Category Archives: General

This therapy will fail!

“Some patient called me and asked me about fearing pigeons. In my opinion, this is the best way to ignore herself. She is forcing me to talk about pigeons instead of herself. As a result, I think the therapy will be failed just before beginning. What do you think?” Thanks to one of our community members for asking this question!
How can we know if the therapy will fail? We have not met her yet. If we do not sit with her and explore, how can we know her capacity, her degree of motivation, even her other difficulties. If we give up before we have met her, we are responding to our own projections (She is hopeless.), not to her.
Instead, we need to be the welcoming openness in which the unknown of this woman may be revealed to us and to her. Due to our fear of the unknown, the patient as mystery, we are often tempted to “predict” [fancy word for therapist projection]. Instead, we must let go of our desire to “know” her before we have had the chance to come to know her. And we must let go of our desire that she be a certain way. Otherwise, we will be relating to our desire, not to her.
She will “force” you talk about pigeons? She must have very great powers to do such a thing! In my experience, no patient can “force” me to do anything. She can ask me to do something. I can say yes to her and no to myself, and then blame her for my choice. Or I can say no to her and yes to myself. Or it may be saying yes to her feels like a yes to me too, and then I’ll do it. If she insists on talking about pigeons rather than her inner life, this can be dealt with as we would with any defense involving self-neglect.
And let’s not forget. No matter how much I know a patient even after a therapy, she is always something other and greater than any idea I can have about her. Can we accept that we do not know the future of this patient? Can we let go of our ideas which are a substitute for living with, being with, another person? Can we bear this unknown we enter into each day? The challenge of therapy: how to be the welcoming openness to the mystery that is another person.

“I’m glad she’s dead!”

“I’ve gotten to the point in my training where I can start helping patients with murderous rage. However, some patients switch to a cold, hateful position toward the object, with no signs of anxiety. My thinking is that they’re splitting or shutting down their mixed loving feelings, and that portrayal of this black-and-white rage would only be destructive. I’ve tried reminding them that they are angry with someone they love. But some patients lose the anger and become anxious instead. How can I help these patients tolerate and experience their full mixed emotions?” Thanks for this important question!
In life our loved ones can only deliver, delay, or disappoint. Thus, the experience of love and anger toward the same person is inevitable. The question becomes: how do we deal with those mixed feelings? Some people detach from their feelings. Some people feel love toward us and turn the rage upon themselves, becoming depressed, suffering somatic problems. And others, unable to tolerate these mixed feelings, split them apart, and project them onto other people.
The patient feels rage toward a neglectful parent. Yet this neglectful parent almost always was at times kind and loving. The patient, when facing his feelings, feels both rage for the harm she did and love for the good she did. But if he cannot tolerate the grief, pain, and guilt aroused by these mixed feelings, he will split his love apart from his rage. He will claim, “She was never any good to me.” He will devalue her, calling her a “bitch” or worse. If he admits loving feelings toward her in the past, he will maintain that, “It was only because she fooled me.” Typical comments that indicate splitting are: “I’m glad she’s dead.” “I would just burn him up.” “I would spit on his body.” These are not expressions of guilt but of contempt and devaluation, the results of splitting.
Now he views her as “all-bad” and feels only rage toward her; no love, no grief, no guilt. Thus, no anxiety. Remember: anxiety is not triggered by rage; it is triggered by the mixed feelings of love and rage. If the patient splits his love off, and feels only rage toward this “all-bad” person, he will feel no anxiety over expressing his rage.
If we mistakenly encourage the patient to feel and express this split-off rage, we will only help him get better at splitting and devaluation! That would be destructive. Rather than explore his split-off rage, we need to address the splitting of his rage from his love. That way he will be able to face the love and rage within himself and the good and bad of the other person.
When we remind him of his love toward the person toward whom he feels rage, these mixed feelings will trigger guilt and anxiety. This is a positive sign, building his capacity to tolerate mixed feelings without splitting or projection. In the example, the patient stops being angry and feels “anxious” instead. In fact, the patient is feeling anger, plus love, thus anxiety. At that moment, simply remind the patient, “So you feel this anger toward your mother whom you love, and this mobilizes some guilt and anxiety.” Later, you can point out how he devalued his mother to avoid his love, rage, guilt, and anxiety.
Take home point: therapy is not about rage, it is about embracing the fullness of our humanity (our love and rage) and embracing the fullness of the other person, who has both good and bad qualities. If we encourage splitting, the patient never learns to embrace his humanity nor the humanity of those he loved.