Conversing With Uncertainty: Practicing Psychotherapy in A Hospital Setting

173 Pages·1992·2.811 MB·English

by  Rita Wiley McCleary, Glen O. Gabbard, Stephen A. Mitchell

CONVERSING WITH UNCERTAINTY
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Relational Perspectives Book Series
Stephen A. Mitchell, Series Editor
Volume 1
Rita Wiley McCleary
Conversing with Uncertainty:
Practicing Psychotherapy in a Hospital Setting
In Preparation
Lewis Aron
Interpretation and Subjectivity
Emmanuel Ghent
Process and Paradox
Charles Spezzano
Affects and Therapeutic Action
Donnel Stern
Unformulated Experience
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Rita Wiley McCleary
CONVERSING WITH UNCERTAINTY
Practicing Psychotherapy in a Hospital Setting
with a
Foreword by Stephen A. Mitchell
and an
Afterword by Glen O. Gabbard
THE ANALYTIC PRESS
1992 Hillsdale, NJ London
Copyrighted Material
Copyright © 1992 by The Analytic Press, Inc.
All rights reserved. No part of this book may be reproduced in any form, by
photostat, microform, retrieval system, or any other means without prior
written permission of the publisher.
Published by The Analytic Press, Inc.
365 Broadway, Hillsdale, NJ 07642
Set in Korinna by Lind Graphics, Inc., Upper Saddle River, NJ
Library of Congress Cataloging-in-Publication Data
McCleary, Rita Wiley.
Conversing with uncertainty : practicing psychotherapy in a
hospital setting/Rita Wiley McCleary, with a foreword by Stephen
A. Mitchell and an afterword by Glen O. Gabbard.
p. cm.—Relational Perspectives Book Series ; v. 1
Includes bibliographical references and index.
ISBN 0-88163-148-5
1. Psychotherapy—Case studies. 2. Psychiatric hospital care—
Case studies. 3. Psychotherapist and patient—Case studies.
4. Psychotherapy — Philosophy. 5. McCleary, Rita Wiley.
6. Psychotherapy. 1. Title.
[DNLM: 1. Inpatients — psychology. WM 420 M478c]
RC465.M39 1992
616.89'14— dc20
DNLM/DLC
for Library of Congress 92-17730
CIP
Printed in United States of America
10 9 8 7 6 5 4 3 21
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To my parents, Dick and Francesca
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ACKNOWLEDGMENTS
In Educating the Reflective Practitioner, Donald Schön (1987) argued
that "the paradox of learning a really new competence is this: that a
student cannot at first understand what he needs to learn, can learn
it only by educating himself, and can educate himself only by
beginning to do what he does not yet understand" (p. 93). While in
many respects Schön's depiction of learning-in-action inspired the
following case study, I think that here he overstates his point. To
agree that I could learn to be a good psychotherapist only through
my own practicing is not to detract in the slightest from the indis
pensable support, guidance, and constructive criticism from others
that 1 gratefully received, depended on, and used.
My first thanks goes to Kay, the adolescent inpatient who tolerated
my often clumsy efforts to be her psychotherapist and whose talking
back yielded insights into how I was treating her that I could never
have gained from a textbook. For all her very real difficulties in living,
I remember her intelligence, humor, and admirable—if, at times,
exasperating—stubbomess. Kay and I were both lucky to find our
selves on an adolescent unit at State Psychiatric Hospital. By their
example, clinical staff members taught me the value of team work in
a hospital setting and positively contributed to Kay's treatment.
At the Chicago School of Professional Psychology, where this
book germinated as a dissertation, Dennis McCaughan, my advisor,
lent me his remarkable capacity to make sense of problematic
vii
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viii Acknowledgments
materials and shape them into a reflective case study. He balanced
his strong commitment to psychoanalytic inquiry with an equally
deep appreciation for new and often unexpected ways of under
standing. His love of ideas never lost touch with the complex
situations that my own ideas attempted to approximate. Very rarely
in my many years as a student did I have the good fortune to study
with someone at once so talented and generous.
Other colleagues and de facto advisors whose comments and
encouragement have helped me include Margaret Browning, Kirsten
Dahl, Lynn Reiser, Donna Robinson, David Smigelskis, Herb Wein
stein, and Lee Weiss. I owe special thanks to Richard Davis for his
uncomplaining willingness to read and respond to innumerable
drafts, and whose unflagging confidence in the project sustained me
during those long hours of figuring out what I was trying to say.
I felt honored when The Analytic Press accepted my book for
publication and was subsequently awed by the editors' generosity.
Paul Stepansky, Editor-in-Chief, always made himself available as
both a sounding board and source of complementary ideas that
sparked my own. Similarly, John Kerr, who read both the initial and
final drafts, provided stimulating and astute comments. Without
Eleanor Starke Kobrin, TAP's Managing Editor, the book would
never have seen the light of day. She coached me in the finer points
of Wordstar and gently assured me that I, like other new authors,
could surely compile an index.
Last but not least, I want to extend special thanks to Merton Gill.
Often as I struggled through the writing of this case, I thought of it as
a psychoanalysis of my ideas. The confidence and stamina required
to persist in such often disheartening self-scrutiny would not have
been possible without his patience, wisdom, and example.
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CONTENTS
FOREWORD—Stephen A. Mitchell xi
— 1 — FIRST WORDS 1
— 2 — NOISY WORDS 13
— 3 — CONFLICTING WORDS 39
— 4 — MAGIC WORDS 59
— 5 — SHARED WORDS 78
— 6 — CONVERSATION 111
REFERENCES 133
AFTERWORD—Glen O. Gabbard 137
INDEX 151
ix
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