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WHY DON'T YOU CRY? PSYCHIC CONTAGION: CHALLENGES OF THE TRANSFERENCE AND COUNTERTRANSFERENCE


WHY DON'T YOU CRY? (POR QUE VOCE NÃO CHORA?)

PSYCHIC CONTAGION: CHALLENGES OF THE TRANSFERENCE

AND COUNTERTRANSFERENCE

IN MENTAL HEALTH OF THE THERAPIST

The movie Why Don't You Cry portrays the episode when Cibele Amaral was a psychology intern at the Instituto de Saúde Mental (ISM) in Brasília (DF) and is available on Amazon Prime

In the movie, Jéssica (Carolina Monte Rosa), a girl of humble origin who came from the countryside to study in the capital, is faced with a new world during her internship in psychology school, when she starts seeing Bárbara (Bárbara Paz), diagnosed with Borderline Personality Disorder. Jessica is too serious, while Barbara is a ticking time bomb. Jessica knows nothing about herself, and Barbara is always in a process of self-knowledge. While Barbara is gaining boundaries and confidence to reclaim her life, Jessica is discovering that she never had one.

The issues related to transference and countertransference are common to the case studies that usually occur during training in the Psychology course and in specializations in several areas of Psychotherapy, Psychoanalysis and Analytical Psychology.

Clinical Supervision keeps one eye on the patient and the other on the supervisee, always observing what difficulty each specific case presents, be it of theoretical orientation or of therapeutic attitude towards the patient. For this, it is necessary that the therapist asks himself how he feels in the presence of each analisand, how the behavior of the analisand interferes in how I feel during each session. Do any psychosomatic reactions manifest themselves during the session? In me or in the analisand? Are anxiety and abandonment fantasy exacerbated or ameliorated by the therapeutic relationship? Does this change during the online session? Which expressive techniques are pertinent to each case? Which ones should be avoided?

All these questions, and many others, must be part of the backstage of therapeutic thinking, and we must always be attentive to all the details that may interfere in the therapeutic relationship.

Psychotherapy rests on the tripod of extensive theoretical study, personal analysis, and case supervision. The personality of the analyst becomes his working tool, only when these three vertices are balanced. Transferential relations are an extremely important aspect in clinical practice, and the focus of supervision, besides the theoretical understanding of each case, aims at analyzing the analyst-analyzed relationship, and the actualizations of the archetypal complexes that characterize the transferential relationship.

It is not enough to supervise the case, it is also necessary to supervise the transference relations, principally the countertransference, as it is this that gives the possibility of identifying what works or not in the process. Both the patient and the therapist must be safe during the therapeutic process; for this, it is necessary that the therapist, be it a student or a qualified professional, be aware of the risks of emotional contamination that each case may represent. Many times, the patients may bring issues not yet elaborated by the therapist, and an identification via complexes, or shadow complementarity may occur, preventing the success of the analytic process, or triggering serious psychic processes, both in the patient and in the therapist.

The therapeutic relationship between Jessica and Barbara in the movie is that of T.A., Therapeutic Accompaniment, in this type of service, the therapist accompanies the patient in his daily activities for a longer period than that of a therapy session, which lasts, on average, 50 minutes, and may extend to several hours a day, several days a week, depending on the clinical indication of each case. The work as a T.A., for having these characteristics, may encounter difficulties in establishing a clear professional setting, since the meetings may take place either in a clinic or in private life situations, as in the case of Jessica and Barbara, which may make the limits of the relationship difficult, causing the therapeutic work to be confused with friendship or any other personal relationship. I must emphasize that this risk also occurs when the therapeutic setting is protected by physical and virtual spaces.

This confusion of roles, between personal and therapeutic relationship becomes clear in the following scene, for we have a lot of material to analyze Jessica's role.

Jessica - People don't see me, but you saw me, even though I'm like this, too quiet. Too closed. I don't want my sister to be like me. She is the best part of my life. And now there is you, my first and only friend. You broke this shell, and now I don't know what to do without it. Without the shell it feels like I'm nothing.

Upon being seen for the first time, Jessica realizes the lack of intimate connection in her entire life.

Initial dream

Scenery of destruction - dark and rough sea, separated by a wall. On the other side of the wall are signs that the area had already been invaded. Baby crying in the crib, while the mother alternates between looking out the window, looking at the child, covering her ears to avoid hearing the crying, going out and closing the door, letting the baby cry. The rain seems to invade the room, there is no clear separation between the rain falling outside and inside the room. The mother shows signs of apathy and depression.

