Chapter 51 Section 11 Stubborn Gender Roles

In the above case, the patient made a symbolic sexual obscenity, which caused the psychiatrist to flee.What would happen if the patient really made sexual obscenities?In a class discussion, Joan, a female intern, shared an interesting case of hers. I made him masturbate in the consulting room "Peter is a homosexual and always declares that he is not interested in women, but recently I found that every time he sat a little closer to me than the last time." Joan expressed her doubts.As a result, other students in the class expressed their opinions. "This shows that he has a good impression of you. Good impression is the basis of psychotherapy."

"You have to set a boundary so he doesn't push himself." "Did you point out to him that he was approaching you, and explore the psychological significance of that approach?" "The gradual approach to a woman shows that his stubborn gender role positioning has loosened." Joan said that she is somewhat aware of what everyone just said, but in fact, she has always adhered to the "patient-centered theory" of the humanistic school, that is, to give unconditional positive affirmation to patients' demands. "Then you will allow him to push his feet?"

"Yes! Between the unreasonable demands of patients and the unconditional respect for patients, I do feel a serious conflict. In fact, my indulgence to patients has reached my bottom line." Joan said very frankly her confusion. "So what is your bottom line?" Everyone seems to be interested in this question. "He made a request to me one day that he wanted to masturbate in my consulting room." "You fulfilled his request?" "At the time, I was really embarrassed by his request, but I stayed true to my patient-centricity, and I walked away for a moment and let him do that."

Joan's case is very interesting.In the conventional sense, Joan's approach is too conniving and loses the position that a psychiatrist should have.But in the sense of complete respect for patients, such an approach does create an extremely loose space for self-remodeling for patients.For a patient with extreme low self-esteem, when his most absurd demands are properly satisfied, the germ of his self-confidence begins the first step of courageous growth. Joan's case was on the razor's edge.The intensity and timing of the process are carefully controlled, and for some vulnerable and sensitive patients, there is a basic sense of security in exploring their psychopathology.But if the control of the razor is not perfect, then this razor will hurt the patient and the therapist himself.

In the eyes of psychoanalysts, Joan's approach cannot be simply measured by moral standards. More importantly, as a psychologist, you must always keep a clear mind about what you are doing. There are many layers of meaning behind Joan's approach, such as: I dare not refuse the patient's aggressive request. In my subconscious, do I have the anxiety of being abandoned by others because of refusing their request?Even, is there a masochistic tendency in my subconscious that likes to accept the patient's aggressive demands? I don't want to refuse the patient's aggressive request, because the patient's aggressive request produces a faint pleasure in my heart. Do I have the same desire to masturbate in other people's offices in my subconscious?

I couldn't bear to refuse the patient's aggressive request, because this poor child aroused a kind of maternal care in me. Do I have the same desire for maternal care in my subconscious? As can be seen from the above two examples, psychologists can have completely different reactions to patients' sexual behavior.Leon made a symbolic sexually obscene gesture to his therapist in the consulting room, which ended up scaring his therapist away.And Peter actually got his psychiatrist's consent after making his apparently excessive masturbation request.So, curious readers will ask, is it possible that the patient took off his pants in the consulting room?

Generally speaking, it is absolutely unacceptable for patients to take off their pants in the consulting room. This is the ethical basis for the existence of psychotherapy.If this bottom line cannot be kept, psychotherapy has no legitimacy in our ethical society.But what if something like that actually happened on extremely rare occasions?The answer is yes.In fact, I have encountered such embarrassing things. Wow!This pervert Zhang Yuanxia actually asked his patient to take off his pants in the consultation room.Once such a notoriety spreads all over the world, it is a small matter that damages my personal reputation and the reputation of the entire psychotherapy industry. I cannot bear it.Therefore, readers, before reading the following story, I hope not to take it out of context.

I once heard a woman say this philosophical statement: "A woman can reveal her all to two men." If the sentence were to stop there, the poor husband would be furious and sleepless: "I know that one of the men is me, so who is the other? If you don't tell me, I will never end with you." The philosophical woman smiled and said, "That's my doctor." There is no doubt that a woman can reveal herself to a male gynecologist, and although she may not want to, she usually has no choice.Although a psychiatrist is also called a doctor, he has no right to make patients take off their pants in the consulting room.When that happens, it is usually an irrational phenomenon that occurs when a severely psychotic person loses rational control of the ego.

I encountered that irrationality one day in the psychiatric ward of a hospital in Chicago.I was rotated into "social rehabilitation group therapy", which is mainly for the severely mentally ill.Every morning at 9 o'clock, when other group therapy has already started, I am still busy going to various wards to invite my patients to receive my group therapy.Most often, people who can't be found in bed can be found under the bed, and the bathroom is often their escape from group therapy.I can't go to the bathroom to ask them, so I can only wait quietly at the door for my patients to come out, and then catch them.

My group therapy business is usually poor, with five or six people at my peak, and sometimes not even one.When there were no patients on a certain day, I sat alone in the patient activity hall, my eyes were staring, like a psychopath. The story I am going to tell happened on a day when there was only one patient.With great difficulty, I got my patient baby up from the corner. He was wearing a long brown-red nightgown and sat in front of me, with two shining white eyes looking at me.I suddenly felt a bit of a trance in my sense of reality, which is an occasional psychological feeling when dealing with severely mentally ill patients, but I tried to start group therapy with only one patient.