The Things We Don't Do - EXCERPT
from “Juan, José”
Monday 14 May. The sessions continue to take place in the following way. Juan arrives at my consulting room, and, in order to be able to allude to, or possibly to elude his grief, he behaves as if he were the therapist. For my part, I try to devise as many questions and observations my role as make-believe patient permits. This dynamic has remained unchanged since the patient’s last acute crisis. If at that time I went along with this symbolic role reversal (naturally revealing nothing of a truly intimate nature, and always maintaining the distance my profession and common sense prescribe), it was because the patient soon began to talk about himself with an ease and frankness hitherto unimaginable. Although I still harbor a few misgivings about this strategy, going over my files I realize that, by comparison, the conclusions drawn from my sessions with Juan do not differ wildly from those of other patients receiving orthodox therapy. Depending on his progression over the next few weeks, I will consider whether to prolong the special treatment for a while, or return the sessions to their proper place and put the patient back on his previous medication (see prescriptions17.doc).
The monothematic nature of our exchanges presents no significant variations. When, in my role as an alleged patient showing the classic curiosity toward his or her therapist, I question him about his own personal life, Juan refers to his daily routine, taking for granted that his parents are still living. He even describes to me trivial everyday incidents in startling detail. Notwithstanding his pathology, Juan’s observations on marriage, relationships or the smugness of children are surprisingly deep and incisive. Despite my reservations, I can’t help secretly approving of many of his remarks. To give an example, in today’s session he declared that people born in the ’70s are orphans through excess. That is to say, a generation that feels unprotected due to its parents’ overprotectiveness. Juan and I belong more or less to the same generation, and I, too, am an only child. This fact occasionally contributes to my being momentarily distracted from his case and referring back to my own experience, which further complicates the difficult balancing act our game of role reversal forces me to maintain. I mention these small interferences in my communication with my patient in order to be aware of them.
At times, José shows signs of worsening, or at least I think I detect in him symptoms of an imminent relapse. During the last few sessions he has only been collaborating when our roles are acted out according to strict rules. Until recently I was able to steer our dialogue into a buffer zone, where, despite the premise of the game, I was able to move with relative ease and coax him into expressing himself, provided our implicit roles (he is eager to ask, I don’t mind responding) were not explicitly challenged.
Now, however, the routine is becoming complicated because José scarcely engages in digressions of a personal nature, and is inclined to resist when I pose any intimate questions. Consequently, I am limited to projecting his own anxieties in my increasingly lengthy monologues, and must be content to catch his brief remarks on the fly and swiftly analyze them. My replies are an attempt to inject the patient with a measure of reality, aware that my words produce a mirror effect in him. [. . .]
Having reached this point, and when I read over my reports on our latest sessions, I begin to doubt whether playing along with José’s game was the correct thing to do. To confuse things further still, in spite of his increasing refusal to talk, the patient shows a self-possession he did not have before, and his expressions (voice, gestures, motor coordination) have become considerably calmer. I mentioned at the beginning, as the roleplay progressed, my suspicion that the patient might have deteriorated. However, from a strictly behavioral point of view, he seems to have improved. With regard to this apparent contradiction, I fear my limited professional experience is playing a dirty trick on me, even though I can see that this experiment is directly enhancing it. I am convinced that this audacious praxis will help me attain my father’s level more quickly, equaling if not surpassing his clinical achievements. In the meantime I still haven’t mentioned this case to him. I don’t think it is advisable. This is something I must resolve on my own.
Monday 28 May. Encouragingly, Juan seems to have accepted my frequent questions as a given, and he dutifully submits to answering them. The fictitious confidences I have been forced to share with him have been reduced to a minimum, and for the most part I limit myself to listening and, rather ironically, to exercising my true role. That is to say, to pretending I am a patient who prefers to listen to the confidences of his garrulous therapist.
I am not unaware that Juan’s progress has a complexity and subtlety that never cease to surprise me. Not only does the patient pretend that it is he who in theory is treating me, he now makes as if he is grudgingly tolerating my questions. He regularly expresses in no uncertain terms his displeasure and unease during these interrogations. In other words, Juan appears to be on the way to overcoming part of his previous conflict, but only at the cost of starting a fresh one between us. I trust it will be provisional, a sort of pain-scaffolding. In the meantime, the patient speaks less about his parents’ objective presence in the house and evokes their image instead, focusing on the emotional meaning they had for him. As I say, these symptoms are positive.