Jessica's situation when she has her first dream - It rains outside, the rain invades her bed, there is a drop on her face, a drop falls on her right eye, like a tear imposed from the outside in.

In analyzing this dream, I keep in mind that all developmental authors agree that abandonment generates early trauma. This dream scene later reveals to be the reality that Jessica faced while still a baby, left crying, alone in her crib, until she stopped crying, not because she had been cared for and comforted, but because there was no use crying, care would not come.

According to Newmann, the Uroborus is the initial archetypal stage, corresponding from gestation to the first year of life, that is, the pre-egoic period, a borderline experience, equivalent to a stage in human prehistory, where the individual and the group, the ego and the unconscious, man and the world were indissolubly linked by the mystique participation.

Erik Erikson calls this stage trust versus distrust, also corresponding to the period from zero to one year of life, a stage in which the child experiences the world through its caregiver, and must receive consistent, predictable, and reliable care in order to develop a sense of trust that extends to other relationships.

Donald Winnicott develops the concepts of holding and the good enough mother and considers that the technique of the mother giving lap (or the caregiver), bathing, feeding and everything else she does for the baby, complements the idea of the body as a safe place.

In Jessica's case, we observe that these primordial needs for a baby were not met, a secure and stable care bond was not established with her mother, which led her to develop a shadow therapeutic bond with Barbara, based on the confluence of the affection-laden affective complexes of both.

At the beginning of the movie, already in the clinic, we see a Bárbara at first apathetic and isolated, observed by Jessica and by other colleagues, who question whether or not Bárbara would be a patient, since she was pretty. When Barbara notices a depressed, almost catatonic, patient approaching Jessica, she practically jumps in front of Jessica, taking control.

Barbara brings Jessica out of apathy, practically ordering Jessica to help her look for a black hair for her puppet, creates a puppet that looks like Jessica, and uses the puppet to tell her how sad Jessica is, and presents her with the puppet.


Building the therapeutic bond


Later Barbara tells Jessica to sit next to a catatonic patient, saying that the two would get along very well because they are both quiet. Jessica obeys, and only leaves when Barbara, visibly bothered by Jessica's apathy, goes to get her.

Jessica brings the passivity of the baby who waits to be taken out of the cradle to the therapeutic relationship.

Barbara demands activity and questions Jessica's obedience.

Who is whose therapist?

Barbara initiates the therapeutic bond, choosing Jessica, bringing her out of apathy.

Jessica chooses Barbara, thinking she would be an easier case, because she is not delusional.

Jessica functions in the patriarchal dynamism, has a rigid persona, shows no emotions, follows the formal instructions like a robot. Following the formal protocols is a way to avoid intimate relationships.

Barbara says she needs control, limits. Jessica is very good at respecting the limits of others, at not imposing her presence or her will. Barbara, a Borderline Personality Disorder patient, needs clear limits, characteristic of the creative patriarchal archetype, because she behaves like a child who has not learned to regulate her own emotions and to respect the social limits of behavior.

Personal History of the Characters

Jessica - depressive and apathetic mother. Depressive aunt, caring for Joice is an obligation. Passive family, watching TV like automatons. She works, studies and takes care of her sister, Joice, who is about eight years old, about the same age as Barbara's son. Her house is simple, with a leak on her bed, her routine is dull, lifeless, as if she were living on autopilot. We must be careful not to confuse the material poverty with the emotional poverty of Jessica's life, all her gestures are automatic, without grace or lightness, the basic needs of food and care are performed without joy or affective interaction between her and her sister, Joice.

Jessica's mother is also depressed, apathetic, but passive-aggressive, because aggressive individuals usually show aggressiveness in an indirect way, as in the sentence, when referring to the idea of Jessica leaving Joice with her mother, because she is worried about her, to which her mother says - Child stays where we leave her. The same apathy and passive-aggressive behavior can be observed in Jessica's aunt, who is upset at having to take care of Joice so that Jessica can do her internship at college, and says, annoyed: - Am I going to have to come here every Saturday now? Joice, as well as Jessica, seem to be a nuisance to those who take care of them, that is, the pleasure of living with and caring for a child is not present in Jessica's family.

Barbara - had a loving and playful mother, who was replaced by a caregiver who also puts her in the crib, alone, when she cries. Her mother disappears, possibly after she died by suicide. Barbara abandons her son because she does not feel able to take care of him. She kidnaps her own son, whose custody belongs to his father, and tries to recover the right to see her son, but again tries to kidnap him, prevented by Jessica.

The two represent different faces of the consequences of abandonment.

