By C. Girvani Leerer, Ph.D.
On Sunday, March 6, 2005, Dr. Richard Kluft conducted a Master Class entitled “Listening to the Dissociative Patient” attended by 19 NESTTD members interested in deepening our understanding of clinical material underlying the verbalizations of our dissociative patients.
Dr. Kluft began by presenting brief overviews of the Dissociative Surface, Luborsky’s Core Conflictual Relationship Themes (1976) and Robert Langs Communcative Fields (1981) as ways of understanding patients’ verbalizations. These were presented quite quickly to allow plenty of time to consider the verbatim material brought in by Dr. Kluft and two brave NESTTD members who presented clinical material.
Going over this clinical material was incredibly rich. Dr. Kluft pointed out the importance of the therapist’s attunement to the Third Reality of ongoing abuse reenactments inside the patient’s mind that can manifest in sensory hallucinations that an abuser is present or that abuse is currently occurring to the patient. He talked about how reassuring patients that our offices are “safe” misses the patient’s internal experience of the Third Reality. I found myself thinking of the many times that I have tried to ground patients while missing this internal reality by not fully understanding the internal experience of the part of mind I was talking to, or fully checking out that the part is really oriented to being in the present in my office. The Master Class definitely increased my awareness and attunement to the quadruple levels of reality -- the patient’s external world as well as their internal world of the third reality and co-presence of other alters; the transference-countertransference field between myself and the patient; and my own internal reality of my parts -- in each interaction.
Kluft also focused our attention on the many subtleties of the language we use with patients and cautioned the women in the group to not forget that the role of the abusive male can be projected onto us. He reminded us that all words are potential intrusions or penetrations and therefore may be regarded as abuse. For example, he noted that statements in which we invite patients to “go inside” or “open yourself to” (feelings or experiences) can be experienced as symbolic penetrations, and suggested using language such as “notice,” “turn your attention to,” “let’s wonder together about that.” In another example, he responded to a question about asking a patient to “try something” as suggestive of experimentation and therefore abuse because experimentation may be regarded as not for the patient’s benefit, but rather because the therapist wants the patient to try an approach or technique.
Kluft also sensitized us to not leading our patients in ways that could be construed as producing “false memories.” For example, when dealing with a patient who identifies a tightness or feeling that something is in their throat, rather than asking the patient to “Allow whatever is lodged in there to come out” thereby agreeing or suggesting something is/was lodged in the throat, it is better to ask the patient to “does any part of mind want to say more about that feeling” or to ask her/him to focus on “when you notice that sensation.”
Kari Gleiser, who presented clinical material in the Master Class, shared “I was so grateful for the opportunity to present the tape and hear everyone's feedback. The depth and various dimensions of understanding offered, not just by Kluft but by all present, were so sophisticated and illuminating. I walked away feeling that I had taken in so much from that hour, and wishing for more!” Based on how difficult it was to end the Master Class, it seemed everyone present wished for more and were enriched by the experience!