client or trainee

[georgia rigg]

Patricia--Certainly not an easy topic nor one with an
easy solution.  I spent over 20 years in private
practice with a population similar to the one you
describe--Since I worked extensively with adults who
were the survivors of childhood physical and sexual
abuse, there were many who had attachment issues and
Axis II behavioral disorders.  The full blown
Borderline Personality Disorder is a "black hole" for
energy of all kinds.  I did have considerable success
with a combination of DBT in action; use of John
Mosher's Healing Circle Model as an educational tool;
and of course, enacting the psychomotor therapy model
of ideal parent, which includes the function of
setting limits.  At some juncture, you have to decide
just how much energy you yourself have for the
process--you are an important element, for yourself as
well as for the client.  I'd be glad to discuss this
further with you, and also send you some of the
information I still use with clients.  I'm using most
of my energy for training now; I do have a felt sense
of gratitude for all of the clients who did come to me
and courageously set out to change and have a life for
themselves.  Georgia Rigg

--- PATRICIA DESERT <honeybwomn at msn.com> wrote:

> Hello Everyone--Adam hit on an area that deeply
> resonates for me at this time--that is,
> characterological disorders.  I am in the midst of
> working with two clients exhibiting classical
> symptoms of Borderline Personality Disorder.  It
> continually manifests in rage at me for not fixing
> them, for caring more for my other clients, for
> holding to time boundaries of sessions when they are
> late, for not giving them 2 hr sessions whenever
> they want them, for long phone message between
> sessions criticizing all that I haven't done, for
> not remembering exactly what was said last summer,
> last month, last week, etc., etc.  These criticisms
> are relentless. 
> 
> I have had 18 years of enormously rewarding work
> with clients, mostly Axis I disorders and some with
> mild to moderate Axis II.  Until this year, after
> working with these two for over a year, I have never
> felt this sense of frustration, anger, or at times
> inadequacy.  And for the first time in my 18 years
> as a therapist I acted out my anger at one client
> and told her with no compassion or empathy that her
> behavior was both rude and disrespectful to me and
> to the other client whose session she attempted to
> interrupt. 
> 
> Obviously my stuff got triggered big time and I
> recognize that I need supervision around this and am
> getting it.  However, I'm curious to hear from
> anyone else who has had their own similar responses
> to these kinds of clients and some action methods
> that were helpful, besides the TSM Containing Double
> and mindful breathing, both which are definitely
> powerfully helpful at times.   Private practice is
> sometimes a lonely place, with little peer
> connection, and hearing from you all about your
> experiences is helpful.  Thanks.  Patti
> 
> ----- Original Message ----- 
>   From: Adam Blatner<mailto:adam at blatner.com> 
>   To:
> list at grouptalkweb.org<mailto:list at grouptalkweb.org> 
>   Sent: Tuesday, August 29, 2006 2:11 PM
>   Subject: client or trainee
> 
> 
>   Hello All, Responding to an excellent professional
> question: Can a group member join a training group:
> And responding further to Bud's response (attached
> after this below):
> 
>   Bud's attitude is understandable and somewhat
> compatible with many directors and perhaps even
> Moreno's generous spirit, but it is also I think
> mistaken for the following reasons. Part of this
> emerged with the difficulties emerging with the
> encounter group fad of the 1970s:
>         There are many people who are clearly
> mentally ill and just want to get better, have no
> aspirations to being a therapists.
>        Some people, on the other hand, are vibrantly
> healthy and self-sufficient, and while they have
> some mild issues that need to be worked on, they
> basically have the character to train and be
> therapeutic for others, should they be interested in
> taking on that task.
>          A significant number fall between the two,
> and their problems are associated more with their
> interpersonal style. In the APA's Diagnostic and
> Statistical Manual, the problems they encounter are
> noted in the category called personality disorders,
> also known as "Axis 2" disorders. 
>           Many people who have depression, anxiety,
> and other Axis I diagnoses are also co-morbid,
> meaning they have more than one problem--not just
> their anxiety, but also character or personality
> tendencies that set them up for the defeats that
> then eventuate in depression and/or anxiety, or
> other symptoms.  (Another example of co-morbidity is
> the way people with mild PTSD--perhaps not
> fulfilling all the criteria for full diagnoses--
> and/or addiction problems may also come crashing
> into more clearly Axis I types of symptom clusters.)
>           The second and most important thing that
> wasn't much recognized before the mid-1960s is the
> pervasiveness of varying degrees of Axis II
