I'd heard quite a lot about this guy. That he was well worth a read. One of my friends mailed me his book 'Talking With Patients' and I've just finished it now. I posted an exerpt in one of the other threads. This one really spoke to me too, so I'll post it here for others.

HOPELESSNESS

The hardest challenge for any analyst is treating hopelessness. To stay connected with a patient's hopelessness means to feel our own hopelesness. Therapists fear that understanding hopelessness will encourage suicide, but patients do not commit suicide because they feel hopeless; they commit suicide because they feel hopeless and alone. As long as patients feel understood in their hopelessness and connected with another person, they will stay alive...

THE "NO-WIN" EXPERIENCE

Treatment is a delicate balance. When patients experience us as understanding, they reveal more painful experiences, and anticipate the perfect understanding they failed to receive in infancy. No therapist can understand perfectly, and disapointments are inevidable. Patients often experience these disapointments as disruptions and may feel hurt or frightened, or sometimes injured and betrayed, and present therapists with a dilemma. If they feel guilty and try harder to be more understanding, the patient may experience a seduction, a promise that the longings for perfect understanding will be fulfilled. Yet if the therapist does not try harder, the patient may feel abandoned and rejected, and believe that the therapist no longer cares.

Sometimes no matter which tack we take, our patients will despair and feel hopeless, and will anticipate that their complaints will drive us away or move us to criticise them. If we feel guilty and try harder, they feel anxious and worry that they have hurt us. If we stay calm, they feel abandoned and complain that we do not care. Inadvertently, we end up reliving with them an early traumatic situation of injury or rejection.

OPPORTUNITY

These painful experiences of disruption in treatment are not brought about intentionally, but when they occur, they provide opportunities for new developmental experiences. One opportunity is to have an experience of being taken seriously. Our attempts to understand, from the patient's point of view, how we have hurt them, and our taking their complaints seriously without being defensive or blaming, helps to heal the disruption and to provide a new developmental experience.

I saw this in my work with Linda's therapist when the supervisory relationship became disrupted. When the therapist expressed her disapointment in me for not being able to do more with Linda, I took her seriously and was neither defensive about my "failure" nor critical of her for "expecting so much". Our relationship was restored and she in turn became more confident, and more understanding of Linda's criticisms. Their relationship was also restored. And as her therapist felt stronger and more confident in the face of Linda's complaints, Linda became stronger and better able to stand up for herself in relationships with peers and employers. Her arrested development of self confidence and self-worth was back on track.

It may be hard to imagine that unbearable hopelessness and overwhelming psychic pain can be a treatment opportunity, but if you think of a small child with a limited vocabulary who is... [having traumatic experiences]... what words can the child use to describe the experience? Caregivers must work very hard to help the child process - talk about and master - the pain, the rage, the helplessness, the fear, and the humiliation. If caregivers cannot listen or, instead, discount or criticise the child, then the child must learn to disavow or sequester the feelings.

As adults in therapy, these individuals will, when they feel safe and connected, use the therapist to help process this early pain and fear. The hopelessness and despair that now arise may represent feelings experienced during repeated ... [trauma]... when no adult figure was available for help and protection. How can a therapist attune to or stay connected with the experiences of a small child with little or no vocabulary?

That is the challenge. We can try talking about anger or rage, but these terms rarely fit the child's experience, and our patient feels more distant and alone. However, allowing ourselves to feel our own shame and failure, to stay with our own hopelessness and despair, can bring us closer to our patient's inner emotional world and early childhood experiences.

The abused child suffers two traumas: abuse and isolation. When attempts by the child to talk about the abuse pushes parental figures away, the child is deprived of the opportunity to process the pain and fear. The child learns to disavow the pain to preserve essential relationships.

Painful experiences of hopelessness and despair can provide a special opportunity for a deeper level of communication between analyst and patient. When I feel stuck in a no-win situation, I wonder if my experience in some way parallels or reflects the patient's early experience. Perhaps my patient felt she could not win with her mother. Th emother may have gotten upset and looked to her daughter for relief. If the daughter tried to "fix" her mother, and her mother continued to be unhappy, the little girl felt like a failure. If she left her mother to take care of herself, she was subjected to accusations of not caring and of being selfish. The child could not win....

FRUITS

People ask why I bother treating such difficult patients, pointing out that the process is slow and stormy, and the risks are high... I answer that my development proceeds in tandem with my patient's development, and I have never had a patient experience significant change or growth without some parallel change or growth in myself. The work never becomes dull or routine. One of my teachers, the Los Angeles psychoanalyst Rudolph Ekstein, once said that we were like the natives who live at the foot of Mt. Etna, the volcano. Every twenty years or so, it erupts and destroys the village. When someone asked why they keep rebuilding their village in the same spot and not in a safer spot a few miles away, a native answered, "Because here is where we grow the choicest grapes".