Denial Through Fantasy

One of the most common forms of denial occurs when the patient has trouble facing reality, denies it, and relates to a fantasy instead. As long as the patient uses denial through fantasy we cannot establish an internal focus in therapy. Let’s look at a role- play from a core training the other day that illustrates this defense and one way of working with it.

The therapist agreed to do a role-play in which she would be her patient and I would play the role of the therapist. As I tried to find out what internal problem the patient wanted to work on, she quickly claimed that her depression was entirely the result of her husband. In fact, she wondered why I was asking her questions when she believed her husband was the cause of her depression.

Th: How is he the cause of your depression? [Inquiry to flesh out her externalization.]

Pt: For instance, I wanted him to change the tires on my car, which I think is a man’s job. And he didn’t want to do it. Don’t you think he should have? [Denial: she relates to her fantasy of how she wants her husband to be rather than the real husband she has.]

Th: You seem surprised that he didn’t want what you wanted.

Pt: Well, don’t you think he should change the tires on my car? [She invites me to be in conflict with her. That would distract her from her conflict with reality. Get out of the way.]

Th: He should want what you want? [Mirror her denial through fantasy.]

Pt: Yes. [Denial through fantasy]

Th: He should want what he doesn’t want? [Keep the focus and mirror her denial through fantasy.]

Pt: You ask funny questions.

Th: Should he want what he doesn’t want? [Mirror her denial through fantasy.]

Pt: I think he was wrong. It’s a man’s job. I’m right on this. [Denial through fantasy]

Th: So he should want what he doesn’t want? [Mirror her denial through fantasy.]

Pt: Yes. [Denial through fantasy]

Th: So the reality of him should be different from what the reality of him happens to be?

Pt: We should be as one. Don’t you think so? [Denial through fantasy. Avoid her attempt to make the conflict between you and her. Let it be between her and reality.]

Th: You think you should be as one, and he thinks you should be as two. [Mirror her denial through fantasy.]

Pt: He should realize that I’m right. [Denial through fantasy]

Th: So someone who does not realize you are right should realize you are right. [Mirror her denial through fantasy.]

Pt: Yes. [Denial through fantasy]

Th: So reality should be what reality isn’t. [Mirror her denial through fantasy.]

Pt: Hmm. I’m getting confused. [This is not cognitive/perceptual disruption. Reality is confusing when you start relating to it instead of your fantasy.]

Th: It sounds like it is confusing when you realize he doesn’t think what you think, doesn’t want what you want. It’s confusing when you realize he isn’t you.

Pt: I don’t think it’s too much to ask of him. [Denial through fantasy]

Th: You don’t think it’s too much to ask him to want what he doesn’t want. Yet he keeps not wanting what you want. Is it true that he should want what you want?

Pt: Yes.

Th: Do you mind if I offer another opinion?

Pt: Ok.

Th: I don’t think he should want what you want. It’s his job to want what he wants. Your job is to want what you want. But you keep asking him to do your job, to want what you want. Do you see what I mean?

Pt: But shouldn’t he want what I want? [Denial through fantasy]

Th: You want him to want what you want. But then he keeps wanting what he wants. Isn’t it hard when reality keeps bumping into your fantasy of how you want him to be? [Reality is such a patient teacher, isn’t it? It just keeps waiting and waiting until we are ready to deal with it.]

Pt: It is. It feels so hopeless. [Realistic appraisal of denial’s effectiveness.]

Th: How wonderful you can see that! Have you ever noticed that if you have a fight with reality that reality always wins? [Price of the defense.]

Pt: Yes.

 

In this case, the patient’s husband was leaving her. Now it makes sense. She has been having an affair with her fantasy husband rather than relate to and love the husband she had in reality. Constantly bullying him to be someone else, she showed that she did not love him. She loved her fantasy.

In cases like this, we have to help the patient let go of her denial of reality through fantasy. Only then, will the feelings repressed by her denial become available. Further, only when she sees that her problems are caused by her defenses, not by her husband, only then will we have an internal focus for a therapy that can be effective.

If you are interested in this particular technique for dealing with denial through fantasy and externalization, get Byron Katie’s book, Loving What Is. Although not a therapist, her techniques for helping people let go of externalization are very powerful and well worth knowing.

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