Who am I without my defenses?

 

“I have helped a patient see his defenses and their price. But now he asks, ‘When I no longer have all these ways to hide myself and my feelings, who am I?’ I said, ‘Then you are your real and original self.’ He responded, ‘But who am I when I do not have my old way to be me. Because I do not know what you call my real and original self.’ I did not know what to say. What do you suggest?” Thanks to Iben for this interesting question!

 

When a patient uses defenses habitually for a lifetime, they seem as if they are his being rather than the way he hides it. The patient, identified with his defenses, cannot differentiate who he is from the ways he deals with his feelings.

 

If you challenge his defenses when he is identified with them, he will experience you as attacking him as a person rather than inviting him to let go of his defenses. Thus, we must help highly resistant patients differentiate themselves from their defenses.

 

For this patient, we might say, “These defenses are not you. They are the way you hide your feelings and yourself from others. They are like a grimy coat you put on. We see the coat. But we never get to meet who you really are underneath. Would you be willing to take off that coat so we can see who you really are underneath?”

 

If he asks, “Who am I if I don’t have my old way to be?” we can’t answer that question. We don’t know the answer for it will be revealed only in the living reality of becoming himself without his crippling defenses. Rather than respond to the content, you can respond to his unconscious therapeutic alliance:

Th: “Would you like to find out?”

Th: “Would you be willing to let go of this old way so you can find the new you  underneath?”

Th: “The caterpillar wonders what he will look like as a butterfly when he comes out of this cocoon of defenses. Would you like to find out?”

 

If his questions remain, you could address the transference resistance dimension.

Th: “Do you notice how you ask what will happen if you let the wall down rather than let it down now here with me? What is the feeling here toward me that makes you put up this wall of questions?”

Th: “You invite me to relate to a hypothetical man who might appear in the future. But then we will just have a hypothetical relationship and hypothetical therapy. What is the feeling here toward me that makes you put up this wall of the hypothetical man?”

 

This patient is only somewhat identified with his defenses. He sees his defenses and their price, and he can intellectualize about them. Thus, his identification is fairly weak and can be countered by mobilizing the unconscious therapeutic alliance and some challenge:

Th: “Would you like to find out who you really are underneath this cocoon? So what can we do about this façade you are putting up here with me?”

 

In his case, identification serves as a defense. In fragile patients, identification often results from a failure of defense.

 

Fragile patients require more extensive restructuring work. Let’s look at how to build self-observing capacity so they can dis-identify with the defense.

 

A patient with bipolar mood disorder.

Pt: “I hate myself.” [She is identified with the defense of self-hatred.]

Th: “You are aware of something in you that wants to hate.” [This helps her observe and be with her defense rather than act it out.]

 

A patient projects onto her therapist and suddenly says,

Pt: “I have to leave.” [She is identified with the impulse and identifies the therapist with a projection from which she must run.]

Th: “You are aware of an impulse in your body. Where do you notice that impulse in your body, if you were to describe it in words.” [This encourages the patient to observe and describe an impulse rather than identify with it.]

 

A patient floods with anxiety.

Pt: “I feel terrified.” [She shifts from describing her anxiety to identifying with it. If you say, “you are feeling afraid”, she will flood with anxiety because you are encouraging identification.]

Th: “You’re aware of something inside you that gets terrified of this feeling of anger.”  [This shifts her from identifying with to observing her experience. Help her be with rather than drown in her experience.]

 

Shift the fragile patient from identifying to observing her experience. Use phrases like:

“There’s an awareness…of sensations in your body…of an urge within…of something inside you.” Help the patient be in relation to a defense such as self-hatred rather than overwhelmed by it.  When the patient appears to be overwhelmed by a feeling, most likely she is overwhelmed by a defense.

 

To help the patient observe her defense you could say:

Th: “Can we acknowledge that there is something inside that has a hating urge?”  [Saying, “Do you notice how you want to hate yourself?” would only deepen her identification with the defense.]

Th: “You’re aware of an urge inside you that wants to hate.” [We don’t say it’s an urge “to hate you.” By saying “an urge to hate”, we leave an opening for the rage to go other places.]

Th: “You’re aware of something inside you that wants to hate.”

Th: “You’re aware of something inside you that hates anxiety.” [Help the patient see that the hate is directed toward some aspect of her (a feeling, anxiety, or defense). Now she can see herself in a less global fashion. She sees a relationship (something within her hating something else: the implicit object relation being enacted).]

 

Help the patient compassionately witness her defense rather than identify with it. Before she can observe the defense, any comments on it or its price will not help. Once she can witness the defense, then ask, “I wonder what feelings are coming up here toward me underneath that thought?”

 

Take home point: we can never know who the patient will become without his defenses. We can never know in advance the mysterious potential of the person hidden underneath impersonal defenses. That is what is exciting and frightening about therapy.

 

 


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4 responses to “Who am I without my defenses?”

