In the next section of Candace Orcutt’s book, Trauma in Personality Disorder, we read of Mr. H. and Mrs. M. Mr. H., she describes, presents a case with “traumatic overtones”, though the trauma isn’t obvious at first. Is it the rejection from his wife? The business failure, coupled with the partner’s nefarious financial actions? The problems with his adult children? He is depressed, Narcissistic, manifestly so (exhibitionistic?), and according to Orcutt, needful of mirroring, and not always with an accompanying interpretation. The Narcissist has an antipathy towards interpretation, she writes (p. 100), but she points out that the Masterson model bypasses this antipathy by wrapping such interventions with empathy for the patient’s vulnerability. With that seeming understanding in mind, one wonders why her transcripts appear to wander so often from the technique: instances of reassurance (p. 97: “it will get better in the end”, p. 91: “you have your kids and your pride. You’re managing”); so-called reasoning (p. 88: “Wouldn’t it be easier to stop fighting and accept the offer?”); a warning (p. 86: “Maybe it’s important to remember that reaction plays into others’ hands”); a confrontation (p. 85: “are you really defending yourself by turning this into WWIII”). The mirroring aims at maintaining idealized unity with the therapist; the confrontation a containment of acting out; the reassurance perhaps girds Mr. H. for his subsequent disclosures about an incestuous relationship with his mother. He ends therapy having broken a secret, and seems happy enough, with a new woman in his life and a better relationship with his kids.
Orcutt writes that mirroring alone may be necessary when the patient is feeling especially vulnerable. This feels very permitting somehow, as though the interpretive piece were an extra chore for both patient and therapist; both are spared the task of dealing with the question of criticism that ambiguously lies within mirroring interpretations. Mrs. M is stoical, likes to “fix” problems. She seeks to control feelings, often by dismissing them, and thinks that having feelings and acting upon them are conflated concepts. She also discovers a family secret, through the experience of an accident in which no was injured, though Mrs. M. begins to suffer symptoms of PTSD. She wants medication, and hypnosis; she doesn’t want to dwell. She resists the psychologizing of her reaction from doctors, but soon integrates the therapeutic suggestion that her symptoms derive from stress, and more importantly, she acknowledges helplessness with respect to her fears. This appears to open up memories, including an incident in her teens wherein she felt responsible for a friend’s accident. Symptoms persist, and the therapist gives homework for Mrs. M. to interview family members about recurrent dreams of a little girl being killed. The investigation unearths a horrific family secret: a tragic incident in which Mrs. M’s four year old twin sister is accidentally killed by her mother’s first husband. Mrs. M. had witnessed the scene, but was thereafter amnestic, and the mother resolved to not talk about it. This is a painful story, one that had me reflecting sympathetically upon the father of the deceased girl as much as the horror of Mrs. M. She is distraught by the discovery, and blames the therapist for not preparing her for the burdens of memory. The therapist reassures that life will be put back “into one piece”, and adds that perhaps time will bring a change. Cliches aside, attributing change to the passage of time seems incomplete, even careless.
Graeme Daniels Psychewriter 