Monthly Archives: January 2017

Optimal hopelessness

A patient was angry with her husband. As I started to explore her anger, there was no sighing. Hmm. I thought. “This must be a defense.” I paused and asked what this anger made her want to do. She said she wanted to bring up his failure to pay for their children’s college, even though he could afford to. For some time, he had refused to pay for house expenses and was no longer wearing his wedding ring. Since she was thinking of bringing up this issue to him for the 1,000th time, I realized this rage was a defense. Then her unconscious therapeutic alliance came to the rescue. She said she felt “hopeless.”

Th: That makes sense. Would you agree that bringing up this issue again would be hopeless?

Pt: That’s true. It has never done any good. That’s why I feel so hopeless.

Th: So I don’t know if you are hopeless, but could we agree that arguing with him has proven to be a hopeless strategy?

Pt: I hadn’t thought of it that way. I just thought of myself as hopeless. Hmm. A hopeless strategy.

Th: Right. It’s like you were on a hike in the woods to get to a particular mountain -top. And it was a great trail for a while. But now we have come across an area where the trail has been swept away by a landslide.

Pt: But shouldn’t he want to pay for his own children?

Th: Shouldn’t reality be the same as my fantasy?

Pt: It would be nice.

Th: Yes it would. We can wish the trail was still there, but it’s not. We can sit here and rage at the trail for not existing. Or we can realize we will have to take another path. This one doesn’t work. Giving up on this trail doesn’t mean you have to give up on yourself or on life. It just means we have to retrace our steps and take another trail to get to your destination.

Pt: I get it. I have to face reality.

The patient used rage as a defense against hopelessness. When reality bumps into your fantasy, you suddenly realize your fantasy is hopeless. However, rather than give up on our fantasy, we may mistakenly give up on ourselves.

Holding onto her fantasy and bullying her husband into being her fantasy were defenses against facing reality, loss, and the hopelessness of her fantasy (I want my husband to want what he does not want.). Hopelessness is not a state. I am not hopeless. I give up hope on a fantasy. I never give upon a person or myself, although it may look that way. In fact, I have to give up hope on a fantasy about that other person or myself. But rather than face the hopelessness of my fantasy, I might turn the rage upon myself or someone else for not being the same as the fantasy. But this rage toward others or self-attack is a defense against facing the hopelessness of a fantasy, a failed strategy to deal with reality.

That’s why we need to talk about optimal hopelessness. When a patient sees that a fantasy or defense is hopeless, that path is closed. Good news. Now we can shift to a hopeful path. That is essential for change.

And that murderous rage we have heard so much about? As long as the patient uses defensive rage to avoid letting go of the fantasy, the complex mixed feelings cannot rise. I have worked with people who in previous therapies had many breakthroughs to rage, but it did no good. They would go home and rage at people to get them to change rather than accept reality: the other people could not or did not want to change. Once the patient lets go of the fantasy and faces the grief and loss, then the murderous rage and complex feelings will rise as a whole.

Take home point: when rage triggers no sighing, it is probably a defense. If so, examine how rage may be form of denial through fantasy. [I will rage until reality turns into my fantasy.] Undo denial through fantasy so the patient can mourn the loss of her fantasy. With denial out of the way, access to mixed feelings becomes possible. When a patient reports feeling hopeless, she is giving up on herself rather than her fantasy. Find out the fantasy in which she must give up hope. After all, we should feel hopeless about hopeless defenses and fantasies. That’s optimal hopelessness.

Confidentiality

“I visit your page to read your posts about the importance and kindness of accepting and experiencing one’s feelings. I find them helpful and beautifully written.

But as a patient, it makes me uncomfortable to read the detailed questions that therapists ask you. The first paragraph of your most recent post, ‘she attacks me as a therapist!’ hit so close to home for me that my heart skipped a beat. I sank into my chair, mortified at the thought that the interaction between me and my therapist, which happened within the boundaries and confidentiality of our therapeutic relationship, made its way onto a public forum. Reading on, I realized — fortunately — that the other details did not describe any of the sessions I had with my therapist.

I can’t convey to you how damaging it would have been to our alliance had this post fully matched the details of my interaction with her. I would have been devastated, at a time when I am already struggling.

I admire your efforts in educating others. But anyone can see your posts, including the patients that therapists ask you about. By making your posts public, there is a risk of damaging the patients you ultimately want to help.”

Thank you for raising this important issue. Precisely for the reasons you outlined above, I delete any personal details that could identify the patient or therapist. And sometimes I add different details to ensure confidentiality.

In these posts, I do not describe particular patients but universal patterns of suffering which are not unique to any one person. And after reading a number of these posts, every one of us will find ourselves in them. We are not alone. Others suffer in the same way we have suffered. Our personal struggles are universal. When we read a history like ours, it can be a sign to us that we are not alone. We have secret brothers and sisters scattered across the globe. Their cries are our cries. Their struggles are our struggles.

I offer these posts with details removed to reach out to the secret brotherhood and sisterhood of sufferers. And to convey the message that our suffering makes sense. It can be understood. It is universal.

When these posts “hit home” it is not because the post was specifically about you. It’s because the truth of someone else’s life was able to touch you and your inner “home.” The truth of suffering is common to us all. On these pages, we do not just read about “others” or “patients”. We read about ourselves.