1st November 2021.

He - "How are you"?

Me - "I'm fine..."

And I would say " Fine! Hey how are you"? 

But I don't. 

I've been told that I'm tangential, and if I talk it will be labyrinthine; long, coiling, discursive. 

Tangential. 

His silence, is wide open waiting. 

Even though I do this silence thing myself too, I feel obliged to fill it.

I go full tangential - I'm talking about episodic and autobiographical memory, and the work of Tulvig and I know that anything like this is considered cold, and CBT, and he will see it as tangential to the relational work of therapy. 

But I have assignments to write, and I'm chasing Evan George's statement that 'our' work is to help people create future memories. I love that idea, future memories! That we step through past, future, present - to find the better in the past, to place instances of good memories into a functional sequence, coherent and believable and possible. Using memory is such rich work! This is fundamental to how we construct 'I' 'Me', 'Us, relationship, belief and meaning. 

He doesn't join in. 

I change tack.

I'm talking about seeing the film version of Frank Herbert's Dune.

He - "So who was the character that you were likened to by your teacher"?

Me - "Jessica..."

He - "And who is she..."

Now, I'd got the impression from his initial response that he had read the book? In which case, how would you not know who Jessica is! I'm assuming that this is some kind of Kohut tomfoolery and head into comedy mode - again - as I say that I hoped my son would be the Kwisatz Haderach! 

He doesn't join in.

We join together on Marx, via the phenomenon of how people suffer exploitation via mythologies that mediate and control who has power. And then he brings it back to memory, and we are talking about how stories fill in the gaps, often creating what seems to be a cover story. And the moral dilemma when a person's cover story doesn't correspond with anything the therapist considers ethical. 

My answer is to work with the story - always! 

But I'm curious what his version will be. 

So I ask.

He - "The difficulty comes if you recognise that the framework in which somebody puts their experience is in itself problematic"

Me - "Could you say some more about that please, could you give me an example of a problematic framework"?

He - "Well if a client's way of life involves visiting certain websites and identifying scapegoats, and they are going to tell you that that is really helpful because now they know who to blame - then what do you do therapeutically?"

I'd just ask them what difference it makes for them to know who is to blame, and how it helps them, and then ask how else they can get those moments in more positive ways. But I'm only going to be talking about this if they say that there is really is a problem here...otherwise, I would be making a value judgement about their life. 

I don't say that.

Me - "Thank you for clarifying. Yes...what do you do therapeutically?"

He - "In my experience it doesn't come up that often, but it does come up. Then it is a dilemma when they are absolutely hell-bent on convincing you. And they don't think that the therapeutic space will work unless you are convinced - then we are into very tricky territory."

Me - "There are two things here. Their explanation of the cause of their discomfort, which you can hear in their diagnosis and their cure for the problem. And then secondly their need for someone else to confirm it. That for me is the curious part."

He - "It is what Heinz Kohut would call a twinship transference need, in other words the client needs to think that the therapist is a person like me. A person who 'gets' me because he or she is like me. Now some people don't have that belief and some people do. And if you do then if I know that its all the Xs fault, then I know its all the Xs fault as well. The reason Kohut called it a transference need is because it is about developmental deficits. So somebody as a child felt as if no one understands me, no one gets me, no one knows what it is like to be me, and nobody really made the effort to have the child feel as if they belonged, then that's going to become a chronological need for the person. And a person like that is likely to think that their therapeutic needs are going to be met by having a therapist on the same side as them - which of course we want to be anyway - but that will mean very particular things for that sort of person. 'I know what's wrong with the world and you do as well don't you - it's all the Xs fault isn't it' and then you are in very, very difficult territory".

Me - "Yes, it is very difficult...what do you do?"

Oh! I'm doing twinship...

I don't say that!

Instead we both dissolve into laughter!

He - "Well I mean there is a book in this isn't there! A very tortured book I think that ends with - well, here's a few good ideas in here but there's no good answer to it! - I mean when somebody wants to tell you that they know who is secretly running the world and they want you to agree, well it's a matter of integrity isn't it"...

Me - "Ultimately though...it is a person's explanation for what is happening to them"

He - "But I think that there is something very important emotionally going on, which is 'I feel isolated in the world and I don't want to feel isolated. I'm one of the very few people who know the secrets of how the world really works, and most people don't know. And I don't want to feel isolated. So agree with me...' I think that is what is really going on....it's a symbolised re-enactment of their childhood experience. 'I am in this family, and people are against me, and no one even notices me the way I want to be noticed'. Becomes, 'I am in the world and the world is malevolent and I'm not even noticed in the way I want to be noticed' it just transfers across, so they look for the therapist to be an ally - so that they are noticed by somebody who knows X is 'controlling everything' " 

Or do they simply feel that now they know the true state of affairs it is abhorrent for them to watch 'innocent' others suffer?

Me - "But in terms of interaction - I'm assuming from what you have said it would mean that you couldn't work with them"?

He - "I have worked with clients like that. It's really hard going....The work, as far as I'm concerned is exactly as I understood that you were saying before therapeutically. That is, helping the client come to the understanding that how they are symbolizing their experience is a core experience, and how that is being re-enacted in the world. I mean these are beliefs, of course. Which are reinforced by the people they choose to associate with. And you are coming in and challenging that potentially, by saying 'Well I don't think it is X' or actually you don't need to say that, just not agree with them - if that's what they are looking for. And in my experience it is possible to go as far as getting someone to recognise that was my core experience, and what I'm experiencing in the world now is replicating that"

Unless of course their perception of reality was correct and your assumptions about their assumptions were incorrect? The only question that matters is, do they intend to do something that will harm others as a consequence.

No, I don't say that.

Me - "So it would be a focus on emotional tone, texture."

He - "Absolutely, you can do that much. Taking the next step to say ' and therefore there is a question mark over whether all this conspiracy stuff is actually true'...that's the hard bit. Because that's getting them to recognise that they are replicating, but going the next step to say 'does it feel true because I'm replicating  something that was true, or is the replicating replicating something that was real, but now isn't real'? - that's the hard work"

Unfortunately new and fearful realities in the present that are too different to anything a person has previously experienced can only be understood in terms of what has come before - this is something Aby Warburg called cause projection -  until a new understanding is created the present inevitably feels like replication!

No, I certainly did not say any of that!