ABSTRACT
This chapter contains two Clinical Pearls (CP), aphorisms that the author has used during his career as a psychotherapist and a supervisor to advance the therapeutic process. It is impressive the variety of ways that murderous rage can find expression. Patients can kill off continuity from session to session so that every session feels like starting anew. A patient can fulfill his parents’ malignant prophecy for his future (hostile compliance). Patients can kill off friendships. On closer inspection, patients who threaten suicide in the future may already be emotionally dead. Patients can be this destructive without being aware of what they are doing. This chapter provides ways to get their attention and discusses how the CP “You are a serial killer” can be therapeutic.
The second CP, “You don’t treat your help very well” addresses the power differential in psychotherapy. Patients often experience the therapist to possess most or even all of the power. Patients though possess a considerable amount of power as well. They hire and can fire us. This chapter discusses ways that the therapist can help patients experience the power they do have, and emerge from the therapy with a greater sense of agency. The psychodynamics of money are discussed.
