In Treatment -- Alex, week 2

Alex returns for a second session, to Paul's surprise. Again from the outset, Alex wants to be in charge, querying Paul about why he doesn't drink coffee and implying it is because of his heart. Alex spits out the coffee and Paul interprets it in light of his strong efforts to be in control. 

Alex knows that there is a problem that he feels nothing about the people who were killed by his bomb. But he sees it as a consequence of "the system", that it has rendered him unable to feel guilt or anything for those people.

Paul is trying hard, maybe too hard, to get Alex to acknowledge feelings. It feels to me he is pushing interpretations too fast -- out of anxiety perhaps that Alex will not come back and he has to try to penetrate his defenses in what time he has with him?

We hear about Alex's father and then his wife, both with a touch of disdain and grudging admiration. Both of them controlling and he believes without guilt. After a lot about his wife, discovering he doesn't know her really and declaring he never loved her, he tells Paul he is leaving, thanks to Paul.

And here, at the end, Paul does a confrontation that seems momentarily at least to find its mark. He heatedly tells Alex that it is Alex who makes these decisions -- to visit Iraq, to leave his wife -- and that the decisions were already made before he came to either session. Alex wants to make it because of Paul he has chosen what he has and Paul is not accepting that. For a moment, just a moment, Alex pauses and his face shows us that he felt what Paul said, but then he ends the session, again throwing cash on the table and leaving, telling Paul he will keep him posted.

Alex is a tough patient. He comes but so far refuses to accept being in treatment, preferring instead to see this as consultation. He doesn't want to be surprised. He doesn't want to surrender to the process and go where it takes him. So the sessions become a series of parries and thrusts, a fencing match between him and Paul. I suspect Paul is wondering how he can get through to Alex and he seems to be reacting to the challenges rather than allowing them and letting Alex run out his control string, get tired of the game he is playing.

And, we now know as well that Alex's marital situation mirrors in some ways what Paul is experiencing in his own. 

As a Jungian, I believe that we get the patients we need, which sounds like an odd idea. But Jungian therapy assumes that both therapist and patient are in the soup together and that both will be changed by the process. Paul's practice is filled with people with marital, sexual and commitment issues, which he is wrestling with in his own life. Were his own life not in turmoil, his responses to these patients would be different, though not necessarily better. It is just that in therapy it is not only the patient whose unconscious is at play. The classic diagram from Jung, showing the transference/countertransference process between analyst and patient, may help here:


If we look at the diagonal arrows, we see this process of patient influencing as well as being influenced by the analyst. Keeping this model in mind, it becomes easier to understand how Paul's own issues are being stirred up by those of his patients. It is not exceptional for this to happen, though it is sadly all to uncommon for therapists to be mindful of these forces at work. It is when the pot gets stirred in a major way, as for Paul now, that it becomes really important for a therapist to seek supervision, as Paul has begun again to do with Gina.

© Cheryl Fuller, 2018. All  rights reserved.