by Luba Palter, MFT

Recently I attended a class at The Psychotherapy Institute discussing the work of Dr. Thomas Ogden. Ontological Psychoanalysis or What Do You Want To Be When You Grow Up? (2019), describes differences between epistemological psychoanalysis (knowing and understanding) and ontological psychoanalysis (being and becoming fully alive). Ogden stresses that the work is neither either/or and that the analyst engages in a kind of shifting back and forth between the two in a nuanced combination. The job of the analyst is to welcome his own being alive in the room to help facilitate the growth of his patient. What this welcoming could look like is, of course, a complicated story…

This talk reminded me of my early work at a methadone clinic. As a baby therapist, I was working with individuals with life-long addictions to opiates. With their daily shot of methadone, patients were mandated to receive counseling to address their chemical dependency issues. Many signed up for this treatment, mostly, because scoring heroin was too costly of a habit.

My patient, I will call him X, was adamant that there was nothing I could tell him from my textbook that he already did not know. He resented that his therapist was alive fewer years on earth than the years he was addicted to heroin. He spent many sessions berating me, any help I could provide him, and the point of counseling. When his anger did not scare me off, he amped up the stakes by threatening to blow up the building. At that point, I felt terrified, desperate, and unprepared. Short of filing a Tarasoff report, I did not know what to do. What came out of my mouth was pure instinct. I told him to stop talking and spewing his anger. I also informed him I would stop talking since neither of us had anything productive to say. When he followed my instructions, I was shocked. With my adrenaline pumping, we sat together quietly for the rest of the session. I went into group supervision and sheepishly revealed my recent interaction and intervention. Without batting an eye, my kind supervisor stated, “Desperate times call for desperate measures.”

Shortly after that, X brought in biohazard stickers and decorated his chair. I wondered what was going on, and he handed me an evaluation from a psychologist that years ago diagnosed him with everything from A to Z in the DSM. He was angry, ashamed, scared, and confused. Is this how I would see him, too? Is this who he was? Was he really the monster that this report described? As we explored his feelings, I understood about the danger and the power that the role of a therapist had become wedged in his mind. I needed to be Luba, a real person, who wanted to know who he was, not some “book-smart therapist” discussing his ambivalence toward sobriety. So perhaps, my spur-of-the-moment instruction for a mutual time-out demonstrated my realness and helplessness that he needed to witness to begin the work.