A publication of the Washington Baltimore Center for Psychoanalysis

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Threshold Moments

Michael (Micheál) Dowling, PhD
Member, New Directions, Washington Baltimore Center for Psychoanalysis
July 2022 | Volume 8 | Issue 7

A psychoanalytically informed treatment can last for many months or years, yet there are moments in the work that in retrospect serve as markers showing important changes are occurring. Such was the case with Sami, a vigilant and anxious man because of childhood abuse from parents and peers. Now in his early 40s, he was established in a successful career yet lived in dread of being fired at work. Being so on guard made access to his emotions and needs difficult. This was evident in our sessions as well; he could not show me his feelings easily. Therapy seemed to be a relatively safe place for him to talk about many things, yet closeness between us proved a challenge.

About seven months into the treatment, I charged Sami for a session he missed since he gave me no notice. Although he was aware of my cancellation policy, he became quite agitated, insisted it was not fair and declared that the therapy was not really important to him. At the following session, he apologized and cited his variable mood and ongoing stressors at work and home. After more discussion, I mentioned that he seemed to have experienced my charging him for the session as an attack. He was visibly relieved, and said he felt understood. We were able to continue to talk about how in that moment it felt to him that I was being abusive, like in his childhood. Over the next few weeks, Sami became more aware that he frequently defaulted to feeling under attack, without pausing and reflecting. He came to realize that there was usually relevant data that he had overlooked. In his lived experience with me, Sami came to realize that current relationships didn’t need to be jeopardized because of an outlook formed by early abuse.

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