Therapeutic Relationship

When beginning work with a new patient, sometimes the difficulty is clear cut. Sometimes the situation is so emotionally charged that it takes a while for the dust to settle so the real work can begin. The aim, the textbooks tell us, is the establishment of the therapeutic relationship. That's all well and good, but most people I treat don't have the ability to form good relationships and they will attempt to replicate their past ones with their analyst (transference). The Kleinians spend years analyzing transference and countertransference. But, in my humble opinion, analyzing transference might not be the best way to help people have better relationships. What helps is forming a better relationship with their analyst. This is not a static thing, however. Some days people will balk and work against me as if I were the demanding Mom or Dad of their childhood. Some days people will appear to cooperate, but quietly sabotage treatment. Sometimes they even fire me. It's not unusual for patients to test me over and over and over just waiting for me to blow up at them or to abandon them repeating some well-entrenched historic pattern.

One patient, who had an unstable, ambivalent bond with her Mom, will from time to time totally smear me or a member of my family. This usually happens around the holidays when she perhaps fantasizes me with my family celebrating happy times. She hates my family for having what she has not. She envies my children and thus attacks them. She attacks me because as much as she yearns for closeness, she fears it even more. Sometimes she sends me syrupy cards which I suspect is her attempt to cover her rage toward me. That rage is most likely anger displaced from her Mom onto me. Despite this bumpy road, we are making progress in treatment. She and her Mom are a lot closer these days. She also is developing a healthier relationship with her 8 year old daughter. She has returned to school and is within a semester of receiving her bachelor's degree in business. She has become more discriminating about the men she dates. She is growing up emotionally and spiritually. Have we formed a therapeutic relationship? I guess it would depend on the day.