What do we know and what do we not know?

In response to a recent post, Timothy proposed the following ideas about a woman who was angry that a boyfriend who habitually did not pay back his loans to her, once again did not pay back a loan.

Timothy proposes: “The reason that she is hiding her true concerns from the therapist is that she still wants to keep a man that cannot support her financially, and her dilemma and frustration on how to handle such a weird problem creates great restriction that she expresses through anger on the man.”

Jon: Staying with a man who cannot support her is a fact. Since it is self-destructive, it is a defense. I would propose that she feels some anger toward the man and punishes herself through her self-destructive behavior. However, insofar as she blames him for her continual choice to loan him money, her anger is also based on externalization. She can be angry with him rather than at her self-destructive behavior. We don’t know if she came to the therapist because he is a man. That is a hypothesis. We also don’t know if “she unconsciously wants your male opinion on what you think about the character of her bf and whether you think she should stay with him any longer.” That is also a hypothesis.

Timothy proposes: “I don’t see her anger as just a defense. She is not being totally truthful and maybe not wanting to get to the point of her real problem.”

Jon: This is a really important point. To a certain extent, every defense represents a moment of dishonesty about one’s inner life. But we must differentiate the conscious lie of the sociopath from the unconscious defense of the usual patient. Our unconscious defenses prevent us from being in touch with the inner Truth of our feelings. The idea that she does not want to get to the point of her real problem is only half of the truth. Every one of us resists the truth. AND every one of us seeks the truth. We must never forget the nature of conflict: we both seek and resist the truth of our inner lives and external reality. When we relate only to the patient’s resistance, we forget the patient’s unconscious longing to be healed. And that is our resistance to facing the complex, conflicted person who is seeking our help.

Timothy proposes: “The woman’s anger is an expression of the restrictions she is feeling from the problem. And she has been focusing the cause of the restrictions she felt on the only logical source she knows that is her bf.

Jon: I agree that her anger is in response to his failure to pay the loans, and it is a response to her self-destructive defenses which cause her more suffering. But she blames him for her choice.

Timothy proposes: “She is also angry at herself for allowing the problem to prolong, because she is desperate to keep her bf, holds fear of losing him, and maybe has low self-confidence of getting another one.”

Jon: I suspect that continuing to loan money to her boyfriend is a way to turn anger upon herself. If she is desperate to keep her boyfriend (something we don’t know), this is maladaptive and, thus, a defense. Desperation to keep a boyfriend is a way to hide anger toward the boyfriend! If she fears losing the boyfriend (something we don’t know), that would also be maladaptive and a defense. I would hypothesize that the conscious fear of the boyfriend is a defense covering up the anger toward him that she really fears. Her low self-confidence I would see not as a feeling but as the result of a defense. Turning anger onto herself and devaluing herself are defenses that would create the state of low self-confidence.

Timothy proposes: “At the end of the day, she came to you because you are a guy and she wants your male opinion on whether or not her bf is really a good man that she should continue to keep.”

Jon: We can’t know this for sure. It’s a plausible hypothesis. But we need evidence from her words, actions, and feelings before we can make such a claim.

Timothy proposes: “For the first example you mentioned, the woman calls her dead husband a bastard because she is expressing restrictions and sadness from no longer being able to be a normal wife with a living husband. She is putting the blame on the only logical source she knows. She didn’t blame God or something else. She is confused. She needs to release her traumatic feelings through Tension/Trauma Release Exercise(TRE) therapy maybe?

Jon: Certainly she is angry with her husband for leaving her and she needs to release her feelings. However, insofar as she calls him a bastard and devalues him, we are looking not just at rage but at devaluation. When she devalues someone, it is usually a way of dealing with grief over the loss of a VALUED person.

Timothy proposes: The more expressive the patient is expressing their anger reflects how justified they are perceiving themselves as the victim of being faced with such restrictions imposed by their unfortunate circumstances. They have been putting up various defenses by great exaggerated expressions of anger and frustration in order to make others feel that they are the justified victims rather than be perceived as the ones who got themselves into their misery.

Jon: This is an excellent way of posing the problem. If I can angrily pose as the victim, I do not have to face how I victimized myself.

Timothy says: “Sorry if what I say is quite conflicting to your ideas.”

Jon: Thank you for sharing your ideas. It is wonderful when we can clarify the differences between feelings, defenses, and the problems created by defenses. Here, the feeling is anger toward an exploitive boyfriend or a dead husband. The woman with the exploitive boyfriend, continues to make loans to him, thereby exploiting herself. Then she blames him for her choice to hurt herself. The woman whose husband died is struggling with grief which she can avoid through defensive anger or devaluation.

But Timothy raises a larger question that we must face as therapists, something larger than any school of therapy: What do we know and what do we not know?

I remember a colleague of mine years ago who taught at a local psychoanalytic institute. He was very upset because he said students would hear a case and they weren’t taught how to analyze a case. They were taught how to speculate about case. They would share their fantasies about the case. But they weren’t taught how to look at the material and see what the evidence was and what the evidence would support.

In other words, they weren’t taught about the scientific method. Our task as listeners is to pay attention to the material and see what hypotheses the material supports and what hypotheses the material does not support.

All of us reading about cases can come with our personal theories and hypotheses based on books we’ve read, our personal experience, or people we have known. But unless we have evidence from the patient, these ideas are merely……….drumroll…… our projections! Yes. You heard it here. We therapists often project a lot onto our patients.

Why? It is hard to bear not knowing what is going on. The hard work is to explore, to ask about feelings, to learn what defenses are operating, to learn gradually the relationships between different conflicts. The hard work is: psychodiagnosis. Through that moment-by-moment work we build a mutual understanding of what is going on in the patient’s life by understanding what is going on here and now in the session.

I applaud Timothy for sharing his thoughts and hypotheses. He is doing what we all do. It is so easy for us to have assumptions about our patients even though we don’t have the evidence to support them. This is our great temptation as therapists. I feel relieved that Timothy has joined me in my group PA (projectors anonymous). We are a large group and contain many therapists. Membership is open to any of you, by the wayJ

If anything, this post is a plea for a measure of humility. Let us always remember that a plausible hypothesis we hold dearly may not be the truth. Our task is to embrace the patient tightly but hold our hypotheses very lightly. Go forth and embrace!

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