Mobilization of the Unconscious

“A patient gets to a breakthrough of rage toward the therapist and murders the therapist in his imagination. Guilt rises but there is no link to the past. The patient just feels guilty about having murdered the therapist and apologizes, feels sad, etc. What is happening? Compliance?” Thanks to Peter for this subtle question.

When we ask the patient what his problem is, he may respond, “I don’t know.” When we ask if it is his will to look at this problem, he may respond, “I’m not so sure.” When we ask if we could look at a specific example of his problem, he may respond, “I can’t think of one.” When we ask what the feeling is in that example, he may say, “I don’t have a feeling.” When we ask how he experiences his anger in his body, he may respond, “I don’t feel anything.” Are you seeing a pattern here?

Defense and resistance can arise at every stage of the therapy to keep feelings and desires out of awareness. Thus, this conflict between the patient’s unconscious therapeutic alliance (his inner wish to become well) and his resistance is ever present.

At the moment the patient has experienced his rage toward the therapist deeply, in the next moment his guilt rises and then a memory of someone in his past arises. This is the beginning of the unlocking of the unconscious. The patient felt tremendous rage toward the therapist. But this conscious rage sits on top of the unconscious rage, the bottom part of the iceberg that lies under the water. This unconscious rage is linked to memories of people in the past who hurt the patient. Thus, the experience of the powerful mixed feelings toward the therapist allows these memories of past figures to come into consciousness.

However, these previously repressed feelings from the past are very painful, a mixture of rage, guilt, love, and grief regarding loved ones in the past. As a result, we often find defenses arising at this very point to keep the unlocking of the unconscious memories from occurring.

Thus, when we do not have an unlocking of the unconscious, several problems may be operating. First, the therapist may not have developed a high enough mobilization of the unconscious feelings in the earlier part of the session. Second, the therapist may not have restructured the defenses sufficiently so they are still operating at this point. Third, the patient may have been complying with the therapist. We would see this if there were no unconscious signaling in the patient. Since compliance is a defense, any pseudo feeling offered in the service of the defense of compliance will not evoke unconscious anxiety. Fourth, the therapist may have done a very good job, but the patient may be enlisting a defense or transference resistance at this very moment to avoid the unlocking of the unconscious. In this situation, the therapist needs to point out the defense, its price, and confront the patient’s defense. We need to help the patient “collide” with his resistance so that he will let it go and face his feelings instead.






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