Academic journal article Journal of Cognitive Psychotherapy

The Postmodern Self in Psychotherapy

Academic journal article Journal of Cognitive Psychotherapy

The Postmodern Self in Psychotherapy

Article excerpt

The complexities involved in encountering and counseling the "postmodern" self in psychotherapy are illustrated via a single session with a client whose self-presentation and in-session behavior were unusual and perplexing. No conclusions are offered.

One of the many lessons of practicing psychotherapy seems to be that no two clients are ever alike, and at the same time there are undeniable patterns and parallels in the persons and circumstances that are presented for consultation. These points were brought home to me recently by the case of a middle-aged man who was unique in his self-presentation and yet eerily similar to other individuals I have counseled over the past two decades. A request to review a book for this journal brought these paradoxical elements into clear relief. The case I describe below is, of course, a fictional reconstruction, but I believe it conveys some of the complexities we face as contemporary therapists on a rapidly-changing postmodern planet.

Paul W. was a 53-year-old business executive when he first contacted me requesting psychological services. His presenting complaint was vague: "a need to talk to somebody." When I asked if he could elaborate, he said "I am struggling with the relationship between love and life." In our phone conversation, Paul informed me that he had been referred by a close friend who had met me at a conference. His English was impeccable, but he spoke with a heavy French accent. Paul said that he was not asking for a place as a client in my ongoing private practice because he did not live in my geographic area. However, he was "traveling through" and wanted a one-session consultation that might include my recommending a therapist near his home. I agreed to see him later that day for a referral consultation.

Paul appeared for our session ten minutes early, smelling subtly of a European cologne, dressed in a Mediterranean suit, and carrying a leather shoulder bag. He was an energetic man of average height and athletic build, with blonde hair and a meticulous suntan. His enunciation was clear, his voice was well-modulated, and he did not hesitate to make eye contact. I noticed my own reactions to his presence as he headed directly for the couch in my office (an easy chair was also available) and kicked off his shoes. It was not clear whether he had come to work or play, but it was clear that he had jumped in feet first. He did not lie down at first, but he loosened his tie with a flair bordering on the theatrical, unbuttoned his starched collar, and unleashed a petite pot belly from behind the last two buttons of his vest.

I was thrown momentarily off balance. Although I have never seen a "typical client" (a phrase that belies self-contradiction to my inchoate understanding of psychotherapy), it was clear that Paul was going to stretch me.

"Can I start?" He asked. His tone was soft but imploring. I half winced at the hint of impatience for me to regain my composure and get on with "the work," and some invisible referee reminded me that projection was more than a visual aid.

"Of course," I said. Then, awkwardly, I handed him a thin book on which I hurriedly balanced a pen and a copy of my Client Consent Form. "Would you mind signing this first?" I felt strangely embarrassed. The feeling image that came to mind did not help me to regain my center: that of a heart surgeon suddenly realizing that he was picking his nose in public. I hid my embarrassment in silence as he looked at the form.

He signed it with gusto and then, beginning the motions of handing it back, interrupted his movement and lifted the form in order to see the title and cover of the book that had served as a momentary lap desk. It was titled Islands of the West (Lanting & Stegner, 1985) and had been a gift from my wife in honor of my unfinished first novel. Paul opened the cover and read the inscription from her. "An aspiring novelist, huh?" Although his tone was neither offensive nor derisive, his question felt intrusive and challenging. …

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