Sooner or later we lose all our capacities. What’s the catch?
During a recent Zoom therapy session with a long-term patient, I was reminded of something that my mentor (the legendary professor of psychiatry Dr. Elvin Semrad) used to say:
There’s something we never lose the capacity for.
That is the capacity to regress.
My patient is a woman I’ve known for decades. Our work has been intermittent, with more regular contact at times when depression and/or somatic symptoms flare. She has grown substantially over time, in knowing and being herself and in managing adaptively in the world. For the past couple of years, we’ve met only a couple of times a season. The recent meeting was the second since the Covid-19 pandemic reached Massachusetts.
This woman had a fraught childhood, at the mercy of a sadistic mother and an alcoholic father. Little by little, over the many years of intermittent therapy, she was able to acknowledge, bear, and put into perspective the traumas of the past.
The most recent session opened with the patient tearful and overwhelmed with feelings of “being trapped.” She reported that she had been waking daily to feelings of hopelessness and sadness that she had not felt for many years. It was apparent to me that the oppressive threat of contagion was creating a circumstance that mimicked the atmosphere of her childhood, an atmosphere in which she suffered and had no recourse.
When I shared this observation with the patient, and reminded her that today’s events are challenging but that today, unlike what prevailed in her childhood, she has the power to keep herself safe. She and her loving and beloved husband are retired, have a comfortable home and garden, prudently managed finances, and have loving grown children. They are generally well-set to ride out the pandemic better than many.
In summary: The threat of the pandemic triggered a regression to the pain and helplessness of her childhood. Interpreting this to the patient resulted in affirmation in the form of supporting ideas, relief, and lightened mood.
When I think about Semrad’s aphorism, I can affix an addendum. While we never lose the capacity to regress, we can return to the point of progress much more readily than we were able to achieve that point in the first place.
The key is to find the trigger to regression, and to identify the distortions that feed the regression.
Rako, S, & Mazer, H. (2003). Semrad: The Heart of a Therapist. iUniverse.