Thursday, March 17, 2011

Putting Your Therapist to Sleep

Fortunately, I don’t have to make it up. The rich history of therapy in and around New York provides a caseload of bizarre practices, all justified on the grounds that they were performed by credentialed professionals.

In another world it’s called … running on fumes.

When I was writing about Dr. Don Levin, the psychiatrist who had replaced psychoanalytic therapy with prescription writing, I suggested that maybe it was good that he was saving people from the indignities of talk therapy. Link here.

Besides, at a time when most New Yorkers have been therapied to within an inch of their sanity, perhaps, now, they all need medication.

While therapists are sworn to eternal silence about what goes on in their consulting rooms, the same strictures do not apply to patients. We recall the compelling stories of Daphne Merkin’s treatments with the best that New York psychotherapy had to offer.

Now Steven Metcalf, a freelance writer in New York, has chosen to go back to each of his four therapists, the better to understand why he put them all to sleep. Link here.

Full disclosure: No, Metcalf does not say that he was putting his therapists to sleep. The phrase is mine, and, of course, the pun is intentional.

Metcalf is puzzled over the fact that all of his therapists fell asleep during his sessions, some on a fairly regular basis.

Think about it for a second. If your accountant or lawyer or physician regularly fell asleep during your consultations, you would consider it to be a bad sign. You might take it to be a sign of illness-- narcolepsy or trypanosomiasis-- of rudeness, or of a lack of interest in your case.

And you would likely not continue your relationship with said unprofessional professional. Therapy notwithstanding, your emotional well-being requires that you refuse to countenance systematic abuse.

Metcalf did not react this way. He reacted as all therapy patients have been taught to react. He tried to find the meaning. He tries to discover what he did to provoke the reaction.

Being a good patient, he blames himself.

When he asks an eminent Kleinian therapist what it might mean that each of his four therapists has dozed off in session, this Kleinian responds that he, Metcalf, is “the common denominator," thus, the culprit.

No serious social scientist would take this information as an objective fact that can be used to indict a patient.

After all, the analyst might have noted that all four of these therapists use psychoanalytic techniques, and that perhaps, the technique itself is a soporific. Perhaps, they all suspect, unconsciously, that their technique is not working and that they would rather be elsewhere doing something else. Or maybe they feel that they will be more helpful if they interpret less and sleep more.

Be that as it may, insight-based and psychoanalytically-inspired therapy has always been in the business of blaming the patient.

In his theorizing Freud was better at explaining why psychoanalysis did not work than in showing how it did.

The reason, of course, was that it didn’t work often enough for anyone to believe that a patient’s improvement had been caused by his participation in the curious ritual of the psychoanalytic session.

So, Freud posited that his patients were not getting better because they stubbornly refused to accept the truth of his interpretations. Later, he concluded that they just wanted to stay sick.

But, psychoanalysis has evolved since Freud‘s time. Today, most therapists have been trained to believe that any time they do or say anything strange, bizarre, or unethical, the patient must have provoked it.

The question no longer becomes: Why did the therapist fall asleep? It becomes: Why did the patient put his therapist to sleep?

One suspects that both new and old theories show therapists how best to avoid taking responsibility for mistakes or ethical lapses. If so, then this form of therapy is fundamentally an amoral enterprise.

If you were engaged in a systematically amoral enterprise, you might also want to be anywhere else but where it was being practiced.

To write his story, Metcalf decided to revisit all four of his therapists, the better to ask them what they now think of the fact that they fell asleep during his sessions.

The first therapist excluded himself from the survey by failing to respond to Metcalf’s messages. His high ethical standards prevent him from returning phone calls.

The others did meet with their former patient, and seem all to have bought the idea that their somnolence was a meaningful expression of something that he was doing or not doing.

One wonders how these therapists could have been building their patient’s confidence by telling him that he was so boring that he was putting them to sleep.

The art of rationalizing failure and avoiding responsibility has a rich history within the therapy world. Metcalf gives Dr. Edward Dean the credit for having taught generations of analysts how to cover up their unethical behavior.

In Metcalf’s words: “He [Dean] taught the analyst to interpret his own sleepiness not as malpractice, or even an embarrassing if inevitable bêtise, but as evidence of the patient’s ‘tenacious and insuperable resistances.’ Explicitly following Dean’s lead, successive analysts have generated a composite portrait of the sleep-inducing patient as a kind of negatively charged superhero. He can be so powerfully dissociative, 'the analyst feels depleted or half-alive, and thus disorientated and out of touch with the basis of what is most alive, or would be most alive at that time if the patient were truly there.' Typically he suffers from ‘passive-obsessional and narcissistic character disorders, [using] isolation, inactive rumination, concealment and displacement of affects to control and dull into passivity the patient himself as well as others.’”

Metcalf does have his doubts: “Are my own powers of resistance so enormous that the composite portrait of me, as an isolated, narcissistic evader, is unavoidable? Can an abandonment of minimal professional duty—to stay heedful of what a patient says, no matter how stonewalling—really be answered with an evasion, a theory, a cliché? Who are the bullshit artists here? Them or me?”

I hope that isn’t a trick question.

Metcalf maintains a healthy skepticism about these pseudo-therapeutic rationalizations. He recognizes the ways that his therapists try to explain away their failings.

And he seems to conclude that: “pschoanalysis [is] not only …a dying art but [is] ... a ball-peen to the right eye.”

But then something strange happens. Metcalf presents it as an addendum, but it is clearly meant to shed light on his question.

He chooses to reveal something of substance.

He tells us the story of how he came to be born. His mother was an unmarried teenager in a New York suburb community in 1963 who got pregnant and decided to give her baby up for adoption.

In his late 30s Metcalf met with his birth mother in upstate New York. Then she told him the story of his birth.

He continues: “After I heard it for the first time, I boarded a train in Westchester and returned to the city. And then something peculiar happened. I fell asleep—not just asleep, but into the deepest sleep of my life.”

Surely, meeting his birth mother for the first time and seeing himself reflected in her facial expressions, was a profoundly moving experience.

Given the expectation attached to such an event, it must also have been emotionally exhausting. To go from there to say that he had spend nearly two decades putting his therapists to sleep because he did not know the whole story of his birth strikes me as a bridge too far.

Could it be that he simply needed to establish some kind of a connection with this woman? Surely, his reaction does not prove the validity of his second therapist’s interpretation, namely that he harbors a repressed rage against his mother.

Perhaps he was simply seeking his birth mother, something that none of his therapists could reasonably provide. We do not know whether any of them recommended that he try to find her.

When Metcalf does find his birth mother and establish something of a relationship with her, he asks her the same question he had been asking his therapists.

He writes: “I called my biological mother and told her about my four therapists and how they had fallen asleep on me. She laughed and laughed and laughed, then said, ‘Did you ever think it means maybe you don’t need therapy?’”


Cappy said...

Mother knows best! Or maybe Metcalf is just very boring.

Stuart Schneiderman said...

Probably both are true...