Thursday, February 24, 2011

Elephants, Rooms, and Icebergs: Conversations about the Invisible World.

If there is one fight to be had in therapy, it’s the fight to connect the brain (the conscious self) to the mind (the sub and un-conscious self). We all have a psyche, and that psyche lives large in the domain of the subconscious, invisible, and almost ineffable world. The visible world, the world of our conscious desires, intentions, and feelings is merely the tip of the iceberg. Vast swaths of the self exist just outside of the visible spectrum… and a good therapist is someone that’s equipped to work in the darkness of the submerged parts of the self. By definition we are translators of that invisible world.

There are no direct entry ports into the psyche except  looking at the relationship with the therapist (the infamous transference) and the resistance to the therapy. The most obvious pathways in appear underneath the conversation, and somehow are communicated non-verbally (Stolorow calls this phenomena UNAC or unconscious non-verbal affective communication). There’s always this struggle in therapy, it presents uniquely with each patient, it erupts in tangible ways that appear to have nothing to do with the deeper meaning, and these things can only be commented on and made conscious if the therapist is connected to his own internal dialogue, can hold the framework as a kind of seismographic rendering of subconscious process, and can muscle through and into the relationship. It’s always in the therapist's knowing before its in the patient's understanding. It takes enormous trust and confidence in the process (and an ethical therapist to not exploit your time and money). It's never clean or effortless and usually evokes anxiety in the therapist (don't worry, we can handle it. It's supposed to go this way).

 Yes, there is this notion of the therapy as a place to seek refuge, to relive the week’s sturm und  drang, and a place to work through ideas and complaint. There is also this living thing there in the room waiting to reveal. It always reveals, and more often than not the patient rushes to check out right as it shows its face. The brain wants to avoid the mind, its too vulnerable, too rooted in early desires and longings, its too foreign, and too big. Most of the time the therapy is about holding the patient in place until the subconscious and unconscious process peaks through in the therapeutic relationship. It’s at that point in the room that the real fix can occur, within the relationship to the therapist… when so much more than what was previously visible and knowable is on the line.

The best part of the therapy exists in the moments that you want to quit, feel locked in, feel trapped, or want to shut it down. There’s so much more going on than meets the eye. I have to convince the patient to stay a little longer to see what happens… and every time they do… something comes. As any old school analyst will tell you it’s all about interpreting resistance.