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exchange in the light of the client’s inner world and unique
difficulties.
A way of reaching others
characterised by ambivalence
As mentioned earlier, a dominant feature in the psychotherapeutic
work conducted in our project, above all
among the women, was the deep ambivalence to enter
into a psychotherapeutic relationship, a hesitation that
could be seen at every stage of the contact. For instance,
several clients came to the initial assessment sessions eager
to continue the contact. An agreement about forthcoming
appointments and routines was then made, but the client
was not heard from since then. Arriving at the wrong time,
or late, cancelling three sessions in a row and then coming
twice followed by further cancellations is another way of
expressing such ambivalence. When therapies have been
interrupted, it has often occurred unexpectedly, at a stage
when from the psychotherapist’s viewpoint there is a possibility
of establishing a trusting working relationship.
It has sometimes seemed as if clients needed to
interrupt the contact just at the moment when it was
becoming meaningful. For those paying a fee for their
visits this has sometimes provided an area for acting out;
the psychotherapist has, for example, discovered that it is
money from prostitution that pays the clinic’s fee. Some
women have also chosen to be anonymous in our contact.
Perhaps this is another way to express the need of keeping
a distance from the psychotherapist. Generally, work with
the women was characterised by a high degree of insecurity
for the psychotherapists. Therapists could often wonder
if the client was going to show up for the therapy session
on a particular day, or at all.
Even the men could express ambivalence about establishing
a psychotherapeutic contact, although this was
often expressed in a different manner compared to the
women. In those cases where the men had an established
and working therapeutic relationship, ambivalence tended
not to be expressed in relation to keeping appointment
times and routines. Instead, an aspect of ambivalence
appeared to enter into how the men often viewed their
therapists. Some of men tended to express an idealising
attitude toward their therapists, where “being saved” was
dominant theme. In our discussions, we increasingly
came to consider such themes as expressions of a deeper,
partly unconscious, fear of what a relationship to another
human being might mean. On the one hand, there was
the contact with a psychotherapist who endeavoured to
understand the client, along with the promise of positive
change that such understanding could lead to. On the
other hand, travelling the road to greater understanding
meant acknowledging to oneself and sharing with another
person what goes on within oneself, and this could feel
extremely frightening.
The conflict between a desire to understand and a
struggle to protect oneself from the fears that threaten
when one opens up to others can be very strong, and likely
caused some clients to drop out or waver at the beginning.
Some to reacted in relation to boundaries, while others
could terminate the contact just when the relationship
with the psychotherapist was starting to become emotionally
meaningful. Obviously questions arise about what is
behind these conflict. What could be so threatening about
starting a relationship?
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