This is one of my favorite books. It’s multilayered sensitively almost poetically written. Raw and beautiful.
I will try my best to do a straightforward review and not go into all different tangents. I’ve had to start the post over again to try and do this!
Note: this story is about Psychotherapy, obvious from the title. The psychotherapy explored is most definitely psychoanalytic, , analysis and psychoanalytic play therapy. This therapy holds a couple of beliefs. One is that there are always unconscious thoughts, feelings, fantasies, and dreams playing a part in both the therapist and the client. The client therapist interactions are very important. And analyzing them, to the smallest details yields a lot of information about progress, areas that are still difficult ETC. Standard psychotherapy of this type believes that the clients feelings, conscious and unconscious about the therapist are hugely important. They do give credit to the therapist having these same reactions to their clients but it is so often intellectualized and effort is made to push these to the side. The core of this book challenges this assumption.
For those who dislike this form of therapy I’d stop reading. If it sounds confusing I’m really sorry it’s been a few years since I’ve been in school! Though Lesley university isn’t by nature a psychodynamic (modern term for psychoanalytic) leaning school, several of my really good professors are firmly rooted in it’s practice. As am I. I believe it really is a gift for the therapist and the client, to have the courage to explore their inner lives in this way.
At the start of the book Annie is twenty seven. She is entering her year long doctoral internship. She will be working at Glenwood in Chicago, a day treatment and residential school for children with various mental illness. Five year old Ben is her first client. Ben is at Glenwood because his adoptive parents are truly at a loss. His first 18 months of life are mostly a mystery only that he had two traumatic hospitalizations, and was abandoned by his first foster family. The first year of life is the most critical stage of development. If things go really wrong it takes a lot to heal. Ben is lucky that he has very committed parents. They’ve put up with his screaming, self-injuring behavior his inability to attach. He’s had various diagnosis in his five short years: autistic, attachment disorder, oppositional. But no one is really sure.
Annie believes that the very beginning of therapy the first session will often bring at least some of the main themes of the whole work to be done. Ben is tense and easily frustrated. When Annie doesn’t initiate anything (waiting for the client to start is important,) he roughly pulls toys off the shelves and throws them around. His play is disjointed showing different scenes all full of danger, such as fires or being left alone at night, being in the hospital. He enlists Annie to play the mother figure a huge theme in his play. At the end of the session she lightly touches Ben’s arm and he pulls away and runs off.
Annie has much time to reflect on these sessions and the pattern of the book illustrates this. The session takes place and then is gone over again with a very psychoanalytic fine toothed comb. Exploring the depts. Of comments made, by Ben and Annie, actions taken and what drives these actions. Big themes for Ben are exploring his need for control, as though he tries to control others through his aggressive behavior he really is out of control. His insistence that he never can get hurt. His abandonment, something that he has no conscious idea of but that drives all his challenges.
Not only does Annie write up these reflections in note form, as well as have the sessions audio recorded, she sees two supervisors. Mary Louise who works at Glenwood, and Rachel who is in private practice at an analytic institute.
Annie shows herself to be a very compassionate and intuitive therapist. Her whole self is tuned to the responses of Ben. Every move and sound and facial expression. As well as her own inner responses. She listens to what is being said as well as not said. She has gained through her training a fair knowledge about interpretations. She is extremely careful not to mold Ben’s experiences to fit these theories. But to be open to what’s happening in the moment. She feels and is right, that other coleagues don’t value this as much as they might.
Sessions pass. Ben gets to know Annie. They work inside and outside. Often the most important pieces of play take place outside. As Ben often takes the “boss” role in the play. A mama and baby bear theme emerges which is played out in order to help explore this issue. Inside art materials are used. Ben in realizing that this place is the one place where he can totally be himself, sees Annie as magic. He makes himself into many magical creatures and this act of costume making reveals Ben’s ability to cooperate take turns and be in relationship with another person.As a note, Annie is not structuring or influenceing these activities for some planned goal. She only sets limets if Ben is going to hurt himself or others. It’s in these limits Ben learns to experiment with the depth of his feelings, thoughts and impulses while being witnessed, and responded to but never in a hurtful or constraining way.
In mid November things do intensify for Ben to the point he needs to be restrained. Annie does this sustaining several bites and bruises. It is at this point we get a glimpse into some memories and nightmares that Annie is having, some paintings of herself and inner others? It’s murky at first and almost not even noticeable as Annie starts to be truly affected by the material brought into the therapy.
Sessions continue things are going very well. Annie is feeling slightly off. Colors seem too bright, often she can’t really remember large chunks of the day. She’s often not able to sleep at night or if she is has horrible nightmares. She tries very hard to not let this push itself into her daytime world. She feels not whole, like she has one life as a student and intern and another life as someone with a lot going on that she doesn’t want to face.
In one snatch of a therapy session with Melanie, her therapist, it comes out that she feels Melanie will only respond to her if she fits her experiences into what Melanie thinks she should feel or think. It is only a short conversation but soon it becomes the core issue
Things reach a head. And about halfway through the book Annie is thrown into a frightening world of psychosis and dissociation. She spends weeks in and out of reality in a psych hospital. Journal entries filled with snatches of dreams memories, third person others commenting on her thoughts. She becomes lucid enough to refuse electroshock and the state hospital at the last moment. Eventually she is discharged and warned by the psychiatrist not to go back to therapy. That what she has will only go away with medication and time.
She lives at a friends house for a few weeks. And quickly feels no choice but to throw away the medicine and step into psychoanalysis. Terrified, shattered, can hardly form sentences at first. She is welcomed by an unconventional psychotherapist named Sam Blumenfeld. Annie comes to just call him Blumenffeled. The beginning as stated being incredibly important Annie feels frozen unable to even speak for the first couple of days of therapy. She’s say an ocassional sentence trying to find a way to start a story about the shattering of her last therapy relationship but she is too overwhelmed. Then one day she does start to tell. About how her own therapist, once a student, came to her as a mother figure first. Really wanting to fill Annie’s deep unmet needs. Really wanting to learn from Annie even write a book with her. As time went on she became more distant, more bobbed down by clinical training. Until Annie does not recognize her. Is told that somehow she manipulated Melanie to do the things outside the boundaries of psychotherapy, like wanting to go to her house. Rather than looking at her own reactions Melanie forced her own fantasies on her. This broke Annie. No one was physically hurt but the last time they saw each other was horribly, well just horrible. It took Annie a long long time to realize what went on. How Melanie messed up b asically, and how she lead Annie to what happened in many ways. With Blumenfeld by her side Annie dives deeply into her inner self.
Dreams and memories jumbled by the dissociative episode and psychosis come back again each time more detailed. They reveal severe physical and sexual abuse by both her parents. They also reveal an inner cast of others that contain memory, sensation and gifts that Annie does not have access to. When Annie Loses time Galle, Emily, Erin, and Margaret Mary take over. Telosporus, a guardian angel of Annies is ever present. Incredibly with all this revealing and processing of trauma Annie is able to go back to work again. And finish the work with Ben. And that’s where the two stories start to intersect. Annie shows great vulnerability in giving access to how Ben’s issues connect with hers. And how in playing out different core scenes with Ben some things get completed for her, and of course Ben is a much different child by the end! I’ve never seen it put so well, the experience of therapist and client and the real potential for great harm, and great healing to take place.
As I said the book is multilayered, poetic and full of hidden meanings. I feel like I could write forever and probably miss something. If any of this makes you curious I’d say read it. Annie is a great writer. She’s written another book on trauma. After she left that internship she worked in Cambridge MA, with Carol Gilligan a famous psychologist on women and girls in therapy.