She never mentions the word addiction
In certain company
Yes, she tells you she's an orphan
After you meet her family
~ The Black Crowes
In several recent posts (12/27/13, 5/27/14, 10/28/14) I brought up the idea
that a story about someone’s family life that one hears from a patient in
therapy, in a news story, in a letter to an advice columnist, or directly from friends and acquaintences, is quite
often, shall we say, incomplete. The story is true as far as it goes, but it
often leaves out details and information about the context in which it
occurs.
In therapy, as the therapist gets to know the patient, listens carefully, and employs certain techniques to help patients get past their shame, guilt, denial, and protection of family members, the whole story gradually emerges. As I mentioned before, the plot thickens. The added information puts everything the patient told the therapist before in a whole new light.
This more complete information allows the therapist to do something called pattern matching. The full story will remind an experienced therapist of common dysfunctional family patterns that may apply to the patient’s situation, and about which the patient would have no way of knowing.
The therapist can then mention that in other similar cases such and such explained similar family behavior that was otherwise inexplicable and confusing to the patient, and inquires if this is what might be going on with the patient and his or her family. This in turn may allow the patient to understand many things in ways they never thought of before.
Before describing a commonly-used psychotherapy technique (which is a version of the facetiously named Columbo style of questioning, named after a famous TV detective, described in the post of 3/13/12), I would like to refer back to a previous post, popular among readers, about parents pretending to be clueless about why their adult children are no longer speaking to them.
In that post, another reader wrote in and mentioned some possibile details that perhaps the aggrieved parent may have conveniently left out.
A more recent letter to advice columnist Amy Dickenson (10/14/14) is a bit more revealing. The cut off parent initially attributes the cut off to what she readily admits was a rather trivial argument. However, as the letter goes along, the parent reveals additional information that shows that she was not so clueless after all, and the advice columnists calls her on it:
Dear Amy: The last time I spoke to my adult daughter was five years ago. I hosted a first birthday party for her son at my home and she severed ties with me after a petty argument. Since then, she has given birth to additional children, and for several years, I sent cards and gifts in the hopes of reconciling. I stopped giving because the only response I received was through secondary sources; she never responded directly to my e-mail or letters. I feel I had every right to be angry that day long ago. Both she and her husband were upset over my choice of party decorations (among other things). Post-fight, it came out that she felt unsupported during my marriage to my abusive ex-husband. And although I divorced him many years ago, it was evidently still acutely painful for her… — Wronged Mother
Dear Mother: You have chosen this space to try to restate your original gripes against your daughter… I can't help but wonder, however, about your daughter's feelings. In the midst of all the detail you supply, you mention your marriage to an abusive ex-husband. Is it possible that this estrangement is based on your daughter's anger over your inability to protect her from an abusive situation?...
Now in this case the mother had moved on from attributing the cut-off to the argument over party decorations and started getting into the important issues involved. But as mentioned, some patients in therapy or who are interviewed in news stories act like their initial explanation is the totality. It’s their story, and they are sticking to it.
My memory is unfortunately not that good, so I take extensive notes after every session. Just prior to the following session, I do a quick overview of all of my previous notes to refresh my memory.
As patients talk about what’s on their mind concerning ongoing issues, they will often mention something in passing which seems to contradict something they told me earlier in therapy. This usually happens while they are discussing seemingly unrelated matters. (I just happen to be paying closer attention to what they said than most people).
As therapy progresses, they often mention the same or analogous contradictory information again. Some time later, when several examples of such ambiguities have arisen, I politely ask them to clarify for me how seemingly contradictory statements they have made fit together. I do this without accusing them of trying to obfuscate issues or to confuse me. In fact, I ask them to help me understand this from a position of my being confused, and perhaps just too thick to understand it (this was the technique Columbo used to get perpetrators to confess to crimes).
This is when patients start to admit that they had
not been completely candid with me at the beginning of therapy. The amount of detail, internal consistency,
and new information that starts to come out shows me that they are not making
things up to please me. If and when that happens, their story begins to fall apart.
Another technique that helps clear up plot holes involves the responses the patient makes to any observation the therapist may make. This involves not only whether the patients are agreeing or disagreeing with what the therapist has observed, but what then follows.
Back in the day when psychoanalytic therapies were king, we were taught that there were four possible patient responses to any observation or interpretation a therapist makes. First, the patient agrees with the therapist, and then a bunch of brand new information begins to come out. That’s obviously the best outcome.
The second best outcome is that the patient disagrees with the therapist, but a whole bunch of brand new information nevertheless comes out. This usually means one of two things: 1. That the therapist is partially correct, but is missing something important. 2. That the therapist is bringing up something prematurely, before the patient is quite ready to admit to certain things for any of a variety of reasons.
The worst outcome is when the patient disagrees with the therapist and then gets quiet. That usually means the therapist is way off, and it is time for him or her to ask for the patient's thoughts, and then shut up and just listen.
The last time I spoke with my cousin, who had been adopted out as an infant (post-WWII illegitimate child, huge secret for 60 years), she told me that her birth mother (my aunt), said that she tried to keep her, but didn't have the money or family support.
ReplyDeleteCue record needle screech...
I am now in the position with source documents to prove that the birth-mother (my aunt) did have the money and was supported by family.
My mother who compromised her own financial position to provide an apartment for her younger sister and nursed her through a post-natal depression, the rather brutal shaming she received in the Home for Wayward Women, and got the new mum employment.
Instead of saving money, the birth-mother (my aunt) indulged in retail therapy, then met a new chap, who she pinned all her fantasies on being a Navy Wife and living in another state.
For three years the birth-mother had rock solid family support, married her new fellow and not once gave that child another thought.
Which, of course, is something that people really do not want to believe about young women who placed illegitimate children up for adoption. They all must have really wanted to keep their baby.
The cost to my mother involved a nervous breakdown and 30 years in-and-out of asylums. My mother surrogated the guilt, never stopped worrying about her 'lost' niece each time a media story broke about children in foster care being sexually abused.
It goes without saying: I was the one who didn't have a mother.