Monthly Archives: November 2016

Should the patient feel guilt over rage toward the therapist?

“Reading Patricia Coughlin’s book, I see that when the patient experiences murderous rage toward the therapist, she encourages the guilt and longing feelings with the therapist and then after that encourages links to past figures. In the immersion with Abbass, he was clear that we do not encourage guilt with the therapist after the murderous rage toward the therapist, but encourages the patient to look at the dead therapist’s eyes to see figures from the past. What are your thoughts on this? I have read a lot of your work but can’t see this point being made anywhere.” Good question!

You can let the unconscious do what it does. Sometimes the patient feels guilt while looking at your face and a genetic figure comes up that way. We ask, “What feelings are coming up as you look into those dead eyes?” This primes the way for the patient to see someone else. Another way to think about this is, “Why would the patient feel guilt about rage toward us?” The patient hasn’t actually done anything except share a fantasy. So the guilt that rises is coming from somewhere else. You are just the vehicle that allows these mixed feelings from the past to rise.

Like Allan, I do not invite the patient to feel lots of guilt vis a vis me. I’ll just ask what feelings come up as he looks at “the dead eyes” or “dead body”. With more feelings mobilized, I’ll ask, “Who comes to mind?” Then we’re on our way. It’s important to realize that the goal of the portrayal is the unlocking of the complex feelings toward people in the past, not toward you. Your imaginary body is just the gateway to the unconscious. Don’t stay at the gateway. Go on in to the unconscious.

 

Am I lovable?

“Hi Jon. Session from yesterday got me thinking about a question I want to run by you.  A client has had debilitating anxiety when doing her academics.  After some focus there, she’s seen that her anxiety is actually about her self-worth, which is wrapped up in her academic performance.  She asked the question (paraphrased) “Am I loveable if I don’t achieve high academically?”  I responded, “That’s a good question to ask yourself” and spent time focusing there.  But I didn’t see much good signaling.  Now it occurs to me that her question could be a subtle form of self-attack, masquerading as an important existential question.  In other words, focusing on that question is the defense.  Have you seen that before?” Great question!

When she asks if she is lovable, she invites you to judge her. If you judge her as lovable, you fail to help her find out why she judges herself as not lovable. She hopes your judgment can drown out hers, and that never works. So she tries to get good grades, hoping to silence her inner judge. But then she spends her entire life on the run from the judge.

Instead, we need to help her find out what feelings are underneath her defense of self-judgment.

Pt: Am I lovable if I don’t achieve high academically?

Th: Sounds like you’re not sure you are. [Block the projection of the superego and invite her to look inside.]

Pt: I’m not. [Now she can see her own self-attack.]

Th: So this belief you are not lovable, could that be a form of self-attack? [Identify the defense.]

Pt: Yes.

Th: Could that be getting you depressed? [Clarify the price of the defense.]

Pt: That makes sense.

Th: I wonder what feelings might be coming up here toward me that could be making you attack yourself like that? If we look under this self-attack, what feelings are coming up here toward me? [Invite the feelings happening in this relationship that are covered up by her self-hatred.]

Self-attack is a form of resistance we call repression. When she experiences mixed feelings in a relationship, she lets her love come up, but protects you from her anger by turning it on herself. Then she becomes depressed.

So the therapist lets her know she does not have to protect him from her anger. Instead, he encourages her to feel her feelings toward him rather than devalue herself as “unlovable.” As she experiences her anger toward him, her depression will drop. Once she can experience the full extent of her anger toward him, earlier memories of anger will arise as her unconscious unlocks. Once she can face those feelings, she will be able to channel them in a healthy way rather than ward them off through her self-attack.

Remember it’s not just an intervention. We offer a different kind of relationship.

Take home point: “Am I lovable” = “I don’t think I am lovable” = self-attack. She attacks herself to protect you from her feelings which are rising toward you. Identify and block the self-attack, then ask about feelings toward you that are underneath the self-criticism. This creates a path for her feelings to go out toward others rather than be turned back upon herself. Metacommunication: You don’t have to protect me from your feelings.