Transference and Countertransference

The transference is contaminated by the identification with the negative parental complex.

The negative matriarchal complex originates in the wounds caused by abandonment, leading to depressive and anxious states.

The negative patriarchal complex originates in the excess or absence of limits, of protection and support, which can lead to excess or lack of limits, the construction of an extremely rigid persona, as in the case of Jessica, or a fixation on the matriarchal dynamism, as in the case of Barbara, who can't adapt to the healthy limits of social norms.

Persona

Jessica - Identified with the social persona, in describing herself, states that there is nothing beyond the social persona.

Barbara - Identified with the persona from the diagnosis of Borderline Personality Disorder. Describes herself as all wrong, that she has messed up a lot in life, but that she would rather be the way she is than be like Jessica. This statement is aggressive towards Jessica. In other words, he would rather be a whirlwind of emotions than not feel anything like Jessica. The mania-like state, or euphoria, suggest an escape from the depressive state, a reactive behavior to the feeling of abandonment.

The identification, and mutual choice of the two, occurs via depression, subliminal in Jessica, fought by Barbara through unbridled extroversion and impulsiveness.

Mirroring via Imitation

Jessica and Barbara begin to build a stronger bond through imitation, throwing pebbles into the water. Barbara does not accept the protocol, patriarchal therapeutic relationship and asks for intimacy. Barbara tells Jessica that her mother got rid of her by sending her to school away from home at an early age. Jessica looks at her in surprise. This insight caused by Barbara's statement allows Jessica to contact her feeling of abandonment, experienced only through her nightmares.

Positive aspects of the therapeutic relationship - rescue of matriarchal and patriarchal creative aspects.

Jessica tries to help Barbara structure her life outside the clinic, such as looking for an apartment, going shopping, and getting a job.

Barbara brings playful aspects into Jessica's life, such as cooking with pleasure, showing affection for her son, going to the park for fun, and dancing.

There is also an identification between the two by the affection they both feel for the children. By observing Barbara's demonstrations of affection for Caio, Jessica becomes more affectionate with Joice, paying more attention to Joice's loneliness, taking her to play and observing that Joice does not play or interact with the other children, at the same time she avoids Barbara not returning her son to her ex-husband, and Barbara does not interfere when Jessica takes Caio in her lap saying that they would take him to her father's house.

Rescuing the wounds through empathy - caring and being cared for

Their relationship helps them find a balance, at least partial, between the predominance of matriarchal mechanisms in Barbara, and patriarchal mechanisms in Jessica. Jessica's predominantly formal, or patriarchal, care for Joice, and Barbara's predominantly affective, or matriarchal, care for Caio, tend toward a balance.

Jessica begins to allow herself to show affection for Joice. Barbara allows Jessica to interfere with her desire not to return Caio to his father.

Negative Matriarchal Complex

Therapy is not friendship - Jessica gives a gift to Barbara as an attempt to establish a stronger therapeutic bond, however, patients with Borderline Personality Disorder tend to easily detect cheating in the bond, demanding that the surrender to the bond be an "all or nothing" type.


Psychoid Archetype - Borderline patients are constantly in the psychoid archetype, that is, between consciousness and unconsciousness, for this reason, they present an instinctive facility to "read" others, therefore the therapeutic bond is very intense and requires an ability to trust the therapist 100%.

This girl has no condition to do this work (Barbara)

This movie leads us to several questions pertinent to psychotherapeutic work:

Barbara gives negative feedback about Jessica's OT, attacking her in a personal way, using the information obtained about Jessica, by way of having more intimacy, to attack her, saying that she didn't even want to be a psychologist. Barbara's attack is disloyal, a true betrayal, both to the therapeutic bond and to the fantasies of friendship that go through Jessica's head.

The bond between them is so confusing that in some moments it is difficult to discriminate who is the therapist of whom.

One must have the humility to accept criticism and identify the flaws in the course in the therapeutic process in order to resume the course, that is, to identify a defense against the transferential relationship of a therapist's failure, however, we observe that the College team acts defensively in relation to Barbara's criticism and tries to solve the problem in a superficial way.

In the case in question, the team was attacked by Barbara, who, when questioning Jessica's performance, and her ability to become a future professional, prefers to stick to Barbara's difficulties in forming solid therapeutic bonds, neglecting the fact that Barbara was pointing out a fact, because when they decided to continue with the A.T., Jessica tells Barbara that she had only said what everyone thought of her, including herself.

The team looks at the patient, but not at the therapist in question, showing clear difficulty in dealing therapeutically with criticism of the treatment. The team also fails to show any empathy for Jessica, who had been heavily beaten by Barbara when she was called dumb and incompetent.

