This is my critique of a therapy work I witnessed. This is a case study of a 27 year old student, Miriam (not real name, and all details are changed) who attends therapy sessions because she had problems sleeping. After several sessions, she got in touch with the running thoughts that go on in her mind at night.
This is a case I witness during a training session. The names and stories are changed to avoid recognition of the individuals involved. The therapist is a trainer demonstrating his work to a group. Though I was not impressed with his work, this case story is interesting. I shall write my own analysis of the work in blue, and leave you to make your own associations. You may send me your feedback in the comments.
Much of these thoughts brought out in Miriam deep rooted anger. She explains that this anger has been with her her entire life. Miriam had also often mentioned of anger bubbling up and interfering with her activities.
The present theme
A theme brought up in one session of therapy within a group, was that she was angry about being responsible…
“I am angry that I have to be responsible for everything that has to be done at work… I cannot rely on anyone to help me, but they expect me to be there to help them.”
“I cannot just let go and leave the scene like everyone else when there is something to be done. It is a burden. ”
“I am envious of my girl-friends, when they need help, someone is there to help them. I, for example, cannot even find anyone to help me to hang up a picture in my apartment. my girl-friend offered to ask her father to help me. That is not the point. I wish that I had a father like hers. He is always there for her.”
At this point, Miriam showed signs of deep sadness.
Miriam’s work
As the group session wore on, Miriam offered to work in the middle of the group.
Miriam explained that her birth father, Mark, is someone who was not there for her in her childhood(i.e. this person was not known to her till she was 17). In fact he has only met her after the death of her mother 10 years ago. She longs nevertheless “for him to acknowledge his fatherhood to her. Even though, he actually acknowledged her within his community, friends and family. This is “not about the money ” [Miriam mentions this several times]. “I just want him to accept me as a daughter.”
Miriam explained the difficulties in communicating with Mark. She describes him as “living in his own world”, that their communication is superficial, that the last christmas was disaster when she was with his family, that she is afraid that he would reject her on grounds that he might think she wants more from him than he is willing to give.
The therapist offered the 2-chair (empty chair) method. He asked Miriam if she would like to put her birth father in that chair. The therapist was more concerned that Miriam showed her emotions of anger clearly, but did not clarify the many things Miriam said that sounded (to me, at least) ambiguous.
2 chairs were set in the middle of the room. One was to be for Miriam, the other, her father. Miriam spent the next 5 minutes explaining again the situation with her father, her frustration . Another 5 minutes was spent deciding where to put the chairs.
Miriam explained that she could not face her father directly. She feels unsafe. (I was wondering what her intention was to say this, since her father is not really there. Was it to avoid the work in front of the group? Maybe it was not the right place and time for the work. On hindsight, I am realizing that this is a sign that the issue was bigger that what meets the eye.)
Miriam says she feels better writing him a letter. The therapist and client talk further, with more explanations on how things were, and how frustrated she is. The therapist managed to get Miriam to talk more about where she wants to be positioned in Mark’s life. Miriam explains, and declares further that she wants to be acknowledged.
The therapist then asks Miriam if that is all… Miriam says, yes, everything is clearer, “I was afraid that he would reject me, because thinks it is about money.”
The 2 chair work ended there.
Towards the End of Miriam’s work
The therapist enquired how Miriam felt. She said she felt “more stable”. The therapist then explains further about how important it is to stay in a position and feel the emotions clearly.
Miriam mentions that this is something that has been all along an issue with her and her family. She goes on to say that her late mother was ashamed of having had 4 children from 3 different fathers. That this was known in the family, but never brought into conversation. Her mother, therefore, never made contact with Mark, and never asked him for anything.
The therapist ended the work there. He did not pick up on this new theme.
It is with this statement, that the existential issue Miriam really surfaced.
Comment on the case:
Miriam’s dilemma is touching, and is different from many other cases of a person trying to make contact with a father: An Adult trying to build contact with a father that one has never met as a child is likely to be in a different situation from coming back to contact with a father one knew as a child but lost contact with.
This is not a story about a person longing for contact with a person she had lost because he was someone she had not known. Many questions arise from this, which were overlooked during the work, that we cannot answer now without the client’s input:
- What is she really longing for? Recognition, “not money”. What is important about being recognized by this person?
- What does achieving this recognition solve?
- The person has actually recognized the client (by introducing her as his daughter to the community, as mentioned). What, then is adequate recognition? How would she know when it is adequate?
The client mention at the end of her mother’s shame, and how this reverberated within the family and kept hushed. The questions worth noting here are:
- How much of this shame is introjected by the client? To what extent does she identify with this aspect of her mother?
- How had the death of her mother affected her need to have a closer relationship with her biological father? (they got to know each other better after her death.)
Since the therapist did not notice the significance, this was not brought to discussion and not worked on.
Comment on the work:
This is an example of a therapist who has overlooked the existential (and hence important) issues because of focussing on technique (wanting to demonstrate 2-chair technique).
Observing this technique , one has to realize that this is not a good demonstration of the 2-chair work. The use of chairs alone does not define the method. Here are the problems with this example:
- The client did not get a chance to really “converse” with her father in the empty chair directly. She couldn’t, because she was talking to the therapist all that time, not to her father.
- She was not asked to sit in her father’s chair, which is an important part of the 2 chair work. To sit in the seat of the other person, is a learning process in having a different perspective. To sit in the other’s seat is also a way to identify how much of what one thinks (about how the other will react etc.) is the product of one’s own projections. Had she sat on her father’s seat, she may have come to realize how much of her projections were hers, and how much of it is real. She may have also had the insight of being her father and looking at Miriam (to see oneself with the eyes of the other).
- A lot of time was spent on arranging the chairs. This lead to a intellectualized discussion on how scary it is, how frustrating it is, how things used to be… there was much talking about, but the emotion had left the client. The likely cause of this was because the client was not ready to get into the exercise. In the end, the client wiggled her way out of it anyway. Rightfully so, since we know that it is not the actual issue.
- There was a lot of mention of emotion, but the expression of emotion got weak. The therapist showed also no emotion, though he looked earnest and attentive. When there is not emotional energy, the work is not possible. This is a pity, because the client started with lots of emotion, but lost it at the chair arrangement part.
What I have learnt from this experience is…
- not to take for granted anything that is said by the client, especially if it was something said “in passing”… especially if the client mentions the parents/family in the context of shame.
- never to forget the existential nature of issues that tend to repeat themselves (i.e. in this case, complaints about work, and anger)….
- when emotions feel deeper than the story, look closer, spend more time.
- don’t get distracted by methods…
- notice when emotional energy is lost in the middle of the talk. You have lost the client to intellectualization. Even if the client is “talking about” emotion, it is then only talk. This happened during the session.
In my opinion, techniques like the empty chair, or art therapy, or behavioral therapy serve only to create an environment to build contact. These techniques are means to an end. That end is the I-thou contact between client and therapist. Fancy techniques do not heal, only contact heals.