In Treatment - Sophie, week 5

Sophie and her mother are outside until time for the appointment. Sophie does not want her to come in with her, even though Paul asked for her to come. Paul opens the door and asks the mother to come in. Sophie pushes past. 

They sit as far apart on the couch as possible. Sophie wants Paul to say she can return to training. Sophie is hostile and attacking with her mother, says she is a crazy bitch that no one understands. Sophie says if she has to stay at home, she will slit her wrists. Sophie threatens that is she doesn't try out for he Olympics she will kill herself. Paul calls for a halt to the threats.

Paul supports Sophie's return to the gym. Sophie smiles smugly and Olivia looks worried and upset. Olympia leaves. Sophie smiles triumphantly.

Paul tells Sophie that he thinks he knows why she took the pills in his bathroom, that she was testing him and that he passed the test. But what if she tested someone else and they did not pass. They need to understand what she finds so attractive about death. 

She says she would escape her mother. She says death means not feeling anything.  Paul says that last week they got to a place of deep feeling and then she went into the bathroom and put herself to sleep. She resists. He points out that on the beam, she is strong and confident but off it, in the rest of her life she is more susceptible, vulnerable. She says she hates that part of her Paul tells her that he will be with her, help he and support her but he will not work under the threat of suicide. 

They talk about her parents, her father and Paul suggests it is easier to feel close to her father because he is at a distance. Olivia knocks on the door and comes in.

Olivia sas she is not going to let her go back to the gym because it is killing her. Sophie says she will go to her dad. Sophie hurls at her mother that she was having sex with Sy in her hospital room while her mother banged on the door. They fight -- Olivia reveals that Sophie's father has not called her in a month.

Paul asks if she was with Sy in the hospital. She denies it. Paul says he has thought long and hard about whether or not to report Sy. He asks again if she was truthful when she said they had not had sex again after the first time. Paul defends Olivia to Sophie, that despite the punishment she gives, Olivia doesn't give up on her.

Sophie gets up to leave. Paul asks about the agreement. She says she won't try to kill herself as long as she is in therapy.

How painful this was to watch! As the mother of a daughter now grown up, one who was never as hostile toward me as Sophie is toward her mother, I could feel the arrows of anger as Sophie shot them into her mother. Sophie is not able yet -- and really are we ever ready -- to see her mother as a person, as something other tan the role she has assigned her. She has no awareness nor wish to be aware of her mother's conflicts, wishes, hopes, regrets. And similarly, she cannot see her father as anything other than her idealized parent, the one who can do no wrong. We don't know much about the divorce, but these are issues that have carried over from it for Sophie.

Still, Paul, while no doubt feeling empathy for Olivia, must protect as much as he can the emerging therapeutic alliance with Sophie. So he puts himself on her side without opposing Olivia too strongly, and this does enable him to defend Olivia to Sophie later.

About Paul's insistence that Sophie commit to not trying to kill herself or threaten to in order for their work to proceed -- this should be standard but too often isn't. Therapy cannot proceed when the patient is holding the threat of suicide over the therapist's head. The suicide of a patient is a devastating event for a therapist and one that as I recall only around 20% of therapists experience. As a member of that unhappy group, I can testify to the terrible effect it has. There is, of course, no way to stop a patient intent on suicide from doing it. But laying the cards on the table, saying openly that the work they do cannot proceed under threat, is essential. The message to the patient needs to be that we can talk about your wish to die and where that comes from, but when you threaten to turn that wish into action, our work stops. The therapist is willing to commit to being there, to walking this path with the patient who can call him or her, ask for additional time, but in return she, the patient, must commit to staying alive. I was pleased Paul did this.

Fathers, fathers everywhere -- Laura's father, Alex' father, Sophie's father. And yes, Paul's father. Disappointing fathers. Abandoning fathers. For each of these patients, Paul is the recipient of their father transferences at the same time that he is swimming in the muddy waters of his own father complex as he struggles to find his way through it without becoming his father. With Sophie, he held his position well. 

© Cheryl Fuller, 2018. All  rights reserved.