“I work with a person who says his problem is that he can not reach his goals. In my opinion, the goals are not reachable, not human. They are set way too high. He tries to reach his goals by forcing himself but never succeeds. He wants me to help him push himself even harder. I’m thinking that he should reconsider his problem. What makes him feel bad is not that he does not reach his unrealistic goals. Instead, I think he feels bad because he treats himself cruelly, ending up with an unfulfilling life, cut off from pleasures, always feeling bad due to his chronic failure to achieve impossible goals. But he does not see it this way. He still wants me to help him push himself more and be more harsh with himself. I almost end up being harsh towards him when I try to help him see his problem in another light!
There is a lot of social anxiety, due to projections. We are working on this quite successfully. Almost no contact with feelings. Anxiety mostly in striated, sometimes in cognitive perceptual disruption. Do you have any thoughts on how to work with this?” Thanks to one of our colleagues for sharing this common predicament!
What is the patient’s conflict? Some mixed feelings rise probably toward the therapist. They make the patient anxious, so he tenses up (striated muscles) or sometimes becomes cognitively disrupted. Then his defenses are to project onto others or to punish himself through pursuing impossibly high goals.
When the therapist points out to the patient that his goals are too high, the patient disagrees, urging the therapist to push him more. If the therapist voices healthy thoughts, the patient takes the part of the punitive superego. That shows the patient’s inability to tolerate this conflict within himself between his awareness that his goals are unrealistic and his superego which urges him to punish himself through their fruitless pursuit.
As the therapist points out, sometimes the patient behaves as if to provoke the therapist to punish the patient. Sometimes patients who punish themselves seek relief from their self-torture by provoking others to punish them.
The psychoanalyst Edmund Bergler had a wonderful bon mot about this. He said the amateur masochist punishes himself. The artistic masochist gets other people to punish him!
The primary problem here is that the patient’s wish to punish himself is ego syntonic. That is, he does not see his defense of self-punishment. What we regard as something bad (self-punishment), he views as something good. What we think he needs to let go of, he thinks he needs to do more of.
Thus, our task is to help the patient see his defense of self-punishment, see its price and function, and help him differentiate himself from this defense. There are many ways to do this as you know from my book, Co-Creating Change. One technique, which can be very helpful, is to mirror the patient’s defenses. When the patient voices a self-destructive attitude, he often expects you to argue with him. Then the conflict is between you and him. If you mirror his comments, however, then the conflict is between him and his self-destructive defenses.
I learned that this therapist had done some mirroring of defenses but ran into problems. Now we’ll look at some common clinical problems that can occur when mirroring superego pathology.
P: I don’t want to look at this right now. [Defiance]
T: I have no right to explore this if it’s not something you want. [Deactivating the projection of will upon which his defiance is based.]
P: You don’t have to be so careful. You can do whatever you want to me. [Inviting the therapist to take a sadistic stance and make the patient submit.]
T: You should be as careful as you think you need to be. If you don’t want to look at this right now, I have to respect what you want. [Blocking the projection.]
Notice in this example the precision of blocking a projection. The patient says, “You don’t have to be so careful.” That is a projection. In fact, by avoiding his problem, the patient is being careful. Rather than point out the projection and then provoke the patient into an argument, the therapist can simply block the projection: “You should be as careful as you think you need to be.” This reminds the patient that the conflict is not between him and the therapist. The conflict is between the patient and his resistance (“carefulness”).
In the following example, we see how the patient may try to lure the therapist into arguing against the patient’s pathological stance. Again, the therapist must allow the conflict to be between the patient and his defenses rather than between the patient and the therapist.
T: So you are giving up all these things that make you feel good in order to reach your goals. What are the consequences? [Asking about the price of the defense.]
P: I don’t feel good now, because I gave them up. [Price] But that’s ok. I will feel good when I reach my goals instead. My problem now is that I can’t reach them. I need your help to reach them. [Proposing an omnipotent role for the therapist.]
T: Silence. [Block the omnipotent transference, the idea that the therapist can do things which no human can do.]
P: Maybe I’m just lazy. I should be able to make it. [Patient takes a superego position, inviting the therapist to argue with him.]
T: It’s good you are able to persist like this. Not everyone is able to push themselves as well as you can. [Mirror the superego so that the patient begins to experience internal conflict.]
P: When you say it like that I think I should stop pushing myself, but I think I should be able to reach these goals anyway! I just have to push myself harder. [The patient’s awareness peeks through for a moment, but he soon returns to the position of the punitive superego.]
T: Why stop now when achieving your goals could be just around the corner? [Mirror the superego so that the patient begins to experience internal conflict.]
P: It sounds weird when you say it. But I just need to try harder! I should be able to reach them. [Emergence of conflict, then a return to his punitive stance.]
T: Just because it sounds weird doesn’t mean it is weird. [Mirror the superego so that the patient begins to experience internal conflict within himself.]
P: But I’ve given up so much already. [Emergence of conflict.]
T: Is there anything more you can give up? What about eating? [Mirroring the superego so that the patient begins to experience internal conflict within himself.]
P: I already eat too little. [Emergence of conflict and healthy awareness.]
T: Could you be underestimating yourself? [Mirroring the superego at this point helps the patient see the absurdity of his punitive position and strengthens his awareness. When you mirror the superego, the patient can observe that voice from the outside rather than be attacked by it from the inside. By being able to observe that voice, he can differentiate himself from it.]
Sometimes therapists mistakenly believe that one or two comments will make the patient let go of his irrational position. But a patient who punishes himself did not start doing this last week. He has been doing it for years. It has become a habitual form of self-attack. It has become a habitual form of relating to others, hating himself, inviting others to protect him himself from himself, then arguing with and defeating them. Thus, you need to be clear about this clinical dynamic so you don’t unwittingly reinforce it.
Instead, mirror the superego consistently until the patient firmly lets go of his self-hating stance. Once he feels the guilt and grief over the ways he has hurt himself, his self-attack and self-punishment will be dystonic. Then we can finally face the feelings underneath which his stance has been warding off for all these years. But this will not occur after only a minute of defense work.
And now, a caveat. Sometimes therapists who read this kind of work think that the therapist is being mean or sarcastic. If the therapist is angry or feels like being sarcastic, he should not mirror defenses because he would, in fact, be mean and sarcastic. And that would be harmful and wrong. When you see the patient’s conflict clearly, you can mirror the conflict like a mirror, without pushing the patient to look different, sound different, or be different than he is.
When I look at the mirror in the morning, I do not accuse the mirror of being mean or sarcastic. (Although, the feedback from the mirror in the morning is not always what I would like to see!) The mirror simply reflects back the reality of me standing before it.
Likewise, when patients suffer from severe superego pathology, we can simply reflect the reality of their conflict or their absence of conflict. When we reflect even their absence of conflict, they see clearly the persona, the mask they put on. They see now what they show to others. They see how crazy this internal voice has been.
Take home points: When we try to do what is impossible, we fail to do what is possible. Helping the patient pursue impossible goals will doom him, you, and the therapy to failure. Arguing with the patient means the conflict is between you and the patient. But the patient’s conflict is his. The belief that he must attempt the impossible is his. And the price of pursuing such goals is his. Your task is to avoid reinforcing his pathology by rejecting it or getting into conflict with it. You have been asking him to accept that his goals are pathological. Would you be willing to do your part as a therapist? Accept him, his pathological goals, and his conflict. Now that he experiences his conflict within him, watch him grow.