Beyond the Clinical Moment
Searching for Realness and Reciprocity In a Long-Term Analytic Relationship
By Malcolm Owen Slavin, Ph.D.
Discussants: Hazel Ipp, Ph.D. and Annette Richard, M.Ps.
Beyond the Clinical Moment
Searching for Realness and Reciprocity
In a Long-Term Analytic Relationship
Malcolm Owen Slavin, Ph.D.
This is the story of the early years of my therapeutic work with my patient, Adam - a young man who, as I came to see it, probed actively in order to assess my capacity for what I would call realness, reciprocity, presence. The meaning of my empathy seems to depend, in good part, on how Adam sees and reads my inner experience of myself and of him; as well as on how I experience being seen, known, by him. How, in the process of facilitating inner change for him, we both engage around the same basic set of universal, human, existential issues.
This narrative is based on my notes, my memory, and the shape that the past takes in light of reflection in the present. Adam has read and fully approves of this version of our story. As well as my telling it to all of you.
Although our relationship is unique, I am aiming to show something a bit wider about what beginning a treatment like this one feels like and means to me. I hope it provides an opportunity for my discussants to read me, Adam, our relationship, and my work from their own perspectives. In discussion, I assume we will touch upon how my way of rendering this particular set of clinical moments - this evolving relationship - relates to classical theory, self psychology, intersubjective systems, and contemporary relational theory.
A Tale of Mutual Vulnerability: Discussion of Malcolm Slavin's Case:
Beyond Clinical Moments
Hazel Ipp, Ph.D.
In discussing Mal Slavin's remarkable long term work with Adam, I focus on the shifting experience of each member of this dyad as they struggle to find purchase together, as they find, lose and re-find their way forward in the nonlinear emergent process that constitutes deep analytic work. We witness how both Mal and Adam grow a little more, risk a little more and paradoxically, find greater safety in their better tolerance of mutual risk and vulnerability.
I posit this clinical story as a story of mutual vulnerability and its inevitable importance for any profound analytic process. It is emergent on the analyst's increasing mindfulness of those moments that trigger his or her own angst and vulnerability and how these may be playing out in intersubjective space.
To meet Adam's escalating demand for "realness" and genuine emotional engagement, Mal is forced to delve into his own affective experience. This is painfully challenging as he begins to emerge from his unconscious identification with Adam himself, to a recognition and acknowledgement of his own despair and his unwitting wish to sidestep it through his persistent refuge to transference interpretations.
Mal's shift to being "in it" with Adam, allowing himself to touch and be touched without, what Ehrenberg refers to as, "psychic rubber gloves" , where he could struggle with his own painful feelings, and find his way to not only survive the feelings but to remain committed and creative was paramount to this case moving forward. In my mind, this marked the beginning of true reciprocity and a deepening of process where mutual vulnerability could be better borne and made use of because they were now both "in it" and engaged in their essential humanness together.
On the road to Damascus: discussion of Malcolm O. Slavin's clinical presentation
Annette Richard, M.Ps.
Mal's narrative of the first two years of his analytic journey with his patient Adam is punctuated by a series of now moments (Stern, 2004). It inspired me the metaphor of the story of Saul on the road to Damascus (Acts 9:1-19, NIV) who was struck down from his horse by a blinding light as he heard the voice of Jesus whom he was persecuting. Saul was blinded and led into Damascus until a disciple restored his sight and let him be filled with the Holy Spirit. The many narrated now moments between patient and therapist are seen as "tipping points" when each in turn, Adam and Mal, are struck off their "high horse" in search of moments of meeting, or more realness and reciprocity.
Mal's narrative is seen as movingly illustrating a systems view of the therapeutic process, that is the reciprocity of mutual influence, however asymmetrical in the shared responsibilities (Aron, 1996), both in the analytic encounter and in the change thus produced. Initially, Mal's resilience and attuned responsiveness to Adam's developmental strivings behind his bravado and aggressive probing seem to be the mutative events in their struggle for emancipation (Brandchaft et al., 2010) from the despairing confines of over-accommodation in the patient's life. Eventually, the table turns and it's Adam who pushes Mal off the "high horse" of his interpretations, probing more and more deeply the paradoxical realness/unrealness of the attachment bond between them. Here, and many other times further down the road, Mal surrenders (Ghent, 1990) to what he calls Adam's "adaptive probing" of his otherness hidden behind his efforts to respond empathically to his patient by "off the shelf" explanations from the patient's narrative of his past.
I show that Adam was able to find his own way out of his self-unforgivingness, acquiring moral agency in his life because Mal acknowledged, time and again, his own situatedness with Adam. Therein lies the moral responsibility of the therapist who cannot choose agentically, from a position of superior knowledge or understanding, to illuminate and respond to the patient's unconscious struggles to be recognized. He finds himself in them, in a developmental enactment (Orange, 2012) and has the moral responsibility to recognize himself in it, thereby putting himself in the position to recognize his patient.
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