“The Delicate Balancing Act of Once-a-Week Treatment”
Ever since joining the New Directions program and feeling freed up to write, I find ideas for writing everywhere. I’ve realized that these ideas don’t have to be profound or earth-shattering, just interesting or novel. I might find an idea in a turn of phrase a supervisee uses, in a movie, in a particularly difficult session, or in some unresolved issue in myself.
“The Delicate Balancing Act of Once-a-Week Treatment” – not initially the title – came about because I was so excited about all the material this once-a-week patient was able to present in this one session. This was, of course, before I knew he was about to terminate and before I realized that my “great” session wasn’t so great after all. When the patient told me he was going to quit I felt sick, thinking, there goes the paper. But during the course of the session in which he announced his immanent departure, I saved my writing idea by deciding that I would write about the benefits and limitations of once-a-week treatment. And that is what I started out to do.
I am never someone who has written with an outline, but I did not realize until this paper how much I used my title as an organizing function and as a way to keep my focus. This paper has had a multitude of titles – Reflections on the Benefits and Limitations of Once-a-Week Treatment, Once a Week Therapy: Can It Be Psychoanalytic?, The Trials and Tribulations of Once-a-Week Therapy – and speaks to my difficulty in formulating my hypothesis. What exactly did I want to say? Saying that once-a-week treatment could be helpful despite its limitations, hardly seemed significant enough to write about. Saying that once-a-week treatment was psychoanalytic led me into excessive theorizing, left me unclear about my own position, and took me far from the clinical example. Discussing the difficulties of once-a-week treatment seemed important, but then I had to be clear about what those difficulties were. My inspiration actually came while I was taking a swimming break from writing. It occurred to me that the difficulty in once-a-week treatment was not that it was un-analytic or insufficiently interpretive, but rather that it could too easily become unsupportive, that the rush to interpret could easily overwhelm the patient. Although I did end up with this as the focal point of my paper, I had meandered so far afield that it took me several more false starts and much reorganizing to return to this main point. There was a lot of material I had to delete – always difficult for a writer or, at least, for me. I still wonder if there is extraneous material in this article and I look forward to feed-back from my New Directions colleagues to assist me in that regard. In the future I know that I need to have a clear idea of both my title and hypothesis. Until I do, I need to jot down thoughts, doodle, sit and think (or swim), but not start writing until I have a fairly good idea of where I am heading.
I will be presenting a condensed form of this article at the International Federation for Psychoanalytic Educators conference. I did not write this paper to present, but rather decided on the paper and then submitted a proposal to IFPE. I have decided to proceed from this direction whenever possible – article first, then presentation. In the past, I would do presentations and not think they were important enough or good enough to be “real” articles. My New Directions writing group has been very helpful in this regard, and I received great reinforcement when I took a presentation I had made, revised it into an article, and had it accepted by The Psychoanalytic Review. I decided that it would be easier to write in article format first and then pare down the material or make it more informal for whatever presentation. For me, however, the most important issue has been to realize that I do have something worthwhile to say even if what I say will not revolutionize psychoanalysis.