The criticisms to the procedure of the team of teachers, therapists and supervisors responsible for the care of Barbara and supervision of Jessica are numerous:

A) The visit to the clinic where Barbara is hospitalized takes place with an informality that could have been a necessary rapport to the introduction of the work, but implies a lightness that borders on inconsequentiality, given the seriousness of the work at hand.

B) Jessica searches for information about Borderline Personality Disorder on the Internet, denoting that her training was flawed. Her intellectual knowledge about the profession was not accompanied by pragmatic information about how to proceed in certain situations.

C) Jessica, in saying that she had made a mistake in presenting Barbara, is reprimanded by the supervisor, scolded and debauched by her colleagues, but no one elaborates with her the attempt to establish a therapeutic bond with the patient, that is, the team in question judges, but does not guide, does not try to understand that Jessica tries to do the best, but without the technical resources to do so. She is once again criticized instead of supported and instrumentalized.

D) Barbara's psychoanalyst disqualifies Barbara's complaint by saying that she, the therapist, also has to deal with her own "shit". This is an indication that the team as a whole may have difficulty establishing a healthy therapeutic relationship with the patient.

E) The supervisor states that wanting to die is better than not wanting anything, opening the possibility of suicide as a better solution than Jessica's affective blunting. The issues pertinent to suicidal ideation are treated in a superficial and clichéd manner, unforgivable to psychology professionals.

F) The appointment of psychotherapy for Jessica is treated in a careless manner, she is not welcomed, neither as a student, nor as an individual. The responsibility of supervision is delegated to a supposed therapeutic intervention over which the supervisor has no control as to whether it will actually occur. Psychotherapy is indicated as an almost magical solution to the lack of preparation the student was given by the supervision team. Upon learning of Jessica's suicide, the supervisor washes her hands of it, saying that she had indicated therapy, but Jessica did not go to therapy, which, in my view, characterizes a psychopathic defense to try to absolve herself of responsibility for her actions.

G) The sociocultural differences between therapist and patient were not addressed at any point, not only how these differences would interfere in the therapeutic relationship, but in the personality development of each of them.

Second dream

Jessica dreams that she was hanging from a tree, in a field, dressed all in black and with a white paper taped to her chest.

Circumstances preceding the dream - a meeting of the A.T. team in which Barbara says that she is not fit to do this job, that they should have chosen someone who was at least more intelligent, and that Jessica is not fit to be a psychologist.

The accusation resonates with Jessica, who says that Barbara just said what everyone thinks of her, including herself.

Jessica drops her first tear before going to sleep and misses the time for the first time. By losing the time to get up, we realize that the structuring defenses of her personality are shaken.

Jessica has defenses that are fundamental to her being able to function socially, her ego is fragile, and her rigid persona allows her to remain functional.

Such defenses are characteristic of early traumas, in which the matriarchal archetype cannot be experienced in its most positive aspect, of care, welcoming and acceptance of the baby, both in its good and bad moments. The breakdown of such important defenses can lead to psychotic break or even suicide, as we observe in the movie.

Barbara defends the intimacy she seeks so much by testing the other person's capacity for affection, sends them away and then calls Jessica back, abandons her son and husband and wants them to understand her absence, wanting to resume living together as if nothing had happened.

Routine as a structuring factor

Jessica keeps herself functional through a rigidly structured routine, while Barbara relies on unconditional acceptance to remain stable.

Barbara needs Jessica's rigidity in order to organize herself, even though she confronts this rigidity all the time, while Jessica needs Barbara's fluidity and exaggerated displays of affection, as these contrast with her family experience of affective blunting.

They develop a symbiotic relationship, but although Barbara's appearance of fragility is more evident, Jessica is much more fragile, and unable to ask for help.

Chico Buarque, in his song Cotidiano , describes the despair of a life in which everything repeats itself, as in these stanzas - every day she does everything the same way, she shakes me at six o'clock in the morning? a routine without expectations, depressing, like Jessica's. Jessica says - I don't have this business of liking it, I do what has to be done. That is, there is no room for the spontaneity and lightness characteristic of the matriarchal dynamism, only the duty to be fulfilled, characteristic of the patriarchal dynamism. The pleasure principle of the matriarchal dynamism is absent in Jessica's life, while it rules the life of Barbara, who lives following her impulses, without thinking about duties and the consequences of her actions, in a childish way.

Arnaldo Antunes, on the other hand, describes depression in his song Socorro , from which I will highlight just a few stanzas - help, I feel nothing, neither fear, nor passion, nor the desire to cry, or smile?

