Quit Trying to be so Close!

In our previous post I talked about how therapists can miss an important shift in therapy: when the patient shifts from avoiding feelings to avoiding contact with you. Technically, we say that the resistance to feeling shifts into a resistance to emotional closeness. Why do patients resist emotional closeness?

Patients come to us because they are suffering. They suffer because they use defenses to avoid their feelings and those defenses create their presenting problems and symptoms. They use defenses habitually because they tried to protect parents and caretakers from their feelings in order to maintain an insecure attachment. Thus, they used defenses initially as a way to adapt to their family.

Think about it. They learned to use defenses to preserve an insecure attachment by hiding feelings that could make caretakers anxious. And what do we do? We invite them to share feelings with us—the very feelings they learned early on should not be shared in any relationship!

So the patient lets us know she has feelings in a current relationship. We ask, “Could we take a look at the feeling toward your boyfriend for saying that?” On one level we are asking about her feelings toward her boyfriend. But relationally, we are asking: “would you be willing to share feelings with me to form an emotionally intimate relationship here and now with me?”

Some lucky patients who did not suffer unduly in childhood will respond, “Yes.” And they will share their feelings with us readily without too much anxiety. However, the more painful the patient’s early life, the more devastating the traumas, the more powerful the feelings which are activated in the patient. That’s why we have the spectrum of resistance.

A low resistant patient says “yes” and shares her feelings.

A moderate resistant patient says “yes” and tries to share his feelings but defenses come up which ward off feelings.

A highly resistant patient says “yes” but gradually begins to distance from you.

A more highly resistant patient says “no” and distances from you right away.

A fragile patient’s resistance collapses, so he floods with anxiety instead.

 

All patients have feelings triggered within them when we invite this emotionally close relationship known as psychotherapy. And the more powerful the feelings that arise, the more resistant the patient will be until the feelings are so powerful that the resistance breaks down and the patient floods with anxiety triggered by these feelings.

 

Many of our patients are like the abused dog we see in a dog shelter. If you approach, he runs away, barks at you, or hides and whimpers. He has learned that people can hurt him, so he is afraid to be close. Our patients are also afraid to be hurt by us. How do they show us? By resisting our invitation to closeness. How do they do that?

 

As you explore feelings in a current or past relationship, the patient will use defenses against feeling. But as you continue to explore the patient’s feelings, the patient realizes, “Wow. This therapist really cares about what I feel. This therapist really wants to know me. This therapist persists and does not give up on me. I’ve never known anyone who cared about my feelings this much to persist for fifty minutes.” Your persistent work (love) triggers very powerful mixed feelings in the patient.

 

Since your relationship is triggering so much feeling, the patient tries to distance from you so that the contact cannot keep arousing these underlying feelings. Here are the signs that the patient is now resisting emotional closeness with you:

 

Gaze avoidance: looking away from your eyes, looking at the ceiling, window, or       floor

Slowing down, long pauses before answering, hesitating while answering

Arms and hands behind the head

Crossed arms on the chest

Slumped posture in the chair, uninvolved, unengaged

Forgetting: “I don’t remember what I felt.”

Passivity: “I was hoping you could tell me what I feel.” Or the patient sits quietly,          expectantly, waiting for you to take the initiative in the therapy.

Helplessness: “I don’t know. Do you have a list of feelings?” “I don’t know what           you are looking for.”

Detaching: “I’m angry. But I don’t feel anything in my body.” “Angry.” [But said           without any feeling in the voice. The word “anger” but without the feeling of       anger is like receiving an empty wine glass when you asked for a glass of       wine. It’s not full of feeling. A feeling word but without feeling is not feeling;         it is detaching, presenting a substitute for the real thing, a wine glass instead of the glass of wine.]

Ruminating

Vagueness: “I’m feeling lots of things but it’s hard to say what exactly.”

False front: “I could throw something out or make something up.”

Withholding: “I don’t know.” Said before the patient even gives himself five           seconds to look inside himself.

Withdrawing: “I’m just processing inside as I go in my head.” You will notice the     patient’s eyes glazing over as he goes back in his head to think rather           than think aloud with you and relate to you.

 

All of these external signs show that the patient is now resisting emotional closeness with you. He is withholding from you. As he continues to distance from you, you will feel frustrated and anger: an internal sign that he is resisting closeness with you. All of these signs let you know to shift your focus. Instead of focusing on his feelings toward someone else, describe his relational behavior with you and ask what feelings he has toward you that make him distance. For instance, you might say,

 

Th: “Notice you are looking at the ceiling now. Notice how you avoid my eyes and pull away from our relationship? I wonder what feelings are coming here toward me that make you pull away?”

 

Th: “Notice how you are sitting here expectantly with me. Notice this passivity coming up between us? What feelings are coming up here toward me that make you go passive?”

