Clinicians ’ Reverie as Private Enactments

AbstractThis paper introduces a concept the authors refer to as private enactments. While the majority of the relational literature has focused on the more dramatic enactments in treatment, private enactments emerge as the therapist becomes aware through reveries and personal associations that she is facing a parallel struggle with the patient, one shaped by the unfolding relational unconscious cocreated in treatment. These moments are private in the sense that the therapist experiences them internally after a period of sustained, often confusing private reflection during moments of clinical impasse. The authors elucidate this process with two cases with traumatized patients that highlight how the eventual resolution of private enactments offered new perspective on the clinical stalemate, novel understanding that evolved into constructive interventions after both authors became aware of shared, dissociated conflicts involving threads of trauma and loss, leading further to mutual reparation. Far from being dramatic moments acted out between therapist and patient, or far from simply involving unresolved emotional conflicts in the therapist, the cases of help illustrate how these subtle, often unnoticed musings operating sub rosa can highlight a shared, cocreated struggle that if identified can provide new insight and relief from impasse, so that we change as our patients change by metabolizing our private associations.

Source: Clinical Social Work Journal - January 9, 2017 Category: Psychiatry & Psychology Source Type: research