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Complex clinical situations pique all of our interest. Debates that we have all engaged in – such as how to distinguish psychoanalysis from psychoanalytic psychotherapy – fade in the face of clinical urgency, as we struggle to intervene most pointedly and with enduring efficacy. Take the following recent dilemma I wrestled with:
My patient Gail, a forty-year-old school teacher, pages me on a Sunday evening. When I call her back, I can’t hear her voice, only rapid heaving through the phone line, and I can almost feel her cold sweat moistening my ear pressed to the phone. At first, she can’t string together a coherent sentence to explain why she has called. But I know her well by now, and I know how our Friday session has gone: recognition of her mother’s basic limitations; a sense of panic as she recalls her confusion about whether she could go to her mother for refueling when she was a toddler. She could almost remember formulating these questions back then: “Could you soothe me? Could I tell you something about my needs? Are you going to whisk me away? Why did you throw away my favorite soft giraffe that had gotten dirty?” And her then wondering if she could trust me: “How are you different from my mother? Why is it that you seem credible for long stretches of time, but then the trust disappears in an instant when you misunderstand what I am trying to tell you or you leave me for a weekend?”
So, informed with the knowledge of our Friday exchange, and recalling previous similar phone conversations, I begin to talk into the phone. “You sound panicked Gail. I know when you’re like this, you aren’t able to tell me what’s wrong. Maybe hearing my voice will help – sometimes it does. I can only imagine that something has gone wrong over the weekend, maybe together with your confusion on Friday.” Over a few minutes, with some reassurance and tentative suggestions on my part about what may have been confusing about my resembling her mother on Friday, Gail begins to breathe mo