  1. M and B Avatar
    M and B

    Thank you for this wonderful blog. I have been here few days now and consumed by it.

    I have a question. I have a very complex childhood trauma for the first 18 of my life. Severe enough that my biggest defense for most of my adult life (I am 47) has been dissociation and probably denial. I said probably for the latter cause no way I could remain in relationship with my parents after the torture of my childhood.

    This is the thing. I grew up a different culture where therapy is not even a concept. Now I am in North America and in therapy for the first time. However, I think I am not alone in my experience.

    This is the thing. Most therapy assumes a baseline of a person actually knowing what is a feeling, a defense, resistance etc? I can speak for myself that all these words have a meaning and I know intellectually what that is but I really do not understand them. I closed myself for 30 yrs since I left home and I stayed in dissociation while going to school, working and getting married to a wonderful man…and now all of sudden I am asked in therapy how do you feel? and I am stumped. I truly do not know. I know few big feelings like anger, sadness (which I used to confuse until my husband pointed out the connection), I know happiness, I know joy…but I am not sure about frustration (gets mixed with others) or disappointed (forget about it) or hurt (never recall feeling it raw).
    I have a severe disability in this area but yet I get along with people because my biggest defense is avoidance of situation not people. It is hard to explain in detail. I created a safe life for my adult life and if a person lies or treats me badly, I acknowledge within this is not good (I may not get the feelings covered) and I either tell the person I am annoyed or bothered or pissed or I leave the situation if possible.

    My main point is this: not everybody is resisting or distancing from the therapist, some they truly do not know what is happening at all. I am not fragile but I do need a lot of education to understand what happened to me is not OK because I dissociated from it so far…it is inside of me as critical person…the thing is too that I do not have neurosis…no anxiety or depression..actually no mental health until I get to therapist and I started to dissociate very easily because I am receptive to know.

    The reason I post here is when a client asks who am I without my defense? a therapist should know the answer. If you know how to diagnose a person or how to take them from defense then you should be able to tell what is the healthy and end result. Otherwise, you are causing the person to close up from the get go.

    A good mother nurtures and promises the world is better. A bad mother punishes you and you never have a dream or a time to dream. A good therapist should be able to see your worst and your best and be able to mirror you and say something like…if your defense is anger and you stop being angry, then you will feel less tension in the body, you will feel free, you will get along with people more…you will this or that or whatever the defense is blocking now.

    As a therapist (and I am training to become one), we assume everybody knows these basic things. If a man or a woman who can pay your bill (whatever that is) asks you who will be be if I do not have a defense and you cannot offer anything? why should that person trust you with their vulnerability?

    I went to therapy as part of my training and I promised myself that I will risk of full neurosis and psychosis to get to the bottom of my childhood memories that I disavowed. I did this because I am educated about therapy but a layperson is not.
    If a client came to me and ask me that question who will I be without my defense?

    I can personally tell that person what I told myself. You will carry less weight in your mind and you will have more energy (that you are spending on defenses) to do other things…is there anything you loved to do when you were young that you no longer do? Maybe you will have energy to do that. I am not promising them anything…just answering the question.

    Why bother pay a person $150/hr if one cannot foresee or visualize what does healing may look like? If a therapist is not sure, then he or she should disclose themselves or share another person’s example.

    Give the client an answer even if that answer is I do not know you well enough but let us see about this after we work together for while and maybe you will see it yourself. Give a hope for the treatment.

    Thank you so much for all the great service you provide. I am learning a lot from you.

    1. istdpadmin Avatar
      istdpadmin

      I will do a post on this, since these are some great questions! Thank you!

  2. Jon Frederickson Avatar
    Jon Frederickson

    As a therapist, we cannot assume a patient knows what he feels or how to describe his feelings, what he wants, or even who he is! Defenses can prevent us from knowing what we feel, what we want, or who we are. That’s why we need the help of a therapist to see those defenses, so that we can begin to discovery this mystery of who we are! So if a patient asked me, who am I without my defenses? What will I discover? One way to answer this would be, who were you, how were you, before all these difficulties began? Who were you before all these defenses tormented you? Another way to answer this might be, what would your life be like without depression and anxiety? What would your life be like if you were not afraid to love? Sometimes we can’t answer who the person will become because this is unknown. But we can help them imagine who they would be without the defenses that torment them. Sometimes a simple question like this might help: would you like to find out who you really are underneath the depression? Wouldn’t be nice to know what you feel so you wouldn’t have to be anxious instead? In a sense, the patient needs an answer like you say. Yet we must always respect the mystery of this patient: they are unknowable and there is a great surprise awaiting us as we discover together their potentials, potentials they never knew before and couldn’t know before.

    1. M and B Avatar
      M and B

      Thank you for your quick response. You are right there is a mystery to all of us but I think it does help to have hope in the treatment.

      Thank you so much for sharing all these information at your own time.
      M

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