Author Archives: Jon Frederickson

“I don’t feel it now”

“A patient is addressing a situation that has come up in the recent past and then says, “I was angry at the time, but I don’t feel it anymore.”  In a lot of examples, this clearly posed a problem for them (anxiety for example), but they state that the feeling is no longer accessible. Just defense? Curious…” Thanks to one of our community members for offering this common clinical problem.

Suppose you had a wonderful meal at a restaurant last week and the bottle of wine was delicious. If I asked you, “How do you feel when you think of that meal?” a smile will cross your face and you will feel happy. If you asked me how I felt last week when I learned that a dear friend is having chemotherapy, I would say I feel sad.

Every day we have feelings from the moment we wake up in the morning and hear the birds singing, when we read the tragic news about Syria in the newspaper, when we sit with our 10 am patient, and when we get a call from a friend inviting us for dinner. We feel all day long and those feelings give us the information we need for living life.

You may have noticed that feelings are very “accessible” for babies. That’s us. We have to learn to use defenses to make our defenses “no longer accessible.”

When the patient can’t tell you what his feeling is, he goes through life without a compass. He does not know what he feels, so he does not know what his passions are. He is directionless. All due to defenses.

When the patient says, “I don’t feel it now,” that is unconscious therapeutic alliance: “I need help with the defenses I am using in this moment.”

When he says, “My feelings are no longer accessible,” that is also unconscious therapeutic alliance: “I need help with the defenses that make my feelings inaccessible in this moment.”

Pt: “I don’t feel it now.”

Th: “And the feeling toward her?”

Pt: “It’s not accessible.”

Th: “Would you like it to be accessible?”

Pt: “Yes.”

Th: “Wouldn’t it be nice to know what you feel so you wouldn’t be going through life in the dark?”

Pt: “Yes.”

Th: “So can we see what the feeling is toward her?”

Now, having explored feeling this much, we will have mobilized complex feelings. These feelings will trigger anxiety and defenses. We watch the patient’s responses now to find out his pathway of anxiety and system of resistance. Then we know what to treat.

For instance, let’s look at two possible responses the patient might offer.

Pt: [teary] “Maybe I just can’t do this kind of therapy.” [self-attack]

Th: “Could that be a critical thought? Could that thought be getting you down?”

Pt: “Yes.”

Th: “If we look underneath that thought could we see what feelings are coming up here toward me?”

Here, the patient’s teariness and self-attack reveal that she is using the resistance system of repression and her anxiety is channeled into the smooth muscles. So you would use the graded format to build her affect tolerance, so she could eventually feel her full feelings without having to use self-attack as a defense.

A second response might look like this.

Pt: [sigh. Looking away.] “I told you I don’t have a feeling.”

Th: “Notice how you look away? Notice how you avoid my eyes? I wonder what feelings might be coming up here toward me that make you put up this barrier of avoidance?”

Here, the patient’s sigh indicates anxiety is in the striated muscles. The verbal statement is the defense of intellectualization, so the patient uses the resistance system of isolation of affect. The use of gaze avoidance indicates that the resistance has shifted from resistance against feeling to resistance against emotional closeness. Therefore, the therapist addresses the gaze avoidance, a sign of mid-rise of transference feelings, and then asks for feelings toward him to mobilize complex feelings and to bring the transference resistance out into the open.

In other words, the patient’s first response is not a problem, “I don’t feel it now.” It’s an opportunity to explore feelings to find out where anxiety is discharged and which resistance system is operating. Then the therapist knows what to treat and why.

Existential depression

It’s a question about myself, but I thought it might interest you:

“Sometimes I suffer existential depression in which my thoughts question the validity of feelings. I have thoughts like, ‘How can feelings be a reliable guide to what is right or important to do when they are just my feelings? Does what I do or don’t do really matter in the grand scheme?’ I suppose part of me wants a guarantee that my actions would have some larger or lasting significance or value besides feeling like the right thing to do at the time, but this doesn’t exist as far as I’m aware. I don’t know of any way of dealing with this state of mind besides waiting for it to pass. Is this something you’ve ever encountered?”

What you call existential depression is depression resulting from the defense of self-attack, using existential themes.

Self-doubt and minimization: “How can feelings be a reliable guide to what is right or important to do when they are just my feelings?”

Self-doubt and self-devaluation: “Does what I do or don’t do really matter in the grand scheme?”

Self-doubt and self-devaluation: “My actions have no larger value unless they last beyond my lifetime.”

Underlying messages: 1) “Your feelings are unreliable, so you should hold yourself back”; 2) What you do doesn’t make any difference, so you shouldn’t do anything; and 3) Your actions have no larger meaning, so there is no point to acting.”

These forms of self-attack could be addressed in therapy, so that you recognize these defenses and also find out what feelings are being warded off, and toward whom they belong. These self-attacks are just sneaky cuts to the soul.

But let’s suppose you think this is reductionistic. You might think, “Jon, these are existential realities. Aren’t you reducing existential issues to a psychological category?” The problem with this argument is that there is a beautiful antinomy here, which is missing. That missing antinomy tells us that there is a psychological issue. Without keeping you in further suspense, here is the antinomy spoke by the great teacher Ramana Maharshi:

“Insofar as I am nothing, I am knowledge.

Insofar as I am everything, I am love.”