Brief Communications

A PSYCHOTHERAPEUTIC RELATIONSHIP: TEN MINUTES A MONTH, OR CLOSE ENCOUNTERS OF THE REAL KIND (With Apologies to Steven Spielberg)

Jane Simon

My therapeutic relationship with Ms. W. has been limited to ten minutes a month for the past seven years. Ms. W. has a primary psychotherapist. I am the psychopharmacologist.

Ms. W. who has been in and out of therapy for over twenty years, has witnessed the styles of diverse therapists, men and women, marital and pastoral. Ms. W. hasn't worked or socialized for ten years. She doesn't feel able to deal with job demands or with the interpersonal aspects of the work environment. She has never related any personal contacts with any- one except her daughter, of whom she is most critical. Her daughter always lets her down. She doesn't meet Ms. W.'s expectations, which in- clude phoning once a week, visiting on Mother's day and birthdays.

In our once a month visits Ms. W. relates an anecdote, usually voicing a complaint, finding her therapist lacking in one way or another. I listen and nod my head, generally remaining silent or asking if she has discussed this with her therapist. She knows that I know simply by looking at her how she is doing. On the days or months during which she is drinking, she appears discouraged and disheveled. When she takes her medication, antidepres- sants and major tranquilizers, she appears composed and generally re- signed. She frequently comments on my appearance, something like, "You always look so nice."

Today Ms. W. was glowing. She attributed the improvement to the change in medication.

"1 think there has to be another change in your life besides the medica- tion," I challenged.

"Well my daughter hasn't contacted me yet," she added in a down note. "1 think she's still taking drugs. You know a priest here told me many years ago, that he thought I wanted my daughter to'be on drugs. Do you think that's possible?"

"What do you think?" I asked.

The American Journal of Psychoanalysis © 1987 Association for the Advancement of Psychoanalysis

Vol. 47, No. 4, 1987

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366 SIMON

"1 think it's possible," she said. "And another therapist years ago said I see my life as a complete catastrophe. What do you think?"

"It does seem so," I agreed. "Those therapists years ago were direct. Nowadays, you people sit and

listen and don't say much. The style has certainly changed. I wish we could bring back the old days."

I smiled and nodded. I recalled last Easter when Ms. W. sent me an Easter card with blessings signed by her priest, included with her own greetings. I was impressed with the effort she had taken and caring she showed. Of course, I sent her a card in return.

"Why did you send me a card?" she asked, obviously surprised. "Why not?" I asked. "Because you're the psychiatrist and I'm the patient," she answered in a

confirmed tone. "We're both people," I said, realizing I was moved. So was Ms. W. Tears

filled our eyes. An important barrier, the wall of alienation blocking her path toward integration, had been weakened.

Revealing personal data is not the style in which I do therapeutic work. In general, I find personal revelations often used in the service of avoid- ance of the therapeutic task at hand. But Ms. W. had asked me so directly, catching me off guard, that I answered, "Yes, I have a 'relationship' and I have children." Each month she asked me about my children and my "rela- tionship" and I answered, "fine."

To return to the present and the reason for Ms. W.'s glowing face. "Well I met a man. We spend time together everyday. I don't like him too

much," she cautioned. "You don't have to like everything about him," I interjected. "1 hope he doesn't want too much from me. I only want to talk to him." "How about taking matters one step at a time? You can tell him what you

want and what you don't want." "Yes," she said thoughtfully, looking at me. "Your hair looks so nice. May

I ask a favor?" "Yes," I said feeling slight trepidation. "Would you tell me where you have your hair done? I don't mind spend-

ing the money but not when they do a bad job." I was delighted to give her the name of the beauty parlor I frequent. I was

supporting our similarities, lessening our distance as persons and hope- fully, her sense of alienation. I suggested she give the shop a call and speak to them directly to see if her needs could be met there.

Ms. W. appeared appreciative. She smiled and her glow seemed to light up her eyes. We were both women, as much as doctor and patient, and this recognition, lessening our distance, appeared to be therapeutic.

TEN MINUTES A MONTH 367

DISCUSSION

Karen Homey appreciated the theme and variations of self hate, making it a cornerstone of her theories. "The third factor that renders self-hate such a cruel and merciless f o r c e . . , is alienation from the self" (Homey, 1950). In Ms. W.'s case, the self hate was directed against herself as well as exter- nalized onto her environment, excluding her from any satisfactory human contact and rendering her sense of alienation that much more acute.

Real therapy is possible in a relationship of ten minutes or less a month. Ms. W. managed to create with me the kind of therapeutic relationship which proved helpful to her. What Ms. W. required was as much a relation- ship of women as a doctor-patient relationship, the therapist as role model.

My work with Ms. W. contrasts with my experience with Anna (Simon, 1987). While Ms. W. used the personal data in the constructive service toward integration, Anna attempted to seduce the analyst into speaking about herself in order to avoid the therape~Jtic task.

Therapeutic progress depends as much, if not more, upon the therapist's and the patient's openness to modification of the therapeutic relationship based on individuality as it does on diagnosis and chronicity. Remaining receptive to the individual patient, with an open mind to what is thera- peutic, is vital. Although I could not predict how Ms. W. would use my personal revelations, I thought whatever happened would provide "grist for the therapeutic mill." Azorin (1972) says that if the analyst is too cau- tious, he or she deprives the patient of "experiencing his analyst as a human being with both shortcomings and assets."

In my work with Ms. W. consisting of an average often minutes a month, I discovered a powerful tool, the healing effect of personal revelation. Recognition of our similarities as women served to reduce Ms. W.'s self hate and alienation.

REFERENCES

Azorin, L.A. (1972). The analyst's personal equation. In J, L. Rubins (Ed.), Develop- ments in Homey Psychoanalysis, pp. 195-199. New York: Robert Krieger.

Homey, K. (1950). Neurosis and Human Growth, pp. 110-I 14. New York: Norton. Simon, J. (1987). The therapist's and the patient's role in the integrity of the psycho-

therapeutic relationship. Presented at the 31 st Annual Meeting of the American Academy of Psychoanalysis, Chicago, May 1987.

Address correspondence to: Jane Simon, M.D., 145 Central Park West, New York, NY 10023.