Two: if I explained the case to my father, he might be able to guide me based on his lengthy experience. But I am afraid that if I let him intervene, his help would undermine my self-esteem. My father has always had a tendency to invade my professional space in the same way that he evades his marital space. I am well aware that I have consented to those intrusions and that, ultimately, I am to blame for them. Knowing this makes me refrain. On the other hand, if in spite of everything I decided to speak to my father about José, I would be guilty of an unforgivable contradiction: encouraging my patient to escape from the father figure, while I myself regress in that respect.
4. JOSÉ
Monday 14 May. The sessions continue to take place in the following way. Juan arrives at my consulting room, and, in order to be able to allude to, or possibly to elude his grief, he behaves as if he were the therapist. For my part, I try to devise as many questions and observations my role as make-believe patient permits. This dynamic has remained unchanged since the patient’s last acute crisis. If at that time I went along with this symbolic role reversal (naturally revealing nothing of a truly intimate nature, and always maintaining the distance my profession and common sense prescribe), it was because the patient soon began to talk about himself with an ease and frankness hitherto unimaginable. Although I still harbour a few misgivings about this strategy, going over my files I realize that, by comparison, the conclusions drawn from my sessions with Juan do not differ wildly from those of other patients receiving orthodox therapy. Depending on his progression over the next few weeks, I will consider whether to prolong the special treatment for a while, or return the sessions to their proper place and put the patient back on his previous medication (see prescriptions17.doc).
The monothematic nature of our exchanges presents no significant variations. When, in my role as an alleged patient showing the classic curiosity towards his or her therapist, I question him about his own personal life, Juan refers to his daily routine, taking for granted that his parents are still living. He even describes to me trivial everyday incidents in startling detail. Notwithstanding his pathology, Juan’s observations on marriage, relationships or the smugness of children are surprisingly deep and incisive. Despite my reservations, I can’t help secretly approving of many of his remarks.
To give an example, in today’s session he declared that people born in the ’70s are orphans through excess. That is to say, a generation that feels unprotected due to its parents’ overprotectiveness. Juan and I belong more or less to the same generation, and I, too, am an only child. This fact occasionally contributes to my being momentarily distracted from his case and referring back to my own experience, which further complicates the difficult balancing act our game of role reversal forces me to maintain. I mention these small interferences in my communication with my patient in order to be aware of them.
5. JUAN
At times, José shows signs of worsening, or at least I think I detect in him symptoms of an imminent relapse. During the last few sessions he has only been collaborating when our roles are acted out according to strict rules. Until recently I was able to steer our dialogue into a buffer zone, where, despite the premise of the game, I was able to move with relative ease and coax him into expressing himself, provided our implicit roles (he is eager to ask, I don’t mind responding) were not explicitly challenged.
Now, however, the routine is becoming complicated because José scarcely engages in digressions of a personal nature, and is inclined to resist when I pose any intimate questions. Consequently, I am limited to projecting his own anxieties in my increasingly lengthy monologues, and must be content to catch his brief remarks on the fly and swiftly analyse them. My replies are an attempt to inject the patient with a measure of reality, aware that my words produce a mirror effect in him. What is awkward from a subjective viewpoint, is that the intensification of this dynamic has led to the patient feeling he has the right to interrogate me in an increasingly impertinent way, and to address me in an exasperating tone.
Having reached this point, and when I read over my reports on our latest sessions, I begin to doubt whether playing along with José’s game was the correct thing to do. To confuse things still further, in spite of his increasing refusal to talk, the patient shows a self-possession he did not have before, and his expressions (voice, gestures, motor coordination) have become considerably calmer. I mentioned at the beginning, as the role play progressed, my suspicion that the patient might have deteriorated. However, from a strictly behavioural point of view, he seems to have improved. With regard to this apparent contradiction, I fear my limited professional experience is playing a dirty trick on me, even though I can see that this experiment is directly enhancing it. I am convinced that this audacious praxis will help me attain my father’s level more quickly, equalling if not surpassing his clinical achievements. In the meantime I still haven’t mentioned this case to him. I don’t think it is advisable. This is something I must resolve on my own.
6. JOSÉ
Monday 28 May. Encouragingly, Juan seems to have accepted my frequent questions as a given, and he dutifully submits to answering them. The fictitious confidences I have been forced to share with him have been reduced to a minimum, and for the most part I limit myself to listening and, rather ironically, to exercising my true role. That is to say, to pretending I am a patient who prefers to listen to the confidences of his garrulous therapist.
I am not unaware that Juan’s progress has a complexity and subtlety that never cease to surprise me. Not only does the patient pretend that it is he who in theory is treating me, he now makes as if he is grudgingly tolerating my questions. He regularly expresses in no uncertain terms his displeasure and unease during these interrogations. In other words, Juan appears to be on the way to overcoming part of his previous conflict, but only at the cost of starting a fresh one between us. I trust it will be provisional, a sort of pain-scaffolding. In the meantime, the patient speaks less about his parents’ objective presence in the house and evokes their image instead, focusing on the emotional meaning they had for him. As I say, these symptoms are positive.
The only shadow hanging over this well-founded optimism is that, after many months, I yielded to temptation and called my father to talk about Juan, who is without doubt the most intricate patient I have ever treated. Perhaps I wasn’t seeking his professional opinion so much as his parental approval. That is possible. The point is that when I left my practice this afternoon, I called my father to discuss the case with him. And (to my disappointment) he not only strongly advised me to discontinue the game of role reversal, but expressed the opinion that I should hand the case over to a colleague immediately.
Although it shouldn’t, this has renewed my doubts about my approach to Juan. I don’t know why I mentioned him to my father, when I am all too conscious of how our discussions end up. With him always trying to come out on top. When I got home I told Mama about it. As usual, she said nothing.
MY FALSE NAME (An Argentinian Memoir)