How do you work with the feeling of loneliness?

“How do you work with the feeling of loneliness (or more precisely, the core feelings of sadness and longing due to loneliness). My patient feels lonely and feels sadness and longing, but her life is still not changing. Her relationships with others are somewhat better but not as much as she would like. Since she can’t ultimately control when the right people/persons comes into her life, I’m not sure whether we need to work on acceptance of what is (being single) or addressing possible defenses against closeness.

In the session I don’t feel close to her. She does not take in my caring during the session. I felt that especially in the last session where my countertransference was that I felt neglected and not acknowledged by her. I would say things to her, but then she would continue with her ruminations about loneliness without actually responding to what I said. Any ideas?” Thanks to Jackie for this question.

What creates emotional closeness? Sharing our feelings with others while feeling them. Is loneliness a feeling? No. Most of the time, loneliness is the state that results when our defenses isolate us from others. If we distance from others, we will feel emotionally distant from others. If we ward off our feelings, we feel isolated even from ourselves. And if hold our feelings in, we will feel lonely, emotionally unconnected to others.

Thus, loneliness, by and large, is not a feeling. It is the result of defenses against emotional closeness. Since it is the result of defenses, we don’t want to explore it. We want to help the patient see her defenses, let go of them, and explore the feelings her defenses ward off. When we explore her loneliness and her sadness about being lonely, she does not feel better. She just feels more lonely and sad. We merely deepen the feelings (sadness and loneliness) that result from her defenses (dismissal and detaching).

Instead, we need to help her see the defenses she uses to ward off emotional closeness. What does she do to make herself lonely? How can we find that out? The best way is to focus on the ways she wards off closeness with the therapist in the here and now.

This is a leap of faith here, but I’ll take the leap: I think all of you care for your patients. That’s why you entered the field. I suspect Jackie cares for her patient very much. Yet her patient does not take in Jackie’s caring. That refusal to take in caring is one defense that makes the patient feel lonely now and here with Jackie.

Th: “Do you notice how you don’t take in my caring right now?”

Pt: “Well, you’re a therapist. You’re supposed to care.”

Th: “When you say it’s just because I’m a therapist, do you notice how you dismiss me and my caring right now?” [point out the defense against emotional closeness]

Pt: “Isn’t it true?” [defense]

Th: “It’s true I’m a therapist. And it’s also true that you are dismissing me and my caring. This is how you distance from me right now. Do you see what I mean?” [point out the defense of dismissal.]

Pt: “I see what you mean.”

Th: “And that’s why you are lonely. You don’t let me get close to you. You deprive yourself of my caring. Although I am here for you, you distance from me and make yourself lonely in my presence. Then I just become another useless person to you.” [pointing out the price of the defense]

Pt: “How do I know you won’t hurt me?”

Th: “The issue isn’t whether I will hurt you. The issue is that you hurt yourself by distancing from me and everyone else. You thought the enemy was me. But do you see how the distancing is hurting you, making you a lonely woman?” [clarifying the causality and the price: defenses hurt her.]

We can also focus on rumination about loneliness as a defense in and of itself. For instance, Jackie says something. The patient, rather than respond to Jackie’s statement, ruminates again.

Th: “Do you notice that you ignored what I said?”

Pt: “What do you mean?”

Th: “When I mentioned how you distance from me, you ignored what I said and how you distance, and then began to ruminate about loneliness again. Do you see how your rumination is a barrier here between you and me?” [point out the defense against emotional closeness]

Sometimes therapists become angry with a patient who ignores and dismisses them. Remember that this transference resistance (ignoring and dismissing you) almost always functions simultaneously as a character defense (ignoring and dismissing herself). Thus, if the patient dismisses you, keep an eye out for the ways she dismisses herself in session.

Does she need to accept being single? I think the question is different. Does she want to keep using the defenses that keep her isolated? Does she want to continue to divorce herself and her inner life, or does she want to stop being “single” and finally become married to her inner life? Only when we have achieved the inner marriage with our desires and feelings is it possible to have the outer marriage with another person. The inner marriage with yourself is the precondition for the outer marriage with another person. If you do not know what you feel, how can you share feelings with others to have emotional closeness? If you reject yourself and your feelings, your inner divorce will prevent the mutual outer marriage to you. Help your patients form the inner marriage with their inner life. Only then will the outer marriage be possible.

Take home point: when a patient says she feels lonely, look for the defenses she uses that create her loneliness. And in session look for the ways she makes herself lonely with you. If you feel lonely with her, notice what she does to reject contact with you. Does she ignore what you say by talking over you, interrupting, going off on another topic? Does she dismiss what you say (“We’ve talked about that before.” “I know that already.” “I want to talk about something else.”)? Does she refuse to collaborate? All these responses are good. They tell you what to work on: the patient’s defenses against closeness that create her lonely life.

 

 


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