Beginning to draft a therapeutic contract
Mark is paralyzed, devitalized and I feel powerless. I realize now that if I try to push it towards what I consider a healthy direction, it would be counterproductive. Mark would probably feel even more controlled and dominated and still do not figure out a way out from the cage he lives in. It is therefore necessary to try and have Mark commit himself to doing something in order to live a different live and eventually overcome depression. My awareness of these needed passages, is a first step towards an explicit formulation of the therapeutic contract.
T: “Mark, I listen to your stories, you kind of live always the same day, and this is just frustrating. I would like to help you find a way out, but I have a sense of pushing you to do something to get out of it almost against your will. If this is the case, I’m making a mistake ”.
M: “Yes, I know. I’ve always been sick. I told you! Can’t see any solution ”.
T: “Yes, I know, but… in order to support or help you get somewhere I have first to understand what is the direction you would like to follow, I can’t fortune-tell it on my own. What do you think about it?
M: “I… I don’t know… sounds useless… nothing ever changes…
T: “I imagine, you’ve been down for ages. Of course you are discouraged! But I am confident that if we connect with that part of you that wants to change the course of your life, and we know it exists, that could help us finding a way ”.
M: “Ok, let’s see what you propose” (in this passage Mark is not sarcastic anymore, he is really curious about my ideas).
T: “You told me that you would like to have an aperitif with your colleagues, go to clubs that often play live music in the evening. What do you think if we get ready to do something?
M: “I could ask a colleague of mine if he wants to have dinner together on Friday evening ”.
T: “Excellent. So you try? And we will see together what will happen.
Even if it looks like we have a real agreement, I still have to make sure that Mark does not covertly see me as dominant or controlling. So, I explore that with focused questions:
T: ”One last thing, Mark. How do you see me right now while I’m asking you to really try and invite a colleague for a dinner? Or while I insisted that new action is necessary in order to change?
M: “HmmYou tell me to do things, like everyone else… but at least you’re telling me that I can choose or at least that we can think together. How to say… you are not really forcing me.
T: “Oh, good. Well, this is ok, but if in some moments you have the idea I am giving you kind of orders… just let me know, it will help us.
In the first passages we can trace what the reasons were, for lack of agreement on objectives and tasks, coherently with what was anticipated in the introduction: 1) Mark was focused on others, including the therapist, and dwelt on feelings of envy and contempt, instead to focus on the problems he had; 2) Mark was completely distant from his desires for him: he no longer even knew what he liked to do, he was only attracted by the desire to redeem himself in society so as not to lose in comparison with others; 3) Mark believed that his well-being depended on events and not on his actions, thus remaining a spectator of himself and often feeling depressed and understimulated. I had to understand if Mark wanted to work on these aspects, in the direction of what we were understanding to be fundamental for him: the freedom to explore freely. Mark wanted to revitalize himself but I couldn’t give him any indications, to preserve our relationship and not be yet another person who imposes himself on him. he should have started acting himself but did he want to? Also, did Mark want to get in touch with the pleasure that can come from doing activities for the sheer fun of it? above all, Mark wanted to get in touch that the emotions that he always tried to push away?