Thursday, May 21, 2020

Doing it in the Displacement

It begins with the Guinea Pigs:

What are we talking about when we are talking? In therapy when you talk about one thing but you are really talking about something deeper we call it "doing it in the displacement." Today we dealt with life and death by talking about my patient's guinea pigs.  50 year old white woman, from a privileged background, with a history of eating disorders, body dysmorphia, borderline, suicidality, and bipolar with depressive features.  When I meet someone like this their prescriber hands them off to me with a sigh--they take medication to smoothe out some of the rough patches but often they have a lifetime of multiple hospitalizations for delusional thinking or suicidality and the twenty minutes they get with their doctor or psychiatric nurse is the most therapy that they are getting--and often the most enduring relationship that they have in a lifetime of explosive or failed relationships, stressed family members, sad losses.

As a social worker, and an ex anthropologist, I tend to come at therapy from a strengths based perspective--what can this person do, not what can't they do.  More integral to my approach is that I tend to focus on joy, creativity, expansion rather than contraction, on the idea that most of my patients are already taking care of themselves pretty well they just need more encouragement to recognize what they are doing as valuable and skillful.  Also, because of my interest in Trauma work, I tend to draw on a model of the person which is multiplex--all of us have at least five nameable parts to our responses to stress: Fighter, Flier, Freezer, Fawner, Follower.  Most of my patients rotate through these five responses to stress, or to me, or to therapy, or to family so fast that I can get fired several times in one session by a fighter, or someone who is experienced in freezing may collapse and seemingly go catatonic in session.  Princess Sparkle Pony once mimicked freezing so successfully that she got hospitalized right out of my session room when none of us could rouse her although once she got to the ER she sat up and said "Aimai was wrong" quite normally and furiously.

We started session with [Brenda] telling me that she had nearly had a panic attack trying to take her guinea pig to the veterinarian (immediate problem) which I addressed practically.  We ended it talking about death--about her fear of death and her experience, as a child, of her mother's near death and multi-month hospitalization, of her mother's depression, and of her own desire to shrink, starve, and vanish.  To blow her brains out through a pillow. "I think I've always been afraid of death" she said dreamily, as she packed up pumpkin to go to the vets.


  1. So, did the guinea pig die, or did her pet's illness bring on the memories?
    This enquiring mind wants to know!

    Btw - Looking for what the patient CAN do sounds like a very positive approach.

  2. >> white woman, from a privileged background, with a history of eating disorders, body dysmorphia, borderline, suicidality, and bipolar with depressive features. <<

    If not for her age, I could almost have sworn you must be treating my ex-wife. Oh wait. I forgot also episodes of flee-floating rage.

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