A Reflection

To my Therapist,

I have been needing to write you a proper email since yesterday. I could have written to you several pages worth of material. The last two days have been very trying. Full of things to think about. Lots has happened. I won’t even know where to start in therapy tomorrow.
You know it’s strange not feeling suicidal when I get overwhelmed now, these days. I think about how I used to obsess about the idea of jumping off the overpass over the freeway by my house, or even longer ago, about jumping off of the big bridge near downtown. I think about having really wanted to take an overdose in the past and being really convicted that it was the right thing to do.
Now I don’t think of dying or wanting to end my life. I came very close to telling my program director about my history of sexual abuse and trauma. I told her some other things that maybe I shouldn’t have said. I even volunteered to tell her about my fertility treatments, because she is a mom and a therapist and I thought she would understand. Did I want empathy? No. I just wanted to share something very personal with her because she had participated in the expressive arts team building exercises and I felt closer to her. But maybe I made a mistake. Maybe I did.
I have to talk with you about what to do with my volunteer job and whether to quit. I need help in thinking this through. I would also like to cry and have some healing tears with you because I feel like I have a lot to cry about, but who knows if I will even cry at all in the next couple days. I almost cried twice today at university. One was when the mentors were talking about finances and funding the education because I feel like I failed since I got denied the second loan. If I had gotten it each year I could have stayed on the three year graduation track. But wasn’t it me who said to myself just the other week that I have a lot of personal growth to do and if I can spend an extra year in personal therapy working through my own issues then I will be doing my future clients a favour and that I won’t have so much countertransference?
I just need tomorrow to come so that I can sit with you in therapy. We only have one hour. Let’s see what we can accomplish in one hour, 50 minutes. It’s never enough time yet it’s exhausting and more than that in a day wouldn’t be good for my health.
I just want the end of tonight to come so I can finally go to bed and just let go of everything I am holding on to and just dissolve into the night. Can you help me to disappear for just a little while from my busy, complex, over committed and over involved life, just for a bit? I was really hoping we could do more therapy soon again but I remembered my Mum is coming to town on Monday. I still want to try to get her to meet you next week on Saturday if you are available, just like we tried to do last time that first week of December. Does she really live to where she moved? Has it only been nine months since she was last here, in my home, in this city? Does she really still deliver food for a living and how can she even tolerate her life with that awful husband who is less than even a roommate in terms of their interpersonal connection to each other?
I have to stop now. See you very soon.

In Learning About Psychodynamic Psychotherapy

First week of grad school, done! I did it. I made it. I am here. One of my classes is Theories of Psychotherapy and Counseling. Chapter 3 is about psychodynamic psychotherapy. At the end of our first class, after we had gone over the first two chapters, the professor asked who would like to do the role play for psychodynamic psychotherapy (yes, it is a mouth full to say). My hand shot up. I was the very first person to volunteer. You see, I have an inkling that part of the type of therapy I have been in for the last nine years is just that, based on that theory.

I met with my therapist today to get help on my assignment and do some role play practice. It was very helpful. You see, I read the entire chapter, which took me about 4.25 hours over two days, and if I had to recite or recall anything from the chapter, well, I don’t think I would do so well.

Here is the scenario that we came up with. I am the therapist and my client is AM (Adult Male). AM is married to a woman who works in the theater industry and is always gone at night doing plays. AM works in the banking industry at a 9 – 5 job and when he comes home at night the house is always empty and he feels lonely. In addition to that his wife recently made them get a dog and she is never home to take care of the dog so he is always walking the dog. AM is not sure if he wants to stay in this marriage. I tell him I can imagine that this must be very difficult for him.

I ask him if there was ever another time where he has felt like this before. He reflects and tells me that when he was a kid his mom and dad worked very hard at their careers and he knew they loved him but that he was self-sufficient and a lot of the time he took care of himself. He says again that his parents loved him very much but looks down and to the side while saying it. As a therapist I notice this nonverbal gesture and realize that what was said may not be accurate as per AM’s perception, but this is his defense mechanism by defending his parents.

I tell him, “I notice you looked down when you said that and shifted your position. Tell me about what is happening on the inside for you.” He says, “I don’t know, I guess this topic makes me uncomfortable.” I say, “what is it like sitting with this discomfort?” “It doesn’t feel good,” he replies. “No, I bet it doesn’t.”

Shift of topic. I ask him what the experience was like when he was left alone and he says it was fine, really. I point out that just as AM’s parents were often gone, his wife is often gone and what does he think about that? I don’t know, he replies. “I think there might be a connection there, that maybe it is no coincidence that you chose to marry a person who is very involved with and focused on her career, just like with your parents.” It’s just something to notice, maybe a pattern.

This scenario happens during the working phase of treatment, not the initial phase. The scene with my scene partner only needs to be 10 – 20 minutes long. We can record it on video ahead of time, which is what I will be doing, or we could present the scene live in class. Either way the professor is going to help us to interpret the style of therapy, point out elements of the theory which were applied noticing interventions used.

I used empathy in the beginning when I said this must be hard for him. I guess what the intervention would be at the end is providing some insight as to the connection between the past and the present. I just added in the paragraph of how the therapist focuses on the here and now moment and his reaction to telling me about his past, insisting that his parents loved him even though he may have felt abandoned or neglected by them.

For each case, I am to come up with a case conceptualization and then a treatment plan. The treatment plan goes over the goals for the initial, working, and closing phases of treatment. For each goal listed there needs to be a set of interventions which I am going to use. Just the term itself, “intervention” is new to me and although by definition I know what it means, to intervene in a way which provides a positive outcome, I barely know what the interventions are. I know that using empathy might be a type of intervention but I don’t know what else is. I will have to refer back to the textbook.