Posted by Honore on January 24, 2007, at 15:26:52
In reply to Re: My T's Appearance » annierose, posted by mair on January 24, 2007, at 12:52:42
Hi, mair.
Maybe your T isn't handling in the way that could be helpful for you-- and maybe you really need to talk with her about it. I know it could be hard-- but she may be struggling with how is best for you-- and missing you-- but be really eager to hear more about what you do need now.
It's so possible that she's aware of how difficult this is-- no matter how ill she feels, unless she's too sick to be seeing patients-- in which case, she needs to confront that. But she sounds as if she could be more capable of handling your real feelings than you realize..
It's eally important to get to a better place with her, for your own sake-- you do matter here-- I'm sure she would agree--this has to be primarily about /for you, not her (even though she may also get a lot from it, too, of course).
When I've gone through various crises in my life (and in therapy), I've been helped by reading about it in the psychoanalytic journals. There are a lot of thoughtful and very insightful articles, and it occurred to me that I'd seen some on the subject of illness in a therapist.
The articles all address the very real problem that a therapist's illness can be a really damaging experience for a patient. Yet they also point out the potential for growth and deepening of both relationship and the patients' own self-awareness.
---
I had trouble actually accessing any of the articles online-- many are in Journals of Psychoanalysis or Psychotherapy-- which I know I could get through the Medical School here-- but I haven't gotten library privileges there personally. If you're near connected to a University, you might be able to get access through the library. If not, I'll see if I can figure out more about my own access.
Also, I don't know if you've read any psychoanalytic articles. If not, some of the language (which is a private, sort of analytic language) can be hard to interpret-- I could just define a few words that would make it all much clearer. It's really not complicated-- just a specialized terminology.
A couple are:
1. [A Book] "Illness in the Analyst: Implications for the Treatment Relationship": edited by Harvey S. Schwartz, M.D., and Ann-Louise S. Silver, M.D., International Universities Press, Madison, CT, 1990, 347 pp., $24.95.
Review by: George Nicklin, M.D. Author Information
"Cycles of interest on how professionals cope with major illness run through the social fabric. Forty years ago, When Doctors Are Patients (1952) edited by Pinner and Miller, was published. Each chapter was a study of a physician coping with a major illness. Recently (1987) a follow up book, When Doctors Get Sick edited by Mandell and Spiro, was published, and now a book on how 14 analysts—both medical and nonmedical—cope with the onset of major medical problems appears. These problems range from conditions so vivid the patients inevitably become aware (e.g., pregnancy), to obscure situations that force absence from the office in such a way as to leave the patient free to conjecture the illness in the transference neurosis, as the analyst gives minimal information of the etiology of the disruption. Eleven of the contributors are physicians, two are Ph.Ds, and one is an M.S.S.W.
The ailments range from silent heart attack with cardiac arrest and revival to several ..." (no more given)
2. Am J Psychother. 1990 Oct;44(4):590-7.
A patient-therapist's reaction to her therapist's serious illness * Simon JC.Clinical attention to a crisis in the therapist's life has been scant. Both therapist and patient are touched by a significant occurrence in the therapist's life. Impact on the psychotherapy process is unavoidable. This paper traces the patient's (who is also a therapist) reactions, feelings, thoughts, and experiences in response to her therapist's acute cardiac illness. These include denial, abandonment, anger, compassion, and concern. Writing as patient, the author is re-reminded of the importance therapists hold in their patients' lives. She discusses her concurrent distancing from the psychotherapy process and the depth of her involvement in it. Writing as therapist, she raises salient questions for the clinician, offers recommendations stemming from her experience, comments about transference components of the relationship and discusses the place of the real relationship. Included is a brief review of the limited literature on the subject.
PMID: 2285082 [PubMed - indexed for MEDLINE]
3. [In German--but I left it in, because the abstract is pretty good]
Psyche (Stuttg). 1995 Jun;49(6):564-80.
