In Treatment -- Further thoughts

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.

© Cheryl Fuller, 2018. All  rights reserved.