by Nicholas Hack, Psy.D.

LEADING THE WAY, OR GOING ASTRAY?

A patient tells me that their wellbeing is their top priority. “It’s the most important thing. Nothing else matters.” A few minutes later they tell me something else is their top priority. “I’d say it’s the most important thing to me. Nothing else really matters.” Again, later in session I’m told another part of their life is their top priority. Again, like an echo bouncing back, “It’s the most important thing to me.”

With some people this would have felt like a refinement, an evolution in their awareness of what their values truly are. I’ve certainly gone through these moments myself, when suddenly the things that really matter stand out in technicolor against the gray backdrop of life.

In the context of this person, I experience something very different. Rather than hearing a process in play, with a single, consistent self at the center, I get the sense that I’m listening to several distinct fragments, each split off and lost from a greater wholeness. Each priority is THE top priority, and they don’t compete with one another because they don’t exist in relationship to each other.

When this fragmentation has shown up in the past, I’ve often felt an urgency to bring the parts back together. I might try to address the pain underlying the self-break-up, or the reality of the broader, whole-self situation. One way or another, I jump to lead them back to the depressive position and into the land of loss.

But recently I’ve become aware of something different. Knowing how painful it is to not be able to go back to life-before-trauma, or to unsee/unknow what you’ve been non-consensually forced to know, I start to tune into the sanctuary of the paranoid schizoid state. Yes, there are many problems that come with it, but within that world they’re safe in a way that can’t otherwise be. In that state they get to experience a relief and free-ness that they can’t otherwise experience: free from guilt, free from internal conflict, free from grief.

This leads me to wonder if – instead of serving my client by trying to guide them to the depressive position – I’m actually participating in an assaultive enactment. Regardless of whether my intention, tone, and words are gentle, if I’m ripping the patient from their amniotic sanctuary into the cold, painful, depressive world, am I truly helping them, or am I just doing something to them that’s been done before? Maybe even the very thing that led them to need this intrapsychic retreat in the first place?

As I write these words, I feel new paths open up within me. Alongside concern and urgency, I start to feel an expansiveness. Rather than feeling like I’ve lost them and trying to get them to come back to my world, I’m far more curious about what it’s like to spend time in their world. And maybe that’s what they’re really needing: not another person requiring them to change, but somebody who will companion them no matter where they go.