Real World Clinical Blog: It's Not You, It's Me
by Dr. Danna Bodenheimer, LCSW, author of Real World Clinical Social Work: Find Your Voice and Find Your Way
I had a client come in the other day saying that she is not sure about how she is feeling about our work together. She said that sometimes when she leaves session, she starts to feel unclear about what is coming from her mind and what is coming from my mind. She went on to say that she feels like our “energy gets all mixed together.” She is articulating a powerful reality of how this all can feel by speaking to the pain of trying to delineate between a pair of subjectivities - her subjectivity versus mine, my subjectivity versus hers.
We have long been taught that the clinical relationship is based on the client as the psychological centerpiece. While this notion sustains its importance, it was falsely supported by the fantasy of a a social worker’s clinical objectivity. It was believed that the social worker could remain neutral enough to contain, reflect, and support the clients’ arrival at their own truths, struggles, and insights. As we have come to realize, this neutrality is a false construct that is essentially impossible to achieve. Further, the idea of a dyad constructed of an object and a subject has been replaced by the understanding of a mutually built and co-created inter-subjectivity. When my client said that she can’t tell our minds apart, perhaps she was on to something.
I had another client who felt wounded by a recent report given to her by a psychologist based on weeks of psychological testing - everything from Rorschach to IQ tests. It offered up some negative conclusions about her character structure that led her to rethink her idea about who she is. I offered up the possibility that the tester/psychologist was a subjective actor who wrote the report. Although the tests are presumably valid and reliable, the tester always confounds the findings by bringing his own subjectivity to the interpretation of the findings. This brought tremendous relief to her as she realized, of course, the natural fallacy that accompanies any practitioner’s humanity.
The whole issue of subject and subject versus subject and object becomes toxic in two predictable ways. The first is when a subject/social worker claims a level of positivistic objectivity that can leave a client feeling crazy and alone. The other is when a subject/social worker claims the fact of their subjectivity, but insists that there is some level of righteousness to their perception (because of experience or training) that leaves the client feeling like the subjugated student to the clinician’s supposed expertise and teachings.
If we can claim the fact and struggle of our intersubjectivity, the coming together of two minds, the important work of sorting out who is who and what is what can begin to happen.
Sandor Ferenczi (1919), Jessica Benjamin (2008), and Thomas Ogden (2005) have all worked to name the power of intersubjective work, mutuality, mutual transformation, and the co-creation of psychic spaces. Ferenczi called it “mutual analysis,” Benjamin calls it “thirdness,” and Ogden calls it “the analytic third.” What all three were trying to say is that any clinical dyad paves the way toward a mutual psychological experience, a merging of each player’s past and present coupled with their historic tendencies toward transference and countertransference.
My client who leaves confused said that she sometimes feels like she goes too far in her anger toward her husband when we are sitting together. She feels almost inauthentic in her presentation of their dynamic, making their marriage sound much darker than it actually is. And accordingly, when I hear her talk, I start to feel this weird wish for her to consider leaving him. I call the wish “weird” because it feels sort of displaced and misattuned. I think about my past, long-standing wish for my parents to get divorced, although they never did, and how this must be playing out in our work.
Perhaps my unconscious wish for my childhood to have been different is interacting with her unconscious wish to please - a relic from her childhood patterns.
There are so many ways this inferno could blow if I were unwilling to take responsibility for my part in it. At the same time, if I were to take sole responsibility for my role in it, she would be left off the hook with nothing of her own disavowed process to make sense of. So, I take a risk to bring myself into the room, in an effort to remove myself from the room enough for her to reconnect with her own inner world. It sounds tricky. And it is. I say to her, “I do think that sometimes we go to extreme places about him. I think that part of this is my stuff. At the same time, I wonder if any of it feels like it authentically belongs to you? What I do know is that, though it might not seem like it, I never think of your husband in one dimension. I realize that we are just sifting through pieces of a complex person.”
In my response, I am taking some responsibility. I am reassuring her that my perception is more complex than I might be portraying. And, I am inviting her in subjectivity. The truth is that there is no real way to ever precisely separate her mind from my mind. There is no clear path to exactly compartmentalize who thinks and feels what. But through transparency, we can start to clear things up.
Also, by recognizing what happens when the two of us are together, we give voice to the “thirdness” that arises in our work. Giving voice to this thirdness allows the therapist to properly exit stage left, recreating the authentic possibility of the client psyche as ultimate centerpiece.
References
Benjamin, J. (2004). Beyond doer and done to: An intersubjective view of thirdness. Psychoanalytic Quarterly, Vol. 73, pp. 5-46.
Ferenczi, S. (1919). On the technique of psycho-analysis. In: Further contributions to the theory and technique of psycho-analysis. Hogarth Press, 1950.
Ogden, T. (1994). The analytic third: Working with intersubjective clinical facts. International Journal of Psycho-Analysis, 75, 3-20.
Dr. Danna R. Bodenheimer, LCSW, is in private practice at Walnut Psychotherapy Center in Philadelphia, PA, and teaches at Bryn Mawr College Graduate School of Social Work and Social Research. She provides more of her clinical perspective and tips for developing clinicians in her book, Real World Clinical Social Work: Find Your Voice and Find Your Way.