Week 6: Paul & Adele

Paul is with a doctor who is asking questions about drug and alcohol use. The doctor suggests anti-anxiety meds which Paul refuses. The doctor writes a recommendation for a psychiatrist.

Paul is with Adele. He tells her that this doctor did not recommend her and he makes a crack about her contacts at Columbia. She asks what the doctor said. Paul said he has to wait and see -- because he is not exhibiting enough symptoms -- yet. Adele says his dilemma is like everyone’s -- not knowing what will happen. Paul asked him for a worse case scenario and he confirmed what Paul already knew, that he could become paralyzed with complete dementia in less than 4 years. Adele says less than 0.5% of people develop that form of the disease that he probably does not have. She asks what he would do if he were told with absolute certainty he had the disease and just a few years to live, what would he do? He says he might close his office and leave, move closer to the kids. She asks what he would do if he were told the opposite -- would he also lock up the office or would he stay as he is? Adele says not knowing allows him to stay in stasis, to keep things as they are. Paul says stasis is hell. He doesn’t know what actions she is talking about. 

Paul spars with her and says he doesn’t know what she wants from him, what was urgent. He says she did call him at home and he didn’t know what she was trying to say. Adele asks if he was asking why she called. She says she believes she left the reason in her message -- she called to offer him another session if he needed it, he asks needed it for what? She asks what he imagines. He asks her what her lingering concerns were, what she felt was so depressing. She says she felt they should revisit what he said about Sunil. He shakes his head. Paul says you wouldn’t let me talk about my patient. She says she won’t supervise him but she would like to talk about his feelings and concerns. He says he was asking her opinion. She says some details stayed with her - the presence of small children. Paul says she didn’t hear what he was telling her. He says he does not feel the children were at risk. And Julia, she asks. Paul says they had an intense session Monday -- that Julia had come in to end the treatment. Adele asks if there was an explanation. Paul gives Sunil’s rather blander explanation and says it was an accident, downplaying his own concern. Adele asks if he had taken the opportunity to talk with both Julia and Sunil about what had happened and his concern. He says he talked with Sunil and convinced him of the need to stay in treatment. He tells her Sunil is coming back and will see him in pro-bono. 

Paul then asks if she is aware they are playing out his fantasy that they would meet and talk about their difficult cases. She says she does. Paul asks her if she saw she was doing it when she called him. She says she felt she had been negligent last week. Paul says at 7:30 in the morning? He asks if she was in the office. He says he knew she was not because of the caller id. Adele says she was at home. He asks if she called to talk about the patients. Paul is being seductive and says he just wants them to be honest. Adele asks what he thinks is happening there. The phone rings and she says she is sorry, she thought she had turned the ringer off. She does so and then sits again. 

Adele says he wanted to be honest what is happening here and Paul says it doesn’t matter. Adele starts to interpret her call but Paul does not want to hear it. She says she should have thought more carefully to the timing of the call. She tells him why she called -- he put her in a difficult spot and she didn’t know if there was a legitimate danger or if he was trying to hand over the worry to her so he wouldn’t have to carry it. He snorts. And he says he should never have asked her in the first place. 

He says she thinks Sunil is dangerous and he is a paralyzed fool. She asks him to tell her -- why he is willing to see Sunil free of charge and talks about his identification with Sunil. They are both immigrants, isolated, about the same age. Paul is angry now. He says he has a great deal of sympathy for Sunil but he thinks he has a special window into Sunil. That he has an instinct about him -- he is justifying his action and refusing to see it as other than his version. He sees making the offer he made as a bold step, that therapy is working, Adele asks how it is working. he says it is giving him an outlet for his violent fantasies so he doesn’t have to act them out. Paul accuses her of being smug and remote, a Freudian ice queen. She asks where the anger is coming from. Paul justifies that -- he says Sunil is coming back, is coming back and is trusting him. He says Sunil gave him the cricket bat. Adele asks why he did that, she asks why he takes that as a good sign. Paul says it was a mistake to bring it up in the first place. 

Paul wants to change the subject and gets snide. She says “my pregnancy?” -- she says she thought she saw him notice it. He asks her if she is pregnant. She says she is. She asks if she is wrong, had he not noticed. He says no. She says he seems upset. He says she is cruel because she deliberately encouraged him to talk about his stupid fantasies. He wanted to see her as lonely and able to understand his miserable life. She encouraged him to indulge his delusions all the while being in a happy relationship with a growing family. She asks if that is what he assumes? He says who cares what he assumes, it’s all a crock of shit. She says she never intended to humiliate him. He says he doesn’t know her so how could she humiliate him. He wants to leave. She says she is worried about him, that he does not understand the gravity of the situation he is in with Sunil. He says she doesn’t understand what would happen if he compromised the treatment. She says Paul needs to step back and look at the situation. He could include the family first before notifying authorities. She says Sunil is similar to Paul, both attracted to a younger women. Sunil feels rage toward Julia and Paul is very angry with her. Adele says it is different because he and Sunil are very different but she wonders how well Paul really knows Sunil. She challenges him on his dissatisfaction with his work, maybe he is secretly hoping Sunil will explode and if he does, it will destroy his career and make his decision for him and he will have to live with knowing he could have protected Julia and her children.

Then we see Paul at home calling someone. Julia answers. 

Paul is indeed a difficult patient. He is very defensive and easily wounded so he feels tricked into revealing himself to Adele. Therapy makes a demand of Pal that he does not want to meet, which is to be willing to reveal himself and be vulnerable without being in control. His reactions to interpretations or confrontations from Gina were very much like those from Adele. He parries them and turns session into fencing matches, fighting desperately for control and to conceal his deep desire to be dependent. He seems to me to be quite counterdependent -- which is to say, he masks his deep need and desire for dependency by being in charge and independent. Think of how he was charged was caring for his mother at a time in his life when he needed to be the one cared for. Where could that need go but underground? And how could he trust anyone to be there for him? So he attacks when the possibility of dependence appears. So he experiences the revealing of her pregnancy as really wounding to him, meaning that yet another woman let him down and will not be there for him in the way he wishes. That she is there for him in the way he needs, i.e. as his therapist, just doesn’t touch this level in him.

Should Adele have called him? The call itself is not a problem. But it can be argued that she should have called during regular business hours and from her office not home, especially with a patient like Paul is going to read every little nuance for things to jump on. On the other hand, it is possible to view this in a different way -- that we therapists will fail our patients in exactly the way they need for us to. To believe that one can count on another to never hurt or betray or violate trust in any way is naïve and is to live in a bubble of unreality. Primal trust, arising from the relationship between infant and mother, even that trust, gets broken as the mother does not come immediately to soothe the infant or fails to correctly identify the source of her baby’s difficulty. Development requires betrayal in order to develop tolerance for the frustration of ordinary failures in relationship and the resilience to not only survive but also learn from them. “The broken promise is a breakthrough of life in the world of Logos security, where the order of everything can be depended upon and the past guarantees the future.” (James Hillman) 

Paul’s fantasy about Adele was unsustainable and in making the call as she did, she managed to make the right error and that error broke the bubble and opened to the possibility of a more functional therapeutic relationships. One of the frustrations of being in therapy is the suspension of reality -- this is necessary in order to be able to speak of fantasies and wishes about the therapist, as Paul did in the previous two weeks and showed this week. But it also requires an ability to accept that those fantasies cannot be realized. And though Paul may know that intellectually, he is like any patient in not wanting to really believe it. 

I am not arguing that therapists should create errors. Just that we will make errors and often they are exactly the kind the patients needs. That is a way we unconsciously each influence the other.

© Cheryl Fuller, 2018. All  rights reserved.