Beginning to draft a therapeutic contract
Mark is paralyzed, devitalized and I feel powerless. I realize now that
if I try to push it towards what I consider a healthy direction, it
would be counterproductive. Mark would probably feel even more
controlled and dominated and still do not figure out a way out from the
cage he lives in. It is therefore necessary to try and have Mark commit
himself to doing something in order to live a different live and
eventually overcome depression. My awareness of these needed passages,
is a first step towards an explicit formulation of the therapeutic
contract.
T: “Mark, I listen to your stories, you kind of live always the
same day, and this is just frustrating. I would like to help you find a
way out, but I have a sense of pushing you to do something to get out of
it almost against your will. If this is the case, I’m making a
mistake ”.
M: “Yes, I know. I’ve always been sick. I told you! Can’t see any
solution ”.
T: “Yes, I know, but… in order to support or help you get
somewhere I have first to understand what is the direction you would
like to follow, I can’t fortune-tell it on my own. What do you think
about it? ”
M: “I… I don’t know… sounds useless… nothing ever
changes… ”
T: “I imagine, you’ve been down for ages. Of course you are
discouraged! But I am confident that if we connect with that part of you
that wants to change the course of your life, and we know it exists,
that could help us finding a way ”.
M: “Ok, let’s see what you propose” (in this passage Mark is
not sarcastic anymore, he is really curious about my ideas).
T: “You told me that you would like to have an aperitif with your
colleagues, go to clubs that often play live music in the evening. What
do you think if we get ready to do something? ”
M: “I could ask a colleague of mine if he wants to have dinner
together on Friday evening ”.
T: “Excellent. So you try? And we will see together what will
happen ”.
Even if it looks like we have a
real agreement, I still have to make sure that Mark does not covertly
see me as dominant or controlling. So, I explore that with focused
questions:
T: ”One last thing, Mark. How do you see me right now while I’m
asking you to really try and invite a colleague for a dinner? Or while I
insisted that new action is necessary in order to change? ”
M: “Hmm … You tell me to do things, like everyone
else… but at least you’re telling me that I can choose or at
least that we can think together. How to say… you are not really
forcing me ”.
T: “Oh, good. Well, this is ok, but if in some moments you
have the idea I am giving you kind of orders… just let me know,
it will help us ”.
In the first passages we can trace what the reasons were, for lack of
agreement on objectives and tasks, coherently with what was anticipated
in the introduction: 1) Mark was focused on others, including the
therapist, and dwelt on feelings of envy and contempt, instead to focus
on the problems he had; 2) Mark was completely distant from his desires
for him: he no longer even knew what he liked to do, he was only
attracted by the desire to redeem himself in society so as not to lose
in comparison with others; 3) Mark believed that his well-being depended
on events and not on his actions, thus remaining a spectator of himself
and often feeling depressed and understimulated. I had to understand if
Mark wanted to work on these aspects, in the direction of what we were
understanding to be fundamental for him: the freedom to explore freely.
Mark wanted to revitalize himself but I couldn’t give him any
indications, to preserve our relationship and not be yet another person
who imposes himself on him. he should have started acting himself but
did he want to? Also, did Mark want to get in touch with the pleasure
that can come from doing activities for the sheer fun of it? above all,
Mark wanted to get in touch that the emotions that he always tried to
push away?