Transference + sleep

First of all, Happy Birthday to Kate! Holy shit, you're 30!

There's a lot of that going around these days....

Meanwhile...I had more to say around my post yesterday, actually, but was just so damn tired. I'm looking forward to not being quite so exhausted all the time. Although, I have this feeling, I'm probably going to find ways to be just as busy next year. But with less call, and less commuting than I did this past year, so, that'll definitely help.

So, transference. We've been talking about this a lot lately at work, and will talk more about it as we spend much of our second year learning the ins and outs of psychodynamics and analysis. And transference is sort of the primary concept in analysis. Plus, I'm thinking of entering the NC Psychoanalytic Institute if I can make it fiscally feasible (see? Plenty to do next year), which means I'll be up to my id in transference.

Transference, though, is an integral part of what we do. Not that it isn't present in every patient-physician interaction, but we're the only ones who really pay attention to it and even encourage it. Truth is, it's central to most human interaction. And, apologies to Dr. Freud, but it's not that dramatic a concept - we all view our lives through the filter of our past experiences. We make judgments about people based on cues that are familiar, that we've seen before. Thus, we're conditioned to respond to a stimulus we've seen and responded to before, and when we see that stimulus in someone else, we'll of course respond in kind. At least at the automatic level; at a more conscious level, we can modulate this response. Often, for us, our own transference is a useful tool - i.e., feelings that are evoked in our interactions with patients are in response to something about them. If we can use those responses to identify what that something is, it can tell us a lot about people. Problem is, you have to know a lot about yourself, and possess a certain humility about that, to do this well.

And once you start to be able to recognize this, it becomes problematic sometimes to be able to dissect these responses from what's just a genuine response to the person in front of you. My woman's husband, who I did the couples' session with yesterday, I think he's genuinely a jackass. So it was a lot to sort through, you know? What of my dislike of him was due to my own transference, my own response to other malignant narcissists and sexual sadists I've encountered in my personal and professional life? What was my protective, maternalistic feathers being ruffled over what I knew he'd done to my patient? What was the fact that he was just an asshole in our session?

It was interesting, really. His wife, my patient, afterwards, was like, wow, I can't believe how well you handled him, how you got him to talk about things. I've kind of discovered that, in my professional dealings, I actually deal pretty well with controlling, narcissistic men. It's a power play, and if you operate on their level, they win. So instead, I tap into what they're evoking in me to give me cues about what sort of traits they might possess, and this where their weak points might be. And I think that in itself is a cue to pull back, which allows me the detachment to institute a number of techniques to gain the upper hand. In the words of everyone's (okay, my) favorite TV psychiatrist, "One of the ways to beat a psych defense is a psych offense."

Sometimes I don't like that about myself. Sometimes I feel that it's very useful. It is what it is, I guess.

And regardless, I still have to honor the fact that I left there wanting to kick him in the shins.

Oy.

My other patient, well, it's awkward. And I had much the same thought as PenguinShrink's, in her comment to the last post, but frankly, I think it may actually be a reason I should do therapy with him. He's an interesting patient, particularly from a biological perspective (he's got this old brain injury). I think he's reasonably innocuous, and I think identifying a strong woman who can set and maintain good boundaries with him is going to be a positive step towards dealing with a few of his issues. Plus, it wasn't a predatory kind of thing, I think it was more of an impulsive kind of slip, from someone who has fairly poor impulse control (see above re:old brain injury).

But don't think for a second that I'll hesitate to discharge him from my practice if he can't respect the boundaries of the therapeutic setting. And I'm definitely getting a left-hand ring before I start doing outpatient (I've been debating this for a while. This did sort of clinch it).

It's such a complex landscape, the human psyche.