“Mr. Robot” - Christa Gordan
Consultation #1
I taught Christa in a seminar at a psychoanalytic institute two years ago. She is a psychiatrist newly in private practice, and wants a combination of psychiatry and psychotherapy patients in her practice. Elliot, a young adult cisgender male patient, self-referred to Christa, having suffered from diagnosed delusions and seeking a therapist who could prescribe his meds. They have been meeting for approximately a year.
“So remind me why you wanted to meet.”
“I’ve been working with Elliot for a while and I feel like I’m not getting anywhere with him.”
“What is it like being in the room with him?”
“Well, he’s very polite. And quiet.”
“What does it feel like for you being there with him?”
“Hmm. He’s a little bit unnerving. He pauses a lot. Well, actually stops. Almost freezes.”
“How long are the “stops”?”
“The can be for several minutes.”
“Does he often start up as if he hadn’t paused? Finish the thought, or sentence, or paragraph?”
“Yes! That’s what’s unnerving. Like he paused the video, then starts back up.”
“What about eye contact?”
“He looks at me at the beginning and ending of each hour, and if I speak to him directly he’ll look up, but he doesn’t initiate it. Actually, the unnerving part is when he holds my gaze while he’s talking.”
“Have you tried playing around with your gaze? To see what he’s most responsive to? With paranoia, the eyes are the most dangerous thing. They can penetrate you, almost concretely. They can peer in, like look into the cavity of the mind. They can scoop out, scoop out the thoughts and take them away. ‘The eyes are the windows to the soul.’
It’s important you give him some control over eye contact. I had a patient who didn’t look me in the eye for three years. But she finally chose to, and it really was like looking into her soul. She knew I wasn’t dangerous to her by that time. Mind you, it’s not like we make a great deal of eye contact 5 years later, but when we do I know that something special is occurring.
If you look softly in his direction, catching him mostly in your peripheral vision, you might find that he talks more.”
Probably the pauses are conversations with himself or with hallucinated voices. It could be either, it could be both. If you watch his expressions and can perceive a shift, you might try just noting that you perceived a shift. See if he takes it up and fills you in.”
“I call his attention to it. Say his name and tell him he has stopped talking.”
“How does he respond?”
“He usually just says, ‘oh’, or ‘I didn’t realize’ or ‘sorry.’ “And what does it feel like when he makes those comments.” “It feels rather frustrating.”
“You run the risk of him feeling like you are trying to control him. Then he’ll be more likely to lie about what is going on. Probably the single most important thing is to let him have control over the gas, the break and the steering wheel. You just get to ask what’s out the window now and again.”
Why don’t you take some notes after your next session and I can see if I can provide any more insight.
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