Who am I and what do you see?

This has been a thought provoking week about the question of identity. I’ve been to two different art galleries, Tate Britain and the National Portrait Gallery. Tate Britain is showing a collection of paintings by Lucien Freud and others whilst the National Portrait Gallery has a permanent exhibition of twentieth century notables. There were many pictures that caught my attention in both galleries. In the National Portrait Gallery it was the picture of Amy Winehouse, painted by Marleen Dumas, that moved me. She  seems to have caught the varying aspects of Amy Winehouse in one portrait – her vulnerability as well as her strength, amongst other qualities. One of the featured artists in the Tate’s “All too Human” exhibition was David Bomberg. The blurb that goes with this exhibition noted that Bomberg et al “… maintained an emphasis on the rendering of the physical experience of a person or a landscape rather than just a recording of their appearance.” I had never considered the meaning of a portrait. I took it to be a simple image of a person or landscape, albeit that each painter or photographer used a different way to describe what they saw. It hadn’t occurred to me that a painting might also be an observation about the experience of meeting that person or space. It would be very interesting to hear from anyone who is involved in the visual arts.

My responses to these exhibitions lead me to reflect on my clinical work. I invariably note my responses to a patient, particularly if it’s a new assessment. I equally try to capture their responses to me and my interventions. So I will often say something like “It seems to me that what might be happening here is …” based on my experience of that person. (Technically this is Transferenceand Counter-Transferencein psychoanalytic jargon.) When I was a Nursing Lecturer I used to interview students who were hoping to do a nurse training. It was a different experience. We met such a range of students wanting to become psychiatric nurses. Some of their responses to a question were memorable. One who stands out was a girl who was asked how she might manage a patient who was dangerously disturbed and potentially violent. (I had a picture of David and Goliath in my mind’s eye.) I had an idea of a range of possible answers. The one she gave stopped me in my tracks. “I would let the love of Jesus pour out of my heart and into his.” I and my colleagues were speechless. How to respond in a “professional” manner? We managed to make a non-comital sound and moved on with the interview. We did not offer this girl a training place. In our feedback we tried to point out that a response about the love of Jesus was fine but it needed to be allied with other responses as well. (At the time her response to the feedback did not suggest she was going to be able to hear what were telling her. I have no idea what happened subsequently.)

Another story also came to mind when thinking about this blog. It too is about a student whom I interviewed. We asked the group to tell us about an experience they had had that had been important in some way. Various stories were given and one student told us about the death of his young son a couple of years ago. “It was painful at the time but we’ve moved on now” was his summary. He appeared unmoved now by this death. He was a Malaysian who had been in the armed forces for several years. We chose not to offer him a place for several reasons, one of which was his seeming lack of awareness of how he portrayed his reactions to the death of his son. We subsequently saw him for a feedback session. I gave him my reasons for our decision but wanted to help him think about what we were saying. After ten minutes with him it became apparent that he was deeply moved by his son’s death but had thought that a display of grief was unmanly. His fantasy was that we expected him to have “got over it” by now, hence his seeming detachedness. We pointed out that as a nurse, if he was going to be effective, he needed to show his patients that he was moved by their distress and difficulties. I hope he took something positive from his interview. He had the potential to become a good nurse.

I cite these two students as examples of my responding not only to what they said, but also to my experience of them. The “Jesus” girl whilst doubtless confident of her ability to allow Jesus’ love to pour out of her heart, came across as naive and unthinking. Her world view seemed simplistic. I am happy to have religious believers become nurses. I am happy to think that a nurse might choose to pray for a patient – albeit in their own time. But spirituality needs to be linked with practical nursing skills. The other student came across as unthinking and uncaring, yet something about my experience of him lead me to explore further and to discover a man who was deeply touched but who thought that he had to appear to be over a difficult and painful event. With time and support I think he could have made a good nurse.  Therapy is a dynamic process. My patients talk to me. I meet them and try to understand my responses to this meeting, given what I know of them and their history. It is often the case that when I comment about how they seem to be responding to me, this opens up new areas for exploration. It also challenges me as the therapist. What is it in me that is responding in a particular way to this person?  It’s why we have supervision and are expected to have our own therapy. Both can be very challenging!

The point i’m hoping to make here is that good psychotherapy goes beyond listening just to my patients words – important though these are. There is in this encounter a going beyond words. One tries to capture the experience of the encounter in such a way as to bring into consciousness material that may be unconscious on both sides. It seems  to me that this is what good artists attempt. Which is why I’ll leave the last “word” to the portrait of Amy Winehouse.

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