Week 6, Thoughts

There are a couple of things from this week that I have been thinking about further.

First, about Sunil and Tarasoff warnings. It is important to remember that the Tarasoff case and subsequent case law came out of lawsuits against therapists. And the reducing liability is a major factor in whether or not confidentiality is breached to warn. Some of this comes from a wish, very strong in American culture, to believe that behavior can be predicted and therefore a therapist ought to be able to know, with some degree of certainty, when a patient says something that indicates a real threat against another person. But making that determination is very difficult and we are not very good at predicting behavior. So risk avoidance is the ruling factor many many times.

One problem is that once the therapist has breached, the therapy is done. Trust has been broken, no matter how sound the reasons and the patient is just not likely to speak openly again with that therapist and perhaps no therapist. Letting patients know at the outset of therapy that such a breach could occur if threats are spoken often means that such thoughts and fantasies may never be expressed. Does this make acting them out more likely? Who knows. But when weighing such situations, all of these factors have to be considered. 

Second, I remain puzzled about Adele's revelation of her pregnancy. It seemed out of place and as I think about it, inappropriate. It would have been one thing had Paul raised it, but he did not. So I believe this is an instance of countertransference and an error. She reacted to the pressure from Paul and his relentless pushing by dropping her pregnancy on him, as a kind of retaliation. Now, yes, it was an error. But we all make errors and it need not be fatal to the treatment. It should serve as a flag to her, something to reflect on and probably get some supervision on, because together with the call she made to Paul from home, it indicates she needs to take a look at what this is setting off in her.  

© Cheryl Fuller, 2018. All  rights reserved.