Tuesday, May 12, 2015

Writing about Patients -- or Not

CouchNovelist and psychoanalyst Lisa Gornick has an article in today's NYTime Opinionator, Why I Never Write About My Patients.  She talks about how she ended her career as a psychoanalyst when her novels became successful.  First a leave of absence, then the separation became a divorce.

Gornick writes:

During the years when my stories appeared only in obscure literary journals, never seen by any of my patients, the marriage between my occupations was comfortable. With the publicity that accompanied the publication of my first novel, in 2002, however, many patients became aware of my writing. I knew that whatever responses they might have were “grist” for the therapy mill, but I also knew that just as dreams are transformations of the unconscious of the dreamer, literary works plumb their authors’ inner lives. Analytically oriented therapists such as myself use our responses in sessions as a way of understanding our patients — in a sense, lending our unconscious for the purposes of the treatment. But adding my patients’ responses to my novel into the mix — having my characters, with their links to other corners of my unconscious, in the treatment room — risked, I feared, both clogging the therapeutic mill with too much grist and inhibiting my writing work out of concern for its impact on my patients.

I stopped taking new patients, gave my current patients 18 months notice (sufficient time for nearly all to complete their treatment) and commenced an extended leave.

Eight years later, I tested the waters for returning to my practice — only to discover that the separation should be a divorce. With many of my stories and essays and interviews now available online, and with new mores in which there is no hesitation about looking up anything about anyone, I felt too exposed.
 I'm not one for writing about my own patients, it just doesn't seem either necessary or right, so I can relate to Gornick's concerns.  But when it comes to the analytic belief that the psychoanalyst must be a blank slate whose personal life remains hidden from the patient, then I drift off.  Times have changed and it's hard to remain obscure.  I like social media, and the Internet makes us all so much more more exposed than we'd like to be.  It takes a rare person to ward off every activity that might show up online.  When I think about it, I feel smothered.  In the office, I'm mostly me, but modified to meet the needs of my patients.  In my free time, I'm all me and fortunately the 'me' who lets loose has no criminal convictions.  

1 comment:

Steven Reidbord MD said...

No one is, or ever was, a blank slate. Freud invented therapeutic anonymity, yet saw patients in his home. They knew a lot about him, both professionally and personally. Nonetheless, when patients wondered about his life (or inner life) he used their uncertainty in the service of treatment, rather than immediately answering and relieving their anxiety. This approach can be used without being a complete cipher — indeed, in real life that's the only way it CAN be used.

Nothing has changed in the age of internet exposure. There will always be questions and concerns in patients' minds, starting with what their therapists think of them. In dynamic work we may use this in the service of treatment, regardless of whether the patient has discovered the name of our dog, or what we paid for our house. (And it's fair game to be curious about the effort they expended to find out.)

I admire Gornick's careful attention to confidentiality, her own conflicts of interest, and her effect on patients. She seems a bit purist or over-careful, but I can hardly fault her for that. The inevitability that patients will know things about us doesn't justify pro-actively filling them in. As she wrote, too much grist can clog the mill.