Bridges to Our Patients’ Selves, to Our Selves
and to Each Other
By Marian Margulies, Ph.D.
Bridging darkness and despair with light and repair.
The topic of trauma and dissociation, the theme of
this year’s Retreat, was compelling for me. In my work with parents and their infants and children, in foster care,
I see the effects of trauma and dissociation daily. For this vulnerable group of individuals who enter my consulting room,
I find that an important part of the healing process is my presence and my willingness to listen. We need to hear our patients’
stories, whether an adult tells it in words, or a child brushes it with paint on paper, or positions fierce toy animals to
attack families who are then left with feelings of desolation. We need to hold and contain the unspeakable, inchoate fragments
of painful affects that may lie just beneath or way below the surface. And we need to give time, to allow our patient’s
story to unfold at a pace that feels comfortable and safe so that in the telling it slowly grows more coherent. We knit together,
strand by strand, the different threads of our patient’s life, past and present, sadness, disappointment, and longing,
anger, fear and shame. Interwoven are also threads of hope, delight, and courage. We hold one needle, the patient the other,
or the patient holds both needles, handing them back to us now and then only to undo a tangle here or a knot there, while
gently providing encouragement to continue.
And when darkness descends, we help hold a candle so the patient can
walk through the tunnel that is deep and dark, guided by this light. Inevitably, we make mistakes. But these clinical errors
often spark the therapeutic process. Take the parentinfant relationship and all that we’ve learned in the last decades
about what is most important for babies to thrive. Parents misread cues, over-stimulate their babies, respond too quickly
or slowly, or not at all. Much is gained when a parent adjusts her response so it is more sensitive and attuned to her baby’s
needs than before. The baby feels disappointment and anger, but this is short-lived. A bridge gets mended and the relationship
survives (even thrives), in spite of these missteps. These ruptures, when repaired, lead to a relationship that is more attuned
and fine-tuned, teaching us a valuable lesson: we are human and we err, but we also can make up and move on in our everyday
relationships and in our more intimate ones. here is a phrase that comes to mind when I think of dissociated selfstates in
our patients and in ourselves. I was well into a year of authentic movement a year ago, when my “witness” and
teacher told me to welcome all those unsavory aspects of myself in for a cup of tea. This notion has its origins in Zen teachings
(dialoguing with Mara) and in Hasidic lore (tales of the Rebbi of Bereditchev). Rather than rid myself of former ways of being
that I no longer felt comfortable with, she encouraged me to embrace them, to get to know them better and understand why they
played an essential art in my life up to that point in time. I found this notion of acceptance of all my parts held up to
an honest mirror, both comforting and healing. An acceptance of, a curiosity about, and an empathy for, our patients’
many different self states is a gift we as therapists can give. It may be the first time in their lives that these other selves
are allowed in and given the respect, time, patience, and caring they deserve. Not having been given this opportunity as children
to learn to value and honor these essential parts of themselves, to learn self care by being cared for fully, lovingly and
unconditionally early on, our patients need our help to get in touch with, give voice to, and integrate these other self states.
We, as therapists, have a special responsibility to take on this task and to do it in the most caring and careful way possible.
Given its daunting nature, it is important that we take time to consult with others when we reach an impasse, join a peer
supervision group, attend retreats, take relevant workshops and carve out time to take care of ourselves, for ourselves and
for our patients who also benefit from this emotional refueling.
One of the hardest things to do is sit with uncertainty.
We can make the conscious decision to live with it and be with it. We can even engage in a creative dialogue with it. We need
to let the therapeutic process unfold in its own natural time, following our patient’s pace, and being there every step
of the way. This is very hard in an era when quick fixes are sought, and pressure to meet treatment goals rapidly is high-sometimes
in ten sessions or less! There is also the task of holding our patient’s pain, while experiencing it vicariously. We
need to allow ourselves the freedom to feel all that we might-discomfort, fear, anger, shamewhatever feelings that get aroused
in the course of our work. So, not only must we hold our patients and contain their painful affects, but we must holdourselves
too, and explore the dissociated parts of ourselves that might feelinvite these parts in and in so doing learn something important
about ourselves, some of our own work yet to be done. By joining our patients on their journey to recover those dissociated
self states and engage them in dialogue, we help our patients to grow as individuals. In the process, we grow ourselves.
Bridging with lightness and laughter
This brings me to thoughts of dance, music, and play, the part of
the Retreat that provided a welcome respite from the weighty topic of trauma and dissociation. The capacity of our community
to play is one that Winnicott would have admired, I am sure. Laughter is certainly the most costeffective in today’s
economy-and Rob and Marty provided us with plenty of that in their warm and witty skit. The music of the bands of Ken B. and
Al F. made it easy to play. And what better way than to dance, as many of us did to the lively blues music. In fact, dancing,
be it solo, with a partner or within a circle, made me think of bridges. When dancing alone, we connect to the music bringing
one’s own rhythm and unique dance style to the dance floor. When dancing with a partner, we take it to another level,
adjusting our rhythms and body movements to our partner’s. To many, it seems risky to dance with another, never quite
knowing how connected we will feel-maybe
we’ll step on their toes or they on ours. But it is well worth the risk.
In dance and in the work we do as therapists, we build bridges that help us feel more alive and more in touch, with ourselves
and with each other.
Bridge to friendships
I attended this year’s Retreat with a mixture of trepidation
and excitement. Trepidation, because it was my first time; excitement because I love to try new things, once I’ve put
my fear of the unknown behind me. I left with the
wonderful feeling of having found my own bridge to the community of
WCSPP and newly formed friendships, each with their own promising bridge.