> tendencies, which can be mild, moderate, or severe,
> and more, the key here is that these folks don't
> have primary anxiety--i.e., feeling ego-alien or
> uncomfortable with their own symptoms; rather they
> are ego-syntonic with their life style, whether it
> be passive-aggressive, obsessive-compulsive,
> hypomanic, hystrionic, borderline, narcissistic,
> etc. What this means is that they become upset when
> people get tired of their behaviors, abandon them,
> divorce them, fire them from their jobs, but they
> don't see what they did that got people so riled up!
>  Folks with character problems tend to deny it,
> minimize it, and so forth. Now we're getting closer
> to the games people play in wanting to become
> "therapists."
>         It doesn't matter if you buy the diagnostic
> categories I've mentioned--they're just tools, and
> I'm not all that attached to them in their
> specifics. What we're talking about is, in Eric
> Berne's Transactional Analysis language, the "games
> people play."
>          I will confess that I have some mild
> characterological tendencies, and I haven't met
> anyone yet who doesn't have a bit, so we're talking
> about how much, and whether a person is really
> committed to cleaning up his or her act. Lots of
> folks don't really get down.
>         
>        Perhaps another factor here is whether much
> significant therapy can happen in a
> group--especially a training group. The problem is
> that there is a dual relationship: On one hand,
> there is the deal with my problems goal; on the
> other hand, there's a bit of do you respect me as a
> therapist, can you? I confess, there are people with
> patterns of behavior that are intense enough, and
> lack of insight deep enough, and a kind of
> resistance to really looking just thick enough, or
> lack of mental agility, so that while I might find
> them okay to work with as clients, I would never
> ever consider them capable of actually helping
> others. We have to really get clear about this. 
>         I am afraid that there is a kind of
> humanistic egalitarianism-- in California it used to
> be called "woo woo," that is post-Hippie "whatever"
> "it's all good" blind to the actual range of issues
> in people. It would be nice to assume that all can
> be wonderful, but there is absolutely no evidence
> that supports this assumption. 
> 
>       So back to the problem: I've been in groups,
> sometimes with people who were in counseling
> programs, and it was clear to me that they were not
> only miles from being ready to help others, or even
> begin to; but were fairly blind to the deficits in
> their personalities that would be problematical:
> Some were painfully inhibited, passive, reticent,
> highly defended; others were "drama queens," seeking
> emotional catharses and tending to dominate and
> exhaust the group. And so forth. Experienced group
> leaders could make a list of their most trying group
> members. 
> 
>        We must also remember that the desire to
> graduate, to be seen as being good as the group
> leader, to be a trainer, is a common desire of
> people whether or not they have the talent, ability,
> experience, maturity, or other role requirements for
> the job. To accede to such desires is only one step
> away from letting any teenager do brain surgery
> without having to go to medical school, much less
> residency. 
> 
>            So, yes, trainees who have more than the
> mildest of problems should indeed have as their
> primary therapist someone who is out of the stream
> of their own vocational guidance, someone who can
> confront their manipulations, and someone to whom
> they don't have to hide those manipulations. They
> also need someone outside the group to whom they can
> complain about the group leader. (This observation
> is a variation on the saying, "No man is a hero to
> his wife's psychotherapist.")
> 
>           So it's not the "rules," that are the
> problem, but the actual principles that acknowledge
> the reality that transferential problems will
> emerge, they are common, and they are made almost
> impossible to address if the group has any other
> agenda than the commitment to explore the
> interactions themselves, with a view to clearing up
> blocks and blind spots. A secondary hope to be
> appreciated, admired, respected, to prove
> competence, to gain final approval for vocational
> advancement, is a significant dual relationship. Add
> the financial element: What is the group member
> paying for, therapy or training? This further
> muddies the water. 
> 
>       Well, sorry, but I want to indicate to the
> group members that the more conservative
> practitioners aren't just defending their guild
> status, but trying to address actual complexities in
> dual relationships.      I'm open to your thoughts.
> Warmly, Adam Blatner
> 
> 
>     ----- Original Message ----- 
>     From: BARNETT WEISS<mailto:budweiss at verizon.net>
> 
>     To:
> connie at souldrama.com<mailto:connie at souldrama.com> ;
> list at grouptalkweb.org<mailto:list at grouptalkweb.org> 
>     Sent: Tuesday, August 29, 2006 11:52 AM
> 
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