How Should Practitioners Deal with People Who Are Insufficient in Specific Life Functions, Which in Themselves Will Create Further Emotional Problems? In the long run, we hope, as mentioned in the section on “Dependence, Independence, and Initiative” in Chapter 4, that each of us will stand on his or her own two feet. But, at the different stages of a therapeutic relationship, some degree of leaning and dependency is necessary, especially during transitions. The trick is to let people lean so that they can grow stronger (not weaker). Still, they must lean and we must deal with our problem, if we have one, with dependency. Dependency has poor press in our “pull yourself up by the bootstraps” culture. We are in constant fear of nurture as undermining self-reliance in our children and our patients and speak more easily of “tough love” than love. Nevertheless, this repugnance in our society reflected in the psychotherapeutic world is entirely illogical. Acting for the patient, when it is clear to me that they truly cannot act for themselves, has often had dramatic effects in terms of teaching by example, on the rare occasions people use my intervention to escape facing the issue. I am not fearful of a dependency that I see as a necessity in the course of individuation, a dependency that failed to lead to growth and maturity during the appropriate stage of development and must be revisited within a therapeutic relationship. One of the ways that practitioners feel uncomfortable with the dependency of their patients is the latter’s inability to take the initiative for themselves. Sometimes this involves the simplest things, such as the patient calling the telephone company when they move house. Sometimes it involves more complicated procedures such as applications for a job. I have assumed these ego functions frequently, in the service of our having the time to build the terrain, the missing pieces, that render the patient ultimately able to function on their own. The following is an elaboration of the example in the section on “Dependence, Independence, and Initiative” in Chapter 4 of the proactive role that I have played with people whose egos (“terrain”) are not yet stable or sufficient to perform certain functions that interfere with their goals in life and our efforts to achieve them. Example The young man in question, a 39-year-old carpenter, had been abusing substances since he was 14 years old, beginning with alcohol and excessive use of marihuana, cocaine “if nothing else is available,” and intravenous heroin for the past 9 years. Recently he felt the need for more, especially heroin, “to feel good.” He was beginning to realize that he was almost 40 years old and was unproductive, unmotivated, without direction or aspiration, inadequate at work and in relationships, isolated, and remorseful of a wasted life with no energy. He stated that “I am a creative person with no outlet, guilty due to not working, sleeping all day to avoid awareness and staying awake all night when I am not expected to do anything (work) except watch TV.” The patient has grandiose ideas of what he sees himself doing for a just society, recognizing that he is not accomplishing much in real life. He is a hero in many fantasies. He confides that he inflates himself in how he walks and talks to give the appearance of strength, while inwardly feeling weak and not able to stand up for his ideals. He is at the same time the interminably and fanatically arch critique of a society in which he feels a victim. He describes high ideals for society, especially for peace, and yet he does not wish to be involved in life unless he can do so without straining himself. In this context, saving the environment was one of his principle preoccupations. He disdains ordinary approaches to solving his problems such as AA, and even my work, as all on a low spiritual level. He seeks a higher spiritual guidance, apparently in the “New Age” fashion it seems, rather than through the pain and hard work involved in the daily struggle of life. His goal is to feel strong enough to work and live out his ideals. He was described by his mother, who was traumatized early and throughout the pregnancy, as vulnerable from birth and unable to talk until he was 3 years old, requiring protection throughout his childhood. Diagnostically there was severe liver qi deficiency and retained pathogen, severe kidney qi deficiency and separation of yin and yang of the heart. It was clear from the beginning that so many years of the cold substances, marihuana and heroin, that his ability to put his thoughts into action were severely impaired. Where would we begin? Based on past experience in similar circumstances, I realized that he did not have the ability to move out alone from his current morass and enjoy whatever help was available until he could break the vicious cycle described above. Work was available to him as a carpenter if he could get to it. I proposed that since he “did not have a liver” to provide planning, decisions, and a direction in order to break the impasse of night-day reversal that I would “loan” him my liver. We agreed that I would call him every morning at 7: 00 a.m, plan the work for the day, and at first check with him in the evening. This began and lasted for several months, taking a total of about 2 minutes of my time per day. He began to work productively, reversed his night–day schedule, and gradually reduced his use of drugs. He left working with me after a few more months because I was not spiritually advanced enough for him, and took excursions literally into the wilderness. Nevertheless, with no other therapy I am aware of, he has rarely taken drugs and has continued to work. Nothing has changed about his view of the world or of his ability to intervene on its behalf, while still loudly proclaiming its leaders to be scoundrels. We see each other occasionally on the street and hug.
Answer by Dr. Hammer
Introduction
Related posts:
The Practitioner’s Role
Can Practitioners Recognize and Deal with a Situation that is Beyond Their Knowledge or Capacity to Handle and Requires Assistance and Referral to Other Health Care Providers Including Hospitalization?
Should Practitioners Cope with “Difficult” Patients?
Can Practitioners Extract the Essential or Correct from the Less Important or Incorrect?
Should Practitioners Talk to Patients about Psychological Problems and Processes in the Context of CM Thinking and Treatment?
Can Practitioners Handle Inappropriate Sexual Approaches by Patients?
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