 'existential' or 'moral' moment. This moral moment is what I will call trust. A moment  not for residing somewhere, but for taking a step of faith. The kind of trust I have is not of the earned, reasoned, evidenced, warranted sort. Yet neither is it helpful to frame it in terms of the negations of those qualities - in terms of something unearned, irrational, unwarranted. Such epithets still make it look like we're playing the pre-moral-moment game. As if we're still supposed to be residing rather than leaping somewhere, sitting on the throne of our extant reactive dispositions, reading the other just as we would normally read him.

This moment of trust itself amounts to a lowering of defence, an opening of the 'front door' of the house of the self. (ISTDP talks of a front door and a cellar door, the former being interpersonal defences, the latter defences against the repressed material kept in the unconscious. I think, though, following the psychoanalytic understanding that in nuce all mental-emotional disorders are at root personality disorders, that they're one and the same.) For the patient it's a leap into the unknown; it feels unsafe. For the therapist it can feel difficult too: a moment in which one actually asks something from the patient.

I'm writing about this moral moment because we tend to overlook it. How often does the therapist hide behind mere descriptive interpretations, or behind mere kindnesses? How often do they issue a call to courage in trust? And how often does the patient take it spontaneously? Well, in my experience, sometimes they do. And those moments, they can be the most transformative in the whole of a therapy. Post-leap the world looks different, the other trustable, the other someone who cares, the other someone whose care can be internalised, someone with whom one can share one's troubles, someone who can through his sheer ongoing presence disconfirm the lurking-yet-warded-off suspicion that one is, as one is in oneself, unlovable.