Bless you!

Life is funny. Just when I was losing faith in my patients' ability to identify and acknowledge me as a real person, as opposed to a nebulous maternal object placed in front of them in a listening capacity, something happened to restore my faith.

I was in session with my first patient of the morning. This is a patient that, sadly, I have had to learn to endure, mostly because he smells. He also happens to be very narcissistic, which means that a previous therapist's attempt to bring up the body odor caused a major disruption in the treatment, ending with said patient dropping out, and wanting a new therapist.

Enter: me.

I have never said anything to him directly, but I did come up with a pretty smart technique to fight the smell: I spray industrial quantities of Lysol before he enters. As a side-note, I hate the smell of Lysol, but it is pervasive enough to numb my sense of smell for about half a session. The other half I endure. I have tried holding my breath for the duration but 45 minutes really is too long, hence the Lysol.

After four years as his therapist, I have learned that this patient really wants very little from me. Mostly, he needs to come and talk, uninterruptedly, for the entire duration of his session. Often he starts talking when we're still in the waiting room, and continues talking on his way out the door. This is the kind of patient that understands a session is over only when I get up from my chair, walk to the door, open the door, and start walking out. On him.

Anyway.

What he does is he talks about everything that has or has not happened to him in a given week. Any interruptions on my part, I have learned, bring on extreme anxiety and at times confusion. The general idea is that he needs to come and dump his thoughts onto me, as his maternal object, and this will make him feel less adrift. However when I say something, I stop being an object and become a person. He does not like that. It annoys and confuses him. Imagine you are talking to the picture of a loved one. Maybe someone who has passed away. And suddenly, the picture talks back! You can understand how it might be disorienting. So I have learned to be quiet, and listen, and try not to space out too much (that's true, therapists do space out! but that's for another post).

There is an old joke in the field about the 'cardboard cutout' therapist. That is the kind of therapist that this patient requires, someone who is there, but does not have dymension, or a mouth from which to speak. A listener made of heavy duty paper. This is one of the most difficult things for me to endure as a therapist. Forget the smells. Forget the heart-breaking topics. Forget the rage, the depression, the traumas. The cardboard thing depersonalizes me and fills me with un-therapeutic resentment. It forces me to juggle my countertransference so I can be what the patient needs me to be. Nothing new, only hard.

This is until this morning, when fumes of recently-sprayed Lysol tickled my nose and, while the patient talked, I sneezed. The sneeze was followed by a short silence, at the end of which there was a curt and annoyed "Bless you!".

I felt momentaily confused and disoriented. It was great.