[Physical illness in the transference and countertransference] [Article in German] * Rodewig K. Niedersachsisches andeskrankenhaus Tiefenbrunn, Rosdorf/Gottingen.The significance of severe physical illness in terms of the repercussions it may have on the course of psychoanalytic treatment is a topic that has received very little attention in the literature. The author approaches the problem from the point of view of transference and counter-transference on the one hand, and from a distinction between self and body-self on the other. Rodewig proceeds on the assumption that a physical ailment can have the character of an object and may thus attain the status of third object. Given the threat posed by dangerous physical illness, the ego has recourse to defence mechanisms such as splitting and separate projective identification of positive and negative object- and self-parts, projecting the omnipotent, idealizing desires onto the therapist and the negative desires onto the ailment itself. In a later stage a de-idealization of the therapist sets in and the latter is identified with the illness so that the illness is then bandied back and forth between patient and analyst. The most challenging technical problem for analysts is avoiding the projection of their own illness and death anxieties onto the patient with a view to resolving them there. Instead, they need to be worked in independently and then given back to the patient devoid of their original virulence. The author illustrates the various facets of the problem with brief reference to various case histories.
PMID: 7610265 [PubMed - indexed for MEDLINE]
4. Am J Psychother. 1994 Spring;48(2):221-30.
Countertransference issues when the therapist is ill or disabled. * Dewald PA.
St. Louis University School of Medicine, MO.Multiple external life events and vicissitudes can impinge upon the traditional privacy and isolation of the usual psychotherapy situation and relationship. Among these are major illness and disability in the therapist, which will activate conscious and unconscious responses in both patient and therapist. If worked with and well handled by the participants, such events may stimulate therapeutic growth and working through of multiple issues related to illness, separation, death, anxiety, and fantasies of omnipotence and idealization. However, multiple factors in both patient and therapist may combine to foster avoidance of the conflicts that have been activated. To the extent that countertransference responses in the therapist interfere with his/her ability to bring conscious attention to these issues, a potentially valuable therapeutic opportunity may be lost. It is important for therapists to therapists to anticipate such situations, and to make use of colleague consultation to assist in managing them.
5. * Counselman EF, * Alonso A.
Boston Institute for Psychotherapy, MA.
This paper examines the potential countertransference problems therapists face when they become ill. Personal illness creates conscious and unconscious dilemmas for therapists, and the psychotherapy relationship may be strongly affected by the ways in which the dilemmas are managed. Psychotherapy is a relationship based on trust. A therapist's illness does not necessarily damage the trust that has been developed; however, the handling of the illness and interruption can create a major rupture in the relationship. Alternatively, the therapist's illness can create a useful opportunity for therapeutic work. Successful management of countertransference is a crucial ingredient for the latter outcome. Relatively little has been written until recently on countertransference aspects of therapist illness. Available literature has noted such defenses as denial, omnipotent fantasies, and reaction formation against dependency and weakness. Illness has been seen as a problem for "older" therapists, but, in fact, illness can occur at any age. Illness may cause a defensive withdrawal from one's patients and in its most serious instance lead to total empathic failure. Clinical concerns for the ill therapist fall into two categories: how much (if any) information to give patients about the illness and how to work therapeutically with patients' reactions. While there are no clear guidelines, we recommend a flexible, common sense approach with the central focus always on the patient's reactions to information or to changes in the therapy. The foundation for decisions about information and for subsequent processing of reactions must be the therapist's own awareness of countertransference. We recommend consultation with trusted colleagues or supervisors. In addition, we emphasize the ethical responsibility every therapist has to provide for patients in the event of an emergency ahead of time. Finally, we surveyed a small number of experienced therapists who were known to have had personal experience with illness. The results indicated that decisions about giving information were not difficult. However, the countertransference reactions of anxiety, denial, sadness, and avoidance (of patient anger) were often troublesome. We recommend that psychotherapy training include management of therapist illness. We also recommend that supervisors be familiar with the countertransference aspects as they may be called on suddenly to give consultation. Our conclusion is that therapist illness is as big an event for the therapist as it is for the patient, and we hope that a body of literature will be developed on this important topic.
Hope one or another of these gives you a sense of what's missing now with your T. I'm really sorry you're having such a hard time.
Honore
poster:Honore
thread:725771
URL: http://www.dr-bob.org/babble/psycho/20070119/msgs/726021.html