My patient, Karen, emailed me saying she had come to my office for our appointment and I was not there. Oh my God! I had it written down in my scheduling book, but decided it was a mistake and crossed it out. I didn’t call or email her before the session to confirm that it was cancelled. I didn’t go to my office at the time of the session to make sure I didn’t make a scheduling mistake. It was obvious to me that this was countertransference. I responded to her email saying I was very sorry for my mistake and that I would see her at the next appointment. Then I started to think about what this “mistake” meant.
I thought about what had been going on in recent sessions. She had been changing appointments frequently, so maybe I was angry at her for treating her therapy (and me) so casually. Then I thought about our last session—it had been particularly difficult. At one point in the session Karen said she thought therapy was about learning lessons.
“What kind of lessons?” I asked.
“You know, you’re the therapist, you tell me what I’m doing wrong.”
“Therapy isn’t about lessons or showing you what you’re doing wrong. It’s about understanding how you feel,” I said.
“I know it isn’t about lessons. I’m not stupid,” she responded tersely.
I knew this was going in a bad direction. How was I going to get the two of us on the same side again?
“Let’s take a time out, okay? Let’s look at what’s going on between us,” I said.
She nodded, but in a stilted way.
“You said you thought therapy was about lessons about what you do wrong,” I said. I thought I was just going back to the beginning of the interchange so we could trace the steps.
“No,” she protested, “I never said the word ‘lessons’, you used that word, not me.”
She was defending herself from what she experienced as my criticism and she also didn’t believe me.
“You sound angry,” I said.
“Not angry. I’m frustrated. You don’t get it.”
“What is it that I don’t get?” I asked.
“You want to go in a direction and you’re just focused on that,” she said.
I understood that this was her mother transference. She felt her mother had constantly criticized her and didn’t tell the truth. She had told me, in earlier sessions, that her mother had her own agenda. Discussions were never about Karen and her needs.
“You seem to feel therapy is not for you. I have my own agenda and it’s telling you what’s wrong with you.”
She was quiet for a few moments. Then she said, “It’s strange. I don’t feel therapy is for me.”
The session was over and I sat in my chair for a while after she left the office. I felt beat up. The next session was the one I missed. I decided it must have been cancelled! I acted out my unconscious wish.
When Karen arrived for the next appointment, I apologized again. She said it was okay, shrugging it off. I asked how she felt about arriving at my office for her session and finding I was not there.
“I thought I made a mistake,” she said.
“That’s curious, isn’t it, that you thought it was your mistake?”
“Well, I figured you would say I got the time confused,” she said.
“You mean, you thought I would blame you?”
“Yes, I guess I’m used to being blamed when things go wrong. My mother never admitted being wrong about anything,” she said tearfully. “I don’t think anything is for me,” she continued. “It’s always for someone else and I get blamed for everything that goes wrong. I think I’ve been living like that for a long time.”
Admitting that I made a mistake was a breakthrough in the treatment. It made Karen aware that she didn’t trust me. She expected me to blame her for my mistake as her mother would have done. The fact that I took responsibility for my mistake helped her begin to understand that she often feels criticized unjustly and when she defends herself, she expects the other person to respond like her mother.
Missing the session was also a breakthrough for me because it made me realize the depth of my reaction to her mother transference toward me. I know that her constant defensiveness and distrust of me will not end because of her new insight, but this episode was the beginning of a working alliance, and I think my ability to withstand her defensiveness will be enhanced. While I was at first mortified that I had missed a session, now I was hopeful that her insight that she was treating me as if I was her mother, would help to grow and deepen our work.
File under: The Art of Psychotherapy, Musings and Reflections
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I thought about what had been going on in recent sessions. She had been changing appointments frequently, so maybe I was angry at her for treating her therapy (and me) so casually. Then I thought about our last session—it had been particularly difficult. At one point in the session Karen said she thought therapy was about learning lessons.
“What kind of lessons?” I asked.
“You know, you’re the therapist, you tell me what I’m doing wrong.”
“Therapy isn’t about lessons or showing you what you’re doing wrong. It’s about understanding how you feel,” I said.
“I know it isn’t about lessons. I’m not stupid,” she responded tersely.
I knew this was going in a bad direction. How was I going to get the two of us on the same side again?
“Let’s take a time out, okay? Let’s look at what’s going on between us,” I said.
She nodded, but in a stilted way.
“You said you thought therapy was about lessons about what you do wrong,” I said. I thought I was just going back to the beginning of the interchange so we could trace the steps.
“No,” she protested, “I never said the word ‘lessons’, you used that word, not me.”
She was defending herself from what she experienced as my criticism and she also didn’t believe me.
“You sound angry,” I said.
“Not angry. I’m frustrated. You don’t get it.”
“What is it that I don’t get?” I asked.
“You want to go in a direction and you’re just focused on that,” she said.
I understood that this was her mother transference. She felt her mother had constantly criticized her and didn’t tell the truth. She had told me, in earlier sessions, that her mother had her own agenda. Discussions were never about Karen and her needs.
“You seem to feel therapy is not for you. I have my own agenda and it’s telling you what’s wrong with you.”
She was quiet for a few moments. Then she said, “It’s strange. I don’t feel therapy is for me.”
The session was over and I sat in my chair for a while after she left the office. I felt beat up. The next session was the one I missed. I decided it must have been cancelled! I acted out my unconscious wish.
When Karen arrived for the next appointment, I apologized again. She said it was okay, shrugging it off. I asked how she felt about arriving at my office for her session and finding I was not there.
“I thought I made a mistake,” she said.
“That’s curious, isn’t it, that you thought it was your mistake?”
“Well, I figured you would say I got the time confused,” she said.
“You mean, you thought I would blame you?”
“Yes, I guess I’m used to being blamed when things go wrong. My mother never admitted being wrong about anything,” she said tearfully. “I don’t think anything is for me,” she continued. “It’s always for someone else and I get blamed for everything that goes wrong. I think I’ve been living like that for a long time.”
Admitting that I made a mistake was a breakthrough in the treatment. It made Karen aware that she didn’t trust me. She expected me to blame her for my mistake as her mother would have done. The fact that I took responsibility for my mistake helped her begin to understand that she often feels criticized unjustly and when she defends herself, she expects the other person to respond like her mother.
Missing the session was also a breakthrough for me because it made me realize the depth of my reaction to her mother transference toward me. I know that her constant defensiveness and distrust of me will not end because of her new insight, but this episode was the beginning of a working alliance, and I think my ability to withstand her defensiveness will be enhanced. While I was at first mortified that I had missed a session, now I was hopeful that her insight that she was treating me as if I was her mother, would help to grow and deepen our work.
File under: The Art of Psychotherapy, Musings and Reflections