Completion of Therapy
The Water said to
theDirty one, “Come
here.”The dirty one
said, “I am too ashamed.”The Water replied.
How will yourshame be washed
away without me?”
How can we help our patients/clients be done with therapy? My patient arrives at my door for the first session holding tightly to her defenses, especially shame[i](Maier 2017). She leaves the last time with those same defenses held within her ability to imagine her future, while laughing at her painful self-talk. Now, she can see that her emotional burdens are resources for others who suffer as she used to.
We, patient and therapist, need to see our shared world from our innermost core with all its terror and glory. We must trust the patient’s ability to get her own development back on track. Early in therapy her coping habits about being thwarted in her attachment needs, and her resulting feelings of shame, need to come up against our attention. This is about feeling safe while exploring her imagined infant feelings. We pause and listen then. We pause to allow the patient to evolve spontaneously, while she presents new areas needing investigation in the dyad. These new areas are fertile for sublimated aspirations.
The end of therapy is about sublimation. Sublimation is a technique used by chemists to purify compounds. The solid volatilizes, leaving the non-volatile residue of impurities behind. It is a similar process in therapy. When habits related to feeling ashamed can be recognized, they can be volatilized and left behind. Then she can clarify feelings of disgust as the final product of effective therapy. In healthy development she will use information from visceral senses such as disgust, fear and rage [ii](Maier 2017) in socially appropriate ways to harmonize with her values to fuel realistic dreams and phantasies. This allows contemplation of an image of self from which emerges novel thoughts, feelings and behaviors.
If my patient can embrace her disgust, she has a better chance to modulate the tendencies to push people away or smother her friends with dependence. Once she consistently transmutes the stance of her self-judgments, she can begin to recognize the healthy and unhealthy processes of disgust she has towards people, places and things. The power of her healthy disgust is then able to fuel intuition when she needs to stand up for herself.
The areas of known inadequacy travel through the course of therapy emerging as uncertainty. From uncertainty, her developmental second chance allows her to risk pushing the boundaries of her thoughts, feelings and behaviors. As she acts ever more strongly from her values, she dreams of ways to be useful and notices when she is hiding in crestfallen self-doubt. She, like a healthy developing child, learns the right amount of passion to express by acting out and letting mistakes become guides to appropriate assertiveness. By trusting her uncertainty she can risk acting strongly on her beliefs.
The dark thought, the shame, the malice, meet them at the door laughing, and invite them in. Rumi
[i] Ibid. Sublimation might be thought of as an ability to imagine. The way the patient and the therapist imagine the future will influence their self-images in the present. A major portion of the patient’s deeply felt self-images were formed before they were six years-old. All parent/caregivers have areas where they do not have the abilities necessary to provide “good enough” support for their babies. When the child expresses an instinctive need that is not satisfied over and over again, they develop a strategy of internal attempts to soothe herself Thus creating a deficit in implicitly generating and integrating of what Stern (2004) calls ‘a present moment,’ the basic fabric of lived experience created in continuous small packages of interactions with others.
[ii] Maier, B., 2017. “The Compulsion to Predict Shame.” As a two-year-old sees a caregiver attempting to interrupt a very important game, a sudden expression of murderous rage appears. Maybe the most difficult urge to sublimate is the desire to kill the “other”, which shows itself in a more pronounced way in the ‘terrible twos’ and adolescence.