::   8 O'CLOCK TRAIN   ::

In Treatment : Week 1 : Gina : talking about April

In her first session April tells Paul that he alone knows she’s been diagnosed with lymphoma and she also tells him in various ways that no one can help her, that no one, so far, has been competent to meet her. Within minutes April establishes an impossible condition for Paul. Paul listens well and lets her know how well he’s listened. Then he abandons his analytic stance and does his best to help — she must get treatment for cancer. Ok then – he’s made a good mistake.

When he tells Gina, she makes a more serious mistake. She interprets his action with April in terms of his necessity and failure to save his mother. Gina may be right but she, like Paul, forgets how to think psychologically about April and Paul. My guess is that it would be more to the point for Gina and Paul to wonder why April responds to her cancer diagnosis by asserting her complete independence in the face of an overwhelming need for the help of others (from a therapist, an oncologist, and friends for starters). She positions Paul so that he feels an urgency to act while knowing that he will fail. The session ends, April doesn’t reschedule, and Paul carries the impossible conflict April has shared with him. The critical conflict here is not Paul’s psychological history but April’s: why does she respond to this life-threatening crisis in this way? Has she been subjected to such impossible conflicts by a parent (”you must help – you are incompetent and will fail if you act – if you do not act, you will fail — … help me!”)? Was and is she dependent on an incompetent parent who crushingly failed and still fails her? Has she made a promise to herself never to depend on anyone?

You get the picture. Difficult as April is, her conflict, pain, and intelligence deserve our interest and respect. She deserves Paul’s best questions and confidence to sit still and reflect.

I may not have asked the right questions or asked them well, but I still think Gina and Paul have failed to see April — though Paul to his credit listened to April extraordinarily well and clearly told her what he heard so that she would know.

Tags:   countertransference · HBO · Psychotherapy · supervision No Comments