 

Th: “It’s true. You could throw something out, but then I would be relating to a cardboard figure instead of you. Would you be willing to come out from behind that fake, cardboard figure so we could see who you really are? What feelings are coming up here toward me that make you distance in our relationship?”

 

Once the patient resists contact with you, keep pointing out his relational defenses for distancing and then keep asking what the feeling is toward you that makes him distance. We don’t do this to find fault with the patient. We do this so he can begin to see how he distances himself with us and everyone else. Through his experience with us, he learns for the first time how he has made himself into a lonely man, how he isolates himself, how he deprives himself of the milk of human kindness.

 

Sometimes therapists ask why we focus on the resistance to emotional closeness with the therapist. Josette Ten Have de Labije had a wonderful metaphor for that: a house. If you visited my home and knocked on the door, you hope I would let you in. If I didn’t let you in, you would not be able to visit my living room (current relationships) or the basement (past relationships). As a result, you would not ask about my living room or basement. You would focus on the main fact: my front door is shut and I refuse to open it (my resistance to emotional closeness). You would point out how my door is closed and then you would ask what feelings I have toward you that make me shut you out.

 

When the patient distances from us, we keep asking about his feelings toward us and pointing out his distancing behavior. We keep doing this until his resistance drops and breakthrough to feeling occurs. Once he is no longer resisting contact with us….then we can finally explore feelings in current or past relationships. If he begins to distance again, then we go back to asking about the feelings toward us that make him distance again.

 

ISTDP is unique among therapies because we focus on the patient’s resistance to emotional closeness, we have specific signs that tell us when to focus on the resistance, and we ask about the feelings toward us that make the patient shut us out. We don’t take the resistance personally because we understand that we represent people in the patient’s past who hurt him, and whom he does not want to let in again. But, insofar as we ask the patient about his feelings toward us, we give him an opportunity to face the underlying feelings that have led him to shut his door against people throughout his life. And by our persistence and willingness to face the full extent of his feelings, we provide an opening for him to face the full extent of his feelings, let down his wall, and come out of his self-imposed prison of defenses.

 

A patient once blurted out to me, “Would you quit being so persistent?” “What feeling is that triggering for you?” I asked. He burst into tears and revealed a memory of his depressed mother and her inability to persist and seek emotional closeness with him. Noting how the patient distances from you and asking for the feeling toward you provides an opportunity for experiential healing in the relationship, a new experience of intimacy.

 

Take home point: Whenever you explore feelings in a current or past relationship, the patient will experience mixed feelings toward you. When the patient starts to distance from you, shift your focus to the ways the patient distances from you and the feelings toward you that make him distance. Only through this pathway will you help the patient overcome his fears of emotional closeness with you and, thereby, with the rest of the world.

 

Take home point: when the patient avoids contact with you in the ways described above, describe the ways the patient distances from you. Then ask him what feelings he has toward you that make him distance from you.

 

Hint: some new skill building studies are coming out soon that will help you address the ways the patient distances from you. Stay tuned!

 

3 thoughts on “Quit Trying to be so Close!

  1. Juliana Kunz

    I can see the reasoning behind this, and how it could work if executed well, and yet the therapist who really helped me did exactly the opposite. She would let me sit there in silence for ten minutes at a time, and if I started staring out the window she would join me and comment on the view. I think she knew that I wanted to be in contact but that it became more impossible the more under pressure I felt. Contrary to what you write here, she never seemed to feel frustrated by my distancing. Years later I still feel an immense sense of gratitude for her patience, which I understand as a different form of love. I guess your reasoning though is that such an approach might not be time efficient?

    Reply
    1. Jon Frederickson Post author

      This is a beautiful example of contact functioning described by Spotnitz and the modern psychoanalysts. It illustrates the principle that we judge an intervention (not in advance but) by the response. If the response is an increase in emotional closeness and more collaboration toward the therapeutic task, the intervention was effective. The patient’s response to intervention must be our guide.

      Reply
      1. Peter

        Hi Jon,
        First of all I want to thank you for your blog and books, they’ve been immensely helpful to me.

        Secondly, I have a follow up-question to your answer to Juliana’s question.
        You said our guiding principle should be the client’s response to our intervention. I am just starting
        to learn ISTDP but in my (brief) experience the clients at the out-patient clinic I work at
        often start to use more defenses when the issue of resistance to emotional closeness is approached.
        So the initial response is not an increase in emotional closeness but almost the opposite. Going
        by the information found in books about ISTDP and from what I’ve heard from other practitioners,
        this happens quite frequently. As I’ve understood it, this shouldn’t be viewed as an error in technique
        but something that is expected since, as you wrote in your allegory about an abused dog, increasing
        emotional closeness is seen as something dangerous. So we need to be patient and diligent so we can
        “push through” and exhaust these defenses, in order to show them that we can offer them a new
        experience of closeness and caring. I just wanted to check if I’ve misunderstood the technique, since
        this really is an important issue that comes up over and over again in my therapies.

        Best regards

        Reply

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