While Jessica doesn't give herself the right to like it or not, Barbara alternates between the unbridled search for pleasure and depression.

Barbara needs Jessica, she needs someone to contain her and to put limits on her impulsiveness, but she cannot stand the expectations of others on her, personified in Jessica's expectation that she finds a job "up to her standards". Barbara, although very intelligent, has not been able to finish college, nor to explore her full potential and intelligence, because she has difficulty following the norms.

Jessica needs Barbara to bring the colorfulness of emotions into her life, to teach her the expression of affections. While Barbara cannot stand the confrontation between her reality and the expectations on her, defining herself as someone whose potential has not been realized, Jessica suffers from the lack of expectations on her. Jessica is expected not to move unless she is told to, after all, according to her mother, - a child stays where we let her, emphasizing that the word "let" in this context implies not only consent, but abandonment. These commands and expectations are internalized, complementary, and mirror the shadow of one in relation to the other.


Barbara - I want to die, not kill myself.

There is a scene in which Barbara says she wants to die, to which Jessica understands that she wants to kill herself, to which Barbara clarifies, I want to die, not kill myself, and the two briefly discuss the difference between suicide and the will to die.

According to Hillman, the desire for death is intertwined with the desire for the soul, with the desire to be in touch with the fullness of the self. The desire for death can also be related to the desire to experience a participation mystique, a state of symbiosis or communion with the other, characteristic of the uroboric phase and the beginnings of the mother-baby relationship.

Both Barbara and Jessica desire to connect with the essence of their own being, but the traumas and pathological defenses prevent the numinous experience of the encounter with the very essence of being.

Each one, in her own way, behaves in a stereotypical way, with opposite and complementary personas.

All excess leads us to lack.

The extroverted world of the nightclub, of Jessica's change of persona by wearing Barbara's clothes, putting on make-up and doing her hair in an exuberant way, feeds the intimacy between the two women, satisfying Barbara's need for intimacy, however, by experiencing this moment of spontaneity with Barbara, However, by experiencing this moment of spontaneity with Barbara, dancing, having fun, creates a counterpoint, exacerbating the lack of intimacy that Jessica has felt all her life, or even making her experience a false persona that does not match her internal reality, after all, she literally goes dressed as Barbara.

In trying to relive, alone, the previous experience with Barbara, Jessica cannot enjoy herself in the same way, because it is not enough to dress as Barbara, she cannot enjoy Barbara's exuberant company that makes her feel part of the place and of the experience that the place provides. She attracts the attention of men who harass her, but Jessica is in search of affective intimacy, characteristic of a primitive matriarchal stage, of welcome and care, not an erotic relationship, which hurts her.

Cry - Primal manifestation of suffering

Crying and screaming are the most primitive, the baby's first forms of communication. It is through the initial relationship with his mother or caregiver that the baby learns, through proper care received, to identify his physical and emotional needs, learning both to identify and regulate his emotions, naming them appropriately. This learning only happens when there is adequate care, where the baby feels loved and safe.

When Barbara and Jessica feel, they feel instinctively, with emotion, not feelings. Jessica tries to help Barbara regulate her emotions, but there is no one to help her do the same, much less welcome her. Emotion is prior to feeling, more instinctive, while feelings are more elaborated by consciousness.

Barbara shows her the world of emotions, but neither of them knows how to deal with them.


- Mom, look at me


Dream - the baby is crying in the cradle, when the mother approaches, it has the face of the negative matriarchal archetype, the witch, in her most terrible aspect.

Circumstances - end of OT care.

Jessica's rigidity does not allow her to maintain contact with Barbara, even though the service at A.T. has formally ended. At the same time that she ends the service with Barbara, Jessica drops out of college.

Symbolic crying

When she hits the ceiling, releasing the pent-up water from the leak, Jessica releases the dammed-up crying in her, but the feeling of emptiness that was dammed up in this crying overflows and invades her ego, and says in a tone of absolute desperation and helplessness.

- You are nothing to people.

- Because you don't cry, dumb girl.

Final dream

Jessica is immersed in water, naked, the doll that her mother held in her hands while she was in the crib, and that was left in the crib with her, as a substitute for her mother, floats with her.

Symbolically speaking, the reconstruction of the primordial bond is not possible, because it is contaminated by the negative matriarchal complex. Jessica regresses to a pre egoic state, before or immediately after birth, in which the symbiotic relationship with the mother does not evolve into a relationship with the other, she has become objectified, as her mother states - the child stays where we put her.


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