In Treatment -- a couple of thoughts

A note  or two here about what we are seeing with Paul and his patients and Paul in his own therapy. 

Each of these patients does exactly what patients are supposed to do when they see 
their therapist: they bring their "illness", their self-destructive patterns, in the 
only way they know how—by repeating it with the therapist right there in the room. The therapist can either react as others have, or  can offer a way to begin recovering from past injuries.  At these critical moments, the path taken depends not on the patient but entirely on the therapist.

So, yes, the therapy with Alex can continue, but it falls to Paul to respond to what happened, to the fact the he acted out, probably in a way similar to Alex's father, by creating a new and different path. By apologizing. By being willing to look at it and see what was going on, what Alex was feeling.

As Paul did with Sophie when she returned and he received her without scolding or ignoring what she did and then being willing to make an entirely appropriate demand on her, that she agree not to threaten or try to kill herself again while they are working together. This is a different path for Sophie.

And yes, with Laura too. Paul must reassert the boundaries, not punitively, not reactively but out of knowing that doing so, that holding the boundary is what she needs and only through doing so can she begin to move out of her old patterns.

As Anne Ulanov writes:  How does the analyst heal the wound that has been evoked in himself or herself and still serve the patient? Ethics based on doing no harm 
demand: not by perverting the analytic relationship.  As the fictitious analyst 
remarks to himself, “She is no other, she is I.  In loving her I love myself, in 
rescuing her I redeem a part of myself—weak, frightened, ... 
of which otherwise I must be ashamed”. The analyst must turn to other 
resources, not the patient, to tend to this part of himself, as shameful or embar- 
rassing as that may be. 

© Cheryl Fuller, 2018. All  rights reserved.