Thursday, May 2, 2013

A transference dream

A patient of mine who has been with me for more than two decades and treats me with great familiarity and friendliness, came for his biweekly session and said I had this hilarious dream from which I woke up laughing, because it is something that could never happen in real life.

The dream is about you. I come to the office at our usual time. But the location of your office has changed. It is not this old ranch building - not that anything is wrong with it, I love your place -  but  a magnificent high rise, all glass and beautiful. The staff has changed too. They are young, spiffy and professionally dressed, not like how your staff dresses so casually.  But what is funny is that they are not one bit friendly.  In fact they are nasty and hostile. They ask me who I was, and do I really have an appointment. I tell them what are you talking. I have been seeing Dr. Kelwala for 22 years, and you all should know I come here every other Friday at 11 or 11.30 am. 

I at once knew that it was an expression of hostility towards me that was being "projected" into my being hostile towards him though I was being represented by my staff.

When I told the patient that perhaps behind accusing my staff as being nasty and hostile it is me who he is accusing of being nasty and hostile, he said that that is impossible for he respects me too much. Then he suddenly remembered another section of the dream which confirmed that the interpretation was in the ballpark.  

"A part of the dream that I had forgotten now comes back to me. While I am being blown off by your staff you come out of your office and say that my appointment is at 8.30 pm. And I woke up laughing aloud as to how you could be so ridiculous, for you never see patients that late in the evening. 

"That I don't even know as to what time I see my patients, is it an expression of contempt ?" I asked him.

The patient protested that in no way he can be contemptuous towards me for he respects me too much but then immediately confirmed the accuracy of the interpretation by stating that recently he has been talking big-time in his sleep, and waking out out of his dreams laughing. For example the other day "I woke out of a dream laughing because I was calling my Dad you son-of-a-bitch, you crazy man. Which is  surprising for I never ever said anything like that to him when he was alive."

"Calling your father son-of-a-bitch and telling me that I don't even know the timing of my own office hours appear to have the same origin: contempt for authority/father figures. Where is the contempt coming from?"

"I dreamt the dream this morning, a few hours before coming for the therapy session. Around 8.30 a.m to be exact for I looked at the clock on waking out of the dream. I had run out of my Suboxone and Xanax couple of days ago, because I had been taking them more than the prescribed dosage. I was withdrawing and feeling nasty and could not wait for 11.30 to arrive when I could see you and get new prescriptions. Then I dozed off and had the dream. Now you know how you get mad when I take too much of these medicines and have at times refused to refill them or told your staff to not call them in if I have demanded them on phone if they are not due. So I always have this fear when I take too much of these medications that you will not refill the prescriptions or the appointment will get cancelled or you will fill them but not right away."

So his fear of that I may not refill his prescriptions which will prolong his withdrawal symptoms was making him think of all kinds of insulting thoughts towards me.

"Why the building was tall and magnificent?"

"It was eight stories high too!" the patient added

"Why eight?"

"It has to do with the 8 mg. of Suboxone tablets. I was craving for them and if only I could have gotten the 2 mg. tablet [Suboxone comes in two strengths 2 and 8 mg.] it would have eased the suffering. But 8 mg. would have been ideal. So I was granting you an eight stories high office building instead of this modest ranch of yours if you would prescribe me that dosage right away."

The magnificent office and professional looking neatly dressed staff were expressing two other concepts which were diametrically opposite to each other. On one hand it was an attempt to exalt my position. If only I would fill his prescription without any problem he would value me as a real upper class doctor whose office    was in a magnificent high rise building with professionally dressed staff instead of the humble office in which I see patients and the unpretentious staff who work for me. On the other hand it was an expression of contempt that given your humble office and even humbler staff and the fact that you don't even know your own hours of practice you better not make me wait for my prescriptions. And the dream was expressing this contempt by showing the offices of the more magnificent doctors with their sparkling glass offices. 

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