Unconscious Phantasy or Conscious Fantasy

At our summer school this past week a wonderful question arose that I thought would be useful to explore for those of you who are trying to do ISTDP. As you know, we explore avoided feelings as deeply as possible with the patient in order to restructure the pathway of anxiety, restructure the system of resistance, and to to help the patient experience the complex mixed feelings as deeply as possible so that the engine of self-punishment has been dismantled.
And as part of that process, when we help patients experience their complex feelings as deeply possible, a phantasy arises of how those feelings would be expressed: the portrayal. When done correctly, we mobilize these feelings as intensely as possible, helping the patient let go of his defenses, so that an unconscious phantasy can arise spontaneously from the patient. Unconscious phantasies are ideas that were previously repressed, unknown to the patient, arising due to the rise of previously repressed feelings.
Instead, therapists often make a mistake: rather than mobilize the feelings as highly as possible, when a little movement occurs they ask the patient for a conscious fantasy: if you let those feelings out on me what would that look like? This question merely invites the patient to offer conscious thoughts, a defense, which is not helpful. After several times, the patient will begin to feel that therapy is just a case of Scheherezade: “Ok, if I give him another gory story, he’ll be happy, and then we can go back to doing therapy.” Then these pseudo-portrayals lead to a kind of ritualism where the therapist demands a “story” each time, the patient gives it, and both think, “Ah, this is ISTDP.” Nope.
Instead, mobilize feelings as highly as you can and keep addressing defenses and the resistance. Don’t worry about getting the almighty “portrayal.” Instead, mobilize unconscious feelings as highly as possible while removing the resistance. As you do so, the unconscious will come to you. Rather than ask the conscious thoughts to come to you, work hard and let the unconscious come to you. It will come to you when you have done your work. So be patient, go back to your work, and stop begging for conscious fantasies.

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