I submitted a proposal to present at the Eastern Group Psychotherapy Society’s Annual Conference in November. The topic is on working in the Here and Now, specifically with an approach developed by Betty Joseph, a prominent Kleinian psychoanalyst.
Joseph’s significant contribution, as I presently understand it, was to pay close attention to how patients unconsciously engage in a subtle form of self-sabotage.
We all resist change, however much we long for it. The status quo has a seductive quality. It is a siren’s call lulling us to lazy nonchalance. It offers a constant stream of rationales, distractions and important-seeming excuses to avoid the discomfort of the new.
A person musters the courage to reach out for help. They overcome the delusion that they can handle everything on their own and make a call. They begin working with a psychotherapist. Perhaps the immediate results are dramatic. They no longer feel as alone as they did. They are more grounded, relieved. At some point however something changes. Now they feel stuck. They’re talking about the same things in therapy and not much is happening. Perhaps their therapist has ran out of gas. Maybe it wasn’t as good a fit as they thought at first. They wonder if perhaps their issues are resolved…or if they’re incurable.
Betty Joseph would suggest we look for how the patient is preserving their psychic equilibrium and actively, if unconsciously, preventing the therapy from deepening.
In all relationships and interactions, you may notice from time to time an unspoken pull to respond in a certain way, independent of what you’re actually thinking or feeling.
How are you?
Does this make me look fat?
Can you believe  just happened?!
To respond other than expected is breaking routine and can be provocative. Depending on the circumstance, it can be off-putting and unsettling. Who is this person and why aren’t they just going along with things? Don’t they know social mores? What do they want from me? It is usually easier and more comfortable for everyone if we fulfill the role that is being asked of us. Who wants to be a weirdo? Why make things awkward?
But if we consult our feelings, we discover that there is a sometimes a price to pay for this compliance. We may not want to play the role and feel invalidated by the whole setup. If I feel like I have to give you a response that you’re looking for, what am I getting out of the interaction? How will you ever see me? How will I be known by you?
In therapy the pressure to comply can feel even greater. After all, you’re coming to me for help. You’re paying for me to understand your needs, not to have to take care of mine. The temptation to create an established pattern of communication is strong. You talk about what’s on your mind and I compassionately listen, from time to time offering wise words or some encouragement. Predictable.
Betty Joseph would invite us as therapists to pay close attention to those moments where we feel invalidated, impotent, ineffective. Hidden in those exchanges, in the imagery expressed, the tone of voice, the mannerisms and the feelings induced in us, is the therapeutic gold.
As we realize the ways that patients stimulate us to respond in familiar ways, we can bring this understanding into the room, explore it and create a space for something new.
The same applies for group work. Each member has their own set of roles that they unconsciously want the other members and the leader to play. We can get glimpses of these roles by studying the feelings and inclinations prompted in us. Are we habitually pulled to reassure one member rather than inquire? Do we rush to save instead of studying? How is each member using us as the leader to maintain their own psychic homeostasis?